Journal of Preventive Medicine and Public Health

Volume 52(6); November 2019

Original Articles

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH): Woojin Kim, Munjoo Bae, Sei-Jin Chang, Jin-Ha Yoon, Da Yee Jeong, Dae-Sung Hyun, Hye-Yoon Ryu, Ki-Soo Park, Mi-Ji Kim, Changsoo Kim; J Prev Med Public Health. 2019;52(6):345-354. Published online October 24, 2019; DOI: https://doi.org/10.3961/jpmph.19.116

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Abstract Summary PDF Supplementary Material

Objectives
It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.
Methods
A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.
Results
Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).
Conclusions
Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Summary

Korean summary
535명의 현직소방관을 대상으로 소방공무원에서 업무관련스트레스, 폭력노출, 외상노출, 소진(번아웃), 외상후 스트레스 장애(PTSD) 증상 설문을 시행하였고, 구조방정식 통해 업무스트레스에 의한 소진이 PTSD에 주는 영향과 다른 요인간의 연관성을 분석하였다. 그 결과, 업무 환경에서의 높은 직무요구수준과 낮은 노력-보상 균형은 소진을 증가시키며, 업무스트레스에 의한 소진과 근무 중 겪게 되는 폭력노출 경험은 PTSD 점수와 양의 연관관계를 보였다. 반면, 업무 도중 외상사건 경험은 PTSD 점수와 직접적으로 유의한 연관관계를 보이지 않았으나, 소진을 통한 간접적으로 영향을 주는 것을 확인하였다.

Citations

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Post-Traumatic Stress Disorder Symptoms among Pediatric Healthcare Workers
Nikolaos Rigas, Zacharias Kyritsis, Maria Dagla, Alexandra Soldatou, Eirini Orovou, Maria Tzitiridou-Chatzopoulou, Panagiotis Eskitzis, Evangelia Antoniou
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Samar Younes, Souheil Hallit, Irfan Mohammed, Sarah El Khatib, Anna Brytek-Matera, Shadrach Chinecherem Eze, Kenneth Egwu, Rawshan Jabeen, Nebojša Pavlović, Pascale Salameh, Michelle Cherfane, Marwan Akel, Chadia Haddad, Randa Choueiry, Feten Fekih-Romdha
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Elena R. Serrano-Ibáñez, Tania Corrás, Mirtha del Prado, Javier Diz, Carmen Varela
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The short form effort−reward imbalance: Measure of occupational stress for firefighters
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Association Between Convenience of Transportation and Unmet Healthcare Needs of Rural Elderly in Korea: Youngeun Choi, Kiryong Nam, Chang-yup Kim; J Prev Med Public Health. 2019;52(6):355-365. Published online October 3, 2019; DOI: https://doi.org/10.3961/jpmph.19.172

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Abstract Summary PDF Supplementary Material

Objectives
In rural areas of Korea, where public transportation infrastructure is lacking and alternative systems are poor, the elderly experience inconveniences in using healthcare, although their need is high. This study aimed to analyze the association between the convenience of transportation and unmet healthcare needs among the rural elderly.
Methods
The data used were collected in the 2016 Community Health Survey among rural elderly individuals aged 65 or older. Dependent variable was the unmet healthcare needs, explanatory variable was the convenience of transportation. The elderly were divided into 3 groups: with no driver in the household, with a driver, and the elderly individual was the driver (the self-driving group). Covariates were classified into predisposing, enabling, and need factors. They included gender, age, education, income, economic activity, household type, motor ability, subjective health level, number of chronic diseases, anxiety/depression, and pain/discomfort. The data were analyzed using logistic regression and stratification.
Results
A significant association was found between the convenience of transportation and unmet healthcare needs. When examined unadjusted odds ratio of the group with a driver in the household, using the group with no driver as a reference, was 0.61 (95% confidence interval [CI], 0.54 to 0.68), while that of the self-driving group was 0.34 (95% CI, 0.30 to 0.38). The odds ratios adjusted for all factors were 0.69 (95% CI, 0.59 to 0.80) and 0.79 (95% CI, 0.67 to 0.91).
Conclusions
We confirmed a significant association between inconvenient transportation and unmet healthcare needs among the rural elderly even after adjustment for existing known factors. This implies that policies aimed at improving healthcare accessibility must consider the means of transportation available.

