Journal of Preventive Medicine and Public Health

Original Article

Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of 4 Databases: Eunsil Cheon, Yeun Soo Yang, Suyoung Jo, Jieun Hwang, Keum Ji Jung, Sunmi Lee, Seong Yong Park, Kyoungin Na, Soyeon Kim, Sun Ha Jee, Sung-il Cho; J Prev Med Public Health. 2024;57(4):327-338. Published online July 3, 2024; DOI: https://doi.org/10.3961/jpmph.23.471

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Objectives
Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020.
Methods
Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020.
Results
The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths.
Conclusions
Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

Summary

Korean summary
한국의 흡연율은 상당 수준 감소하였지만 흡연의 장기적인 건강영향은 지속적으로 나타나고 있다. 4개의 대규모 코호트와 1995년 흡연율을 사용하여 2020년 한국의 흡연기인 사망자수를 산출한 결과 남성 53,930명, 여성 6283명으로 총 60,213명이였다. 효과적인 담배규제와 금연 정책을 위하여 장기적인 사망자수 모니터링이 필요할 것이다.

Key Message
Despite the significant decrease in smoking rates in South Korea, the long-term health effects of smoking continue to manifest. Our analysis using four large-scale cohorts and 1995 smoking prevalence revealed that in 2020, the number of smoking-attributable death in South Korea was 53,930 for men and 6,283 for women, totaling 60,213. Long-term monitoring is necessary for effective tobacco control and smoking cessation policies.

Citations

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Early age at smoking initiation is associated with elevated cardiovascular disease and mortality risk in a nationwide population-based cohort
Jung Hun Koh, Kyungdo Han, Minsang Kim, Jeong Min Cho, Sehyun Jung, Soojin Lee, Yaerim Kim, Semin Cho, Hyuk Huh, Seong Geun Kim, Eunjeong Kang, Kwon Wook Joo, Dong Ki Kim, Sehoon Park
Scientific Reports.2026;[Epub] CrossRef
Risk of all-cause mortality by various cigarette smoking indices: A longitudinal study using the Korea National Health Examination Baseline Cohort in South Korea
Heewon Kang, Eunsil Cheon, Jieun Hwang, Suyoung Jo, Kyoungin Na, Seong Yong Park, Sung-il Cho
Tobacco Induced Diseases.2025; 23(January): 1. CrossRef
Cohort profile: the Korean National Health Examination Baseline (KNHEB) cohort for longitudinal health monitoring in South Korea
Suyoung Jo, Eunsil Cheon, Heewon Kang, Min Kyung Lim, Wankyo Chung, Sun Ha Jee, Keum Ji Jung, Yeun Soo Yang, Seong Yong Park, Sunmi Lee, Jin-Kyoung Oh, Kyoungin Na, Soyeon Kim, Jieun Hwang, Sung-il Cho
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I. Yu. Torshin, O. A. Gromova, T. E. Bogacheva, A. N. Gromov
FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology.2025; 18(3): 376. CrossRef
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Systematic Review

Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men: A Systematic Review and Meta-analysis: Suchitra Hudrudchai, Charin Suwanwong, Pitchada Prasittichok, Kanu Priya Mohan, Nopphadol Janeaim; J Prev Med Public Health. 2024;57(1):8-17. Published online December 12, 2023; DOI: https://doi.org/10.3961/jpmph.23.345

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Objectives
The effectiveness and efficiency of pre-exposure prophylaxis (PrEP) in reducing the transmission of human immunodeficiency virus (HIV) among men who have sex with men (MSM) relies on how widely it is adopted and adhered to, particularly among high-risk groups of MSM. The meta-analysis aimed to collect and analyze existing evidence on various factors related to PrEP adherence in MSM, including demographic characteristics, sexual behaviors, substance use, and psychosocial factors.
Methods
The meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included articles published between January 2018 and December 2022, obtained from the PubMed, ScienceDirect, and Scopus databases. The studies that were included in the analysis reported the proportion of MSM who demonstrated adherence to PrEP and underwent quality appraisal using the Newcastle-Ottawa Scale.
Results
Of the 268 studies initially identified, only 12 met the inclusion criteria and were included in the final meta-analysis. The findings indicated that education (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12 to 2.40), number of sexual partners (OR, 1.16; 95% CI, 1.02 to 1.31), engaging in sexual activities with an human immunodeficiency virus-positive partner (OR, 1.59; 95% CI, 1.16 to 2.26), substance use (OR, 0.83; 95% CI, 0.70 to 0.99), and lower levels of depression (OR, 0.55; 95% CI, 0.37 to 0.82) were associated with higher rates of PrEP adherence among MSM.
Conclusions
Despite these findings, further research is necessary to investigate PrEP adherence more comprehensively. The findings of this meta-analysis can be utilized to inform interventions aimed at improving PrEP adherence among MSM and provide directions for future research in this area.

Summary

Key Message
This systematic review and meta-analysis confirmed that factors such as education, number of sexual partners, engagement in sexual activities with an HIV-positive partner, substance use, and lower levels of depression were associated with higher rates of PrEP adherence among MSM. Healthcare providers and interventions should take these aspects into consideration when developing strategies to promote optimal PrEP adherence and reduce the risk of HIV transmission.

Citations

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Socio‐economic status and adherence to HIV preventive and therapeutic interventions: exploring the mediating role of food insecurity among men who have sex with men and transgender and non‐binary persons from Brazil
Paula M. Luz, Thiago S. Torres, Victor C. Matos, Giovanna G. Costa, Brenda Hoagland, Cristina Pimenta, Marcos Benedetti, Beatriz Grinsztejn, Valdilea G. Veloso
Journal of the International AIDS Society.2025;[Epub] CrossRef
Intention to Use Pre-Exposure Prophylaxis Among Age Groups of Brazilian Men Who Have Sex With Men: National Cross-Sectional Study
Alvaro Francisco Lopes de Sousa, Caique Jordan Nunes Ribeiro, Guilherme Reis de Santana Santos, Emerson Lucas Silva Camargo, Herica Emilia Félix de Carvalho, Guilherme Schneider, Leticia Genova Vieira, Liliane Moretti Carneiro, Ana Paula Morais Fernandes,
JMIR Public Health and Surveillance.2025; 11: e58405. CrossRef
Understanding Factors Influencing HIV pre-exposure prophylaxis adherence among men who have sex with men in Western China: a data-driven exploration using bayesian networks
Qian Wang, Qin Qin, Jiaxiu Liu, Pinyi Chen, Bing Lin, Xiaoni Zhong
BMC Public Health.2025;[Epub] CrossRef
Barriers and Facilitators to Pre-exposure Prophylaxis Adherence Among Thai Men Who have Sex with Men in Bangkok: COM-B Model Analysis
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Special Article

