Objectives Disability weights require regular updates, as they are influenced by both diseases and societal perceptions. Consequently, it is necessary to develop an up-to-date list of the causes of diseases and establish a survey panel for estimating disability weights. Accordingly, this study was conducted to calculate, assess, modify, and validate disability weights suitable for Korea, accounting for its cultural and social characteristics.
Methods The 380 causes of disease used in the survey were derived from the 2019 Global Burden of Disease Collaborative Network and from 2019 and 2020 Korean studies on disability weights for causes of disease. Disability weights were reanalyzed by integrating the findings of an earlier survey on disability weights in Korea with those of the additional survey conducted in this study. The responses were transformed into paired comparisons and analyzed using probit regression analysis. Coefficients for the causes of disease were converted into predicted probabilities, and disability weights in 2 models (model 1 and 2) were rescaled using a normal distribution and the natural logarithm, respectively.
Results The mean values for the 380 causes of disease in models 1 and 2 were 0.488 and 0.369, respectively. Both models exhibited the same order of disability weights. The disability weights for the 300 causes of disease present in both the current and 2019 studies demonstrated a Pearson correlation coefficient of 0.994 (p=0.001 for both models). This study presents a detailed add-on approach for calculating disability weights.
Conclusions This method can be employed in other countries to obtain timely disability weight estimations.
Summary
Korean summary
이 연구에서는 장애보정생존연수의 산출 방법론 중 발생률 기반 접근법을 이용하여 질병부담 산출에 활용할 질병원인에 대한 장애가중치를 산출하고 한국의 문화사회적 특징을 고려하여 이에 대한 타당성을 검증하였다. 특히, 지난 연구에서 활용한 질병원인에 대한 장애가중치 결과값을 add-on study 방법으로 활용하여 장애가중치를 개정하였다. 이번 연구에서 수행한 add-on study 방법을 활용하여 장애가중치 값을 산출할 경우 다수의 전문가의 누적된 의견을 기반으로 장애가중치를 안정적으로 개정하여 특정 질병원인의 장애보정생존연수를 보다 정확하게 산출할 수 있게 될 것이다.
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Traditional mediation analysis, which relies on linear regression models, has faced criticism due to its limited suitability for cases involving different types of variables and complex covariates, such as interactions. This can result in unclear definitions of direct and indirect effects. As an alternative, causal mediation analysis using the counterfactual framework has been introduced to provide clearer definitions of direct and indirect effects while allowing for more flexible modeling methods. However, the conceptual understanding of this approach based on the counterfactual framework remains challenging for applied researchers. To address this issue, the present article was written to highlight and illustrate the definitions of causal estimands, including controlled direct effect, natural direct effect, and natural indirect effect, based on the key concept of nested counterfactuals. Furthermore, we recommend using 2 R packages, ‘medflex’ and ‘mediation’, to perform causal mediation analysis and provide public health examples. The article also offers caveats and guidelines for accurate interpretation of the results.
Summary
Korean summary
전통적 매개분석은 여러 유형의 변수 혹은 복잡한 상호작용을 포함할 경우, 직접 및 간접효과의 정의가 불분명하다는 비판에 직면해왔다. 이에 대한 대안으로서 인과매개분석은 반사실적 개념에 기반하여 직접 및 간접효과를 명료하게 정의하며 유연한 모델링을 가능하게 한다. 다만 이 새로운 접근의 주요 개념을 응용 연구자들이 이해하는 데에는 다소 어려운 측면이 있다. 이러한 점에서 이 논문에서는 중첩된 반사실적 변수에 기반한 인과적 모수의 정의를 상술하고 인과매개분석을 위한 대표적인 R 패키지인 medflex 및 mediation을 활용하여 공공 보건 사례에 대한 분석 실례 및 유의사항을 제공하였다.
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Social class and moral judgment: a process dissociation perspective Andreas Tutic, Friederike Haiser, Ivar Krumpal Frontiers in Sociology.2024;[Epub] CrossRef
Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study Codie R. Rouleau, Daniele Chirico, Stephen B. Wilton, Matthew K. MacDonald, Tianqi Tao, Ross Arena, Tavis Campbell, Sandeep Aggarwal Journal of the American Heart Association.2024;[Epub] CrossRef
Objectives We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR).
Methods We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR.
