Journal of Preventive Medicine and Public Health

Volume 52(4); July 2019

Review

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies: Wan Rosmawati Wan Ismail, Raudah Abdul Rahman, Nur Ashiqin Abd Rahman, Azman Atil, Azmawati Mohammed Nawi; J Prev Med Public Health. 2019;52(4):205-213. Published online July 2, 2019; DOI: https://doi.org/10.3961/jpmph.19.020

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Objectives
Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer.
Methods
A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review.
Results
Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19).
Conclusions
Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

Summary

Citations

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Original Articles

Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran: Satar Rezaei, Mohammad Hajizadeh; J Prev Med Public Health. 2019;52(4):214-223. Published online June 14, 2019; DOI: https://doi.org/10.3961/jpmph.19.046

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Abstract PDF

Objectives
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
Methods
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
Results
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
Conclusions
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.

Summary

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Factors Affecting Breast Self-examination Behavior Among Female Healthcare Workers in Iran: The Role of Social Support Theory: saeed bashirian, Majid Barati, Leila Moaddab Shoar, Younes Mohammadi, Mitra Dogonchi; J Prev Med Public Health. 2019;52(4):224-233. Published online June 26, 2019; DOI: https://doi.org/10.3961/jpmph.18.277

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Abstract PDF Supplementary Material

Objectives
In women, breast cancer is the most common cancer and the leading cause of cancer death. Screening tests are the basis for early diagnosis. In Iranian women, the mortality rate of breast cancer is high due to insufficient screening examinations and delayed visits for care. Therefore, this study aimed to determine the factors affecting breast self-examinations among Iranian women employed in medical careers.
Methods
This cross-sectional study included 501 women working in the medical professions at Hamadan University of Medical Sciences in western Iran in 2018. The subjects were selected by stratified random sampling. Data were collected using a researcher-developed, self-report questionnaire that contained demographic information and questions based on protection motivation theory and social support theory. Descriptive data analysis was conducted using SPSS version 23 and model fitting with PLS version 2.
Results
The mean age of the participants was 37.1±8.3 years, and most of the women (80.4%) were married. Most women had a bachelor’s degree (67.5%). The findings of this study showed that the coping appraisal construct was a predictor of protection motivation (β=0.380, p<0.05), and protection motivation (β=0.604, p<0.05) was a predictor of breast self-examination behavior. Additionally, social support theory (β=0.202, p<0.05) had a significant positive effect on breast self-examination behavior.
Conclusions
The frequency of practicing self-examinations among women employees in the medical sector was low; considering the influence of social support as a factor promoting screening, it is necessary to pay attention to influential people in women’s lives when designing educational interventions.

Summary

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Interactions of Behavioral Changes in Smoking, High-risk Drinking, and Weight Gain in a Population of 7.2 Million in Korea: Yeon-Yong Kim, Hee-Jin Kang, Seongjun Ha, Jong Heon Park; J Prev Med Public Health. 2019;52(4):234-241. Published online July 3, 2019; DOI: https://doi.org/10.3961/jpmph.18.290

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Abstract Summary PDF

Objectives
To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status.
Methods
This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status.
Results
Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight.
Conclusions
These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

Summary

Korean summary
이 분석은 흡연, 음주, 체중의 동시적 변화에 대해 패널분석방법론인 고정효과 모형을 이용하여 분석하였으며, 2009년부터 2016년까지 2년 주기로 4차례 모두 건강검진을 수검받은 720만 명을 대상으로 하였다. 흡연, 음주, 체중의 동시적 변화에 대한 방향성을 탐색하여 생활습관 관련 행태가 독자적이 아닌 유기적으로 변화하는 양상을 확인하였다, 또한 당뇨병, 뇌졸중, 암이 신규로 진단되었을 때 행태 변화가 나타나는 것을 확인하였다.