Statin Intake and Gastric Cancer Risk: An Updated Subgroup Meta-analysis Considering Immortal Time Bias: Jong-Myon Bae; J Prev Med Public Health. 2022;55(5):424-427. Published online August 18, 2022; DOI: https://doi.org/10.3961/jpmph.22.209

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Abstract Summary PDF

A retrospective record-linkage study (RLS) based on medical records containing drug prescription histories involves immortal time bias (ITB). Thus, it is necessary to control for this bias in the research planning and analysis stages. Furthermore, a summary of a metaanalysis including RLSs that did not control for ITB showed that specific drugs had a preventive effect on the occurrence of the disease. Previous meta-analytic results of three systematic reviews evaluating the association between statin intake and gastric cancer risk showed that the summary hazard ratio (sHR) of the RLSs was lower than 1 and was statistically significant. We should consider the possibility of ITB in the sHR of RLSs and interpret the results carefully.

Summary

Korean summary
이차자료를 활용하여 구축한 코호트 추적연구는 immortal time bias가 개입될 개연성을 염두에 두어야 한다. 이들 연구결과들을 제외한 메타분석 결과 스타닌 복용에 따른 위암발생 위험 감소는 관련성이 없다는 결과를 도출하였다.

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Statin repurposing in gastrointestinal cancer: from metabolic reprogramming to immunoregulation
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Systematic Reviews

Vitamin D Deficiency and Comorbidities as Risk Factors of COVID-19 Infection: A Systematic Review and Meta-analysis: Pinki Mishra, Rizwana Parveen, Ram Bajpai, Nidhi Agarwal; J Prev Med Public Health. 2022;55(4):321-333. Published online June 13, 2022; DOI: https://doi.org/10.3961/jpmph.21.640

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Abstract PDF Supplementary Material

Objectives
Extensive evidence links low vitamin D status and comorbidities with coronavirus disease 2019 (COVID-19) outcomes, but the results of published studies are contradictory. Therefore, we investigated the association of lower levels of vitamin D and comorbidities with the risk of COVID-19 infection.
Methods
We searched MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for articles published until August 20, 2021. Sixteen eligible studies were identified (386 631 patients, of whom 181 114 were male). We included observational cohort and case-control studies that evaluated serum levels of vitamin D in COVID-19-positive and COVID-19-negative patients. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated.
Results
Significantly lower vitamin D levels were found in COVID-19-positive patients (MD, -1.70; 95% CI, -2.74 to -0.66; p=0.001), but with variation by study design (case-control: -4.04; 95% CI, -5.98 to -2.10; p<0.001; cohort: -0.39; 95% CI, -1.62 to 0.84; p=0.538). This relationship was more prominent in female patients (MD, -2.18; 95% CI, -4.08 to -0.28; p=0.024) than in male patients (MD, -1.74; 95% CI, -3.79 to 0.31; p=0.096). Male patients showed higher odds of having low vitamin D levels (odds ratio [OR], 2.09; 95% CI, 1.38 to 3.17; p<0.001) than female patients (OR, 1.17; 95% CI, 0.74 to 1.86; p=0.477). Comorbidities showed inconsistent, but generally non-significant, associations with COVID-19 infection.
Conclusions
Low serum vitamin-D levels were significantly associated with the risk of COVID-19 infection. This relationship was stronger in female than in male COVID-19 patients. Limited evidence was found for the relationships between comorbidities and COVID-19 infection, warranting large population-based studies to clarify these associations.

Summary

Citations

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Jia-ming Yang, Ze-qin Li, Yan-biao Zhong, Hui-yong Xie, Yun Luo, Li Xiao, Jing-hai Liao, Mao-yuan Wang
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Low Social Support and Risk for Depression in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis: Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo; J Prev Med Public Health. 2022;55(1):37-48. Published online January 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.490

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Abstract PDF

Objectives
Depression is a frequent complication of type 2 diabetes mellitus. This study aimed to investigate the relationship between low social support and risk for depression in people with type 2 diabetes through a meta-analysis.
Methods
PubMed, ProQuest, SpringerLink, ScienceDirect, Scopus, the Cochrane Library, Embase, and Google Scholar were searched for English-language articles published up to 2021. Pooled adjusted odds ratios (aORs) were calculated using a random-effect model with 95% confidence intervals (CIs). Heterogeneity was evaluated by using the Cochrane Q test and I² statistics. The risk of publication bias was estimated using a funnel plot, the Egger test, and the Begg test. The Joanna Briggs Institute Critical Appraisal Tools were used to assess the quality of evidence and the risk of bias.
Results
Eleven studies were included in this meta-analysis, containing a total of 3151 people with type 2 diabetes mellitus. The pooled analysis showed that people with type 2 diabetes mellitus who had low social support had twice as high a risk of depression as those with high social support (aOR, 2.02; 95% CI, 1.51 to 2.70; p<0.001). A random-effect model was used because the heterogeneity was high (I²= 87%).
Conclusions
Low social support was found to increase the risk of depression among people with type 2 diabetes mellitus. Further investigation into factors that may moderate this relationship is required.

Summary

Citations

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Prevalence of Sarcopenia Among the Elderly in Korea: A Meta-Analysis: Yoo Jin Choo, Min Cheol Chang; J Prev Med Public Health. 2021;54(2):96-102. Published online March 4, 2021; DOI: https://doi.org/10.3961/jpmph.21.046

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Abstract Summary PDF

Objectives
Sarcopenia is a common disease in the elderly population that causes disability, poor quality of life, and a high risk of death. In the current study, we conducted a meta-analysis to report basic knowledge about the prevalence of sarcopenia in the elderly in Korea.
Methods
We searched for articles in the MEDLINE, Cochrane Library, Embase, and Scopus databases published until December 28, 2020. Studies investigating the prevalence of sarcopenia in elderly Koreans aged ≥65 years were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa scale. Publication bias was evaluated using the Egger test and funnel plots.
Results
In total, 3 studies and 2922 patients were included in the meta-analysis. All 3 studies used the European Working Group on Sarcopenia in Older People criteria for the diagnosis of sarcopenia. The total prevalence of sarcopenia was 13.1-14.9% in elderly men and 11.4% in elderly women.
Conclusions
This meta-analysis is the first to estimate the pooled prevalence of sarcopenia in elderly Koreans, and its findings suggest that sarcopenia is common in this population. Therefore, attention should be paid to the prevention and control of sarcopenia.

