Journal of Preventive Medicine and Public Health

Original Articles

National Trends in Healthcare Quality in Korea: A Multidimensional Assessment Using OECD Health Care Quality Indicators (2008–2023): Hyejin Lee, Soo-Hee Hwang, Sang-A Cho, Hyemin Jung, Youngs Chang, Jieun Yun, Sanghyun Cho, Un-Na Kim, Hye Yeon Koo, Eun Byul Cho, Do Hee Kim, Jin Yong Lee; J Prev Med Public Health. 2026;59(3):225-238. Published online May 20, 2026; DOI: https://doi.org/10.3961/jpmph.26.233

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Abstract Summary PDF Supplementary Material: Objectives
Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators.
Methods
We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages.
Results
Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages.
Conclusions
Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.; Summary

Korean summary
이 연구는 OECD Health Care Quality Indicators(HCQI)를 활용하여 2008년부터 2023년까지 한국 의료의 질 변화를 주요 OECD 국가와 비교·분석하였다. 분석 결과, 한국의 급성기 치료 성과(급성심근경색과 허혈성·출혈성 뇌졸중의 30일 사망률)와 만성질환 관리 수준(천식·만성폐쇄성폐질환·심부전·당뇨병의 입원율 감소와 당뇨병 환자의 적절한 약물치료 증가)은 전반적으로 향상된 것으로 나타났다. 그러나 광범위 항생제 사용, 고령층 다약제 처방, 중증 정신질환자의 초과사망 및 퇴원 후 자살률 등은 여전히 OECD 평균 대비 취약한 영역으로 나타나, 지속적인 질 관리와 정책 개선이 필요하다.

Key Message
This study analyzed changes in healthcare quality in Korea from 2008 to 2023 compared with major OECD countries using the OECD Health Care Quality Indicators (HCQI). Acute care outcomes and chronic disease management improved overall, including reduced 30-day mortality for acute myocardial infarction and stroke and lower hospitalization rates for major chronic diseases. However, broad-spectrum antibiotic use, polypharmacy among older adults, excess mortality among patients with severe mental illness, and post-discharge suicide rates remained worse than the OECD average, highlighting the need for continuous quality improvement and policy reform.

Exploring Factors Influencing Decisions to Withdraw Treatment in Iranian Patients With Metastatic Cancer: A Qualitative Content Analysis Study: Faezeh Abadi, Mostafa Bijani, Esmat Nouhi, Camelia Rohani; J Prev Med Public Health. 2026;59(3):267-277. Published online April 30, 2026; DOI: https://doi.org/10.3961/jpmph.25.872

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Abstract Summary PDF: Objectives
The decision to withdraw treatment in patients with metastatic cancer is a complex and emotionally charged process influenced by multiple interrelated factors. Despite its significant clinical and ethical implications, this phenomenon remains insufficiently explored through qualitative inquiry. This study aimed to explore the factors influencing decisions to withdraw treatment among patients with metastatic cancer.
Methods
A qualitative study using conventional content analysis was conducted. Fourteen patients with metastatic cancer were purposively selected. Data were collected through in-depth, semi-structured interviews and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. Data organization was facilitated using MAXQDA software.
Results
The analysis yielded 1 main theme (“Finding the meaning of life, and freedom from cycles of suffering”), 4 categories, and 15 subcategories. The overarching theme suggests that understanding life’s meaning enables patients to situate their illness within a broader existential purpose, thereby affirming life’s intrinsic value beyond mere physical survival. The 4 categories were social and family influences, physical health factors, psychological determinants, and divine and spiritual beliefs.
Conclusions
This study outlines a multilevel approach to improving end-of-life care. At the clinical level, holistic nursing assessments are needed to guide transitions to palliative care. At the institutional level, implementing structured protocols with multidisciplinary support and financial counselling is essential. At the national level, policies should ensure universal health coverage and promote cultural acceptance of dignified treatment withdrawal. These findings provide actionable insights for healthcare administrators and policymakers and offer a foundation for strategies aimed at reducing barriers and improving access to supportive care services.; Summary

Key Message
This qualitative study with the conventional content analysis method explored the factors influencing treatment withdrawal decisions in 14 Iranian patients with metastatic cancer. The results revealed one overarching theme: “Finding the meaning of life and freedom from the cycles of suffering,” along with 15 subcategories and four main categories: “social and family influences,” “physical health factors,” “psychological determinants,” and “divine and spiritual beliefs.” These findings provide practical insights for healthcare administrators and policymakers to develop strategies for mitigating barriers and enhancing access to supportive care services for this vulnerable population.

Income-related Inequalities in Cancer Screening Among Korean Adults Aged 40 and Above: A Cross-sectional Analysis of the Age-varying Mediation of Health Literacy: Hyejin Hong, Hyun-Jin Goo, Hyebin Choi, Sin Kam, Jong-Yeon Kim; J Prev Med Public Health. 2026;59(2):184-193. Published online March 12, 2026; DOI: https://doi.org/10.3961/jpmph.25.866

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Abstract Summary PDF Supplementary Material: Objectives
This study investigated how the mediating effect of health literacy (HL) on the association between income and cancer screening participation varies by age among Korean adults aged 40 years and older, with the aim of identifying the optimal timing for HL interventions.
Methods
Data from 4171 adults aged ≥40 years in the 2023 Korea National Health and Nutrition Examination Survey were analyzed using moderated mediation analysis implemented with the lavaan.survey package, accounting for the complex sampling design. The Johnson–Neyman technique was used to identify age thresholds at which the mediation effect became statistically significant, and the number needed to benefit (NNB) was calculated to estimate the potential efficiency of interventions targeting this pathway.
Results
Each 1-quintile increase in income was associated with a 16.0% higher likelihood of undergoing cancer screening (odds ratio=1.16, p<0.001). The mediating effect of HL increased significantly with age (index of moderated mediation=0.000438, p=0.048). Mediation became statistically significant from age 54.2 years (Johnson–Neyman threshold), with the proportion of the total effect mediated rising from 0.1% among adults aged 40–49 years to 8.1% among those aged ≥70 years. The NNB for this pathway indicated substantial intervention efficiency in older adults (NNB=372 for ages ≥70), whereas the mediation effect was not statistically significant in the 50–59 age group.
Conclusions
HL significantly mediated the relationship between income and cancer screening participation from the mid-50s onward, with progressively greater contributions at older ages. These findings support age-differentiated strategies, including structural accessibility improvements for adults in their 40s and early 50s and integrated income–HL interventions for individuals aged ≥55 years. Experimental studies are warranted to confirm these associations.; Summary

Korean summary
40세 이상 한국 성인에서 소득과 암검진 참여 간 건강문해력의 매개효과는 54.2세부터 유의해지기 시작하여 연령 증가에 따라 점진적으로 강화되었다. 70세 이상에서 매개 비율은 8.1%, 중재효율(NNB=372)이 가장 높았다. 이는 55세 이상에서 소득 지원과 건강문해력 향상을 결합한 연령별 맞춤형 중재가 필요함을 시사한다.

Key Message
Health literacy mediation of the income–cancer screening relationship became statistically significant from age 54.2 years and strengthened progressively with age among Korean adults aged ≥40 years. Among adults aged ≥70 years, health literacy accounted for 8.1% of the total income effect, with the highest intervention efficiency (NNB=372). These findings suggest that integrated income support and health literacy interventions are warranted for adults aged ≥55 years.

Assessing Hospital Surgical Functions in Korea: A Functional Analysis Using the Disease Control Priorities, 3rd Edition Essential Surgery List (2013-2022): Haibin Bai, Jin-Hwan Kim, Yukyung Park; J Prev Med Public Health. 2025;58(6):635-646. Published online September 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.407

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Abstract Summary PDF Supplementary Material: Objectives
Korea has achieved near-universal health coverage through a predominantly privatized healthcare system. However, this structural fragmentation has created significant ambiguity regarding the roles of different healthcare organizations, particularly in ensuring equitable provision of essential surgical services across geographic and institutional boundaries.
Methods
We conducted a retrospective study using the full national health insurance claims database provided by the Health Insurance Review & Assessment Service (2013-2022). Essential surgical procedures from the Disease Control Priorities, 3rd edition Essential Surgery List were mapped to insurance claims codes, and their provision was analyzed across healthcare facilities and regions. Functional capacity was defined using minimum annual volume thresholds of 12, 24, 60, and 120 procedures.
Results
Essential surgery more than doubled between 2013 and 2022, increasing from 2.79 million to nearly 6 million cases. Superior general hospitals and general hospitals consistently delivered high volumes of essential surgeries, while hospital-level facilities experienced marked functional decline, particularly in obstetric services. We observed increasing centralization of surgical services in higher-tier and metropolitan facilities, alongside selective decentralization for lower-risk procedures such as cataract surgery. Regional disparities were especially pronounced for obstetric care.
Conclusions
Functional capacity for essential surgery remains highly uneven across hospitals and regions, undermining equitable access. Policy efforts should focus on strengthening lower-tier hospitals in underserved areas and implementing minimum functionality standards tailored to local needs. Clarifying institutional roles within Korea’s mixed healthcare system is essential to improving accountability and ensuring equitable distribution of essential surgical services.; Summary

Korean summary
본 연구는 DCP3 Essential Surgery List를 한국의 건강보험 청구자료(2013–2022)에 적용하여 필수수술 제공기관의 기능적 변화를 평가하였다. 전체 필수수술 건수는 크게 증가했음에도 불구하고 이를 제공하는 의료기관 수는 지속적으로 감소하며 지역 간 격차도 확대되고 있었다. 필수수술 접근성을 강화하기 위해서는 우선 의료기관 수준별로 제공해야 할 필수 기능을 명확히 규정하는 정책적 가이드가 필요하며, 이를 기반으로 지역 단위의 종합병원·병원급 기능을 지속적으로 모니터링하고 관리하는 체계를 마련해야 한다.

