Journal of Preventive Medicine and Public Health

Original Articles

Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea: Jongmin Oh, Youn-Hee Lim, Changwoo Han, Dong-Wook Lee, Jisun Myung, Yun-Chul Hong, Soontae Kim, Hyun-Joo Bae; J Prev Med Public Health. 2024;57(2):185-196. Published online March 29, 2024; DOI: https://doi.org/10.3961/jpmph.23.514

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Abstract Summary PDF Supplementary Material: Objectives
Excess mortality associated with long-term exposure to fine particulate matter (PM_2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM_2.5 by considering the potential non-linear concentration–response relationship in Korea.
Methods
Daily cause-specific mortality rates and PM_2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM_2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM_2.5 concentrations below 15 μg/m³. Overall deaths attributable to short-term PM_2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM_2.5 exposure.
Results
Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM_2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM_2.5. The estimated number of all-cause excess deaths due to short-term PM_2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472).
Conclusions
Our findings indicate an association between short-term PM_2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM_2.5.; Summary

Korean summary
본 연구는 2010~2019년 한국의 초미세먼지 단기 노출로 인한 사망 부담을 추정하였으며 2010~2019년간, 초미세먼지 단기노출로 인한 전체원인 사망은 10,814명, 비사고 사망은 7,855명, 심혈관 사망은 1,642명, 호흡기 사망은 708명으로 추정하였다. 본 연구 결과는 대기오염 관리, 규제, 정책 수립에 있어 도움을 줄 것으로 예상한다.

Key Message
- We estimated mortality burden attributable to short-term exposure to PM 2.5 in Korea from 2010 to 2019 - Over the 10-years study period, the estimated excess deaths due to short-term exposure to PM 2.5 totaled 10,814 for all-causes, 7,855 for non-accidental, 1,642 for cardiovascular disease, and 708 for respiratory disease. - Our findings can assist in air pollution management, regulation, and policy-making.

Symptoms, Mental Health, and Quality of Life Among Patients After COVID-19 Infection: A Cross-sectional Study in Vietnam: Hai Nguyen Thanh, Duc Cap Minh, Hien Hoang Thu, Duc Nguyen Quang; J Prev Med Public Health. 2024;57(2):128-137. Published online February 27, 2024; DOI: https://doi.org/10.3961/jpmph.23.511

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Abstract Summary PDF: Objectives
This study was conducted to characterize the symptoms, mental health, quality of life (QoL), and associated factors following the coronavirus disease 2019 (COVID-19) infection.
Methods
This cross-sectional study included 394 participants previously infected with COVID-19 in Ho Chi Minh City, Vietnam. Mental health was assessed using the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Participants self-reported health-related QoL was measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L) scale.
Results
Among the participants, 76.4% reported experiencing at least one symptom following COVID-19 infection. The most common symptoms were fatigue (42.1%), cognitive dysfunction (42.9%), and hair loss (27.9%). According to the DASS-21 results, the proportions of depression, anxiety, and stress were 28.7%, 26.4%, and 20.6%, respectively. The mean scores on the EQ-5D-5L and the EuroQol Visual Analog Scale were 0.94±0.11 and 84.20±13.11, respectively. Regarding QoL issues, the highest proportion of participants (32.7%) reported experiencing anxiety or depression, followed by pain or discomfort (25.4%). Multivariable logistic regression analysis revealed that factors associated with the presence of symptoms following COVID-19 infection included female (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.65 to 4.91) and having QoL issues (OR, 3.25; 95% CI, 1.71 to 6.19).
Conclusions
The study investigated the prevalence rates of various symptoms following COVID-19 infection. These findings underscore the need to prioritize comprehensive care for individuals recovering from COVID-19 and to implement strategies to mitigate the long-term impact of the disease on mental health and QoL.; Summary

Key Message
This cross-sectional study in Vietnam investigated symptoms, mental health, and quality of life among patients recovering from COVID-19. The study found that most participants experienced post-infection symptoms, with fatigue, cognitive dysfunction, and hair loss being the most common. Mental health issues were prevalent, and participants reported varying levels of quality of life. The findings highlight the importance of comprehensive care and strategies to address the long-term impact of COVID-19 on mental health and quality of life.