Results From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was “C18-C20” (n=20), followed by “C18-C20 with claim code for treatment” (n=3) and “C18-C20 with V193 (code for registered cancer patients’ payment deduction)” (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for “C18-C20 used as the main diagnosis.” The smallest difference in ASRs was observed for “C18-C20,” followed by “C18- C20 with V193,” and “C18-C20 with claim code for hospitalization or code for treatment.”
Conclusions In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of “C18-C20 as the main diagnosis” was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.
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Korean summary
- 국민건강보험공단 자료 기반 연구에서 사용된 대장암의 조작적 정의를 검토하고 각 조작적 정의에 따른 대장암의 연령표준화발생률을 중앙암등록본부에서 보고한 수치와 비교하였다.
- 62개의 출판된 문헌을 검토하여 9개의 조작적 정의를 확인하였고 이 중 "C18-C20"이 가장 일반적으로 사용되었다.
- "C18-C20"을 주진단으로 정의한 경우의 연령표준화발생률은 중앙암등록본부에서 보고한 연령표준화발생률과 가장 유사하였다.
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Worsening of health disparities across COVID-19 pandemic stages in Korea Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee Epidemiology and Health.2024; : e2024038. CrossRef
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Real-world data analysis on effectiveness of integrative therapies: A practical guide to study design and data analysis using healthcare databases Ye-Seul Lee, Yoon Jae Lee, In-Hyuk Ha Integrative Medicine Research.2023; 12(4): 101000. CrossRef
Thang Phan, Ha Phan Ai Nguyen, Cao Khoa Dang, Minh Tri Phan, Vu Thanh Nguyen, Van Tuan Le, Binh Thang Tran, Chinh Van Dang, Tinh Huu Ho, Minh Tu Nguyen, Thang Van Dinh, Van Trong Phan, Binh Thai Dang, Huynh Ho Ngoc Quynh, Minh Tran Le, Nhan Phuc Thanh Nguyen
J Prev Med Public Health. 2023;56(4):319-326. Published online May 31, 2023
Objectives The coronavirus disease 2019 (COVID-19) pandemic has increased the workload of healthcare workers (HCWs), impacting their health. This study aimed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and identify factors associated with poor sleep among HCWs in Vietnam during the COVID-19 pandemic.
Methods In this cross-sectional study, 1000 frontline HCWs were recruited from various healthcare facilities in Vietnam between October 2021 and November 2021. Data were collected using a 3-part self-administered questionnaire, which covered demographics, sleep quality, and factors related to poor sleep. Poor sleep quality was defined as a total PSQI score of 5 or higher.
Results Participants’ mean age was 33.20±6.81 years (range, 20.0-61.0), and 63.0% were women. The median work experience was 8.54±6.30 years. Approximately 6.3% had chronic comorbidities, such as hypertension and diabetes mellitus. About 59.5% were directly responsible for patient care and treatment, while 7.1% worked in tracing and sampling. A total of 73.8% reported poor sleep quality. Multivariate logistic regression revealed significant associations between poor sleep quality and the presence of chronic comorbidities (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.17 to 5.24), being a frontline HCW directly involved in patient care and treatment (OR, 1.59; 95% CI, 1.16 to 2.16), increased working hours (OR, 1.84; 95% CI,1.37 to 2.48), and a higher frequency of encountering critically ill and dying patients (OR, 1.42; 95% CI, 1.03 to 1.95).
Conclusions The high prevalence of poor sleep among HCWs in Vietnam during the COVID-19 pandemic was similar to that in other countries. Working conditions should be adjusted to improve sleep quality among this population.
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A cross‐sectional study of sleep disturbance among middle‐aged cancer patients at Vietnam National Cancer Hospital Anh Tuan Pham, Mai Tuyet Do, Huong Thi Thanh Tran Cancer Reports.2024;[Epub] CrossRef
Poor sleep quality and associated factors among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Winta Tesfaye, Ayechew Adera Getu, Baye Dagnew, Alemu Lemma, Yigizie Yeshaw Frontiers in Psychiatry.2024;[Epub] CrossRef
Objectives Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran.
Methods Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority.
Results Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources.
Conclusions Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.
Objectives Young children’s feeding characteristics can play an important role in eating habits and health during later childhood. This study was conducted to examine the associations of feeding characteristics with dietary patterns and obesity in children.
