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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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  • 82 Download
AbstractAbstract AbstractSummary 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
Key Message
This study examines the determinants of institutional delivery in the Philippines, with a focus on compliance with the WHO-recommended eight antenatal care (ANC) visits. Analysis of data from the 2022 National Demographic and Health Survey reveals a strong positive correlation between completing the recommended ANC visits and choosing institutional delivery, alongside significant influences from maternal age, education, marital status, employment, socioeconomic status, and parity. Findings underscore the importance of expanding ANC access and targeted interventions, particularly in underserved areas, to increase institutional delivery rates and improve maternal and neonatal health outcomes.
The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers’ Perspectives
Sharmin Parveen, Md. Shahriar Mahbub, Nasreen Nahar, K. A. M. Morshed, Nourin Rahman, Ezzat Tanzila Evana, Nazia Islam, Abu Said Md. Juel Miah
J Prev Med Public Health. 2024;57(4):356-369.   Published online June 9, 2024
DOI: https://doi.org/10.3961/jpmph.24.081
  • 2,867 View
  • 303 Download
AbstractAbstract AbstractSummary PDF
Objectives
The objective of this study was to explore healthcare providers’ experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.
Methods
A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.
Results
Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.
Conclusions
The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.
Summary
Key Message
This qualitative study explored healthcare providers' perspectives on the impact of the COVID-19 pandemic on healthcare services. Issues within the health system, such as a lack of skilled human resources, insufficient critical care facilities, low coverage of COVID-19 tests, inadequate logistical support, poor health behaviors and practices among health service seekers posed barriers to managing the pandemic at different healthcare levels. Ensuring personal protection for health professionals in the face of a novel disease presented a significant challenge. Increasing resource allocation and developing the capacity of healthcare providers were identified as potential solutions.
Association Between Cadmium Exposure and Liver Function in Adults in the United States: A Cross-sectional Study
Dongui Hong, Jin-Young Min, Kyoung-Bok Min
J Prev Med Public Health. 2021;54(6):471-480.   Published online November 30, 2021
DOI: https://doi.org/10.3961/jpmph.21.435
  • 5,748 View
  • 179 Download
  • 29 Web of Science
  • 30 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population.
Methods
In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index.
Results
The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively.
Conclusions
Chronic exposure to cadmium showed positive associations with liver damage.
Summary
Korean summary
카드뮴은 사회 전반에서 널리 쓰이고 있어 직업적인 노출은 물론 환경적인 노출이 빈번히 일어나고 있다. 본 연구는 미국 국민건강영양조사 데이터를 이용하였으며 소변 내 카드뮴의 증가는 알라닌 아미노전이효소 (ALT), 아스파테이트 아미노전이효소 (AST), 감마 글루타밀전이효소 (GGT), 총 빌리루빈, 알칼리 인산분해효소 (ALP)의 상승과 관련이 있었다. 따라서 만성적인 카드뮴 노출은 간 손상과 연관이 있다고 할 수 있다.

