OBJECTIVES: Early initiation of breastfeeding (EIBF) is one of the most cost-effective strategies to reduce neonatal mortality. We sought to determine the prevalence and determinants of EIBF in Peru.METHODS: We performed a cross-sectional analytical study of the 2018 Peruvian Demographic and Family Health Survey as a secondary data source. In total, 19,595 children born during the 5 years prior to the survey were included in the study. The dependent variable (EIBF status), socio-demographic variables, and pregnancy-related variables were analyzed using a multivariate logistic regression model to identify the determinants of EIBF.RESULTS: The prevalence of EIBF in the study population was 49.7%. Cesarean deliveries were associated with a lower likelihood of EIBF (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.05 to 0.07) than were vaginal deliveries. Newborns born at public health centers (aOR, 1.37; 95% CI, 1.15 to 1.65) had a higher rate of EIBF than those not born at public or private health centers. Women from the jungle region (aOR, 2.51; 95% CI, 2.17 to 2.89) had higher odds of providing EIBF than those from the coast. Mothers with more than a secondary education (aOR, 0.65; 95% CI, 0.55 to 0.76) were less likely to breastfeed during the first hour of the newborn's life than women with primary or no education.CONCLUSIONS: More than half of Peruvian children do not breastfeed during the first hour after birth. The major determinants of EIBF status were the delivery mode and the region of maternal residence. Strategies are needed to promote early breastfeeding practices.
Breast Feeding ; Child ; Education ; Family Health ; Female ; Health Surveys ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Information Storage and Retrieval ; Logistic Models ; Mothers ; Odds Ratio ; Parturition ; Peru ; Prevalence ; Public Health

OBJECTIVES: India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.METHODS: Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.RESULTS: The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.CONCLUSIONS: In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.
Adult ; Communicable Diseases ; Education ; Family Health ; Female ; Humans ; India ; Logistic Models ; Male ; Malnutrition ; Nutritional Status ; Obesity ; Overweight ; Prevalence ; Public Health ; Smoke ; Smoking ; Socioeconomic Factors ; Thinness ; Tobacco, Smokeless

OBJECTIVES: This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.METHODS: We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using “aged 60 and over,” “physical activity” or “exercise,” and “motivator” and “barrier” as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.RESULTS: In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one's physical condition, being social, and suitability of the physical environment.CONCLUSIONS: Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.
Adult ; Aged ; Aging ; Architectural Accessibility ; Friends ; Humans ; Iran ; Mass Screening ; Motivation ; Motor Activity ; Walking

OBJECTIVES: This study investigated physical activity (PA) participation based on demographic, physical, and psychological variables in Korean adults.METHODS: Participants were divided into four groups (combined, aerobic only, resistance only, and neither) based on meeting the PA guidelines using moderate and vigorous PA time and resistance exercise frequency from the Korea National Health and Nutrition Examination Survey 2017. The association between meeting the PA guidelines and demographic, medical, fitness, lifestyle, and psychological variables were analyzed using complex samples crosstabs and a general linear model.RESULTS: Of the 5,820 Korean adults, 66.0% did not meet any of the guidelines. Among demographic factors, sex, age, marital status, income, education level, occupation, and employment status were associated with meeting the PA guidelines. Chronic disease prevalence, weight, waist circumference, body mass index, diastolic blood pressure, glucose, high-density lipoprotein and triglyceride levels, hand-grip strength, resting heart rate, and family history of chronic disease in the medical and fitness variables; frequency of drinking and eating breakfast, total calorie, water, protein, and fat intake in the lifestyle variables; and perceived stress, depression, suicidal thoughts, and quality of life in the psychological variables were associated with meeting PA guidelines.CONCLUSIONS: Most Korean adults participate in insufficient PA. Moreover, individuals who are socially underprivileged, have low-income or poor physical and mental health conditions participated in relatively less PA. Our findings suggest that government and individual efforts are required to increase PA and resolve health inequality in Korean adults.
Adult ; Blood Pressure ; Body Mass Index ; Breakfast ; Chronic Disease ; Demography ; Depression ; Drinking ; Eating ; Education ; Employment ; Glucose ; Health Equity ; Heart Rate ; Humans ; Korea ; Life Style ; Linear Models ; Lipoproteins ; Marital Status ; Mental Health ; Motor Activity ; Nutrition Surveys ; Occupations ; Prevalence ; Quality of Life ; Socioeconomic Factors ; Triglycerides ; Waist Circumference ; Water