Knowledge, Attitudes, and Practices Regarding Dengue Prevention Among Health Volunteers in an Urban Area – Malang, Indonesia: Alidha Nur Rakhmani, Lilik Zuhriyah; J Prev Med Public Health. 2024;57(2):176-184. Published online February 21, 2024; DOI: https://doi.org/10.3961/jpmph.23.484

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Abstract Summary PDF: Objectives
The dengue prevention program known as “One House One Mosquito Larva Inspector” involves health volunteers who play a crucial role in the surveillance of mosquito larvae and reporting their findings to local public health officials. This study aimed to identify factors related to the knowledge, attitudes, and practices (KAP) of dengue prevention behavior among these health volunteers.
Methods
A study was conducted in 5 sub-districts in Malang, an urban area in Indonesia. We employed a cross-sectional design and utilized a semi-structured questionnaire to assess the KAP of 400 health volunteers. Data were collected through face-to-face interviews.
Results
Multiple logistic regression analysis revealed that individuals with a more positive attitude (odds ratio [OR], 1.69; p<0.05) and those with family sizes greater than five persons (OR, 1.90; p<0.05) were more likely to engage in effective dengue prevention practices. Additionally, possesing good knowledge was significantly assocated with more positive attitude (OR, 2.24; p<0.001). Furthermore, 40% reduction in positive attitude was observed in those over 45 years (OR, 0.60; p<0.05). The best practices most frequently reported by the majority of respondents included always reporting their surveillance activities (75.8%) and cleaning the water container in the bathroom at least once a week (65.2%). However, only 52.2% of respondents regularly checked for mosquito larvae in their neighborhood.
Conclusions
Sustainable promotion and training for the “One House One Mosquito Larva Inspector” initiative are necessary, particularly among young health volunteers, to improve dengue prevention behaviors both within their own homes and in the surrounding environment.; Summary

Key Message
The study among health volunteers emphasizes that better knowledge and younger age < 45 were associated with a positive attitude. While a positive attitude and family size > 5 persons were associated with better dengue prevention practices. Therefore, there is a need for sustained promotion and training among health volunteers to enhance the knowledge and attitude that may shape good dengue prevention practices.

Environmental Health Literacy Regarding Fine Particulate Matter and Related Factors Among Village Health Volunteers in Upper Northern Thailand: Nattapon Pansakun, Warangkana Naksen, Waraporn Boonchieng, Parichat Ong-artborirak, Tippawan Prapamontol; J Prev Med Public Health. 2024;57(2):138-147. Published online February 10, 2024; DOI: https://doi.org/10.3961/jpmph.23.434

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Abstract PDF: Objectives
Fine particulate matter pollution has emerged as a significant life-threatening issue in Thailand. Recognizing the importance of environmental health literacy (EHL) in disease prevention is crucial for protecting public health. This study investigated EHL levels and aimed to identify associated factors among village health volunteers (VHVs) in the upper northern region of Thailand.
Methods
A cross-sectional study was conducted to collect data from 710 VHVs using the EHL assessment tool developed by the Department of Health, Thailand.
Results
The overall EHL score was moderate (mean, 3.28 out of a possible 5.0), with the highest and lowest domain-specific mean score for the ability to make decisions (3.52) and the ability to access (3.03). Multiple linear regression revealed that the factors associated with EHL score were area of residence (urban areas in Chiang Mai: B=0.254; urban areas in Lampang: B=0.274; and rural areas in Lampang: B=0.250 compared to rural areas in Chiang Mai), higher education levels (senior high school: B=0.212; diploma/high vocational certificate: B=0.350; bachelor’s degree or above: B=0.528 compared to elementary school or lower), having annual health checkups compared to not having annual health check-ups (B=0.142), monthly family income (B=0.004), and individuals frequently facing air pollution issues around their residence (B=0.199) compared to those who reported no such issues.
Conclusions
The VHVs exhibited moderate EHL associated with residence area, education, health check-ups, family income, and residential air pollution. Considering these factors is vital for enhancing VHVs’ EHL through strategic interventions.; Summary