Summary

Korean summary
본 연구에서는 노인인구에서 삶의 질 저하 및 높은 사망률을 야기시키는 흔한 질환인 근감소증의 유병률을 조사하고자 메타분석을 시행하였다. 분석에는 65세 이상 한국 노년층의 근감소증 유병률을 조사한 3건의 연구들과 총 2,922명의 대상자가 포함되었으며, 3개의 연구 모두 European Working Group on Sarcopenia in Older People criteria를 통해 근감소증을 진단하였다. 분석 결과, 근감소증의 총 유병률은 남성에서 13.1-14.9%였고, 여성에서는 11.4%였다. 이 결과는 우리나라의 노인 인구에서 근감소증이 흔하게 발생하므로 근감소증의 예방과 통제에 주의를 기울여야 함을 시사한다.

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COVID-19: Systematic Review

Estimate of the Basic Reproduction Number for COVID-19: A Systematic Review and Meta-analysis: Yousef Alimohamadi, Maryam Taghdir, Mojtaba Sepandi; J Prev Med Public Health. 2020;53(3):151-157. Published online March 20, 2020; DOI: https://doi.org/10.3961/jpmph.20.076

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Abstract PDF

Objectives
The outbreak of coronavirus disease 2019 (COVID-19) is one of the main public health challenges currently facing the world. Because of its high transmissibility, COVID-19 has already caused extensive morbidity and mortality in many countries throughout the world. An accurate estimation of the basic reproduction number (R₀) of COVID-19 would be beneficial for prevention programs. In light of discrepancies in original research on this issue, this systematic review and meta-analysis aimed to estimate the pooled R₀ for COVID-19 in the current outbreak.
Methods
International databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched to identify studies conducted regarding the R₀ of COVID-19. Articles were searched using the following keywords: “COVID-19” and “basic reproduction number” or “R₀.” The heterogeneity among studies was assessed using the I² index, the Cochran Q test, and T². A random-effects model was used to estimate R₀ in this study.
Results
The mean reported R₀ in the identified articles was 3.38±1.40, with a range of 1.90 to 6.49. According to the results of the random-effects model, the pooled R₀ for COVID-19 was estimated as 3.32 (95% confidence interval, 2.81 to 3.82). According to the results of the meta-regression analysis, the type of model used to estimate R₀ did not have a significant effect on heterogeneity among studies (p=0.81).
Conclusions
Considering the estimated R₀ for COVID-19, reducing the number of contacts within the population is a necessary step to control the epidemic. The estimated overall R₀ was higher than the World Health Organization estimate.

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Reviews

High Temperatures and Kidney Disease Morbidity: A Systematic Review and Meta-analysis: Woo-Seok Lee, Woo-Sung Kim, Youn-Hee Lim, Yun-Chul Hong; J Prev Med Public Health. 2019;52(1):1-13. Published online November 20, 2018; DOI: https://doi.org/10.3961/jpmph.18.149

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313 Download
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Abstract Summary PDF Supplementary Material

Objectives
In recent years, serious concerns have been raised regarding the impacts of rising temperatures on health. The present study was conducted to investigate the relationship between elevated temperatures and kidney disease through a systematic review and meta-analysis.
Methods
In October 2017, 2 researchers independently searched related studies in PubMed and Embase. A meta-analysis was conducted using a random-effects model, including only studies that presented odds ratios, relative risks, or percentage changes, along with 95% confidence intervals (CIs). The characteristics of each study were summarized, and the Egger test and funnel plots were used to evaluate publication bias.
Results
Eleven studies that met the criteria were included in the final analysis. The pooled results suggest an increase of 30% (95% CI, 20 to 40) in kidney disease morbidity with high temperatures. In a disease-specific subgroup analysis, statistically significant results were observed for both renal colic or kidney stones and other renal diseases. In a study design–specific subgroup analysis, statistically significant results were observed in both time-series analyses and studies with other designs. In a temperature measure–specific subgroup analysis, significant results were likewise found for both studies using mean temperature measurements and studies measuring heat waves or heat stress.
Conclusions
Our results indicate that morbidity due to kidney disease increases at high temperatures. We also found significant results in subgroup analyses. However, further time-series analyses are needed to obtain more generalizable evidence.

Summary

Korean summary
최근들어 기온상승에 따른 건강영향과 관련하여 전 세계적으로 심각한 우려가 제기되고 있으며, 저자들은 이에 착안하여 본 연구에서 체계적 문헌고찰과 메타분석을 통해 기온상승과 신장질환 발생간의 연관성을 연구하고자 하였다. 연구결과에서는 임계온도 이상으로 기온이 상승하면 참고치에 비해 신장질환으로의 이환율이 30% (95% 신뢰구간, 20% 에서 40%) 증가함을 보였고, 부집단 분석에서도 역시 유의한 결과를 나타내었다. 그러나 보다 일반화 가능한 근거를 얻기 위해서는 기온상승과 신장질환 발생에 관한 더 많은 시계열 분석 연구가 필요할 것으로 사료된다.