Summary

Korean summary
대중교통 인프라가 부족하고 대안적 교통수단 체계가 미흡한 농촌 지역 노인들은 의료 필요는 높으나 도보이동이나 불편한 이동수단을 이용하기 어려워 의료이용에 불편을 겪는다. 본 연구는 의료접근성 향상과 불평등한 접근성 문제에 대한 제안의 근거 마련을 목적으로 질병관리본부 지역사회건강조사 데이터를 이용하여 농촌 노인의 이동수단의 편의성과 미충족의료 경험의 연관성을 살펴보았다. 분석결과 농촌지역 노인에게 교통편 불편은 미충족의료 경험의 주된 이유로 나타났고 기존에 알려진 요인들을 보정한 후에도 이동수단의 편의성과 미충족의료 경험 사이에 유의한 관계가 있음을 확인하였다.

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Perceived Discrimination, Depression, and the Role of Perceived Social Support as an Effect Modifier in Korean Young Adults: Kwanghyun Kim, Sun Jae Jung, So Mi Jemma Cho, Ji Hye Park, Hyeon Chang Kim; J Prev Med Public Health. 2019;52(6):366-376. Published online October 24, 2019; DOI: https://doi.org/10.3961/jpmph.19.114

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Abstract Summary PDF Supplementary Material

Objectives
The relationships among discrimination, social support, and mental health have mostly been studied in minorities, and relevant studies in the general population are lacking. We aimed to investigate associations between discrimination and depressive symptoms in Korean non-minority young adults, considering the role of social support.
Methods
In total, 372 participants who completed the psychological examinations conducted in the third wave of the Jangseong High School Cohort study were included. We used the Everyday Discrimination Scale to evaluate perceived discrimination and the Beck Depression Inventory-II to measure depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support. Multivariate linear regression was conducted to investigate associations between discrimination and depression, along with the effect modification of social support. We stratified the population by gender to investigate gender differences.
Results
Perceived discrimination was significantly associated with depressive symptoms (β=0.736, p<0.001), and social support was negatively associated with depression (β=-0.245, p<0.001). In men, support from friends was the most influential factor (β=-0.631, p=0.011), but no significant effect modification was found. In women, support from family was the most influential factor (β=-0.440, p=0.010), and women with higher familial support showed a significantly diminished association between discrimination and depression, unlike those with lower family support.
Conclusions
Discrimination perceived by individuals can lead to depressive symptoms in Korean young adults, and this relationship can may differ by gender and social support status.

Summary

Korean summary
본 연구에서는 한국인에서 차별이 우울 증상에 미치는 영향을 평가하고 사회적 지지가 차별의 건강영향을 조절하는지 확인하고자 하였다. 인지된 차별은 우울 증상과 양의 상관관계를 보였으며, 높은 사회적 지지는 차별의 부정적 건강 영향을 경감시키는 효과를 보였다. 남성에서는 친구로부터의 사회적 지지가 가장 강한 영향력을 나타냈으며, 여성에서는 가족으로부터의 사회적 지지가 가장 강한 효과를 보였다.