OBJECTIVES: Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents.METHODS: PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included.RESULTS: The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0).CONCLUSIONS: The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.
Adolescent ; Africa ; Americas ; Asia, Southeastern ; Delivery of Health Care ; Dental Health Services ; Europe ; Humans ; Malocclusion ; Methods ; Prevalence ; World Health Organization

OBJECTIVES: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.METHODS: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.RESULTS: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.CONCLUSIONS: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.
Child Health ; Child ; Conservation of Natural Resources ; Family Planning Services ; Growth Disorders ; Hepatitis B ; Human Development ; Humans ; Incidence ; Iran ; Maternal Health ; Maternal Mortality ; Mediterranean Region ; Parturition ; Vaccination

OBJECTIVES: The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox.METHODS: We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics.RESULTS: Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox.CONCLUSIONS: The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.
Bioterrorism ; Korea ; Smallpox ; Surge Capacity ; Vaccination ; Variola virus

OBJECTIVES: The lowest-low fertility status of Korea has continued for the past 17 years despite governmental efforts to encourage childbirth. As the number of working women has increased, their residence patterns have changed; however, the impact of this factor has yet to be explored. Therefore, this study was conducted to investigate the effects of residence patterns relative to the workplace on the total fertility rate of working women.METHODS: Information on eligibility and healthcare utilization was obtained from the National Health Information Database between 2011 and 2015. The study participants were working women aged 15-49 years. We classified their residence relative to their workplace into 3 patterns: same municipality, same province, and different province. The total fertility rate was calculated and logistic regression was performed of childbirth according to residence pattern, adjusting for age, insurance contribution quartile, size of the workplace, year of birth, and province of residence.RESULTS: The total fertility rates of working women from 2011 to 2015 were 1.091, 1.139, 1.048, 1.073, and 1.103, respectively. The total fertility rate by residence pattern was highest in women residing in the same municipality as their workplace. After adjustment, the odds of childbirth in women from the same municipality and the same province were 21.6% and 16.0% higher than those of women residing in a different province, respectively.CONCLUSIONS: The total fertility rate was higher among women living near their workplace. Therefore, effective policy measures should be taken to promote the proximity of working women's workplace and residence.
Birth Rate ; Delivery of Health Care ; Female ; Fertility ; Humans ; Insurance ; Korea ; Logistic Models ; Parturition ; Public Policy ; Women, Working

OBJECTIVES: The purpose of this study was to estimate the effects of health-risk behaviors, alone and in combination, on health outcomes.METHODS: This study used sample cohort data provided by the National Health Insurance Service focusing on the use of hospital services, direct medical expenses, length of stay, and re-entry rate according to health-risk behaviors. A frequency analysis and the chi-square test were used to investigate associations between the demographic characteristics of study subjects and their health-risk behaviors. The strength of the association of each factor was calculated as the odds ratio in a crossover analysis.RESULTS: Obesity had the largest effect, especially in combination with smoking and drinking. In particular, significant associations were shown with the duration of hospitalization and direct medical expenses. After adjustment for sex, age, economic status, and pre-existing medical conditions, the duration of hospitalization was 7.37 times longer and that of medical expenses was 5.18 times higher in the obese group relative to the non-obese group. Drinking showed a statistically significant association with the number of days of hospitalization. After adjusting for the control variables, the number of hospital days was 1.24 longer in the drinking group than in the non-drinking group.CONCLUSIONS: An analysis of combinations of health risk factors showed obesity had the largest effect.
Chronic Disease ; Cohort Studies ; Drinking ; Health Behavior ; Hospitalization ; Korea ; Length of Stay ; National Health Programs ; Obesity ; Odds Ratio ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.
Alcohol Drinking ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Puma ; Residence Characteristics ; Socioeconomic Factors ; Surveys and Questionnaires ; Urban Health