Key Message
This study applies the DCP3 Essential Surgery List to South Korea’s national health insurance claims data (2013–2022) and shows that, despite a substantial rise in essential surgery volumes, the number of institutions providing these procedures has declined, widening regional disparities. Strengthening access to essential surgery requires first establishing clear guidance on the functions expected at each level of care, followed by systematic monitoring to ensure that general and hospital-level facilities maintain the capacity to deliver these core services. Such a combined approach is critical for securing equitable and regionally sustained surgical access.

Perspective

Towards Mental Health Equity: Task Shifting Strategy to Overcome Barriers in Primary Healthcare Services in India: Suganya Panneerselvam, Senthilkumar Ramasamy, Sanjana Agrawal; J Prev Med Public Health. 2025;58(5):548-551. Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.144

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Abstract Summary PDF: Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100 000 population, yet the current ratio is only 0.7 per 100 000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups—particularly residents of rural and remote areas, women, and older adults—are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India’s National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.; Summary

Key Message
Mental illness remains among the top 10 causes of the global burden of disease. Stigma associated with these disorders exacerbates the problem, leading to social discrimination. The Ayushman Bharat initiative is a transformative step towards strengthening India’s healthcare system. CHOs and ASHAs use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders within their communities. This task-shifting approach empowers local communities and fosters participation, reducing disease burden and offering a sustainable, effective model.

Original Articles

Mobile App-based Care Management Training to Improve Family Caregiver Competence in Caring for Children With HIV in Indonesia: A Quasi-experimental Study: Nyimas Heny Purwati, Syamikar Baridwan Syamsir, Mutmainah , Dhea Natashia, Amelia Hartika Rani, Dwi Budiyati, Agus Setiawan; J Prev Med Public Health. 2025;58(5):516-526. Published online May 7, 2025; DOI: https://doi.org/10.3961/jpmph.24.789

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Abstract Summary PDF: Objectives
Family caregivers play a crucial role in the care of children with human immunodeficiency virus (HIV); however, they frequently face limitations in knowledge, attitudes, and skills. Mobile application (app)-based training may offer an effective solution to enhance caregiver competence. This study aimed to assess the effectiveness of mobile app-based care management training in improving the knowledge, attitudes, and skills of family caregivers caring for children with HIV.
Methods
A quasi-experimental design, including pretest, posttest, and follow-up assessments, was conducted at a national referral hospital for infectious diseases in Jakarta, Indonesia. The study involved 44 respondents, divided equally into intervention and control groups (22 per group). The intervention group received mobile app-based training, while the control group received conventional caregiver education. Questionnaires assessing caregivers’ knowledge, attitudes, and skills in managing children with HIV were utilized. Data were analyzed using independent sample t-tests and repeated measures analysis of variance (ANOVA).
Results
Repeated measures ANOVA revealed that the intervention group experienced significant improvements in knowledge, attitudes, and skills from pretest to posttest, which were maintained at the 1-month follow-up (p<0.001). In contrast, the control group did not exhibit significant changes in any of these variables (knowledge, attitudes, and skills) throughout the study period.
Conclusions
Mobile app-based care management training significantly enhances caregiving competencies among family caregivers of children with HIV. These findings underscore the potential of digital technology as an innovative and sustainable approach for caregiver training in various healthcare settings, supporting the long-term effectiveness of educational interventions.; Summary

Key Message
This quasi-experimental study evaluated the effectiveness of a mobile app-based care management training for family caregivers of children with HIV in Indonesia. The intervention significantly improved caregivers’ knowledge, attitudes, and skills compared to the control group. These findings suggest that digital health tools can empower caregivers, enhance pediatric HIV care, and provide a scalable model for supportive training in resource-limited settings.

Prognostic Scoring Model for the Transition From Acute to Chronic Non-specific Low Back Pain in Primary Health Care Units in Indonesia: Djoko Kuswanto, Riva Satya Radiansyah, Dwinka Syafira Eljatin, Muhammad Nazhif Haykal, Rumman Karimah, Ratri Dwi Indriani, Zain Budi Syulthoni, Erna Furaidah, Andiva Satrio Rinaldi, Hafira Nushifa Putri, Jessica Felina Adi, Anak Agung Bagus Wirayuda; J Prev Med Public Health. 2025;58(4):422-430. Published online April 12, 2025; DOI: https://doi.org/10.3961/jpmph.24.581

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Abstract Summary PDF Supplementary Material

Objectives
Non-specific low back pain (NSLBP) is a prevalent health issue that can progress from acute to chronic, resulting in prolonged disability and diminished quality of life. This study aimed to develop a prognostic scoring model to predict the transition from acute to chronic NSLBP in primary care settings.
Methods
This prospective cohort study enrolled 112 adults with acute NSLBP from primary health care units in Indonesia. Participants were assessed at baseline and at a 3-month follow-up visit. Bivariate and multivariable analyses were conducted to identify significant predictors of chronicity. A scoring system was then developed based on the final logistic regression model.
Results
Three factors were found to be significant predictors of the transition to chronic NSLBP: age above 30 years, low education level, and moderate to severe pain intensity. The prognostic scoring model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.705, 70.8% sensitivity, and 62.5% specificity at the optimal cut-off score of 2.5.
Conclusions
This simple prognostic scoring model can help clinicians identify patients at high-risk of developing chronic NSLBP. Early identification of at-risk patients could guide targeted interventions to prevent chronicity. Further validation in diverse populations is necessary to confirm the broader applicability of this model.

Summary

Key Message
This prospective cohort study developed a prognostic scoring model to predict the transition from acute to chronic non-specific low back pain (NSLBP) in primary care settings in Indonesia. The study identified three significant predictors: age above 30 years, low education level, and moderate to severe pain intensity, which formed a simple scoring system with good discrimination ability (AUC = 0.705, sensitivity 70.8%, specificity 62.5%). This practical tool enables clinicians to identify high-risk patients early and implement targeted interventions to prevent chronicity in primary healthcare settings.

Citations

Citations to this article as recorded by

The Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study
Giustino Varrassi, Maria Dolma Gudez-Santos, Magdi Hanna, Magdalena Kocot-Kępska, Antonio Montero Matamala, Marco Antonio Narvaez Tamayo, Serge Perrot, Jose Luis Aguilar, Omar Al Hamad, Lu’i Al-Husinat, Raad Al-Khafaji, Abdallah Allam, Ezio Amorizzo, Nadi
Pain and Therapy.2026; 15(1): 175. CrossRef

Who Dies Alone? Demographics, Underlying Diseases, and Healthcare Utilization Patterns of Lonely Death Individuals in Korea: Haibin Bai, Jae-ryun Lee, Min Jung Kang, Young-Ho Jun, Hye Yeon Koo, Jieun Yun, Jee Hoon Sohn, Jin Yong Lee, Hyejin Lee; J Prev Med Public Health. 2025;58(2):218-226. Published online March 4, 2025; DOI: https://doi.org/10.3961/jpmph.24.704

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Abstract Summary PDF Supplementary Material

Objectives
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea.
Methods
We constructed a database of lonely death cases by linking data from the Korea Crime Scene Investigation Unit of the Korea National Police Agency with National Health Insurance Service (NHIS) records. A descriptive analysis was performed to evaluate the demographics, underlying diseases, and healthcare utilization patterns among lonely death cases.
Results
Among the 3122 individuals identified as lonely death cases, 2621 (84.0%) were male and 501 (16.0%) were female. The most common age group was 50-59 years (n=930, 29.8%). The NHIS covered 2161 individuals (69.2%), whereas 961 individuals (30.8%) were enrolled in Medical Aid (MA). The highest number of lonely deaths occurred in Seoul areas, with 1468 cases (47.0%). Mood disorders were diagnosed in 1020 individuals (32.7%), and various alcohol-related diseases, including alcoholic liver disease, were also observed. Outpatient visits increased leading up to death but declined in the final 3 months, while hospitalizations decreased and emergency room visits slightly increased.
Conclusions
Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Summary

Korean summary
한국에서 고독사란 법적으로 “가족, 친척 등 주변 사람들과 단절된 채 사회적 고립상태로 생활하던 사람이 자살ㆍ병사 등으로 임종”하는 것으로 정의하고 있다. 고독사 사망자는 대체적으로 50대 남성이었고, 의료급여 수급권자의 비율이 일반 인구보다 월등히 높았으며, 사망자 대다수는 정신건강 문제 또는 알코올성 질환을 앓고 있었다. 사회적 고립의 예방 및 사회안전망 구축은 고독사 예방에 있어 매우 중요한 역할을 할 것으로 보인다.