Citations

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Congenital Malformations in Infants of Mothers Undergoing Assisted Reproductive Technologies: A Systematic Review and Meta-analysis Study: Hayedeh Hoorsan, Parvin Mirmiran, Shahla Chaichian, Yousef Moradi, Roza Hoorsan, Fatemeh Jesmi; J Prev Med Public Health. 2017;50(6):347-360. Published online July 5, 2017; DOI: https://doi.org/10.3961/jpmph.16.122

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Abstract PDF Supplementary Material

Objectives
This meta-analysis aimed to evaluate congenital malformations in infants conceived by assisted reproductive techniques (ART), compared with infants conceived spontaneously.
Methods
In this study, available resources searched to find relevant articles included PubMed, ScienceDirect, Scopus, Google Scholar, Cochrane, ProQuest, Iranmedex, Magiran, and Scientific Information Database. After extracting the necessary information from evaluated articles, meta-analysis on the articles’ data was performed using Stata version 11.2.
Results
In this study, from a total of 339 articles, extracted from the initial investigation, ultimately 30 articles were selected for meta-analysis that assessed the use of ART on the risk of congenital abnormalities and some birth complications on 5 470 181 infants (315 402 cases and 5 154 779 controls). The odds ratio (95% confidence interval [CI]) for low birth weight was 1.89 (95% CI, 1.36 to 2.62), preterm labor 1.79 (95% CI, 1.21 to 2.63), cardiac abnormalities 1.43 (95% CI, 1.27 to 1.62), central nervous system abnormalities 1.36 (95% CI, 1.10 to 1.70), urogenital system abnormalities 1.58 (95% CI, 1.28 to 1.94), musculoskeletal disorders 1.35 (95% CI, 1.12 to 1.64), and chromosomal abnormalities in infants conceived by ART was 1.14 (95% CI, 0.90 to 1.44), which were all statistically significant, except chromosomal abnormalities.
Conclusions
The risk of congenital abnormalities and some birth complications were significantly higher in ART than normal conception, while chromosomal abnormalities were not; therefore, the application of ART should be selected individually for patients by detailed assessment to reduce such risks in the population.

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Breast Density and Risk of Breast Cancer in Asian Women: A Meta-analysis of Observational Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(6):367-375. Published online October 21, 2016; DOI: https://doi.org/10.3961/jpmph.16.054

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Abstract PDF

Objectives
The established theory that breast density is an independent predictor of breast cancer risk is based on studies targeting white women in the West. More Asian women than Western women have dense breasts, but the incidence of breast cancer is lower among Asian women. This meta-analysis investigated the association between breast density in mammography and breast cancer risk in Asian women.
Methods
PubMed and Scopus were searched, and the final date of publication was set as December 31, 2015. The effect size in each article was calculated using the interval-collapse method. Summary effect sizes (sESs) and 95% confidence intervals (CIs) were calculated by conducting a meta-analysis applying a random effect model. To investigate the dose-response relationship, random effect dose-response meta-regression (RE-DRMR) was conducted.
Results
Six analytical epidemiology studies in total were selected, including one cohort study and five case-control studies. A total of 17 datasets were constructed by type of breast density index and menopausal status. In analyzing the subgroups of premenopausal vs. postmenopausal women, the percent density (PD) index was confirmed to be associated with a significantly elevated risk for breast cancer (sES, 2.21; 95% CI, 1.52 to 3.21; I²=50.0%). The RE-DRMR results showed that the risk of breast cancer increased 1.73 times for each 25% increase in PD in postmenopausal women (95% CI, 1.20 to 2.47).
Conclusions
In Asian women, breast cancer risk increased with breast density measured using the PD index, regardless of menopausal status. We propose the further development of a breast cancer risk prediction model based on the application of PD in Asian women.

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The Effect of Breastfeeding Duration and Parity on the Risk of Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis: Ho Kyung Sung, Seung Hyun Ma, Ji-Yeob Choi, Yunji Hwang, Choonghyun Ahn, Byoung-Gie Kim, Yong-Man Kim, Jae Weon Kim, Sokbom Kang, Jaehoon Kim, Tae Jin Kim, Keun-Young Yoo, Daehee Kang, Suekyung Park; J Prev Med Public Health. 2016;49(6):349-366. Published online September 8, 2016; DOI: https://doi.org/10.3961/jpmph.16.066

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Abstract PDF Supplementary Material

Objectives
We conducted a systematic review and meta-analysis to summarize current evidence regarding the association of parity and duration of breastfeeding with the risk of epithelial ovarian cancer (EOC).
Methods
A systematic search of relevant studies published by December 31, 2015 was performed in PubMed and EMBASE. A random-effect model was used to obtain the summary relative risks (RRs) and 95% confidence intervals (CIs).
Results
Thirty-two studies had parity categories of 1, 2, and ≥3. The summary RRs for EOC were 0.72 (95% CI, 0.65 to 0.79), 0.57 (95% CI, 0.49 to 0.65), and 0.46 (95% CI, 0.41 to 0.52), respectively. Small to moderate heterogeneity was observed for one birth (p<0.01; Q=59.46; I²=47.9%). Fifteen studies had breastfeeding categories of <6 months, 6-12 months, and >13 months. The summary RRs were 0.79 (95% CI, 0.72 to 0.87), 0.72 (95% CI, 0.64 to 0.81), and 0.67 (95% CI, 0.56 to 0.79), respectively. Only small heterogeneity was observed for <6 months of breastfeeding (p=0.17; Q=18.79, I²=25.5%). Compared to nulliparous women with no history of breastfeeding, the joint effects of two births and <6 months of breastfeeding resulted in a 0.5-fold reduced risk for EOC.
Conclusions
The first birth and breastfeeding for <6 months were associated with significant reductions in EOC risk.

Summary

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Short-term Effect of Fine Particulate Matter on Children’s Hospital Admissions and Emergency Department Visits for Asthma: A Systematic Review and Meta-analysis: Hyungryul Lim, Ho-Jang Kwon, Ji-Ae Lim, Jong Hyuk Choi, Mina Ha, Seung-Sik Hwang, Won-Jun Choi; J Prev Med Public Health. 2016;49(4):205-219. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.037

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Abstract PDF

Objectives
No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM_2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies.
Methods
Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger’s test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3.
Results
We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM_2.5 on children’s hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children’s hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m³ increase in PM_2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I²=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe.
Conclusions
We strengthened the evidence on the short-term effect of PM_2.5 on children’s hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence.