Methods This study utilized data from the Korea National Health and Nutrition Examination Survey conducted between 2013 and 2017. In total, 802 toddlers were included, with information on their demographic characteristics, feeding practices and duration, and 24-hour recall obtained from their parents. Feeding characteristics were categorized into feeding type, duration of total breastfeeding, duration of total formula feeding, duration of exclusive breastfeeding, and age when starting formula feeding. Dietary patterns were identified based on factor loadings for the food groups for 3 major factors, with “vegetables & traditional,” “fish & carbohydrates,” and “sweet & fat” patterns. Overweight/obesity was defined as ≥85th percentile in body mass index based on the 2017 Korean National Growth charts for children and adolescents. Multiple regression analysis was conducted to examine associations between feeding characteristics and dietary patterns. The association between dietary patterns and obesity was analyzed using multivariable logistic regression analysis.
Results The early introduction of formula feeding was inversely associated with the “vegetables & traditional” pattern (β=-0.18; 95% confidence interval [CI], -0.34 to -0.02). A higher “vegetables & traditional” intake was associated with a lower risk of obesity (odds ratio, 0.48; 95% CI, 0.24 to 0.95).
Conclusions Feeding characteristics are associated with dietary patterns in later childhood, and dietary patterns were shown to have a potential protective association against obesity.
Summary
Korean summary
생애 초기 수유 형태는 유아의 식습관 형성에 영향을 주고 아울러 성장기의 식습관에도 중요한 바탕이 된다. 특히, 생애 초기 수유 형태는 유아기의 성장 발달 또는 비만과 관련됨이 알려져 있다. 과일과 채소 섭취 증가 및 다양한 식품의 섭취는 비만을 예방하는 대표적인 식습관 중의 하나이다. 본 연구에는 영아 시기의 수유 형태가 이후 유아기의 식사 패턴에 미치는 영향 및 유아기 비만과의 관련성을 살펴보고자 수행되었다. 이에 본 연구에서는 국민건강영양조사2013-2017년까지 만2-3세 유아 802명 대상으로 수유 형태에 따른 식사 패턴 분석 결과, 4개월 이전 분유 수유를 시작할 경우 ‘vegetables & traditional’패턴 점수가 감소하였다. 식사 패턴과 비만 유병률 결과, ‘vegetables & traditional’ 패턴 요인 점수가 증가할수록 비만 유병률이 감소하는 경향을 보였다. 이에 본 연구 결과들을 통해 생애 초기 수유 형태에 따라 유아기(미취학아동)의 식습관에 영향을 미치는 요인으로 판단되며, 그 식습관이 반영됨에 따라 소아 비만과 관련이 있음을 나타냈다. 따라서 국내 대규모의 표본을 대상으로 한 연구 결과로 건강하고 다양한 식습관 지도를 위한 영양 교육 프로그램의 근거 자료로 활용될 수 있다고 생각된다.
Objectives We investigated trends in the incidence rate of macrosomia and its association with parental nationalities using Vital Statistics data in Japan.
Methods We used singleton birth data every 5 years from 1995 to 2020. The incidence rate of macrosomia was calculated according to specific attributes (maternal age, infant’s sex, parental nationalities, parity, and household occupation) over time (years). In addition, a log-binomial model was used to investigate the relationship between the incidence of macrosomia and the attributes. This study compared Korea, China, the Philippines, Brazil, and other countries with Japan in terms of parental nationalities. “Other countries” indicates countries except for Japan, Korea, China, the Philippines, and Brazil.
Results The study included 6 180 787 births. The rate of macrosomia in Japan decreased from 1.43% in 1995 to 0.88% in 2020, and the decrease was observed across all parental nationalities. The rates for Japanese parents were the lowest values among parental nationalities during the timespan investigated. Multivariate regression analysis showed that mothers from Korea, China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.91, 2.82, 1.59, 1.74, and 1.64, respectively). Furthermore, fathers from China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.66, 1.38, 1.88, and 3.02, respectively).
Conclusions The rate of macrosomia decreased from 1995 to 2020 in Japan for parents of all nationalities, and the risk of macrosomia incidence was associated with parental nationality.
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Comparisons of the Rates of Large-for-Gestational-Age Newborns between Women with Diet-Controlled Gestational Diabetes Mellitus and Those with Non-Gestational Diabetes Mellitus Sirida Pittyanont, Narongwat Suriya, Sirinart Sirilert, Theera Tongsong Clinics and Practice.2024; 14(2): 536. CrossRef
Objectives The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population.