Key Message
Lonely death is defined as “a person living in a state of social isolation, disconnected from family, relatives, and others, who dies from suicide, illness, or other causes”. This study investigated the characteristics of individuals who die alone in Korea. Most lonely death cases involved male in their 50s, with a disproportionately high number of MA beneficiaries compared to the general population. Many of these individuals also experienced mental health issues or alcohol-related disorders. Preventing social isolation and strengthening social safety nets are critical to reducing the occurrence of lonely deaths.

Citations

Citations to this article as recorded by

Comparison of health care utilisation and spending among National Health Insurance and Medical Aid beneficiaries in Korea
Agnus M. Kim, Doojin Ryu, Jin Yong Lee
BMC Health Services Research.2026;[Epub] CrossRef
Understanding of solitary death in people living in the community: A scoping review
Chung Min Cho, Hyeun Jun Moon, Jee-Hye Yoo
Global Public Health.2025;[Epub] CrossRef

Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types: Seowoo Park, Haibin Bai, Jae-ryun Lee, Soomin Kim, Hyemin Jung, Jin Yong Lee; J Prev Med Public Health. 2025;58(1):83-91. Published online November 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.388

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Abstract Summary PDF Supplementary Material: Objectives
This study examined the potential of a new analytical framework for the Korea Community Health Survey (KCHS) with classification criteria for the sub-national governmental level, the degree of urbanization including an urban-rural multimodal category, and population size as a more effective tool to address local health problems and deduce practical implications.
Methods
Retrospective survey data from 2023 KCHS were obtained. Frequency analyses were performed for self-rated good health status, current smoking status, and unmet medical needs as proxies for health status, as well as health behavior and healthcare utilization, utilizing individual weights to represent national community residents.
Results
We established a new classification of local governments into 7 types to facilitate regional comparisons. These local government types are presumably composed of populations showing statistically significant differences in demographic characteristics. There were evident differences in health status, health behavior, and healthcare utilization in comparisons of groups categorized by local government types.
Conclusions
This study suggests that regional disparities can be analyzed using a new typology of local governments. This practically effective approach could be used in decision-making for community-centered health projects in terms of community health planning. Future research should conduct analyses of KCHS data that use these 7 local government types to comprehensively reflect regional characteristics.; Summary

Korean summary
이 연구는 지방자치단체 층위와 도·농복합시를 포함한 도시화 정도, 인구 규모를 고려한 분류 기준을 사용하여 지역사회건강조사(KCHS)에 대한 새로운 분석틀의 가능성을 검토한다. 기초 지방자치단체 7가지 유형으로 분류했을 때, 연구 대상자 집단은 인구 통계학적 특성에 대해 유의미하게 달랐으며 건강 상태, 건강 행태 및 의료 이용에 뚜렷한 차이를 보였다. 이 연구는 지역보건의료계획 측면에서 지역사회 중심 건강증진사업에 대한 의사 결정에 실질적으로 효과적인 접근 방법이 될 수 있는 기초 지방자치단체의 새로운 유형을 제안한다.

Key Message
This study examines the potential of a new analytical framework for the Korea Community Health Survey (KCHS) with classification criteria for the sub-national governmental level, the degree of urbanization including an urban-rural multimodal category, and population size. In comparisons of groups categorized by 7 local government types, populations were significantly different considering demographic characteristics and there were evident differences in health status, health behavior, and healthcare utilization. This study suggests a new typology of local governments which could be a practically effective approach in decision-making for community-centered health projects in terms of community health planning.

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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Abstract Summary 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.

Citations

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Correlates of facility-based childbirth: A health belief model approach using the National Demographic and Health Survey - Philippines
Denise B. Musni, Maria Paz N. Marquez
Philippine Journal of Health Research and Development.2025; 29(4): 34. CrossRef
Prevalence and risk factors of stillbirths among pregnant women from twelve high-volume birthing facilities of Karachi, Pakistan: a longitudinal cohort study
Danya Arif Siddiqi, Muhammad Zia Muneer, Sundus Iftikhar, Mubarak Taighoon Shah, Vijay Kumar Dharma, Fatima Miraj, Mariam Mehmood, Irshad Ali Sodhar, Farrukh Raza Malik, Subhash Chandir
BMC Pregnancy and Childbirth.2025;[Epub] CrossRef

Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea: Jae Woo Choi, Aejung Yoo, Hyojung Bang, Hyun-Kyung Park, Hyun-Ji Lee, Hyejin Lee; J Prev Med Public Health. 2024;57(6):572-585. Published online October 4, 2024; DOI: https://doi.org/10.3961/jpmph.24.275

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Abstract Summary PDF Supplementary Material: Objectives
Transitional periods, such as patient discharge, are notably challenging. This study aimed to explore the perceptions of providers involved in hospital discharge support programs, identify the primary obstacles, and propose strategies for improvement.
Methods
In this qualitative cross-sectional study, we interviewed 49 healthcare professionals, comprising doctors, nurses, and social workers, who participated in two pilot programs. We organized focus group interviews with 3-6 participants per group, segmented by the type of discharge support program and profession. For data analysis, we employed phenomenological analysis, a qualitative method.
Results
Participants recognized the importance of the discharge support program and anticipated its benefits. The Rehabilitation Hospital Discharge Patient Support program saw more active involvement from doctors than the Establishment of a Public Health-Medical Collaboration System program. Both programs highlighted the critical need for more staff and better compensation, as identified by the doctors. Nurses and social workers cited the heavy documentation burden, uncooperative attitudes from patients and local governments, and other issues. They also anticipated that program improvements could be achieved through the standardization of regional welfare services and better coordination by local governments serving as welfare service regulators. All groups—doctors, nurses, and social workers—underscored the significance of promoting these programs.
Conclusions
Discharge support programs are crucial for patients with functional impairments and severe illnesses, particularly in ensuring continuity of care. Policy support is essential for the successful implementation of these programs in Korea.; Summary

Korean summary
퇴원 지원 사업에 참여하는 의사, 간호사, 사회복지사 등 퇴원지원사업 담당자를 대상으로 시범사업 수행에 있어 주요 문제점과 개선방안을 인터뷰를 통해 조사하였을 때 참가자들은 퇴원 지원 사업이 필요하고 특히 기능 저하가 심한 환자들에게 도움이 될 것이라고 응답하였다. 그러나, 의사의 참여 부족, 연계 가능한 서비스의 부족, 다학제 팀구성이 어려운 보상 수준, 의료기관 간 의사소통의 문제 등 어려움을 지적하였다. 다학제팀 구성과 안정적인 운영을 위한 적절한 수가와 인센티브 구조 마련, 지역과의 네트워크와 지방정부 중심의 조정기능 강화가 문제 해결에 도움이 될 수 있을 것이다.

Key Message
Interviews with doctors, nurses, and social workers involved in discharge support programs revealed key challenges and improvement strategies during pilot projects. Participants acknowledged the necessity of discharge support programs, particularly for patients with severe functional impairments. However, they pointed out difficulties such as insufficient participation from doctors, a lack of available services, inadequate compensation hindering multidisciplinary team, and communication issues between medical institutions. Establishing appropriate reimbursement and incentive structures for stable multidisciplinary team operation, strengthening networks with local communities, and enhancing coordination led by local governments could help address these challenges.

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer: Binh Thang Tran, Thanh Gia Nguyen, Dinh Duong Le, Minh Tu Nguyen, Nhan P. T. Nguyen, Minh Hanh Nguyen, The Due Ong; J Prev Med Public Health. 2024;57(4):407-419. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.090

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Abstract Summary PDF Supplementary Material: Objectives
This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.
Methods
This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.
Results
The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.
Conclusions
FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.; Summary

Key Message
- This first large-scale analysis looks into the financial toxicity faced by patients with cancer in Vietnam, as an example of low- and middle-income countries.
- Financial toxicity was remarkably high prevalent and strongly associated with patient- level factors.
- Patients experiencing financial toxicity tend to use various cost-coping strategies.
- These findings underscore the need for routine screening for financial toxicity risk and interventions.

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

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Abstract Summary 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.