Perspective

The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform: Emmanuel Otieno, Josephine Namyalo; J Prev Med Public Health. 2024;57(1):91-94. Published online December 30, 2023; DOI: https://doi.org/10.3961/jpmph.23.110

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Abstract Summary PDF: For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda’s health sector.; Summary

Key Message
For the Ugandans, nearly the last four decades have been years of hope, conflict, and resilience in a myriad of contexts for healthcare reform. Health insurance system has no legal framework and provides benefits not to the entire national population. The 2019 National Health Insurance scheme Bill was passed in 2021. If the President of Uganda assents to the National Health Insurance Bill, it will be a compelling policy in health and health for all policies. But this Bill has several drawbacks. In this perspective, we aimed to provide intricacies and mix of challenges and opportunities for the health sector.

Original Articles

Relationship Between Pesticide Exposure Factors and Health Symptoms Among Chili Farmers in Northeast Thailand: Ratchadaporn Pengpan, Kulthida Y. Kopolrat, Sribud Srichaijaroonpong, Nutta Taneepanichskul, Patiwat Yasaka, Ratanee Kammoolkon; J Prev Med Public Health. 2024;57(1):73-82. Published online December 20, 2023; DOI: https://doi.org/10.3961/jpmph.23.353

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Abstract Summary PDF: Objectives
The unsafe use of pesticides in agriculture represents a major hazard to human health. This study was conducted to investigate the association between pesticide exposure and health symptoms among chili farmers in northeast Thailand.
Methods
This cross-sectional analytic study included 141 chili farmers in Sakon Nakhon Province, in northeast Thailand. Data regarding health symptoms were gathered using a self-report questionnaire. A medical technician tested blood cholinesterase activity using an erythrocyte method, and an occupational medicine specialist at Ramathibodi Hospital in Bangkok, Thailand reviewed the results. Associations between personal characteristics, pesticide exposure factors, and health symptoms were analyzed using multiple logistic regression.
Results
Of the 141 chili farmers studied, 66.7% experienced pesticide poisoning, as indicated by below-normal cholinesterase levels. Fatigue was the most frequently reported symptom associated with pesticide exposure, affecting 37.6% of participants. This was followed by nausea and vomiting (31.9%), dizziness (14.9%), and dry throat (14.9%). Multivariate logistic regression analysis revealed that several factors were significantly associated with adverse symptoms: amount of work experience, volume of pesticides used, use of chemical pesticides, use of leaking containers during spraying, direct pesticide exposure while working, contact with pesticide-soaked clothing, consumption of food and drinks in the fields, and blood cholinesterase level indicating risk.
Conclusions
This study suggests potential health risks for chili farmers stemming from exposure to and contamination by pesticides used in agricultural practices. To mitigate these risks, it is essential to supply personal protective equipment and to implement educational programs aimed at improving protective behaviors among farmers.; Summary

Key Message
This study aimed to demonstrate the impact of pesticide exposure on health symptoms. In a cross-sectional study, the effects of pesticide exposure on acetylcholinesterase erythrocyte activity in blood during agricultural practices were examined as potential health risks for chili farmers. It is crucial to provide personal protective equipment and to implement educational initiatives targeted at encouraging farmers to adopt more protective behaviors to reduce these risks.

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.

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019: Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati; J Prev Med Public Health. 2024;57(1):65-72. Published online November 25, 2023; DOI: https://doi.org/10.3961/jpmph.23.291

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1 Crossref

Abstract Summary PDF

Objectives
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Methods
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
Results
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Conclusions
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

Summary

Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.