Summary

Citations

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Helicobacter pylori Infection and Risk of Gastric Cancer in Korea: A Quantitative Systematic Review: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(4):197-204. Published online July 7, 2016; DOI: https://doi.org/10.3961/jpmph.16.024

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Abstract PDF

Objectives
In the context of the global decrease in mortality due to gastric cancer, previous studies have reported that the effect of chronic Helicobacter pylori (H. pylori) infection on the incidence of gastric cancer varies among regions. This systematic review was conducted to investigate H. pylori as a risk factor for gastric cancer in Korea, where the incidence of gastric cancer is among the highest in the world.
Methods
A search strategy was established to identify articles published in Korean as well as in English. Ultimately, we included observational studies conducted among Korean patients that designed with an age-matched and sex-matched control group that reported the odds ratio associated with H. pylori. Gastric cancer cases were subdivided into overall (OGC), cardia (CGC), non-cardia (NGC), early (EGC), advanced, intestinal (IGC), and diffuse forms of gastric cancer. Summary odds ratios (SORs) with 95% confidence intervals (CIs) were calculated in the meta-analysis using a random-effect model.
Results
Eleven case-control studies were ultimately selected. H. pylori was associated with an SOR of 1.81 (95% CI, 1.29 to 2.54) for OGC. Additionally, statistically significant risks were observed for CGC, NGC, EGC, and IGC.
Conclusions
Chronic H. pylori infection was found to raise the risk of gastric cancer among Koreans, with the highest risk observed for CGC and EGC (SOR=2.88 for both). Follow-up clinical epidemiologic studies are needed to assess the effects of current treatments aimed at eradicating H. pylori infections.

Summary

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Brief Report

Citation Discovery Tools for Conducting Adaptive Meta-analyses to Update Systematic Reviews: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(2):129-133. Published online March 14, 2016; DOI: https://doi.org/10.3961/jpmph.15.074

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Abstract PDF

Objectives
The systematic review (SR) is a research methodology that aims to synthesize related evidence. Updating previously conducted SRs is necessary when new evidence has been produced, but no consensus has yet emerged on the appropriate update methodology. The authors have developed a new SR update method called ‘adaptive meta-analysis’ (AMA) using the ‘cited by’, ‘similar articles’, and ‘related articles’ citation discovery tools in the PubMed and Scopus databases. This study evaluates the usefulness of these citation discovery tools for updating SRs.
Methods
Lists were constructed by applying the citation discovery tools in the two databases to the articles analyzed by a published SR. The degree of overlap between the lists and distribution of excluded results were evaluated.
Results
The articles ultimately selected for the SR update meta-analysis were found in the lists obtained from the ‘cited by’ and ‘similar’ tools in PubMed. Most of the selected articles appeared in both the ‘cited by’ lists in Scopus and PubMed. The Scopus ‘related’ tool did not identify the appropriate articles.
Conclusions
The AMA, which involves using both citation discovery tools in PubMed, and optionally, the ‘related’ tool in Scopus, was found to be useful for updating an SR.

Summary

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Review Article

Epstein-Barr Virus and Gastric Cancer Risk: A Meta-analysis With Meta-regression of Case-control Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(2):97-107. Published online March 4, 2016; DOI: https://doi.org/10.3961/jpmph.15.068

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Abstract PDF

Objectives
Research on how the risk of gastric cancer increases with Epstein-Barr virus (EBV) infection is lacking. In a systematic review that investigated studies published until September 2014, the authors did not calculate the summary odds ratio (SOR) due to heterogeneity across studies. Therefore, we include here additional studies published until October 2015 and conduct a meta-analysis with meta-regression that controls for the heterogeneity among studies.
Methods
Using the studies selected in the previously published systematic review, we formulated lists of references, cited articles, and related articles provided by PubMed. From the lists, only case-control studies that detected EBV in tissue samples were selected. In order to control for the heterogeneity among studies, subgroup analysis and meta-regression were performed.
Results
In the 33 case-control results with adjacent non-cancer tissue, the total number of test samples in the case and control groups was 5280 and 4962, respectively. In the 14 case-control results with normal tissue, the total number of test samples in case and control groups was 1393 and 945, respectively. Upon meta-regression, the type of control tissue was found to be a statistically significant variable with regard to heterogeneity. When the control tissue was normal tissue of healthy individuals, the SOR was 3.41 (95% CI, 1.78 to 6.51; I-squared, 65.5%).
Conclusions
The results of the present study support the argument that EBV infection increases the risk of gastric cancer. In the future, age-matched and sex-matched case-control studies should be conducted.

Summary

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Reviews

Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2015;48(6):280-286. Published online November 9, 2015; DOI: https://doi.org/10.3961/jpmph.15.054

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Abstract PDF

Objectives
Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies.
Methods
We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated.
Results
A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09).
Conclusions
These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.

Summary

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Hormone Replacement Therapy and Risk of Breast Cancer in Korean Women: A Quantitative Systematic Review: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2015;48(5):225-230. Published online September 16, 2015; DOI: https://doi.org/10.3961/jpmph.15.046

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Abstract PDF

Objectives
The epidemiological characteristics of breast cancer incidence by age group in Korean women are unique. This systematic review aimed to investigate the association between hormone replacement therapy (HRT) and breast cancer risk in Korean women.
Methods
We searched electronic databases such as KoreaMed, KMbase, KISS, and RISS4U as well as PubMed for publications on Korean breast cancer patients. We also conducted manual searching based on references and citations in potential papers. All of the analytically epidemiologic studies that obtained individual data on HRT exposure and breast cancer occurrence in Korean women were selected. We restricted the inclusion of case-control studies to those that included age-matched controls. Estimates of summary odds ratio (SOR) with 95% confidence intervals (CIs) were calculated using random effect models.
Results
One cohort and five case-control studies were finally selected. Based on the heterogeneity that existed among the six studies (I-squared=70.2%), a random effect model was applied. The summary effect size of HRT history from the six articles indicated no statistical significance in breast cancer risk (SOR, 0.983; 95% CI, 0.620 to 1.556).
Conclusions
These facts support no significant effect of HRT history in the risk of breast cancer in Korean women. It is necessary to conduct a pooled analysis.

Summary

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Original Article

PM₁₀ Exposure and Non-accidental Mortality in Asian Populations: A Meta-analysis of Time-series and Case-crossover Studies: Hye Yin Park, Sanghyuk Bae, Yun-Chul Hong; J Prev Med Public Health. 2013;46(1):10-18. Published online January 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.1.10

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Abstract PDF

Objectives

We investigated the association between particulate matter less than 10 µm in aerodynamic diameter (PM₁₀) exposure and non-accidental mortality in Asian populations by meta-analysis, using both time-series and case-crossover analysis.