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Patterns of COVID-19 mortality during the second and third waves in Sri Lanka: a cross-sectional study from a tertiary care center
Shamila De Silva, Dileepa Ediriweera, Nimasha Ekanayake, Tharini Solangaarachchi, Kavinda Perera, Asanga Wickremasinghe, Rasika Liyanage
BMC Infectious Diseases.2026;[Epub] CrossRef
The Female Sex Workers' Experiences of Accessing Healthcare Services in Bangladesh: A Qualitative Investigation
Shaharior Rahman Razu, Kim Usher, Rikki Jones, Md. Shahidul Islam
Diversity & Inclusion Research.2025;[Epub] CrossRef
Impacts of Covid-19 on the Treatment of Kidney Dialysis Patients in Bangladesh: Lessons Learned and Future Directions

European Journal of Medical and Health Sciences.2025; : 533. CrossRef
Specific Trends in Blood Utilization During the COVID-19 Pandemic: A Retrospective Analysis of a Hungarian Clinical Centre
Sándor Pál, Margit Solymár, Barbara Réger, Hussain Alizadeh, András Vereczkei, Tamás Kiss, Zsuzsanna Faust
Journal of Clinical Medicine.2025; 14(22): 7943. CrossRef

Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study: Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon; J Prev Med Public Health. 2024;57(3):260-268. Published online May 30, 2024; DOI: https://doi.org/10.3961/jpmph.24.057

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Abstract Summary PDF Supplementary Material

Objectives
Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival.
Methods
A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed.
Results
The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91).
Conclusions
Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

Summary

Korean summary
심혈관 관련 수술을 대상으로 지역적 불균형을 분석한 결과, 관상동맥우회술, 경피적 관상동맥중재술, 스텐트 삽입술은 전국적으로 광범위하게 분포되었다. 반면에 대동맥류 절제술은 지역적 불균형이 발생하였고, 사망률 또한 유의한 차이가 있었다. 따라서 의료 격차 해소를 위해 병원 간 협력체계 구축, 지역 균형적 의료자원 확충 등 정책적 노력이 필요하다

Key Message
An analysis of regional disparities in cardiovascular surgeries revealed that coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and stent insertion procedures were widely distributed nationwide. However, there was a regional imbalance in aortic aneurysm resection (AAR) surgeries, which also showed significant differences in mortality rates. Therefore, policy efforts are needed to bridge the healthcare gap, such as establishing collaborative systems among hospitals and ensuring a balanced distribution of medical resources across regions.

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Nationwide Trends in Coronary Artery Bypass Grafting in the Republic of Korea, 2005–2022: A Comparison with International Data
Min Ho Ju, Jun Ho Lee, Yun Jin Kim, Ho Jin Kim, Ho Young Hwang, Sang Yoon Yeom, Hee Jung Kim, Young-Nam Youn, Wook Sung Kim, Man-Jong Baek, Hyun Keun Chee
Journal of Chest Surgery.2026; 59(1): 7. CrossRef
Association between socioeconomic status and cardiovascular disease by sex: Mediating roles of psychological and behavioral factors
Jiwon Choi, Sung-il Cho, Belal Hossain
PLOS One.2026; 21(4): e0345573. CrossRef
Global trends and practices in coronary artery bypass surgery
Shahzad G. Raja
Academia Medicine.2025;[Epub] CrossRef
Metagenome-assembled genomes reveal microbial signatures and metabolic pathways linked to coronary artery disease
Soomin Lee, Shahbaz Raza, Eun-Ju Lee, Yoosoo Chang, Seungho Ryu, Hyung-Lae Kim, Si-Hyuck Kang, Han-Na Kim, Ying Zhang
mSystems.2025;[Epub] CrossRef
Regional disparities in the distribution of public and private healthcare facilities in South Korea
Jiyu Park, Byeongyun Jeon, Eun Lee, Abel C. H. Chen
PLOS One.2025; 20(9): e0330090. CrossRef

Mental Health Among Healthcare Workers During the COVID-19 Pandemic in Vietnam: Nhan Phuc Thanh Nguyen, Ha Phan Ai Nguyen, Cao Khoa Dang, Minh Tri Phan, Huynh Ho Ngoc Quynh, Van Tuan Le, Chinh Van Dang, Tinh Huu Ho, Van Trong Phan, Thang Van Dinh, Thang Phan, Thi Anh Thu Dang; J Prev Med Public Health. 2024;57(1):37-46. Published online December 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.327

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Abstract Summary PDF

Objectives
The objective of this study was to characterize mental health issues among Vietnamese healthcare workers (HCWs) and to identify related factors.
Methods
A cross-sectional study was conducted with 990 HCWs in 2021. Their mental health status was measured using the Depression, Anxiety, and Stress Scale.
Results
In total, 49.9%, 52.3%, and 29.8% of respondents were found to have depression, anxiety, and stress, respectively. The multivariable linear regression model revealed that factors associated with increased anxiety scores included depression scores (β, 0.45; 95% confidence interval [CI], 0.39 to 0.51) and stress scores (β, 0.46; 95% CI, 0.41 to 0.52). Factors associated with increased depression scores included being frontline HCWs (β, 0.57; 95% CI, 0.10 to 1.10), stress scores (β, 0.50; 95% CI, 0.45 to 0.56), and anxiety scores (β, 0.41; 95% CI, 0.36 to 0.47), while working experience was associated with reduced depression scores (β, -0.08; 95% CI, -0.16 to -0.01). Factors associated with increased stress scores included working experience (β, 0.08; 95% CI, 0.00 to 0.16), personal protective equipment interference with daily activities (β, 0.55; 95% CI, 0.07 to 1.00), depression scores (β, 0.54; 95% CI, 0.48 to 0.59), and anxiety scores (β, 0.45; 95% CI, 0.39 to 0.50), while age was associated with reduced stress scores (β, -0.12; 95% CI, -0.20 to -0.05).
Conclusions
Specific interventions are necessary to enhance and promote the mental health of HCWs so they can successfully cope with the circumstances of the pandemic.

Summary

Key Message
A cross-sectional study of 990 Vietnamese healthcare workers in Vietnam, 2021 revealed significant mental health issues: 49.9 % suffered from depression, 52.3 % from anxiety, and 29.8 % from stress. The study found a correlation between these conditions, with frontline workers being particularly vulnerable to depression. These findings highlight the critical need for targeted mental health interventions for healthcare workers, particularly those new to the field and working on the front lines, in order to better manage pandemic-related stressors.

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Pandemic preparedness in Vietnam: a review of health system resilience and areas for improvement
Bach Xuan Tran, Taufique Joarder, Vincent Junxiong Pang, Clara Marin Carballo, Hoa Thi Do, Cuong Tat Nguyen, Linh Gia Vu, Ngo Van Toan, Shenglan Tang
Journal of Global Health.2025;[Epub] CrossRef
Emotional Competence of Healthcare Workers and Its Impact on Patient Loyalty in Vietnamese Hospitals
Phuoc Thien Mai, Nah Pi Sa, Triet Dinh Luu, Nam Khoa Ly, Phi Duong Nguyen
Health Psychology Research.2024; 12(1): 1. CrossRef

Risks for Readmission Among Older Patients With Chronic Obstructive Pulmonary Disease: An Analysis Using Korean National Health Insurance Service – Senior Cohort Data: Yu Seong Hwang, Heui Sug Jo; J Prev Med Public Health. 2023;56(6):563-572. Published online November 10, 2023; DOI: https://doi.org/10.3961/jpmph.23.346

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Abstract Summary PDF

Objectives
The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services.
Methods
To apply transitional care services that are compatible with Korea’s circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service’s Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days.
Results
The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41).
Conclusions
Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.

Summary

Korean summary
국내 만성폐쇄성폐질환(COPD)의 위험도 표준화 재입원율은 12.7%로, 주요 진단군 가운데 재입원율이 가장 높다. 국민건강보험공단 노인코호트를 활용하여 COPD로 입원한 환자의 재입원 위험 요인을 파악한 결과 고령 환자, 국민건강보험 지역가입자, 300병상 미만 규모 병원 또는 도 지역 소재 병원 에 입원한 환자의 경우 재입원 위험이 높았다. 재입원 위험이 높은 환자에 대하여 우선적으로 퇴원환자관리 서비스가 제공될 필요가 있다.

Key Message
The risk-standardized readmission rate for COPD in Korea is 12.7%, the highest among major diagnostic groups. Using the National Health Insurance Service Senior Cohort to identify risk factors for the readmission of patients hospitalized with COPD, it was found that older patients, local health insurance subscribers, those hospitalized in facilities with fewer than 300 beds, or in hospitals located in provincial areas had a higher risk of readmission. It is necessary to prioritize transitional care services for patients at a high risk of readmission.