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Validity of Self-reported Stroke and Myocardial Infarction in Korea: The Health Examinees (HEXA) Study: Sunho Choe, Joonki Lee, Jeeyoo Lee, Daehee Kang, Jong-Koo Lee, Aesun Shin; J Prev Med Public Health. 2019;52(6):377-383. Published online November 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.089

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Abstract PDF

Objectives
Self-reported disease history is often used in epidemiological studies. In this study, we acquired the hospital records of subjects who self-reported stroke or myocardial infarction (MI) and evaluated the validity of the participants’ self-reported disease history. We also determined the level of agreement between specialists and non-specialists.
Methods
Among the participants in the Health Examinees study, 1488 subjects self-reported stroke or MI during 2012-2017, and medical records were acquired for the 429 subjects (28.8%) who agreed to share their medical information. Each record was independently assigned to 2 medical doctors for review. The records were classified as ‘definite,’ ‘possible,’ or ‘not’ stroke or MI. If the doctors did not agree, a third doctor made the final decision. The positive predictive value (PPV) of self-reporting was calculated with the doctors’ review as the gold standard. Kappa statistics were used to compare the results between general doctors and neurologists or cardiologists.
Results
Medical records from 208 patients with self-reported stroke and 221 patients with self-reported MI were reviewed. The PPV of self-reported disease history was 51.4% for stroke and 32.6% for MI. If cases classified as ‘possible’ were counted as positive diagnoses, the PPV was 59.1% for stroke and 33.5% for MI. Kappa statistics showed moderate levels of agreement between specialists and non-specialists for both stroke and MI.
Conclusions
The validity of self-reported disease was lower than expected, especially in those who reported having been diagnosed with MI. Proper consideration is needed when using these self-reported data in further studies.

Summary

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An Exploratory Study of Health Inequality Discourse Using Korean Newspaper Articles: A Topic Modeling Approach: Jin-Hwan Kim; J Prev Med Public Health. 2019;52(6):384-392. Published online October 25, 2019; DOI: https://doi.org/10.3961/jpmph.19.221

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to explore the health inequality discourse in the Korean press by analyzing newspaper articles using a relatively new content analysis technique.
Methods
This study used the search term “health inequality” to collect articles containing that term that were published between 2000 and 2018. The collected articles went through pre-processing and topic modeling, and the contents and temporal trends of the extracted topics were analyzed.
Results
A total of 1038 articles were identified, and 5 topics were extracted. As the number of studies on health inequality has increased over the past 2 decades, so too has the number of news articles regarding health inequality. The extracted topics were public health policies, social inequalities in health, inequality as a social problem, healthcare policies, and regional health gaps. The total number of occurrences of each topic increased every year, and the trend observed for each theme was influenced by events related to its contents, such as elections. Finally, the frequency of appearance of each topic differed depending on the type of news source.
Conclusions
The results of this study can be used as preliminary data for future attempts to address health inequality in Korea. To make addressing health inequality part of the public agenda, the media’s perspective and discourse regarding health inequality should be monitored to facilitate further strategic action.

Summary

Korean summary
건강불평등 해소는 한국사회의 중요한 목표이다. 이 연구에서는 건강불평등을 다룬 신문기사를 추출, 토픽모델링 기법을 적용해 공공의료, 사회경제적 요인에 따른 건강불평등, 사회문제로 불평등, 보건의료정책, 지역건강격차의 다섯 가지 주제를 도출하였다. 언론이 건강불평등을 다루는 방식은 학술적 연구에서 건강불평등을 다루는 방식과는 유사하였으나, 건강취약지역의 저소득층의 인식과는 차이가 있었다.

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Digital health policy decoded: Mapping national strategies using Donabedian's model
Tahereh Saheb, Tayebeh Saheb
Health Policy.2024; 147: 105134. CrossRef
Regional Health Disparities in Hypertension-Related Hospitalization of Hypertensive Patients: A Nationwide Population-Based Nested Case-Control Study
Woo-Ri Lee, Jun Hyuk Koo, Ji Yun Jeong, Min Su Kim, Ki-Bong Yoo
International Journal of Public Health.2023;[Epub] CrossRef

Sex-specific Associations Between Serum Hemoglobin Levels and the Risk of Cause-specific Death in Korea Using the National Health Insurance Service-National Health Screening Cohort (NHIS HEALS): Yoonsuk An, Jieun Jang, Sangjun Lee, Sungji Moon, Sue K. Park; J Prev Med Public Health. 2019;52(6):393-404. Published online November 1, 2019; DOI: https://doi.org/10.3961/jpmph.19.146