Methods

Among the 819 published studies searched from PubMed and EMBASE using key words related to PM₁₀ exposure and non-accidental mortality in Asian countries, 8 time-series and 4 case-crossover studies were selected for meta-analysis after exclusion by selection criteria. We obtained the relative risk (RR) and 95% confidence intervals (CI) of non-accidental mortality per 10 µg/m³ increase of daily PM₁₀ from each study. We used Q statistics to test the heterogeneity of the results among the different studies and evaluated for publication bias using Begg funnel plot and Egger test.

Results

Testing for heterogeneity showed significance (p<0.001); thus, we applied a random-effects model. RR (95% CI) per 10 µg/m³ increase of daily PM₁₀ for both the time-series and case-crossover studies combined, time-series studies relative risk only, and case-crossover studies only, were 1.0047 (1.0033 to 1.0062), 1.0057 (1.0029 to 1.0086), and 1.0027 (1.0010 to 1.0043), respectively. The non-significant Egger test suggested that this analysis was not likely to have a publication bias.

Conclusions

We found a significant positive association between PM₁₀ exposure and non-accidental mortality among Asian populations. Continued investigations are encouraged to contribute to the health impact assessment and public health management of air pollution in Asian countries.

Summary

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Meta-Analysis

Radiation Exposure and Cancer Mortality Among Nuclear Power Plant Workers: a Meta-analysis.: Eun Sook Park, Kieun Moon, Han Na Kim, Won Jin Lee, Young Woo Jin; J Prev Med Public Health. 2010;43(2):185-192.; DOI: https://doi.org/10.3961/jpmph.2010.43.2.185

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Abstract PDF

OBJECTIVES
We conducted a meta-analysis to investigate the relationship between low external doses of ionizing radiation exposure and the risk of cancer mortality among nuclear power plant workers. METHODS: We searched MEDLINE using key words related to low dose and cancer risk. The selected articles were restricted to those written in English from 1990 to January 2009. We excluded those studies with no fit to the selection criteria and we included the cited references in published articles to minimize publication bias. Through this process, a total of 11 epidemiologic studies were finally included. RESULTS: We found significant decreased deaths from all cancers (SMR = 0.75, 95% CI = 0.62 - 0.90), all cancers excluding leukemia, solid cancer, mouth and pharynx, esophagus, stomach, rectum, liver and gallbladder, pancreas, lung, prostate, lymphopoietic and hematopoitic cancer. The findings of this meta-analysis were similar with those of the 15 Country Collaborative Study conducted by the International Agency for Research on Cancer. A publication bias was found only for liver and gallbladder cancer (p = 0.015). Heterogeneity was observed for all cancers, all cancers excluding leukemia, solid cancer, esophagus, colon and lung cancer. CONCLUSIONS: Our findings of low mortality for stomach, rectum, liver and gallbladder cancers may explained by the health worker effect. Yet further studies are needed to clarify the low SMR of cancers, for which there is no useful screening tool, in nuclear power plant workers.

Summary

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Original Articles

A Meta-analysis of the Association between Blood Lead and Blood Pressure.: Sang Baek Koh, Chun Bae Kim, Chung Mo Nam, Hong Ryul Choi, Bong Suk Cha, Jong Ku Park, Ho Sung Jee; Korean J Prev Med. 2001;34(3):262-268.

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Abstract PDF: OBJECTIVES
To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.; Summary

A Meta-analysis on the Association between Chronic Noise Exposure and Blood Pressure.: Chun Bae Kim, Sang Baek Koh, Jai Young Kim, Bong Suk Cha, Hong Ryul Choi, Jong Tae Lee, Chung Mo Nam, Sang Yun Lee, Seung jun Wang, Keeho Park, Dae Youl Kim; Korean J Prev Med. 2000;33(3):343-348.

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Abstract PDF: OBJECTIVES
This study was conducted to integrate the results of studies assessing the association between chronic noise exposure and blood pressure. METHODS: Using a MEDLINE search with noise exposure, blood pressure and hypertension as key words, we retrieved articles from the literature that were published from 1980 to December 1999. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers employed at a high noise level area 2) The paper should use average and cumulative noise exposure as method for exposure evaluation. 3) Blood pressure in each article should be reported in a continuous scale Among the 77 retrieved articles, six studies were selected for quantitative meta-analysis. Before the integration of the regression coefficients for the association between blood pressure and noise level, homogeneity tests were conducted. RESULTS: All studies were a cross-sectional design and the study subjects were industrial workers. Five papers used a time-weighted average for noise exposure and only one paper calculated the cumulative noise exposure level. The measurement of blood pressure in the majority of studies were accomplished in a resting state, and used an average of two or more readings. The homogeneity of studies was rejected in a fixed effect model, so we used the results in a random effect model. The results of the quantitative meta-analysis, the weighted regression coefficient of noise associated with systolic blood pressure and diastolic blood pressure were 0.05 (95% confidence interval [CI]: -0.03, 0.13) and 0.06 (95% CI: -0.01, 0.13), respectively. CONCLUSIONS: Our results suggested that chronic exposure to industrial noise does not cause elevated blood pressure.; Summary

Relationship between Occupational Electromagnetic Field Exposure and Leukemia: A Meta-Analysis.: Yong Sung Cho, Yoon Shin Kim, Hae Hiang Song, Seung Cheol Hong; Korean J Prev Med. 2000;33(1):125-133.