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Factors Influencing Unplanned Readmission of Elderly Patients: A Secondary Data Analysis
Hyein Seo, Dukyoo Jung
Clinical Nursing Research.2026; 35(2-3): 102. CrossRef

Healthcare Systems and COVID-19 Mortality in Selected OECD Countries: A Panel Quantile Regression Analysis: Jalil Safaei, Andisheh Saliminezhad; J Prev Med Public Health. 2023;56(6):515-522. Published online October 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.162

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Abstract Summary PDF

Objectives
The pandemic caused by coronavirus disease 2019 (COVID-19) has exerted an unprecedented impact on the health of populations worldwide. However, the adverse health consequences of the pandemic in terms of infection and mortality rates have varied across countries. In this study, we investigate whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries.
Methods
To achieve the study objective, we distinguished healthcare systems based on the extent of healthcare decommodification. Using available daily data from 2020, 2021, and 2022, we applied quantile regression with non-additive fixed effects to estimate mortality rates across quantiles. Our analysis began prior to vaccine development (in 2020) and continued after the vaccines were introduced (throughout 2021 and part of 2022).
Results
The findings indicate that higher testing rates, coupled with more stringent containment and public health measures, had a significant negative impact on the death rate in both pre-vaccination and post-vaccination models. The data from the post-vaccination model demonstrate that higher vaccination rates were associated with significant decreases in fatalities. Additionally, our research indicates that countries with healthcare systems characterized by high and medium levels of decommodification experienced lower mortality rates than those with healthcare systems involving low decommodification.
Conclusions
The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

Summary

Key Message
This study investigates whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries. To this aim, a quantile regression with non-additive fixed effects is applied to estimate mortality rates across quantiles. The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

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Social globalisation and environmental sustainability: An analysis on ASEAN countries
Ahmet Kasap
Journal of Cleaner Production.2026; 538: 147230. CrossRef
Do adverse childhood experiences intensify the impact of hazardous drinking on depression? Application of quantile regression analysis
Mi-Sun Lee, Joonbeom Kim
Child Abuse & Neglect.2026; 174: 107976. CrossRef
Clinical Associations with Hospital Escalation Among COVID-19 Patients Receiving Remdesivir in a Hospital-at-Home Service: A Real-World Cohort Study
Manuel Mirón-Rubio, Regina de la Corte-Carmona, Amaya Palomo-Iloro, Eduardo Fernández-Carracedo, José Ramón Sevilla-Resúa, Santiago Somovilla-Moreno, Isabel Ortega-Fernández, Francisco Bas-Sanchís, María del Carmen Montero-Hernández, Irene Gutiérrez-Gómez
Journal of Clinical Medicine.2025; 14(19): 6736. CrossRef

The Trajectory of Depressive Symptoms Across Years of Community Care Utilization Among Older Adults: A 14-Year Follow-up Study Using the ‘Korean Welfare Panel Survey’: Il-Ho Kim, Cheong-Seok Kim, Min-Hyeok Jeong; J Prev Med Public Health. 2023;56(6):495-503. Published online October 6, 2023; DOI: https://doi.org/10.3961/jpmph.23.022

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Abstract Summary PDF

Objectives
While older adults using community care services are known to be vulnerable for depression, community care utilization (CCU) may help to improve the mental health of these elderly. To date, however, it is much less clear how CCU affects depressive symptoms in the elderly population. This study focuses on the trajectory of depressive symptoms across years of CCU among older adults in Korea.
Methods
Using the 2006-2019 Korean Welfare Panel Survey, this study is focused on elderly born in 1940 or earlier and selected 3281 persons for baseline interviews in 2006. This consisted of 35 800 person-year observations during a period of 14 years. Panel data analysis were employed to construct years of CCU.
Results
After controlling for covariates, linear term of years using community care was negatively associated with depressive symptoms, but a quadratic term was positively significant. The trajectory of depressive symptoms across the years of CCU follows a U-shaped curve. Older adults in the first year of using community care reported the highest level of depressive symptoms. However, a significant and steady decrease in depressive symptoms was observed during the following 9 years of CCU, which then gradually increased. The level of depressive symptoms at the 14th year of using community care remains significantly lower than the level at the outset of its utilization.
Conclusions
This finding implies that CCU could be beneficial for improving mental health among older adults.

Summary

Korean summary
한국복지패널조사(2006-2019년)를 활용하여 지역사회 돌봄서비스의 이용기간(14년 간)에 따른 우울변화궤적을 분석하였다. 분석결과, 지난 14년간 돌봄서비스 이용기간에 따른 우울증상의 궤적은 U자형을 따랐다. 즉 노인은 돌봄서비스를 이용한 첫 해에 가장 높은 우울 수준을 보고하였으며, 이후 9년간 지속적으로 감소하였다가, 점차 증가하는 추세를 보였다.

Key Message
Using the 2006-2019 Korean Welfare Panel Survey, this study focuses on the trajectory of depressive symptoms across years of CCU among older adults in Korea. The trajectory of depressive symptoms across the years of CCU follows a U-shaped curve. Older adults in the first year of using community care reported the highest level of depressive symptoms. However, a significant and steady decrease in depressive symptoms was observed during the following 9 years of CCU, which then gradually increased.

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Home- and community-based elderly care reform and mental health: evidence from China’s middle-aged and older adults
Shuni Zhang, Cui’e Zhang
Applied Economics.2026; : 1. CrossRef

Sleep Quality and Poor Sleep-related Factors Among Healthcare Workers During the COVID-19 Pandemic in Vietnam: 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; DOI: https://doi.org/10.3961/jpmph.22.528

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Abstract PDF

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.

Summary

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Belal Aldabbour, Majdi Alkhaldi, Ibrahim Alkordi, Nael Harara, Karam Jouda, Omar Elyazoury, Mohammed Eid, Mohammed Elhendi, Mohammed Ibrahim, Mohammed Matter, Omar Ayesh, Bilal Irfan, Amro Lahlouh
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Sleep quality by clinical training status among medical students and its associated factors: a cross-sectional study in Da Nang, Vietnam
Nguyet Truong, Hung Nguyen, Tung Pham, Duyen Chu, Linh Bui
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Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study: Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim; J Prev Med Public Health. 2023;56(3):248-254. Published online April 12, 2023; DOI: https://doi.org/10.3961/jpmph.23.015

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Abstract Summary PDF

Objectives
Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.
Methods
Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.
Results
The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.
Conclusions
The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

Summary

Korean summary
본 연구에서는 급성심근경색증과 뇌졸중 치명률, 외래진료 민감질환의 예방 가능한 입원율을 사용하여 한국의 의료 질 수준을 분석하였다. 2008~2020년 동안 치명률과 예방 가능한 입원율은 감소하는 추세이다. 그러나, 예방 가능한 입원율은 다른 국가에 비해 상대적으로 높아 환자의 건강결과 향상을 위하여 일차의료 강화가 요구된다.

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National Trends in Healthcare Quality in Korea: A Multidimensional Assessment Using OECD Health Care Quality Indicators (2008–2023)
Hyejin Lee, Soo-Hee Hwang, Sang-A Cho, Hyemin Jung, Youngs Chang, Jieun Yun, Sanghyun Cho, Un-Na Kim, Hye Yeon Koo, Eun Byul Cho, Do Hee Kim, Jin Yong Lee
Journal of Preventive Medicine and Public Health.2026; 59(3): 225. CrossRef
National Expenditures on Anticancer and Immunomodulating Agents During 2013–2022 in Korea
Jieun Yun, Youngs Chang, Minsol Jo, Yerin Heo, Dong-Sook Kim
Journal of Korean Medical Science.2025;[Epub] CrossRef
Evidence of Overlapping Roles Between Clinics and Hospitals in Primary Care
Boram Sim, Jihye Shin, Hyun Woo Kim, Jin Yong Lee, Min-Woo Jo
Journal of Korean Medical Science.2025;[Epub] CrossRef
Impacto da COVID-19 na Atenção Primária à Saúde e suas Condições Sensíveis: Revisão de Escopo
Vinicius Paim Brasil, Juliana Prestes Ferigollo, Felipa Amadigi, Fúlvio Borges Nedel
Saúde Coletiva (Barueri).2025; 16(101): 17732. CrossRef
Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
Ji-Sook Choi, Soomin Kim, Choon-Seon Park, Hyejin Lee, Jin Yong Lee, Sun Min Kim
Yonsei Medical Journal.2024; 65(9): 534. CrossRef

Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care: Eun Hye Park, Seung-sik Hwang, Juhwan Oh, Beom-Joon Kim, Hee-Joon Bae, Ki-Hwa Yang, Ah-Rum Choi, Mi-Yeon Kang, S.V. Subramanian; J Prev Med Public Health. 2023;56(2):145-153. Published online March 31, 2023; DOI: https://doi.org/10.3961/jpmph.22.318

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Abstract Summary PDF Supplementary Material

Objectives
Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume.
Methods
From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.
Results
Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).
Conclusions
The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

Summary

Korean summary
급성 허혈성 뇌졸중 환자에서 “혈관 내 혈전제거술(endovascular treatment, EVT)”의 치료효과는 여러 연구를 통해 증명되었으나, EVT 후보군에서 EVT를 제공하기 위한 의료서비스 연구는 부족한 실정이다. 5~7차 뇌졸중 적정성 평가 자료를 활용하여 연간 EVT 시행횟수와 EVT후보군의 30일, 1년 후 치명률 간의 연관성을 다수준 분석을 통해 확인하였다. 연간 15회 이상 EVT를 시행하면서 뇌졸중 전문치료실과 뇌줄중 관련 전문분과(신경과, 신경외과, 재활의학과) 전문의가 모두 있는 병원(TCHs)에서 치료받은 환자는 EVT를 시행하지 않는 병원(PSHs-without-EVT)에서 치료받는 환자에 비해 치명률이 감소하는 경향을 보였다. 이는 뇌졸중 치료체계에서 EVT가능병원을 정의할 필요성을 잘 보여주고, “연간 EVT 시행횟수”는 TCHs를 정의하는 중요한 지표로 사용될 수 있을 것이다.