Citations

Citations to this article as recorded by

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021
Askhat Shaltynov, Yulia Semenova, Madina Abenova, Assel Baibussinova, Ulzhan Jamedinova, Ayan Myssayev
Scientific Reports.2024;[Epub] CrossRef

Systematic Review

Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications: Seung Jin Han, Kyoung Hoon Kim; J Prev Med Public Health. 2024;57(1):1-7. Published online November 16, 2023; DOI: https://doi.org/10.3961/jpmph.23.250

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Abstract Summary PDF: Objectives
Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.
Methods
We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.
Results
Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.
Conclusions
This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.; Summary

Korean summary
건강보험청구자료를 사용한 성과연구에서는 교란요인 통제가 중요하다. 최근 발표된 연구들은 연구설계와 통계 분석 과정에 적절하게 교란요인을 통제하였다. 연구의 질을 높이기 위해서는 건강보험청구자료에서 수집 가능한 교란 요인에 대한 이해와 방법론적 가이드라인이 요구된다.

Key Message
All recently published studies using Health Insurance Claims Database adjusted for confounders with appropriate study designs and statistical methodologies. The review suggests the need for careful application of confounding variables and the methodological guidance to improve the quality of outcome studies.

Original Articles

Teachers’ Negative Attitudes and Limited Health Literacy Levels as Risks for Low Awareness of Epilepsy in Turkey: Gulay Yilmazel; J Prev Med Public Health. 2023;56(6):573-582. Published online November 13, 2023; DOI: https://doi.org/10.3961/jpmph.23.330

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Abstract Summary PDF Supplementary Material: Objectives
For students with epilepsy, schools are a critical environment for managing the disease properly. This study examined awareness of epilepsy, attitudes toward epilepsy, and health literacy among school teachers in Turkey.
Methods
This study was conducted in a city in Turkey with 1408 public school teachers from June 2021 to September 2021.
Results
The median scores of the scales were 5, 29, and 32 for epilepsy awareness, epilepsy attitudes, and health literacy, respectively. Epilepsy awareness was higher in women, and epilepsy attitudes were more positive in women than men (p<0.05). While epilepsy awareness was higher in primary school teachers, epilepsy attitudes were more positive in secondary school teachers (p<0.05). Epilepsy awareness was lower in secondary school teachers (odds ratio [OR], 1.27; p<0.05), those who did not have an individual with epilepsy in their family/social environment (OR, 1.57; p<0.001), those who did not have a student with epilepsy in their class (OR, 1.45; p<0.05), and in those who had not witnessed an epilepsy seizure (OR,1.19; p<0.05). Compared to those with positive attitudes regarding epilepsy, epilepsy awareness was 1.36 times lower in those with negative attitudes (p<0.001). Epilepsy awareness was 1.92 times lower in those with limited health literacy than those with adequate health literacy (p<0.001).
Conclusions
In this study, low epilepsy awareness, negative epilepsy attitudes, and limited health literacy were common among teachers. The findings from this study suggest that panels, workshops, and health training on epilepsy should be organized for school teachers and included at regular intervals in certified first-aid practices.; Summary

Key Message
• This article examined school teachers' barriers to epilepsy awareness. • Awareness was low, negative attitudes were high, and health literacy level was limited. • Negative attitudes and limited health literacy were the most effective risks for poor awareness.

An Important Strategy to Improve Adolescent Health Literacy: COVID-19 Modules in High School in Indonesia: Nurina Hasanatuludhhiyah, Visuddho Visuddho, Abdul Khairul Rizki Purba, Annette d’ Arqom, Ancah Caesarina Novi Marchianti; J Prev Med Public Health. 2023;56(6):523-532. Published online November 1, 2023; DOI: https://doi.org/10.3961/jpmph.23.113