Citations

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    Nam-Eun Kim, Min Heo, Hyeongyu Shin, Ah Ra Do, Jeeyoung Kim, Hee-Gyoo Kang, Sora Mun, Hyun Ju Yoo, Mi Jeong Kim, Jung-Woong Kim, Chul-Hong Kim, Young-Seoub Hong, Yong Min Cho, Heejin Jin, Kyungtaek Park, Woo Jin Kim, Sungho Won
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  • Therapeutic Potential of Clove Oil in Mitigating Cadmium-Induced Hepatorenal Toxicity Through Antioxidant, Anti-Inflammatory, and Antiapoptotic Mechanisms
    Inas M. Elgharib, Fatma M. Abdelhamid, Gehad E. Elshopakey, Hatem Sembawa, Talat A. Albukhari, Waheed A. Filimban, Rehab M. Bagadood, Mohamed E. El-Boshy, Engy F. Risha
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  • Toxicity Tolerance in the Carcinogenesis of Environmental Cadmium
    Aleksandar Cirovic, Soisungwan Satarug
    International Journal of Molecular Sciences.2024; 25(3): 1851.     CrossRef
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  • Correlation between urinary rare earth elements and liver function in a Zhuang population aged 35–74 years in Nanning
    Xingxi Luo, Liling Wei, Shun Liu, Kaili Wu, Dongping Huang, Suyang Xiao, Erna Guo, Lei Lei, Xiaoqiang Qiu, Xiaoyun Zeng
    Journal of Trace Elements in Medicine and Biology.2024; 84: 127426.     CrossRef
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    Rafał Kusak, Marzenna Nasiadek, Joanna Stragierowicz, Wojciech Hanke, Anna Kilanowicz
    International Journal of Molecular Sciences.2024; 25(7): 3829.     CrossRef
  • Copper, Iron, Cadmium, and Arsenic, All Generated in the Universe: Elucidating Their Environmental Impact Risk on Human Health Including Clinical Liver Injury
    Rolf Teschke
    International Journal of Molecular Sciences.2024; 25(12): 6662.     CrossRef
  • In vivo evaluation by oral administration of chitosan combined with bioactive glass against cadmium-induced toxicity in rats
    Youssef Ait Hamdan, Abdelfatah Ait Baba, Hajar Azraida, Hamid Kabdy, Hassane Oudadesse, Abderrahman Chait, Mohammed Rhazi
    International Journal of Biological Macromolecules.2024; 276: 133845.     CrossRef
  • Mixture analysis of associations between environmental and workplace toxins and liver damage and telomere length, stratified by race/ethnicity
    Ning Ma, Rowena Yip, Mark Woodward, Sara Lewis, Michael Crane, Artit Jirapatnakul, Costica Aloman, Meena B. Bansal, Douglas Dieterich, Louis Gros, Damaskini Valvi, Elena Colicino, David Yankelevitz, Claudia Henschke, Andrea D. Branch
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Association Between Low Muscle Mass and Non-alcoholic Fatty Liver Disease Diagnosed Using Ultrasonography, Magnetic Resonance Imaging Derived Proton Density Fat Fraction, and Comprehensive NAFLD Score in Korea
Hun Ju Lee, Jae Seung Chang, Jhii Hyun Ahn, Moon Young Kim, Kyu-Sang Park, Yeon-Soon Ahn, Sang Baek Koh
J Prev Med Public Health. 2021;54(6):412-421.   Published online October 22, 2021
DOI: https://doi.org/10.3961/jpmph.21.387
  • 5,636 View
  • 142 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent metabolic disease. Muscle is known to influence NAFLD development. Therefore, this study aimed to determine the relationships among low muscle mass, NAFLD, and hepatic fibrosis using various definitions of low muscle mass and NAFLD diagnostic methods, including magnetic resonance imaging-based proton density fat fraction (MRI-PDFF).
Methods
This cross-sectional study included 320 participants (107 males, 213 females) from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population cohort. Muscle mass was assessed using whole-body dual-energy X-ray absorptiometry and adjusted for the height squared, body weight, and body mass index (BMI). NAFLD was diagnosed using ultrasonography (US), MRI-PDFF, and the comprehensive NAFLD score (CNS). Hepatic fibrosis was assessed using magnetic resonance elastography. Multivariable logistic and linear regression analyses were performed to determine the aforementioned associations.
Results
According to US, 183 participants (57.2%) had NAFLD. Muscle mass adjusted for body weight was associated with NAFLD diagnosed using US (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.70 to 5.31), MRI-PDFF (OR, 2.00; 95% CI, 1.13 to 3.53), and CNS (OR, 3.39; 95% CI, 1.73 to 6.65) and hepatic fibrosis (males: β=-0.070, p<0.01; females: β=-0.037, p<0.04). Muscle mass adjusted for BMI was associated with NAFLD diagnosed by US (OR, 1.71; 95% CI, 1.02 to 2.86) and CNS (OR, 1.95; 95% CI, 1.04 to 3.65), whereas muscle mass adjusted for height was not associated with NAFLD.
Conclusions
Low muscle mass was associated with NAFLD and liver fibrosis; therefore, maintaining sufficient muscle mass is important to prevent NAFLD. A prospective study and additional consideration of muscle quality are needed to strengthen the findings regarding this association.
Summary
Korean summary
비알콜성 간질환은 대사질환 중 하나로 적은 근육양과의 연관성이 지속적으로 제시되었으나, 기존 연구들에서 일관되지 않은 결과를 보여주었다. KoGES-ARIRANG 코호트의 320명을 대상으로 초음파·MRI-PDFF·CNS 진단기준을 사용하여 단면연구를 수행한 결과, 세 진단기준에서 모두 적은 근육량과 비알콜성 간질환 사이에 연관성이 나타났다.