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Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants
Jieun Jang, Sangjun Lee, Kwang-Pil Ko, Sarah K. Abe, Md. Shafiur Rahman, Eiko Saito, Md. Rashedul Islam, Norie Sawada, Xiao-Ou Shu, Woon-Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, Shoichiro Tsugane, Hui Cai, Jian-Min
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Self-efficacy to Engage in Physical Activity and Overcome Barriers, Sedentary Behavior, and Their Relation to Body Mass Index Among Elderly Indonesians With Diabetes: Qonita Rachmah, Stefania Widya Setyaningtyas, Mahmud Aditya Rifqi, Diah Indriani, Triska Susila Nindya, Hario Megatsari, Trias Mahmudiono, Wantanee Kriengsinyos; J Prev Med Public Health. 2019;52(4):242-249. Published online July 2, 2019; DOI: https://doi.org/10.3961/jpmph.19.003

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Abstract PDF

Objectives
Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI.
Methods
This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants’ confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test.
Results
In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p<0.001; r=0.116) and sedentary activity (p<0.05; r=0.274). PA self-efficacy and age were not related to BMI. Barriers to PA were associated with PA levels (p<0.05).
Conclusions
Physical inactivity was a major problem in elderly individuals with diabetes, and was correlated with higher BMI. Lower levels of PA might be mediated by sedentary activity.

Summary

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Young-Mee Kim, Sung-il Cho
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Effects of the Short Foot Exercise With Neuromuscular Electrical Stimulation on Navicular Height in Flexible Flatfoot in Thailand: A Randomized Controlled Trial: Juntip Namsawang, Wichai Eungpinichpong, Ratana Vichiansiri, Somchai Rattanathongkom; J Prev Med Public Health. 2019;52(4):250-257. Published online July 14, 2019; DOI: https://doi.org/10.3961/jpmph.19.072

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Abstract PDF

Objectives
Flatfoot, or low medial longitudinal arch, contributes to back and lower extremity injuries and is caused by weak abductor hallucis (AbdH) muscles. The purpose of this study was to investigate the effects of short foot exercise (SFE) alone or with neuromuscular electrical stimulation (NMES) on navicular height, the cross-sectional area (CSA) of the AbdH muscle, and AbdH muscle activity in flexible flatfoot.
Methods
Thirty-six otherwise healthy people with flexible flatfoot were randomly assigned to a group that received SFE with placebo NMES treatment (the control group) or a group that received both SFE and NMES treatment (the experimental group). Each group received 4 weeks of treatment (SFE alone or SFE with NMES). Navicular height, the CSA of the AbdH muscle, and AbdH muscle activity were assessed before and after the intervention.
Results
No significant differences were found in navicular height or the CSA of the AbdH muscle between the control and experimental groups, while AbdH muscle activity showed a statistically significant difference between the groups (SFE=73.9±11.0% of maximal voluntary isometric contraction [MVIC]; SFE with NMES=81.4±8.3% of MVIC; p<0.05). Moreover, the CSA of the AbdH muscle showed a statistically significant increase after treatment in the SFE with NMES group (pre-treatment=218.6±53.2 mm²; post-treatment=256.9±70.5 mm2; p<0.05).
Conclusions
SFE with NMES was more effective than SFE alone in increasing AbdH muscle activity. Therefore, SFE with NMES should be recommended to correct or prevent abnormalities in people with flexible flatfoot by a physiotherapist or medical care team.

Summary

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Perceptions of Contraception and Patterns of Switching Contraceptive Methods Among Family-planning Acceptors in West Nusa Tenggara, Indonesia: Yuli Amran, Narila Mutia Nasir, Dini Dachlia, Fitra Yelda, Budi Utomo, Iwan Ariawan, Rita Damayanti; J Prev Med Public Health. 2019;52(4):258-264. Published online July 19, 2019; DOI: https://doi.org/10.3961/jpmph.18.198

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340 Download
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Abstract PDF

Objectives
The perceptions of family-planning (FP) acceptors regarding contraception influence the reasons for which they choose to switch their method of contraception. The objective of this study was to analyze the perceptions of contraception and rationales for switching contraceptive methods among female FP acceptors in West Nusa Tenggara, Indonesia.
Methods
This study involved the analysis of secondary data from the Improve Contraceptive Method Mix study, which was conducted in 2013 by the Center for Health Research, University of Indonesia. The design of the study was cross-sectional. We performed 3 stages of sampling using the cluster technique and selected 4819 women who were FP acceptors in West Nusa Tenggara Province, Indonesia as the subjects of this study. The data were analyzed using multiple logistic regression.
Results
The predominant pattern of switching contraceptive methods was switching from one non-long-term method of contraception to another. Only 31.0% of the acceptors reported a rational pattern of switching contraceptive methods given their age, number of children, and FP motivations. Perceptions of the side effects of contraceptive methods, the ease of contraceptive use, and the cost of the contraceptives were significantly associated (at the level of α=0.05) with rational patterns of switching contraceptive methods.
Conclusions
Perceptions among FP-accepting women were found to play an important role in their patterns of switching contraceptive methods. Hence, fostering a better understanding of contraception through high-quality counseling is needed to improve perceptions and thereby to encourage rational, effective, and efficient contraceptive use.