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Trends in utilization and impact of hospital procedural volume on mortality after endovascular thrombectomy for acute ischemic stroke
Zafar Ali, Sayyeda Aleena Mufarrih, Amjad Ali, Michael G. Abraham, Gokul Ramani, Kamal Gupta
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Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
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Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
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Changes in the Hospital Standardized Mortality Ratio Before and During the COVID-19 Pandemic: A Disaggregated Analysis by Region and Hospital Type in Korea: EunKyo Kang, Won Mo Jang, Min Sun Shin, Hyejin Lee, Jin Yong Lee; J Prev Med Public Health. 2023;56(2):180-189. Published online March 20, 2023; DOI: https://doi.org/10.3961/jpmph.22.479

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Abstract Summary PDF

Objectives
The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic.
Methods
This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients’ in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type.
Results
The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4).
Conclusions
This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

Summary

Korean summary
코로나19 대유행 지역은 비감염 지역과 달리 2019년에 비해 2020년에 HSMR이 크게 증가했고, 상대적으로 병상 수가 적은 종합병원에서 HSMR이 증가했다. 코로나19 대응에 참여하는 병원은 병원 규모와 관계없이 HSMR이 낮은 경향을 보였다. 감염병 유행 시 병원의 과도한 업무량이 부여되지 않게하고 인력을 적절하게 고용하여 조정하는 것이 필요하다.

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PLOS ONE.2025; 20(2): e0316943. CrossRef
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Hyejin Lee, Jin-Won Noh, Sanghee Lee, Jung-Kyu Choi, Jung-Hoe Kim, Hae-jong Lee, Jin Yong Lee, Erica Barbazza
International Journal For Quality In Health Care.2025;[Epub] CrossRef

Systematic Review

Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis: Mahboubeh Bayat, Tahereh Kashkalani, Mahmoud Khodadost, Azad Shokri, Hamed Fattahi, Faeze Ghasemi Seproo, Fatemeh Younesi, Roghayeh khalilnezhad; J Prev Med Public Health. 2023;56(2):128-144. Published online March 14, 2023; DOI: https://doi.org/10.3961/jpmph.22.394

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Abstract PDF

Objectives
The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms.
Methods
In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment.
Results
After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators’ attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place.
Conclusions
Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

Summary

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Scoping Review

Pre-pregnancy Diet to Maternal and Child Health Outcome: A Scoping Review of Current Evidence: Fadila Wirawan, Desak Gede Arie Yudhantari, Aghnaa Gayatri; J Prev Med Public Health. 2023;56(2):111-127. Published online March 13, 2023; DOI: https://doi.org/10.3961/jpmph.22.472

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Abstract PDF Supplementary Material

Objectives
Pre-pregnancy diet has an important role in preparing for healthy generation. However, evidence on this issue has been scarce. A scoping review synthesising current evidence will support the demand to map ‘what has been researched’ on pre-pregnancy diet and maternal and child health.
Methods
Systematic search was performed using PICOS (Population, Intervention, Comparison, Outcomes, and Study design) framework in electronic databases. Articles were screened for eligibility, summarized, and the quality was assessed using the National Institute of Health assessment tool. The review structure complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guide.
Results
Forty-two articles were included after full-text screening. Twenty-five studies were in high-income countries (HICs), six in each upper-middle income, five in lower-middle income countries (LMICs), and one in low-income countries (LIC). Based on the regions: North America (n=16), Europe (n=5), South America (n=4), Australia (n=4), Asia (n=5), Middle East (n=2), and sub-Saharan Africa (n=1). The two-most observed diet-related exposures were dietary pattern (n=17) and dietary quality (n=12). The most assessed outcome was gestational diabetes mellitus (n=28) and fetal and newborn anthropometry (n=7). The average quality score±standard deviation was 70±18%.
Conclusions
Research related to pre-pregnancy diet is still concentrated in HICs. The context of diet may vary; therefore, future research is encouraged in LMICs and LICs context, and Mediterranean, South-East Asia, Pacific, and African regions. Some maternal and child nutrition-related morbidity, such as anemia and micronutrient deficiencies, have not been discussed. Research on these aspects will benefit to fill in the gaps related to pre-pregnancy diet and maternal and child health.

Summary

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Original Articles

Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries: Miftahul Arsyi, Besral Besral, Milla Herdayati, Revati Phalkey; J Prev Med Public Health. 2022;55(6):559-567. Published online November 13, 2022; DOI: https://doi.org/10.3961/jpmph.22.316

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Objectives
This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN).
Methods
Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017.
Results
The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers’ demographic/socioeconomic factors, health behaviors, and other factors.
Conclusions
In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.

Summary

Citations

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Scoping Review of Health Care–Seeking Behavior and Antenatal Care Visits Among Pregnant Adolescents in Low- and Middle-Income Countries
Siti Khuzaiyah, Khadizah Haji Abdul-Mumin, Sarena Haji Hashim
Nursing for Women's Health.2026; 30(2): 120. CrossRef
Frequency of Low Birth Weight Neonates in Mothers with Low Serum Ferritin Levels
Samra Khan, Falak Naz Baloch, Rabia Bosan, Aiman Khan, Muneeba Khan, Zakir Ali Punar, Zobia Munaf
Pakistan Journal of Health Sciences.2025; : 60. CrossRef
Factors Associated With Low Birth Weight Among Under‐Five Children in Sub‐Saharan Africa: Evidence From Demographic and Health Surveys of 58,857 Children
Sulaimon T. Adedokun, Sanni Yaya
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Synergistic associations of antenatal care visits and iron-folic acid supplementation with low birth weight: a pooled analysis of national surveys from six south Asian countries
Vishnu Khanal, Sangita Bista, Shiva Raj Mishra
BMC Public Health.2024;[Epub] CrossRef
The association of Chinese and American antenatal care utilization indices with birth outcomes
Haibo Zhou, Yi Yang, Peihan Chi, Haoyue Cheng, Xialidan Alifu, Yiwen Qiu, Ye Huang, Libi Zhang, Diliyaer Ainiwan, Yan Zhuang, Hui Liu, Zhi Chen, Yunxian Yu
Frontiers in Public Health.2024;[Epub] CrossRef
Relationship of sociodemographic factors and low birth weight in toddlers
Nikmatur Rohmah, Indah Wulandari, Agil Khoironi Firdaus, Nabilah Auliya, Novannisa Imanda, Dwi Ningtyas Anggraini
Frontiers of Nursing.2024; 11(4): 479. CrossRef
Effect of the enhancing nutrition and antenatal infection treatment (ENAT) intervention on birth weight in Ethiopia: a cluster randomized controlled trial
Y Mekonnen, E Wolde, A Bekele, Z Mehari, S Abebe, T Hagos, Y Tadesse, T Taye, G Asire, T Nigatu, S Kumar, S Girma, M Salasibew
BMC Pregnancy and Childbirth.2023;[Epub] CrossRef
Compliance with the World Health Organization’s 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth outcomes among pregnant women in northern Ghana
Leticia Achangebe Akum, Eunice Amina Offei, Mary Rachael Kpordoxah, Daudi Yeboah, Abdul-Nasir Issah, Michael Boah, Sanjoy Kumer Dey
PLOS ONE.2023; 18(6): e0285621. CrossRef

SWOT Analysis and Expert Assessment of the Effectiveness of the Introduction of Healthcare Information Systems in Polyclinics in Aktobe, Kazakhstan: Lyudmila Yermukhanova, Zhanar Buribayeva, Indira Abdikadirova, Anar Tursynbekova, Meruyert Kurganbekova; J Prev Med Public Health. 2022;55(6):539-548. Published online October 11, 2022; DOI: https://doi.org/10.3961/jpmph.22.360

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Abstract PDF

Objectives
The purpose of this study was to assess the organizational effectiveness of the introduction of a healthcare information system (electronic medical records and databases) in healthcare in Kazakhstan.
Methods
The authors used a combination of 2 methods: expert assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis. SWOT analysis is a necessary element of research, constituting a mandatory preliminary stage both when drawing up strategic plans and for taking corrective measures in the future. The expert survey was conducted using 2 questionnaires.
Results
The study involved 40 experts drawn from specialists in primary healthcare in Aktobe: 15 representatives of administrative and managerial personnel (chief doctors and their deputies, heads of medical statistics offices, organizational and methodological offices, and internal audit services) and 25 general practitioners.
Conclusions
The following functional indicators of the medical and organizational effectiveness of the introduction of information systems in polyclinics were highlighted: first, improvement of administrative control, followed in descending order by registration and movement of medical documentation, statistical reporting and process results, and the cost of employees’ working time. There has been no reduction in financial costs, namely in terms of the costs of copying, delivery of information in paper form, technical equipment, and paper.

Summary

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Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study: Yukyung Shin, Ji-su Lee, Young Kyung Do; J Prev Med Public Health. 2022;55(4):389-397. Published online July 11, 2022; DOI: https://doi.org/10.3961/jpmph.22.208

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Abstract Summary PDF Supplementary Material

Objectives
This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups.
Methods
We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression.
Results
Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache).
Conclusions
OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

Summary

Korean summary
실험적 비네트 디자인을 활용하여 환자 본인부담금 감소가 잠재적 저가치 MRI 이용에 미치는 영향을 소득 수준별로 분석한 연구이다. 본인부담금 감소로 인해 잠재적 저가치 MRI 이용은 모든 소득 수준에서 증가하고 잠재적 저가치 MRI 이용의 소득 수준에 따른 차이는 감소하는 결과를 보였다.