Methods This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index.
Results Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022).
Conclusions Tobacco smoking was associated with dental caries in the Indonesian population.
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Objectives Recent research indicates a potential association between workplace violence and an increased risk of cardiovascular disease (CVD) in the working-age population. However, the relevant evidence in the United States is sparse. Thus, this study was conducted to explore the possible relationship between workplace violence and CVD among United States workers.
Methods We utilized cross-sectional data from the 2015 National Health Interview Survey, which included a representative sample of 18 380 workers, to investigate the associations between workplace violence and the prevalence of CVD using logistic regression. Workplace violence was determined based on self-reported threats, bullying, or harassment at work over the past 12 months, supplemented with additional information regarding frequency. CVD included all forms of heart disease and stroke.
Results A total of 1334 workers reported experiences of workplace violence, and 1336 workers were diagnosed with CVD. After adjustment for covariates, participants who reported any instance of workplace violence had significantly higher odds of having CVD (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.35 to 2.30) than those who reported no such violence. Furthermore, the highest odds of CVD (OR, 1.80; 95% CI, 1.23 to 2.63) were observed among those frequently exposed to workplace violence. Even occasional exposure to workplace violence was associated with 74% excess odds of CVD.
Conclusions Our study indicates an association between workplace violence and CVD in United States workers, exhibiting a dose-response pattern.
Objectives Korea and Japan have managed the spread of coronavirus disease 2019 (COVID-19) using markedly different policies, referred to as the “3T” and “3C” strategies, respectively. This study examined these differences to assess the roles of active testing and contact tracing as non-pharmaceutical interventions (NPIs). We compared the proportion of unlinked cases (UCs) and test positivity rate (TPR) as indicators of tracing and testing capacities.
Methods We outlined the evolution of NPI policies and investigated temporal trends in their correlations with UCs, confirmed cases, and TPR prior to the Omicron peak. Spearman correlation coefficients were reported between the proportion of UCs, confirmed cases, and TPR. The Fisher r-to-z transformation was employed to examine the significance of differences between correlation coefficients.
Results The proportion of UCs was significantly correlated with confirmed cases (r=0.995, p<0.001) and TPR (r=0.659, p<0.001) in Korea and with confirmed cases (r=0.437, p<0.001) and TPR (r=0.429, p<0.001) in Japan. The Fisher r-to-z test revealed significant differences in correlation coefficients between the proportion of UCs and confirmed cases (z=16.07, p<0.001) and between the proportion of UCs and TPR (z=2.12, p=0.034) in Korea and Japan.
Conclusions Higher UCs were associated with increases in confirmed cases and TPR, indicating the importance of combining testing and contact tracing in controlling COVID-19. The implementation of stricter policies led to stronger correlations between these indicators. The proportion of UCs and TPR effectively indicated the effectiveness of NPIs. If the proportion of UCs shows an upward trend, more testing and contact tracing may be required.
Summary
Korean summary
“3T”전략과 “3C”전략으로 대표되는 한국과 일본의 코로나 19 유행 시기의 NPI 정책을 비교하고, 접촉자 추적 및 검사 역량의 지표로 감염경로를 알 수 없는 확진자(unlinked case)와 검사 양성률(TPR)의 역할을 평가하였다. 감염경로를 알 수 없는 확진자(UC)는 전체 확진자수 증가 및 검사 양성률의 증가와 관련이 있었으며, 이는 COVID-19 통제에 있어 검사와 접촉자 추적을 적절히 조합하는 것이 중요함을 보여준다.
The aim of this study was to present a framework for clinicians to use when discussing electronic cigarette (e-cigarette) use and its association with pre-diabetes. A communication tool was designed using evidence-based strategies from the academic literature. A four-step framework is presented, which includes: step (1) helping patients to understand the association between e-cigarette use and pre-diabetes; step (2) the synergistic health impacts of e-cigarette use and pre-diabetes; step (3) management of diabetes-related lifestyle factors; and step (4) stages of change assessment related to e-cigarette reduction. This communication tool provides support for clinicians to discuss the risk of pre-diabetes associated with e-cigarette use. Moving forward, implementation and evaluation of this model are needed.