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Abstract Summary PDF: Objectives
During the second coronavirus disease 2019 (COVID-19) surge, cases increased sharply due to low awareness and compliance with measures to limit disease spread. Health literacy (HL) is an important component of public health initiatives, and schools are potential sources of health education to increase HL via the presentation of COVID-19 educational modules.
Methods
This cross-sectional study involved an online questionnaire administered to students from 5 high schools in Surabaya and Sidoarjo, Indonesia, 6-7 weeks after the start of government-issued directives restricting public gatherings. We collected data on each respondent’s age, gender, parental education, and socioeconomic variables. HL was determined by the Health Literacy Measure for Adolescents. We additionally measured their attitudes and behaviors related to preventing the spread of COVID-19. The students were asked if they watched the COVID-19 module at school, their feelings about vaccination, and preferred online sources of COVID-19-related information.
Results
Most of the 432 respondents had viewed COVID-19 modules at school. Module exposure was associated with significantly higher total and domain-specific HL and more positive attitudes toward government-issued COVID-19 restrictions on travel and public gatherings (p<0.05). However, behaviors to prevent COVID-19 spread and vaccine acceptance were not associated with module exposure. Most students chose social media as their source of COVID-19-related information.
Conclusions
Schools can provide information to increase adolescents’ HL and the public’s support for health initiatives to prevent or limit the spread of COVID-19.; Summary

Key Message
A cross-sectional study carried out on high school students during the second surge of COVID-19 in Indonesia revealed that they benefitted from the COVID-19 module. Students who viewed the module had higher scores on health literacy measures of adolescents (HELMA), had a more favorable attitude toward government-issued restrictive policies, and were more likely to have adequate health literacy, in regard to the ability to use health information. These imply schools as part of the public health response by providing education to increase adolescents’ health literacy and the public’s support for health initiatives to prevent and limit the spread of COVID-19.

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.

Brief Report

Characteristics and Health Care Spending of Persistently and Transiently High-cost Older Adults in Korea: Sungchul Park, Giryeon Bae; J Prev Med Public Health. 2023;56(5):475-480. Published online September 4, 2023; DOI: https://doi.org/10.3961/jpmph.23.270

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Abstract Summary PDF: Objectives
This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost).
Methods
We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics.
Results
Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid.
Conclusions
Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.; Summary

Korean summary
- 한국에서 65세 이상의 고령층 고비용 환자 그룹 내에서 두 개의 이질적인 그룹을 발견하였다. - 지속적으로 고비용인 환자는 일시적으로 고비용인 환자보다 의료비 지출이 유의미하게 더 많았다. - 두 그룹의 특성을 비교한 결과, 건강요인의 차이도 있었지만 그보다는 사회적 요인의 차이가 더 컸다.

Key Message
- High-cost older adults are heterogeneous in terms of health care spending and sample characteristics in Korea. - Persistently high-cost older adults had significantly higher health care spending than transiently high-cost older adults. - Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults.

Original Articles

Reliability of a Newly Developed Tool to Assess and Classify Work-related Stress (TAWS-16) for Indian Workforce: Gautham Melur Sukumar, Runalika Roy, Mariamma Philip, Gururaj Gopalkrishna; J Prev Med Public Health. 2023;56(5):407-412. Published online August 19, 2023; DOI: https://doi.org/10.3961/jpmph.23.219

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Abstract Summary PDF: Objectives
Work stress is associated with non-communicable diseases, increased healthcare costs, and decreased work productivity among employees in the information technology sector. There is a need for regular work-stress screening among employees using valid and reliable tools. The Tool to Assess and Classify Work Stress (TAWS-16) was developed to overcome limitations in existing stress assessment tools in India. This study aimed to test the reliability of TAWS-16 in a sample of managerial-supervisory employees.
Methods
This observational reliability study included data from 62 employees. Test-retest and inter-method reliability were investigated using a TAWS-16 web application and interview by telephone, respectively. Kappa values and intra-class correlation coefficients were calculated. Internal consistency was assessed through Cronbach’s alpha.
Results
For both test-retest and inter-method reliability, the agreement for both work-related factors and symptoms suggestive of work stress exceeded 80%, and all kappa values were 0.40 or higher. Cronbach’s alpha for test-retest and inter-method reliability was 0.983 and 0.941, respectively.
Conclusions
TAWS-16 demonstrated acceptable reliability. It measured stressors, coping abilities, and psychosomatic symptoms associated with work stress. We recommend using TAWS-16 to holistically identify work stress among employees during periodical health check-ups in India.; Summary