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to determine the associations between blood hemoglobin (Hgb) levels and the risk of death by specific causes.
Methods
Using the National Health Insurance Services-National Health Screening Cohort (n=487 643), we classified serum Hgb levels into 6 sex-specific groups. Cox regression analysis was used to analyze the associations between Hgb levels and the risk of cause-specific death.
Results
Hgb levels in male population showed a U-shaped, J-shaped, or inverse J-shaped association with the risk of death from ischemic heart disease, acute myocardial infarction, liver cancer, cirrhosis and chronic obstructive pulmonary disease (COPD) (all non-linear p<0.05; hazard ratio [HR]; 95% confidence interval [CI]) for the lowest and the highest Hgb levels for the risk of each cause of death in male population: HR, 1.14; 95% CI, 0.98 to 1.34; HR, 2.87; 95% CI, 1.48 to 5.57; HR, 1.16; 95% CI, 0.96 to 1.40; HR, 3.05; 95% CI, 1.44 to 6.48; HR, 1.36; 95% CI, 1.18 to 1.56; HR, 2.11; 95% CI, 1.05 to 4.26; HR, 3.64; 95% CI, 2.49 to 5.33; HR, 5.97; 95% CI, 1.44 to 24.82; HR, 1.62; 95% CI, 1.14 to 2.30; HR, 3.84; 95% CI, 1.22 to 12.13, respectively), while in female population, high Hgb levels were associated with a lower risk of death from hypertension and a higher risk of death from COPD (overall p<0.05; HR, 1.86; 95% CI, 1.29 to 2.67 for the lowest Hgb levels for hypertension; overall p<0.01, HR, 6.60; 95% CI, 2.37 to 18.14 for the highest Hgb levels for COPD). For the risk of lung cancer death by Hgb levels, a linear negative association was found in male population (overall p<0.01; the lowest Hgb levels, HR, 1.17; 95% CI, 1.05 to 1.33) but an inverse J-shaped association was found in female population (non-linear p=0.01; HR, 1.25; 95% CI, 0.96 to 1.63; HR, 2.58; 95% CI, 1.21 to 5.50).
Conclusions
Both low and high Hgb levels were associated with an increased risk of death from various causes, and some diseases showed different patterns according to sex.

Summary

Korean summary
본 연구는 2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS)를 이용하여 총 487,643명을 대상으로 2013년 말일까지의 통계청 사망자료 추적관찰 기반 혈중 헤모글로빈과 전체, 심뇌혈관, 암, 기타 질환의 (만성 폐쇄성 폐질환, 간경화증) 사망위험 간 상관관계를 성별 층화하여 콕스회귀모형으로 분석하였음. 연구 결과 남성에서는 낮은 헤모글로빈 및 높은 헤모글로빈 농도와 허혈성 심질환, 심근경색, 간암, 간경화증, 그리고 만성 폐쇄성 폐질환 사망위험이 통계적으로 유의하게 증가함을 보인 반면, 여성에서는 낮은 헤모글로빈 농도에서는 고혈압, 높은 헤모글로빈 농도에서는 만성 폐쇄성 폐질환 사망위험도가 통계적으로 유의하게 증가하였음.결과적으로 낮은 그리고 높은 헤모글로빈 농도가 기존에 알려져 있던 심혈관질환의 사망위험에 영향을 주었을 뿐만 아니라 암 질환 및 기타 다른 질환들의 사망위험에도 영향을 주는 것으로 나타났기에 혈중 헤모글로빈 농도가 사망위험도의 잠재적인 예측인자로써의 가능성을 보였음. 주요 단어: 헤모글로빈, 빈혈, 사망, 성별, 한국인