Summary

Citations

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Influence of internet, mobile phone use, and sociodemographic factors on women’s knowledge and attitude towards contraception in Indonesia
Achmad Kemal Harzif, Amalia Shadrina, Edward Christopher Yo, Nia Reviani, Andon Hestiantoro
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Brief Report

Background and Activities of the Samsung Ombudsperson Commission in Korea: Cheolsoo Lee, Seong-Kyu Kang, Hyunwook Kim, Inhee Kim; J Prev Med Public Health. 2019;52(4):265-271. Published online July 3, 2019; DOI: https://doi.org/10.3961/jpmph.19.033

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Abstract Summary PDF Supplementary Material

Objectives
The Samsung Ombudsperson Commission was launched as an independent third-party institution following an agreement among Samsung Electronics, Supporters for Health and Right of People in Semiconductor Industry (Banolim in Korean, an independent NGO), and the Family Compensation Committee, in accordance with the industry accident prevention measure required by the settlement committee to address the issues related to employees who allegedly died from leukemia and other diseases as a result of working at Samsung’s semiconductor production facilities.
Methods
The Commission has carried out a comprehensive range of activities to review and evaluate the status of the company’s occupational accidents management system, as well as occupational safety and health risk management within its facilities.
Results
Based on the results of this review, termed a comprehensive diagnosis, the Commission presented action plans for improvement to strengthen the company’s existing safety and health management system and to effectively address uncertain risks in this area going forward.
Conclusions
The Commission will monitor the execution of the suggested tasks and provide advice and guidance to ensure that Samsung’s semiconductor and liquid crystal display production lines are safer.

Summary

Korean summary
삼성옴부즈만위원회는 ‘삼성전자 반도체 사업장에서의 백혈병 등 질환 발병과 관련된 문제 해결을 위한 조정위원회’의 조정권고안 중 재해예방대책 부분에 대하여 삼성전자, 반올림, 가족대책위원회 등 3자 간에 조정합의가 성립함에 따라 출범한 외부의 독립기구로서, 삼성전자 내부의 재해관리시스템 운영 상황을 비롯하여 사업장 내 산업안전보건관리 현황 등에 관하여 필요한 정보를 삼성전자로부터 제출받아 이를 검토·평가하고 필요한 경우 개선을 권고하는 종합진단 활동을 수행하였다. 종합진단 결과, 삼성옴부즈만위원회는 현재의 안전보건관리 체계를 보다 강화하고 안전보건관리 영역에서 미래의 불확실한 위험을 효과적으로 해소하기 위해 개선권고사항을 제시하였으며, 앞으로 개선권고사항의 이행점검활동을 통해 삼성전자 반도체 및 LCD사업장이 보다 안전한 사업장이 될 수 있도록 지도 및 조언할 예정이다.

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Perspective

Proposal to Revise the Screening Test for Latent Tuberculosis Infection in Close Contacts at Elementary Schools in Korea: Jong-Myon Bae; J Prev Med Public Health. 2019;52(4):272-275. Published online May 8, 2019; DOI: https://doi.org/10.3961/jpmph.19.043

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Abstract Summary PDF Supplementary Material: The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.; Summary

Korean summary
집단시설에서의 결핵환자 발생시 수행하는 역학조사 지침에는 잠복결핵감염자의 검진을 위해 초등학생에게 투베르쿨린 피부반응검사 (TST)를 시행하도록 되어 있다. 그러나, 6세 이상의 초등학생들은 필수적으로 BCG 예방접종을 받았다는 점과, 역학조사 수행의 협조 등을 고려할 때 TST 대신 인터페론감마 분비검사 (Interferon-gamma releasing assay, IGRA)를 우선 시행하는 것이 보다 더 근거중심적, 가치중심적 으로 타당하다.

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