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  • Prevalence of Sarcopenia and Its Defining Components in Non-alcoholic Fatty Liver Disease Varies According to the Method of Assessment and Adjustment: Findings from the UK Biobank
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    Jing Du, Shizhan Ma, Li Fang, Meng Zhao, Zhongshang Yuan, Yiping Cheng, Jiajun Zhao, Xiude Fan, Qingling Guo, Zhongming Wu
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    JMIR Formative Research.2023; 7: e42087.     CrossRef
  • Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease
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COVID-19: Perspective
Unconventional Answers to Unprecedented Challenges: The Swedish Experience During the COVID-19 Outbreak
Giuseppe Valeriani, Iris Sarajlic Vukovic, Richard Mollica
J Prev Med Public Health. 2020;53(4):233-235.   Published online July 22, 2020
DOI: https://doi.org/10.3961/jpmph.20.235
  • 6,178 View
  • 222 Download
  • 13 Crossref
AbstractAbstract PDF
Since its early stages, the coronavirus disease 2019 (COVID-19) pandemic has posed immense challenges in meeting the public health and healthcare and social care needs of migrants. In line with other reports from United Kingdom and United States, data from Sweden’s health authority show that migrants have been disproportionately affected by COVID-19. Following the World Health Organization’s statements, as well as the European Public Health Association’s call for action, several centres in Sweden’s most populated areas have activated tools to implement national plans for community outreach through initiatives targeting migrants and ethnic minority groups. Unconventional means should be promoted to mitigate the impact of COVID-19 on migrants and the health of the public at large.
Summary

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Original Articles
Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea
Jisun Sung, Seungho Ryu, Yun-Mi Song, Hae-Kwan Cheong
J Prev Med Public Health. 2020;53(5):342-352.   Published online July 17, 2020
DOI: https://doi.org/10.3961/jpmph.20.089
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AbstractAbstract PDF
Objectives
The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease.
Methods
This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors.
Results
Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant.
Conclusions
NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.
Summary

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  • Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults
    Xinjuan Huang, Ruoling Yu, Xinyun Tan, Manjie Guo, Yuanqin Xia, Huihui Zou, Xuelian Liu, Chunxiang Qin
    Journal of Clinical and Experimental Hepatology.2025; 15(1): 102420.     CrossRef
  • Anti-osteoporotic treatments in the era of non-alcoholic fatty liver disease: friend or foe
    Maria Eleni Chondrogianni, Ioannis Kyrou, Theodoros Androutsakos, Christina-Maria Flessa, Evangelos Menenakos, Kamaljit Kaur Chatha, Yekaterina Aranan, Athanasios G. Papavassiliou, Eva Kassi, Harpal S. Randeva
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  • Bone mass, microarchitecture and turnover among young Indian women with non-alcoholic fatty liver disease
    Alpesh Goyal, Suraj Kubihal, Yashdeep Gupta, Shalimar, Devasenathipathy Kandasamy, Mani Kalaivani, Nikhil Tandon
    Endocrine.2024; 86(2): 790.     CrossRef
  • Effects of Metabolic Dysfunction-Associated Steatotic Liver Disease on Bone Density and Fragility Fractures: Associations and Mechanisms
    Shaghayegh Khanmohammadi, Mohammad Shafi Kuchay
    Journal of Obesity & Metabolic Syndrome.2024; 33(2): 108.     CrossRef
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    Minzhe Zheng, Junxiang Xu, Zongxian Feng
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    A.F. Sheptulina, A.A. Yafarova, E.M. Mamutova, A.R. Kiselev, O.M. Drapkina
    Russian Journal of Evidence-Based Gastroenterology.2024; 13(4): 40.     CrossRef
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Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women
Jongmin Baek, Sun Jae Jung, Jee-Seon Shim, Yong Woo Jeon, Eunsun Seo, Hyeon Chang Kim
J Prev Med Public Health. 2020;53(4):256-265.   Published online June 18, 2020
DOI: https://doi.org/10.3961/jpmph.20.140
  • 6,306 View
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AbstractAbstract PDFSupplementary Material
Objectives
We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women.
Methods
The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes—visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)—were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC.
Results
VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women.
Conclusions
Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.
Summary