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Abstract PDF: OBJECTIVES
This study uses meta-analysis methodology to examine the statistical consistency and importance of random variation among results of epidemiologic studies of occupational electromagnetic field exposure and leukemia. METHODS: Studies for this meta-analysis were identified from previous reviews and by asking researcher active in this field for recommendations. Overall, 27 studies of occupational electromagnetic field exposures and leukemia were reviewed. A variety of meta-analysis statistical methods have been used to assess combined effects, to identify heterogeneity, and to provide a single summary risk estimate based on a set of simiar epidemiologic studies. In this study, classification of exposure metircs on occupational epidemiologic studies are reported for (1) job classification (20 individual studies); (2) leukemia subtypes (13 individual studies); and (3) country (27 individual studies). RESULTS: Results of this study, an inverse-variance weighted pooling of all the data leads to a small but significant elevation in risk of 11% (OR=1.11, 95% CI : 1.06~1.16) among 27 occupational epidemiologic studies. Publication bias was assessed by the 'fail-safe n' that may be not influence for all combined results exception a few categories, ie, "power station operators" and "electric utility workers" by job classification on occupational study. And all combined odds ratio results were similar for fixed-effects models and random-effects models, with slightly higher risk estimates for the random-effects model in situations where there was significant heterogeneity, ie, Q-statistic significant (p<.05). CONCLUSIONS: We found a small elevation in risk of leukemia, but the ubiquitous nature of exposure to electromagnetic fields from workplace makes even a weak association a public health issue of substantial power to influence the present overall conclusion about relationship between electromagnetic fields exposure and leukemia.; Summary

Meta-analysis on the Blood Lipids as Risk Factors of Coronary Heart Diseases in Koreans.: So Yeon Ryu, Ki Soon Kim, Yang ok Kim, Jong Park, Jong Ku Park, Chun Bae Kim, Sun Ha Jee; Korean J Prev Med. 1999;32(4):491-493.

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Abstract PDF: OBJECTIVES
To determine the relations between seven blood lipids such as total cholesterol(TC), triglyceride(TG), HDL-cholesterol(HDL), LDL-cholesterol(LDL), apolipoprotein A-1(Apo A1), apolipoprotein B(Apo B) and lipoprotein(a)(Lp(A)) and the coronary heart diseases(CHD), the quantitative techniques of meta-analysis were applied to studies of blood lipids and CHD in Koreans. METHODS: We searched the Korean and the English literature published from 1980 to August, 1997 by manual search and bibliography review. Information on sample size, study design, participant characteristics(gender, age) and blood lipid levels were abstracted by reviewers using inclusion criteria. Estimates of the effect sizes of blood lipid levels on CHD in Koreans and corresponding 95% confidence intervals were calculated using random-effect models. RESULTS: We identified 16 case-control studies to apply meta-analysis. The overall effect sizes for CHD were 20.3(95% CI : 14.23-26.22) in TC, 24.8(95% CI : 12.6-36.86) in TG, 15.16(95% CI : 3.99 - 26.33) in LDL, -3.48(95% CI : -5.79 - -1.17) in HDL, -9.78(95% CI : -16.98 - -2.58) in Apo-a1, 17.88(95% CI : 9.72 - 26.05) in Apo B and 18.95(95% CI : 17.88 - 20.02) in Lp(a). CONCLUSIONS: Our results suggested that seven blood lipids were significantly associated with CHD in Koreans. Well-designed and prospective studies between blood lipids and CHD in Koreans should be performed.; Summary

A Meta-analysis of Ambient Air Pollution in Relation to Daily Mortality in Seoul, 1991~1995.: Jong Tae Lee, Douglas W Dockery, Chun Bae Kim, Sun Ha Jee, Yong Chung; Korean J Prev Med. 1999;32(2):177-182.

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Abstract PDF: OBJECTIVES
To reexamine the association between air pollution and daily mortality in Seoul, Korea using a method of meta-analysis with the data filed for 1991 through 1995. METHODS: A separate Poisson regression analysis on each district within the metropolitan area of Seoul was conducted to regress daily death counts on levels of each ambient air pollutant, such as total suspended particulates (TSP), sulfur dioxide (SO2), and ozone (O3), controlling for variability in the weather condition. We calculated a weighted mean as a meta-analysis summary of the estimates and its standard error. RESULTS: We found that the p value from each pollutant model to test the homogeneity assumption was small (p<0.01) because of the large disparity among district-specific estimates. Therefore, all results reported here were estimated from the random effect model. Using the weighted mean that we calculated, the mortality at a 100 microgram/m3 increment in a 3-day moving average of TSP levels was 1.034 (95% CI 1.009-1.059). The mortality was estimated to increase 6% (95% CI 3-10%) and 3% (95% CI 0-6%) with each 50 ppb increase for 3-day moving average of SO2 and 1-hr maximum O3, respectively. CONCLUSIONS: Like most of air pollution epidemiologic studies, this meta-analysis cannot avoid fleeing from measurement misclassification since no personal measurement was taken. However, we can expect that a measurement bias be reduced in a district-specific estimate since a monitoring station is better representative of air quality of the matched district. The similar results to those from the previous studies indicated existence of health effect of air pollution at current levels in many industrialized countries, including Korea.; Summary

Trends of Preventive Medicine Research according to The Korean Journal of Preventive Medicine and Qualitative Meta-analysis on Articles of Lead Poisoning.: Chun Bae Kim, Jung Ae Rhee, Jong Ku Park, Seok Joon Sohn; Korean J Prev Med. 1999;32(2):113-122.

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Abstract PDF: OBJECTIVES
The purpose of this study was to describe the trends of original research in the Korean Journal of Preventive Medicine, and to evaluate the quality of original articles about lead poisoning. METHOD: The data for the analysis of trends in preventive medicine research was taken from a total of 829 original articles published in the Korean Journal of Preventive Medicine from 1968 to 1997. The qualitative meta-analysis was measured against a checklist of evaluation criteria, which were divided into 10 categories, with 46 articles on lead poisoning. The evaluation process was performed independently by two evaluators. RESULTS: The number of articles per 100 members over the study period increased by almost 4 pieces in the early 1980s, and by more than 9 pieces in the mid-1990s. In the major classifications of subjects, environmental and industrial health, epidemiology and health statistics, and health policy and management published 370 pieces (44.6%), 137 pieces (16.5%), 322 pieces (38.9%) respectively. In the order of the number of articles, five themes about health significance, including metal exposure (73 pieces), diseases associated with exposure to organic solvents (45 pieces), air pollution (36 pieces), maternal and child health (32 pieces), and occupational health (30 pieces) received consistent attention throughout the years 1968-1997. The overall mean score of article quality about lead poisoning was 37.8 out of 50. Of the articles any information on the purpose and hypothesis described well. Of those the originality of the subjects, the form of articles (including tables and figures), and the number of inappropriate words of abstracts showed very low score. For multiple regression analyses, the number of joint research institutes and the acceptance of research grants about the article quality were statistically significant. CONCLUSIONS: The number of original research reports in the Korean J Prev Med has recently increased and their subjects have diversified. Of the basis of this study, the articles need improvement in the areas of abstracts, tables and illustrations (figures), etc. The Korean Society for Preventive Medicine will revise contribution regulations for manuscripts submitted to the Korean J Prev Med. Future studies should address these issues and perform the quantitative mata-analysis about the specific subjects including the quality of articles.; Summary

Prediction of the risk of skin cancer caused by UVB radiation exposure using a method of meta-analysis.: D C Shin, J T Lee, J Y Yang; Korean J Prev Med. 1998;31(1):91-103.