Key Message
The study assessed test-retest and inter-method reliability of Tool to Assess Work Stress (TAWS – 16) developed by Centre for Public Health, National Institute of Mental Health and Neurosciences (NIMHANS) on 62 employees in Bengaluru, India. Kappa statistics, Intra-class correlation coefficient (ICC) and Cronbach’s alpha were calculated. TAWS – 16 demonstrated acceptable reliability, good internal consistency and can be used to identify work stress among employees during periodical health check-ups in Indian setting.

Gender Inequalities in Mental Health During the COVID-19 Pandemic: A Population-based Study in Korea: Minku Kang, Sarah Yu, Seung-Ah Choe, Daseul Moon, Myung Ki, Byung Chul Chun; J Prev Med Public Health. 2023;56(5):413-421. Published online August 19, 2023; DOI: https://doi.org/10.3961/jpmph.23.170

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Abstract Summary PDF Supplementary Material: Objectives
This study explored the effect of the coronavirus disease 2019 (COVID-19) pandemic on psychosocial stress in prime working-age individuals in Korea, focusing on gender inequalities. We hypothesized that the impact of COVID-19 on mental health would differ by age and gender, with younger women potentially demonstrating heightened vulnerability relative to men.
Methods
The study involved data from the Korea Community Health Survey and included 319 592 adults aged 30 years to 49 years. We employed log-binomial regression analysis, controlling for variables including age, education, employment status, marital status, and the presence of children. The study period included 3 phases: the period prior to the COVID-19 outbreak (pre–COVID-19), the early pandemic, and the period following the introduction of vaccinations (post-vaccination).
Results
The findings indicated that women were at a heightened risk of psychosocial stress during the early pandemic (relative risk [RR], 1.01; 95% confidence interval [CI], 0.98 to 1.05) and post-vaccination period (RR, 1.07; 95% CI, 1.04 to 1.10) compared to men. This pattern was prominent in urban women aged 30-34 years (pre–COVID-19: RR, 1.06; 95% CI, 1.02 to 1.10; early pandemic: RR, 1.16; 95% CI, 1.08 to 1.25; post-vaccination period, RR, 1.22; 95% CI, 1.14 to 1.31).
Conclusions
The COVID-19 pandemic has exerted unequal impacts on psychosocial stress among prime working-age individuals in Korea, with women, particularly those in urban areas, experiencing a heightened risk. The findings highlight the importance of addressing gender-specific needs and implementing appropriate interventions to mitigate the psychosocial consequences of the pandemic.; Summary

Korean summary
코로나19 대유행이 국내 경제활동인구의 정신건강에 미친 젠더화된 영향을 조사하였다. 연구대상자는 2017-2021년 지역사회건강조사 조사대상자 319,592명이다. 연구 결과, 대유행 이후 30-39세 연령대 여성의 스트레스 수준이 남성에 비하여 현저히 증가한 것으로 나타났으며, 사회적 거리두기를 엄격하게 시행하였던 도시 지역에서 이러한 경향이 두드러졌다. 이번 연구 결과는 대유행 대응 노력에서 취약 집단을 지원하기 위한 중재 정책의 필요성을 강조한다

Key Message
We investigate the gendered impact of the COVID-19 pandemic on the mental health of the working-age population in Korea, focusing on ages 30-49, utilizing data from the Korea Community Health Survey (KCHS) from 2017 to 2021 including 319,592 participants. Findings reveal a notable increase in stress levels among women in the 30-39 age group after the pandemic compared to men, accentuating in urban areas with stringent social distancing measures. Our results underscore the necessity for intervention policies to support vulnerable groups in pandemic response efforts.

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