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The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study: Mi-Ji Kim, Sung-Hyo Seo, Ae-Rim Seo, Bo-Kyoung Kim, Gyeong-Ye Lee, Yeun-Soon Choi, Jin-Hwan Kim, Jang-Rak Kim, Yune-Sik Kang, Baek-Geun Jeong, Ki-Soo Park; J Prev Med Public Health. 2019;52(6):405-415. Published online October 24, 2019; DOI: https://doi.org/10.3961/jpmph.19.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.
Methods
The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.
Results
The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.
Conclusions
More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

Summary

Korean summary
본 연구는 우리나라 농촌지역 노인들이 인지하는 지역 환경과 노쇠의 연관성을 확인하기 위하여 자기보고식 설문지로 인지된 보행편의성 및 환경오염을 측정하였고, Kaigo-Yobo 평가척도로 노쇠를 평가하였다. 연구 결과, 노쇠에 영향을 미칠 것으로 예상되는 변수들을 통제한 후에도 인지된 보행편의성의 감소와 인지된 환경오염의 증가는 노쇠와 관련성이 있었다.

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Nicola Veronese, Laura Maniscalco, Domenica Matranga, Guido Lacca, Ligia J. Dominguez, Mario Barbagallo
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Faezeh Behnamifard, Zohre Shafieiyoun, Mostafa Behzadfar
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Takumi Abe, Akihiko Kitamura, Satoshi Seino, Yuri Yokoyama, Hidenori Amano, Yu Taniguchi, Mariko Nishi, Yu Nofuji, Tomoko Ikeuchi, Takemi Sugiyama, Shoji Shinkai
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Associations of Ambient Air Pollutant Concentrations With Respiratory Symptoms and Perceived Health Status in Japanese Adults With and Without Chronic Respiratory Diseases: A Panel Study: Motoyuki Nakao, Keiko Yamauchi, Satoshi Mitsuma, Tetsuro Odaira, Hideto Obata, Yoichi Chijimatsu, Yoko Ishihara; J Prev Med Public Health. 2019;52(6):416-426. Published online November 13, 2019; DOI: https://doi.org/10.3961/jpmph.19.180

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Abstract PDF Supplementary Material

Objectives
In recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases.
Methods
Participants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July.
Results
Oxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <2.5 μm levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL.
Conclusions
Respiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

Summary

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Brief Report

Monitoring Compliance and Examining Challenges of a Smoke-free Policy in Jayapura, Indonesia: Wahyuti Wahyuti, Suci Hasairin, Sherly Mamoribo, Abdillah Ahsan, Dian Kusuma; J Prev Med Public Health. 2019;52(6):427-432. Published online November 22, 2019; DOI: https://doi.org/10.3961/jpmph.19.240

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Abstract PDF

Background
In Indonesia, 61 million adults smoked in 2018 and 59 million were exposed to secondhand smoke at offices or restaurants in 2011. The Presidential Decree 109/2012 encouraged local governments to implement smoke-free policy (SFP) with Jayapura city enacted a local bill (1/2015) in 2015. Objective: This study aims to evaluate the compliance and explore the challenges in implementing. Methods: We conducted a mixed-methods study. The quantitative method assessed the compliance to six criteria (as per the bill) including having signage, no smoking activity, no selling, no advertisement, no smoke, and no ashtray at SFP facilities. We surveyed 192 facilities including health facilities, educational facilities, places of worship, government offices, and indoor/outdoor public facilities. The qualitative method explored challenges in implementing through by interviewing 19 informants (government officers, students and community). Results: The compliance rate to all six criteria was 17% overall, ranging from 0% at outdoor public facilities to 50% at health facilities. We found no spatial patterning as shown by similar compliance rates between SFP facilities within and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included (a) limited budget for enforcement, (b) lack of support from local non-government organizations and universities, (c) lack of public awareness at facilities, and (c) lack of examples from local leaders. Conclusion: The overall compliance was low in Jayapura city due to many challenges. This provides lessons learnt for tobacco control policy in the areas that are least developed and farthest from the central government.

Summary

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