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Inter-regional patient outmigration to Seoul in South Korea: the role of regional healthcare quality perceptions
Moo Hyuk Lee, Ji-Su Lee, Young Kyung Do
BMC Health Services Research.2025;[Epub] CrossRef
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Seung Beom Han, Jee Min Kim, Eu Gene Park, Ji Yoon Han, Jin Lee
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Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
Epidemiology and Health.2023; 45: e2023086. CrossRef

“Leisure Life Satisfaction:” Will It Have a Beneficial Impact on Depression Among Older Adults in Community Care Settings in Korea?: Il-Ho Kim, Cheong-Seok Kim; J Prev Med Public Health. 2022;55(4):398-406. Published online July 7, 2022; DOI: https://doi.org/10.3961/jpmph.22.160

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Abstract Summary PDF

Objectives
While the risk of depression is expected to substantially increase among older adults receiving community care, leisure life satisfaction can be regarded as a key component in enhancing the mental health of those receiving community care. However, it is not yet known whether community care utilization increases the risk of depression, or what role is played by leisure life satisfaction in these settings. This study investigated the relationship between community care utilization and depression, as well as the main effect and the moderating role of leisure life satisfaction on the link between community care utilization and depression among older adults.
Methods
This study, using the 2019 Korean Welfare Panel Survey, conducted multiple regression analysis on data from 4494 elderly people aged 65 years or older.
Results
After controlling for potential covariates, older community care recipients were more likely to report symptoms of depression than those who did not receive community care. Meanwhile, leisure life satisfaction was negatively associated with depression in older adults. The test for interaction between community care utilization and leisure life satisfaction revealed that leisure life satisfaction significantly attenuated the link between depression and community care utilization.
Conclusions
The findings of this study imply that leisure life satisfaction could play a meaningful role in improving the mental health of older adults receiving community care. Welfare policies affecting older adults should consider leisure life satisfaction as an important resource for reducing depression in community care settings.

Summary

Korean summary
본 연구는 2019년 한국복지패널조사의 4,494명의 노인들을 대상으로 돌봄노인의 우울 수준과 여가생활 만족의 조절효과를 검증하였다. 연구결과, 돌봄노인의 우울증상이 일반노인에 비하여 유의하게 높았다(p<0.001). 반면 여가생활 만족은 돌봄서비스 이용노인의 우울 증상을 조절하는 효과가 있었다. 이 연구의 결과는 여가생활 만족이 돌봄노인의 정신건강을 향상시키는데 의미 있는 역할을 할 수 있다는 것을 암시한다.

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Evolution of leisure patterns and their relationship with life satisfaction in a highly ageing context
M. D. Dapía Conde, J. M. Faílde Garrido, L. Ruiz Soriano, A. Rivera Nieto
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The association between life satisfaction, depressive symptoms, and common comorbid disorders during the COVID‐19 pandemic
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Bo Zhao, Ji Eon Kim, Jiyoung Moon, Eun Woo Nam
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Journal of Preventive Medicine and Public Health.2023; 56(6): 495. CrossRef

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households: Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza; J Prev Med Public Health. 2022;55(4):379-388. Published online June 27, 2022; DOI: https://doi.org/10.3961/jpmph.22.123

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Abstract PDF

Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Summary

Citations

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Unequal benefits: the effects of health insurance integration on consumption inequality in rural China
Linlin Han
Frontiers in Public Health.2025;[Epub] CrossRef
Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub] CrossRef

Special Article

Well-being Index Scores and Subjective Health Status of Korean Healthcare Workers: Yoonhee Shin, Bohyun Park, Nam-eun Kim, Eun Jeong Choi, Minsu Ock, Sun Ha Jee, Sue K. Park, Hyeong Sik Ahn, Hyesook Park; J Prev Med Public Health. 2022;55(3):226-233. Published online May 31, 2022; DOI: https://doi.org/10.3961/jpmph.22.114

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Abstract Summary PDF

Objectives
The aim of this study was to evaluate the subjective level of health-related quality of life of Korean healthcare workers using various quality-of-life instruments.
Methods
This study included 992 participants, who were doctors and nurses. A survey was conducted between November 28 and December 4, 2019. Data from 954 participants divided into 3 groups (physicians, residents, and nurses) were analyzed. Four measurement tools (29 questions) were used in the survey to evaluate subjective health status and well-being.
Results
In the Mayo Well-being Index, burnout during work (88.5%) and emotional difficulties caused by work (84.0%) were frequently cited by the respondents. Regarding questions on burnout and emotional difficulties, residents and nurses had the highest scores (91.0 and 89.6%, respectively). Emotional problems, such as anxiety, depression, and irritability, accounted for a high percentage (73.1%) of the total, while 82.2% of respondents reported that their work schedules interfered with their leisure and family time. There was no significant difference among the groups in subjective health status. However, 10.1% of the residents experienced very low quality of life, which was a higher proportion than that of physicians (2.7%) and nurses (5.2%).
Conclusions
The level of well-being that Korean medical workers experienced in relation to work was lower than the results of the United States healthcare workers surveyed using the same tool. This study was unique in that it conducted a subjective quality-of-life survey on Korean healthcare workers.

Summary

Korean summary
본 연구의 목적은 다양한 삶의 질 도구를 사용하여 한국 의료종사자들의 건강과 관련된 삶의 질에 대한 주관적인 수준을 평가하는 것이다. 피로와 정서적 어려움, 업무로 인한 일상생활의 방해 등 한국 의료종사자의 일부 삶의 질 점수가 낮았다. 의료 종사자의 소진 경험이 환자의 치료에 부정적인 영향을 미친다는 것을 고려할 때 의료 종사자들의 삶의 질을 향상시키는 정책이 마련되어야하며, 건강과 관련된 직업적 위험요인 연구도 추가적으로 필요하다.

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Original Articles

A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran: Zahra Mohammadi Daniali, Mohammad Mehdi Sepehri, Farzad Movahedi Sobhani, Mohammad Heidarzadeh; J Prev Med Public Health. 2022;55(1):49-59. Published online December 28, 2021; DOI: https://doi.org/10.3961/jpmph.21.401

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Abstract PDF Supplementary Material

Objectives
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
Methods
First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.
Results
It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.
Conclusions
This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

Summary

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Zhifeng Guo, Wangquan Ji, Mengqing Yan, Yang Shi, Teng Chen, Fanghui Bai, Yu Wu, Zhe Guo, Linlin Song
Paediatric and Perinatal Epidemiology.2025; 39(2): 135. CrossRef
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Carolina Luiza Bezerra Silva Webster Barbosa, Eliane Rolim de Holanda, Luciana Pedrosa Leal, Ana Paula Esmeraldo Lima, Amanda Priscila de Santana Cabral Silva, Vânia Pinheiro Ramos
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Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network
David A. Schwartz, Parisa Mohagheghi, Fereshteh Moshfegh, Nazanin Zafaranloo, Narjes Khalili, Mohammad Heidarzadeh, Abbas Habibelahi, Roya Ghafoury, Fatemeh Afrashteh
American Journal of Perinatology.2024; 41(S 01): e1698. CrossRef
Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study
R Peng, Y Tong, M Yang, J Wang, L Yang, J Zhu, Yu Liu, H Wang, Z Shi, Ya Liu
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Operations Research for Health Care.2024; 41: 100430. CrossRef
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João Flávio de Freitas Almeida, Lásara Fabrícia Rodrigues, Luiz Ricardo Pinto, Francisco Carlos Cardoso de Campos
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Public Preferences for Allocation Principles for Scarce Medical Resources in the COVID-19 Pandemic in Korea: Comparisons With Ethicists’ Recommendations: Ji-Su Lee, Soyun Kim, Young Kyung Do; J Prev Med Public Health. 2021;54(5):360-369. Published online August 26, 2021; DOI: https://doi.org/10.3961/jpmph.21.333

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists.
Methods
An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists’ recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists’ recommendations.
Results
Overall, the public of Korea agreed strongly with the principles of “save the most lives,” “Koreans first,” and “sickest first,” but less with “random selection,” in contrast to the recommendations of ethicists. “Save the most lives” was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists.
Conclusions
The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists’ recommendations.

Summary

Korean summary
코로나19 대유행으로 가시화된 의료자원의 부족 상황에서 서로 다른 의료자원 배분 원칙에 대한 일반 대중의 선호를 조사한 연구이다. 제시된 여러 원칙 중에서, 공리주의, 한국인 아이덴티티, 약자우선주의에 기초한 배분 원칙이 가장 높은 선호를 보였다. 이러한 결과는, 일반 상황과 달리 감염병 대유행 상황에서는 공리주의에 기초한 배분 원칙을 강화하되 사회적 유용성도 자원 배분의 주요 원칙으로 받아들일 수 있다는 윤리학자들의 견해와는 차이를 보인다.