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Abstract PDF: Under experimental conditions, UVB radiation, a type of ultra violet radiation, has shown to relate with the occurrence of skin erythema (sun-burn) in human and skin cancer in experimental animal. Cumulative exposure to UVB is also believed to be at least partly responsible for the "aging" process of the skin in human. It has also been observed to have an effect of altering DNA (deoxyribonucleic acid). UVB radiation is both an initiator and a promotor of non-melanoma skin cancer. Meta-analysis is a new discipline that critically reviews and statistically combines the results of previous researches. A recent review of meta-analysis in the field of public health emphasized its growing importance. Using a meta-analysis in this study, we explored more reliable dose-response relationships between UVB radiation and skin cancer incidence. We estimated skin cancer incidence using measured UVB radiation dose at a local area of Seoul (Shin chon-dong). The studies showing the dose-response relationships between UVB radiation and non-melanoma skin cancer incidence were searched and selected for a meta-analysis. The data for 7 reported epidemiological studies of three counties (USA, England, Australia) were pooled to estimated the risk. We estimated rate of incidence change of skin cancer using pooled data by meta-analysis method, and exponential and power models. Using either model, the regression coefficients for UVB did not differ significantly by gender and age. In each analysis of variance, non-melanoma skin cancer incidence after removing the gender and age and UVB effects was significant (p>0.01). The coefficients for UVB dose were estimated 2.07x10-6 by the exponential model and 2.49 by the power model. At a local area of Seoul (Shin chon-dong), BAF value were estimated 1.90 and 2.51 by the exponential and power model, respectively. The estimated BAF value were increased statistical power than that of primary studies that using a meta-analysis method.; Summary

A Meta-analysis on the Risk Factors of Cerebrovascular Disorders in Koreans.: Jong Ku Park, Myung Keun Kang, Chun Bae Kim, Ki Soon Kim, Sun Ha Jee; Korean J Prev Med. 1998;31(1):27-48.

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Abstract PDF: This study was conducted to integrate the results of studies which evaluated or identified the risk factors of CVD(cerebrovascular disorders) for Koreans. We retrieved the literature published in Korean by manual search and the English literature by Medline database to identify studies on the relationship between reported risk factors and CVD conducted for the Korean from 1980 to August, 1997. Hypertension and total serum cholestrol were selected as subjects of quantitative meta-analysis as risk factors of CVD in Koreans. The overall effect sizes of the risk of CVD due to hypertension and total serum cholesterol were calculated by common odds ratio(OR) and average standardized mean difference, retrospectively. Before the integration of each effect sizes into common effect sizes, the heterogeneity tests were conducted. Also, sensitivity tests were conducted for the estimated common effect sizes. Regarding hypertension and CVD, a total of 9 epidemiologic studies were identified with a total of 2,271 cases of CVD. The overall OR of hypertension associated CVD was 4.10(95% confidence interval[CI] 3.56 to 4.71). The OR of hypertension associated with hemorrhagic CVD and ischemic CVD were 6.56(95% CI : 4.92 to 8.80) and 3.28(95% CI : 2.77 to 3.90), retrospectively. The OR of hypertension in relation to hemorrhagic CVD was significantly higher than that of hypertension in relation to overall CVD or ischemic CVD. Regarding serum total cholesterol and ischemic CVD, total 9 epidemiologic studies were identified with a total of 843 cases of ischemic CVD. Average mean difference as an effect size was 0.76, which was judged an important value according to Cohen's criteria. Our data suggested that hypertension was an important risk factor of overall CVD and its subtypes, and that the total serum cholesterol was associated with ischemic CVD in Koreans. For the lack of reliable prospective studies, however, we concluded that further research designed longitudinally would be required in this area.; Summary

Meta-analysis of the Korean Literatures for Developing Clinical Practice Guidelines of Benign Prostatic hyperplasia.: Seung Hum Yu, Chun Bae Kim, Myung Geun Kang, Jae Mann Song; Korean J Prev Med. 1997;30(3):643-664.

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Abstract PDF: This study is to provide evidence-based recommendations for the most-effective treatments of benign prostatic hyperplasia based on patient preference or clinical need, and to meta-analyze the Korean literatures for the development of BPH treatment guidelines. For these analyses, extensive literature searches (208 articles), with priority given to the Korean Journal of Urology, were conducted from 1960 to August, 1996. Meta-analysis, like all statistical analysis, has two main functions: data summarization (qualitative meta-analysis) and smoothing or pattern recognition (quantitative meta-analysis). As well, critical reviews and syntheses with the mean and 90-percent confidence intervals for the likelihood were used to evaluate empirical evidence and significant outcomes of the BPH treatment literatures (106 articles). For this task, the Methodologic Panel for BPH Guidelines was composed of multidisciplinary experts in the field. The results of the study were summarized as follows: For all that watchful waiting is an appropriate treatment strategy for the majority of patients with prostatism, we couldn't find the Korean literatures which carried this article. The literatures on alpha-1-adrenergic receptor blockers provide no evidence to suggest that any one alpha blocker is more effective than another. The finasteride reduces the size of the prostate, on average, and leads to a small yet perceptible reduction in sysptoms. Of all treatment options, prostate surgery with transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and so on, offers the best chance for symptom improvement. However, surgery also has the highest rates of significant complications. Therefore, surgery need not always be a treatment of last resort. Balloon dilation of the prostatic urethra is clearly less effective than surgery in relieving symptoms, but it is associated with fewer complications. Emerging technologies for treating BPH include lasers, coils, stents, thermal therapy and hyperthermia. Established technologies will also be reanalyzed as results of new trials are reported. Although this study has some limitations due to lacking for good quality literatures, it provides a cornerstone for our medical research. It represents the most current scientific knowledge regarding the clinical epidemiology including treatment of BPH. It will be revised and updated as needed.; Summary

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