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  • Usefulness of Body Fat and Visceral Fat Determined by Bioimpedanciometry versus Body Mass Index and Waist Circumference in Predicting Elevated Values of Different Risk Scales for Non-Alcoholic Fatty Liver Disease
    María Gordito Soler, Ángel Arturo López-González, Daniela Vallejos, Emilio Martínez-Almoyna Rifá, María Teófila Vicente-Herrero, José Ignacio Ramírez-Manent
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    Dragoș Constantin Cucoranu, Marian Pop, Raluca Niculescu, Vlad Vunvulea, Irina-Bianca Kosovski, Radu-Ovidiu Togănel, Eliza Russu, Adrian Vasile Mureșan, Răzvan-Andrei Licu, Anca Bacârea
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Impact of Regional Cardiocerebrovascular Centers on Myocardial Infarction Patients in Korea: A Fixed-effects Model
Sang Guen Cho, Youngsoo Kim, Youngeun Choi, Wankyo Chung
J Prev Med Public Health. 2019;52(1):21-29.   Published online November 28, 2018
DOI: https://doi.org/10.3961/jpmph.18.154
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  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality.
Methods
We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes.
Results
We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality.
Conclusions
The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.
Summary
Korean summary
권역심뇌혈관질환센터 설립 사업은 지역별로 심뇌혈관센터를 지정/육성하여, 심뇌혈관질환 발생시 3시간 이내 진료체계를 구축함으로써 급성심근경색과 뇌졸중의 급성기 응급상황에 대한 대응을 강화하고자 시행되었다. 본 연구는 권역심뇌혈관질환센터 설립 정책으로 인해 시술 건수와 30일 내 사망 등과 같은 치료 성과가 지역 수준에서 향상되었는지 살펴보기 위해 건강보험 청구자료로 지역 수준 패널자료를 구축하여 권역심뇌혈관질환센터 설립의 효과를 추정하였다. 분석 결과, 시계열적 효과와 관련 변수를 통제하였을 때 권역심뇌혈관질환센터 설립 이후 설립 지역에서 여성의 치료 사례 수가 통계적으로 유의하게 증가하였고, 사망률은 유의미한 변화가 관찰되지 않았다. 따라서 권역심뇌혈관질환센터 설립은 대비성 향상과 치료 사례 수 증가를 통해 추가적인 치료를 받은 급성심근경색 환자의 잠재적인 원외 사망을 방지하는 효과가 있는 것으로 판단된다.

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The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim
J Prev Med Public Health. 2016;49(4):230-239.   Published online July 14, 2016
DOI: https://doi.org/10.3961/jpmph.16.034
  • 12,069 View
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AbstractAbstract PDFSupplementary Material
Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.
Summary

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Perspective
Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea
Jong-Myon Bae
J Prev Med Public Health. 2015;48(6):271-273.   Published online November 24, 2015
DOI: https://doi.org/10.3961/jpmph.15.059
  • 13,246 View
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AbstractAbstract PDF
Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.
Summary

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Original Articles
Physical Activity- and Alcohol-dependent Association Between Air Pollution Exposure and Elevated Liver Enzyme Levels: An Elderly Panel Study
Kyoung-Nam Kim, Hyemi Lee, Jin Hee Kim, Kweon Jung, Youn-Hee Lim, Yun-Chul Hong
J Prev Med Public Health. 2015;48(3):151-169.   Published online May 15, 2015
DOI: https://doi.org/10.3961/jpmph.15.014
  • 11,212 View
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  • 50 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels.
Methods
Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter ≤2.5 μm [PM2.5], nitrogen dioxide [NO2], ozone [O3], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltranspeptidase [γ-GTP)]) were evaluated using generalized additive and linear mixed models.
Results
Interquartile range increases in the concentrations of the pollutants showed significant associations of PM2.5 with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and γ-GTP (5.0% increase, p=0.0051) levels; NO2 with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and O3 with γ-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers.
Conclusions
Short-term exposure to air pollutants such as PM2.5, NO2, and O3 is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.
Summary