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Identification of Unmet Healthcare Needs: A National Survey in Thailand: Sukanya Chongthawonsatid; J Prev Med Public Health. 2021;54(2):129-136. Published online March 4, 2021; DOI: https://doi.org/10.3961/jpmph.20.318

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Abstract PDF Supplementary Material

Objectives
This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand.
Methods
The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis.
Results
Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were—in descending order of frequency—insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors.
Conclusions
Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

Summary

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Perspective

Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings: Bhanu Pratap Singh Gaur, Jyothi Vasudevan, Bhabani Pegu; J Prev Med Public Health. 2021;54(1):81-84. Published online December 8, 2020; DOI: https://doi.org/10.3961/jpmph.20.349

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Abstract PDF

The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.

Summary

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Original Article

Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly: Kiryong Nam, Eunhye Park, Yuhjin Chung, Chang-yup Kim; J Prev Med Public Health. 2020;53(6):455-464. Published online October 20, 2020; DOI: https://doi.org/10.3961/jpmph.20.341

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Abstract PDF

Objectives
The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals.
Methods
This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources.
Results
The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48).
Conclusions
The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.

Summary

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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

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Abstract 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 Article

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017: Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli; J Prev Med Public Health. 2020;53(4):266-274. Published online June 10, 2020; DOI: https://doi.org/10.3961/jpmph.20.035

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Abstract PDF Supplementary Material

Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Summary

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COVID-19: Original Article

Forecasting COVID-19 Transmission and Healthcare Capacity in Bali, Indonesia: I Md Ady Wirawan, Pande Putu Januraga; J Prev Med Public Health. 2020;53(3):158-163. Published online April 29, 2020; DOI: https://doi.org/10.3961/jpmph.20.152

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Abstract PDF

Objectives
In the current early phase of the coronavirus disease 2019 (COVID-19) outbreak, Bali needs to prepare to face the escalation of cases, with a particular focus on the readiness of healthcare services. We simulated the future trajectory of the epidemic under current conditions, projected the impact of policy interventions, and analyzed the implications for healthcare capacity.
Methods
Our study was based on the first month of publicly accessible data on new confirmed daily cases. A susceptible, exposed, infected, recovered (SEIR) model for COVID-19 was employed to compare the current dynamics of the disease with those predicted under various scenarios.
Results
The fitted model for the cumulative number of confirmed cases in Bali indicated an effective reproduction number of 1.4. Interventions have decreased the possible maximum number of cases from 71 125 on day 86 to 22 340 on day 119, and have prolonged the doubling time from about 9 days to 21 days. This corresponds to an approximately 30% reduction in transmissions from cases of mild infections. There will be 2780 available hospital beds, and at the peak (on day 132), the number of severe cases is estimated to be roughly 6105. Of these cases, 1831 will need intensive care unit (ICU) beds, whereas the number of currently available ICU beds is roughly 446.
Conclusions
The healthcare system in Bali is in danger of collapse; thus, serious efforts are needed to improve COVID-19 interventions and to prepare the healthcare system in Bali to the greatest extent possible.

Summary

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Original Articles

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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Patients’ and General Practitioners’ Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study: Christine Cohidon, Fabienne Imhof, Laure Bovy, Priska Birrer, Jacques Cornuz, Nicolas Senn; J Prev Med Public Health. 2019;52(5):323-332. Published online September 17, 2019; DOI: https://doi.org/10.3961/jpmph.19.184

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Abstract PDF

Objectives
The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention.
Methods
The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices.
Results
Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role.
Conclusions
Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

Summary

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Perspective

What Else Is Needed in the Korean Government’s Master Plan for People With Developmental Disabilities?: Jin Yong Lee, Jieun Yun; J Prev Med Public Health. 2019;52(3):200-204. Published online May 7, 2019; DOI: https://doi.org/10.3961/jpmph.18.249

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Abstract Summary PDF Supplementary Material

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a ‘welfare society in harmony.’ However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals’ unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.

Summary

Korean summary
2018년 9월 대통령이 직접 발표한 “발달장애인 평생케어 종합대책”의 성공적인 수행을 위해 필수적인 정책을 제안하였다. 특히, 발달장애인의 정확한 규모, 유병률, 발생률 등 기초적인 현황 파악과 정책 개발을 뒷받침하기 위한 역학연구, 발달장애인 개인평가에 기반한 미충족 필요의 측정과 이를 바탕으로 한 개인별 맟춤형 서비스 디자인, 서비스의 접근성과 형평성 달성, 그리고 보건-의료-고용-교육-복지서비스를 통합적으로 제공할 수 있는 시스템 구축이 필요함을 지적하였다.

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Original Articles

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea: Youngsoo Kim, Saerom Kim, Seungmin Jeong, Sang Guen Cho, Seung-sik Hwang; J Prev Med Public Health. 2019;52(1):51-59. Published online January 23, 2019; DOI: https://doi.org/10.3961/jpmph.18.162

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.
Methods
Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.
Results
The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and selfrated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.
Conclusions
The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

Summary

Korean summary
이 연구에서는 2011년부터 2015년까지의 한국의료패널 자료를 이용하여 미충족의료과 불건강의 관련성을 살펴보고, 불건강을 매개하는 미충족의료의 크기를 추정했다. 미충족의료는 개인고정효과를 보정하였을 때 불건강에 유의한 영향 준다는 것을 확인할 수 있었고, 미충족의료가 매개하는 저소득의 건강 효과는 저소득이 불건강에 미치는 전체 효과 중 일부에 지나지 않았으며, 효과의 크기는 분석 연도 별로 일정하지 않게 나타났다. 이는 건강불평등을 줄이기 위한 정책 개입에서 미충족의료 해소가 유의미한 정책 목표로 가치가 있지만 그 한계 또한 명확하다는 것을 의미한다.

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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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Abstract Summary PDF Supplementary 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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Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study: Hyang Soon Oh; J Prev Med Public Health. 2018;51(3):121-129. Published online May 14, 2018; DOI: https://doi.org/10.3961/jpmph.17.188

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Abstract PDF Supplementary Material

Objectives
To assess the nurses’ hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak.
Methods
The structured questionnaire was adapted from the World Health Organization’s survey. Data were collected between June 26 and July 14, 2017.
Results
Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y₁=36.678+ 0.555X₁ (HH performance rate of self) (adjusted R²=0.280, p<0.001). The regression model for performance was Y₄=18.302+0.247X₄₁ (peception)+0.232X₄₂ (attitude)+0.875X₄₂ (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R²=0.191, p<0.001).
Conclusions
Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Summary

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Family Members of Cancer Patients in Korea Are at an Increased Risk of Medically Diagnosed Depression: Youngdae Cho, Yongwoo Jeon, Sung-In Jang, Eun-Cheol Park; J Prev Med Public Health. 2018;51(2):100-108. Published online February 19, 2018; DOI: https://doi.org/10.3961/jpmph.17.166

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Abstract PDF Supplementary Material

Objectives
Family members are often cancer patients’ primary source of social and emotional support and make a major contribution to how well patients manage their illness. We compared the prevalence of depression in the family members of cancer patients and the general population. Methods: This study used the data from the fourth, fifth, and sixth rounds of the Korea National Health and Nutrition Examination Survey. The variable of interest was the presence of a cohabitating cancer patient in the family and the dependent variable was the presence of diagnosed depression. Results: The odds of having medically diagnosed depression in those with a cohabitating cancer patient in the family were significantly higher than among those who did not have cancer patients in their families (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.12 to 2.17; p=0.009). The OR for females was 1.59, and this increase was statistically significant (95% CI, 1.09 to 2.31; p=0.02). Conclusions: We need to invest more effort into diagnosing and managing depression in the family members of cancer patients. This will have an impact both on their quality of life and on the well-being of patients, as supporters and caregivers play an instrumental role in helping patients manage their illness.

Summary

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Javier A Cahuana-Berrocal, Jesús Iglesias-Acosta, Ana Isabel Tafur Bermejo
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Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis: Hamed Zandian, Amirhossein Takian, Arash Rashidian, Mohsen Bayati, Telma Zahirian Moghadam, Satar Rezaei, Alireza Olyaeemanesh; J Prev Med Public Health. 2018;51(2):83-91. Published online February 6, 2018; DOI: https://doi.org/10.3961/jpmph.17.050

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Abstract PDF

Objectives
One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

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Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study: Minsu Ock, Hwa Jung Kim, Bomin Jeon, Ye-Jee Kim, Hyun Mi Ryu, Moo-Song Lee; J Prev Med Public Health. 2018;51(1):15-22. Published online January 4, 2018; DOI: https://doi.org/10.3961/jpmph.17.118

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Abstract PDF Supplementary Material

Objectives
The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes.
Methods
We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others.
Results
Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%).
Conclusions
Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

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Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change: Tae-Jin Lee, Chelim Cheong; J Prev Med Public Health. 2017;50(6):393-400. Published online November 9, 2017; DOI: https://doi.org/10.3961/jpmph.17.151

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Abstract PDF

Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

Summary

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Special Article

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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Abstract PDF Supplementary Material

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

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A Systematic Review of Economic Evaluation of Thyroid Cancer
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Original Article

Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

11,992 View
202 Download
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Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

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Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
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BMC Cardiovascular Disorders.2019;[Epub] CrossRef

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