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    Tzu-Yi Lu, Chih-Da Wu, Yen-Tsung Huang, Yu-Cheng Chen, Chien-Jen Chen, Hwai-I Yang, Wen-Chi Pan
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Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010
Eunkyoung Kim, Soonman Kwon, Ke Xu
J Prev Med Public Health. 2013;46(5):237-248.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.237
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AbstractAbstract PDF
Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

Citations

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Special Articles
A Strategy Toward Reconstructing the Healthcare System of a Unified Korea
Yo Han Lee, Seok-Jun Yoon, Seok Hyang Kim, Hyun-Woung Shin, Jin Yong Lee, Beomsoo Kim, Young Ae Kim, Jangho Yoon, Young Seok Shin
J Prev Med Public Health. 2013;46(3):134-138.   Published online May 31, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.3.134
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AbstractAbstract PDF

This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap.

Summary

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  • Non-Communicable Diseases and Transitioning Health System in the Democratic People’s Republic of Korea during COVID-19 Lockdown
    Jin-Won Noh, Kyoung-Beom Kim, Ha-Eun Jang, Min-Hee Heo, Young-Jin Kim, Jiho Cha
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  • Systematic review of evidence on public health in the Democratic People’s Republic of Korea
    John J Park, Ah-Young Lim, Hyung-Soon Ahn, Andrew I Kim, Soyoung Choi, David HW Oh, Owen Lee-Park, Sharon Y Kim, Sun Jae Jung, Jesse B Bump, Rifat Atun, Hee Young Shin, Kee B Park
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  • Awareness of Korean Unification and Health Care in Healthcare Professional Students
    Kyung Jin Jang, Yoon Ki Seoung, Su Hyun Yoon, Hye Seung Chumg, Soo Hyang Kim, You Lee Yang, Sang Hui Chu
    Journal of Korean Public Health Nursing.2016; 30(3): 456.     CrossRef
Public Health Challenges of Electronic Cigarettes in South Korea
Sungkyu Lee, Heejin Kimm, Ji Eun Yun, Sun Ha Jee
J Prev Med Public Health. 2011;44(6):235-241.   Published online November 14, 2011
DOI: https://doi.org/10.3961/jpmph.2011.44.6.235
  • 47,503 View
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AbstractAbstract PDF

Electronic cigarettes (e-cigarrettes) were recently introduced and advertised as a smoking cession device in South Korea. As the social norm to quit smoking has gained hold in the country, the number of e-cigarette users is growing rapidly. This phenomenon should be urgently considered, because of the lack of research that has been conducted to examine the safety of e-cigarettes and its efficacy as a smoking cessation aid.

This paper raises several public health concerns on e-cigarettes in South Korea. Uncertain regulations of the government on e-cigarettes are contributing to an increase of e-cigarette users and allowing the e-cigarette industry to circumvent existing regulations. The aggressive marketing activity of this industry is also a core factor that is responsible for the rapid increase of e-cigarette use, in particular among the youth. Following the enforcement of tobacco control, some cigarette smokers may be encouraged to purchase e-cigarettes in order to circumvent the regulations, even though the dual use of e-cigarette and cigarette may be more harmful.

Until there is clear evidence of the e-cigarette's safety, it is recommended that the industry's marketing and promotional activities be banned and closely monitored, and public campaigns be initiated to educate the public regarding e-cigarettes.

Summary

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English Abstract
The Association of Cardiovascular Risk Factors with Nonalcoholic Fatty Liver Disease in Health Checkup Examinees.
Jae Hee Yu, Kang Sook Lee, Seon Young Lee, A Rum Hong, Yong Sang Park
J Prev Med Public Health. 2008;41(6):407-412.
DOI: https://doi.org/10.3961/jpmph.2008.41.6.407
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AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. METHODS: This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40 g/week, women: 20 g/week). RESULTS: Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (> or =120 mmHg), fasting blood sugar (> or =100 mg/dL), total cholesterol (> or =200 mg/dL), triglyceride (> or =150 mg/dL), high density lipoprotein cholesterol (<40 mg/dL), low density lipoprotein cholesterol (> or =130g m/dL) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61(1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty lliver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91(1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. CONCLUSIONS: The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.
Summary

Citations

Citations to this article as recorded by  
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