Hepatitis C virus (HCV) infection is a major cause of liver cirrhosis, hepatocellular carcinoma, and liver-related mortality. The new antiviral drugs against HCV, direct acting antivirals, result in >90% cure rate. This review aimed to summarize the current prevalence, clinical characteristics, outcomes, and treatment response associated with HCV infection, and countermeasures for optimal HCV control in South Korea. Based on a literature review, the current anti-HCV prevalence in the Korean population is 0.6 to 0.8%, with increasing prevalence according to age. The major HCV genotypes in Korean patients were genotype 1b and genotype 2. Successful antiviral treatment leads to significantly reduced liver related complications and mortality. However, only about one third of the individuals with HCV infection seem to be managed under the current national health insurance system, suggesting a remarkable rate of underdiagnoses and subsequent loss of opportunity to cure. A recent study in South Korea showed that targeted population screening for HCV infection is cost-effective. To prevent recently developed clusters of HCV infection in some clinics, mandatory surveillance rather than sentinel surveillance for HCV infection is required and governmental countermeasures to prevent reuse of syringes or other medical devises, and public education should be maintained. Moreover, one-time screening for a targeted population should be considered and a cost-effectiveness study supporting an optimal screening strategy is warranted.
Antiviral Agents ; Carcinoma, Hepatocellular ; Education ; Epidemiology ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea* ; Liver ; Liver Cirrhosis ; Mass Screening ; Mortality ; National Health Programs ; Prevalence ; Sentinel Surveillance ; Syringes

OBJECTIVES: Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer death in the world. The aim of this study was to investigate the provincial distribution of the incidence of CRC across Iran. METHODS: This epidemiologic study used data from the National Cancer Registry of Iran and the Center for Disease Control and Prevention of the Ministry of Health and Medical Education of Iran. The average annual age-standardized rate (ASR) for the incidence of CRC was calculated for each province. RESULTS: We found that adenocarcinoma (not otherwise specified) was the most common histological subtype of CRC in males and females, accounting for 81.91 and 81.95% of CRC cases, respectively. Signet ring cell carcinoma was the least prevalent subtype of CRC in males and females and accounted for 1.5 and 0.94% of CRC cases, respectively. In patients aged 45 years or older, there was a steady upward trend in the incidence of CRC, and the highest ASR of CRC incidence among both males and females was in the age group of 80-84 years, with an ASR of 144.69 per 100,000 person-years for males and 119.18 per 100,000 person-years for females. The highest incidence rates of CRC in Iran were found in the central, northern, and western provinces. Provinces in the southeast of Iran had the lowest incidence rates of CRC. CONCLUSIONS: Wide geographical variation was found in the incidence of CRC across the 31 provinces of Iran. These variations must be considered for prevention and control programs for CRC, as well as for resource allocation purposes.
Adenocarcinoma ; Carcinoma, Signet Ring Cell ; Centers for Disease Control and Prevention (U.S.) ; Colorectal Neoplasms* ; Education, Medical ; Epidemiologic Studies ; Female ; Humans ; Incidence* ; Iran* ; Male ; Resource Allocation

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p < 0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p < 0.001). CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Bayes Theorem ; Breast Neoplasms* ; Breast* ; Female* ; Health Status Disparities ; Humans ; Incidence* ; Iran ; Residence Characteristics* ; Resource Allocation ; Socioeconomic Factors* ; Spatial Analysis

OBJECTIVES: With access to antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) are able to consider childbearing to a greater extent than previously. In many cases, ART has transformed their intentions to have children. The present study aimed to assess changes in fertility intentions 12 months after ART initiation among HIV-positive women in Addis Ababa, Ethiopia. METHODS: An institution-based follow-up study was conducted among 360 HIV-positive women in Addis Ababa. A logistic regression model was used to assess the influence of socio-demographic, reproductive health, and clinical characteristics on changes in the fertility intentions of women. RESULTS: Overall, 40.8% (147 of 360) of the women reported that they desired to have a child in the future at the baseline visit, while 48.3% (174 of 360) did so at the 12-month follow-up. The proportion of women who reported that they desired to have a child 12 months after ART initiation was higher among ART-initiated women (55.8%, 106 of 190) than ART-naïve women (40.0%, 68 of 170). The adjusted analysis indicated that a change in fertility intentions between baseline and the follow-up visit was significantly associated with ART use (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.20 to 5.20) and marital status, with single (aOR, 5.33; 95% CI, 1.10 to 25.92) and married (aOR, 6.35; 95% CI, 1.44 to 27.99) women being more likely to report fertility intentions than divorced/widowed women. CONCLUSIONS: ART use was a significant predictor of change in fertility intentions between the baseline and follow-up visit, which suggests that additional efforts are necessary to integrate family planning and HIV services to address the safe fertility goals of women in the study area.
Child ; Ethiopia* ; Family Planning Services ; Female ; Fertility* ; Follow-Up Studies* ; HIV ; Humans* ; Intention* ; Logistic Models ; Marital Status ; Odds Ratio ; Prospective Studies* ; Reproductive Health

OBJECTIVES: This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran. METHODS: Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants. RESULTS: The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index. CONCLUSIONS: Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.
Adult* ; Chronic Disease ; Cross-Sectional Studies* ; Education ; Family Characteristics ; Humans ; Iran ; Life Style ; Linear Models ; Male ; Medically Uninsured ; Motor Activity ; Quality of Life* ; Self Care ; Smoke ; Smoking ; Social Class ; Visual Analog Scale

OBJECTIVES: A survival analysis of breast cancer patients in southern Iran according to age has yet to be conducted. This study aimed to quantify the factors contributing to a poor prognosis, using Cox and empirical Bayesian additive hazard (EBAH) models, among young (20-39 years), middle-aged (40-64 years), and elderly (≥ 65 years) women. METHODS: Data from 1,574 breast cancer patients diagnosed from 2002 to 2012 in the cancer registry of Fars Province (southern Iran) were stratified into 3 age groups. The Kaplan-Meier method was used to estimate the overall survival rates. Cox and EBAH models were applied to each age category, and the Akaike information criterion was used to assess the goodness-of-fit of the 2 hazard models. RESULTS: As of December 2012, 212 women (13.5%) in our study population had died, of whom 43 were young (15.3%), 134 middle-aged (11.8%), and 35 elderly (22.3%). The 5-year survival probability by age category was 0.83 (standard error [SE], 0.03), 0.88 (SE, 0.01), and 0.75 (SE, 0.04), respectively. CONCLUSIONS: The Nottingham Prognostic Index was the most effective prognostic factor. The model based on Bayesian methodology performed better with various sample sizes than the Cox model, which is the most widely used method of survival analysis.
Aged* ; Breast Neoplasms* ; Breast* ; Female ; Humans ; Iran* ; Methods ; Prognosis ; Proportional Hazards Models* ; Sample Size ; Survival Rate

As the paradigm in healthcare nowadays is the evidence-based, patient-centered decision making, the issue of shared decision making (SDM) is highlighted. The aims of this manuscript were to look at the relevant concepts and suggest the facilitating strategies for overcoming barriers of conducting SDM. While the definitions of SDM were discordant, several concepts such as good communication, individual autonomy, patient participants, and patient-centered decision-making were involved. Further, the facilitating strategies of SDM were to educate and train physician, to apply clinical practice guidelines and patient decision aids, to develop valid measurement tools for evaluation of SDM processes, and to investigate the impact of SDM.
Decision Making* ; Decision Support Techniques ; Delivery of Health Care ; Evidence-Based Medicine ; Health Policy ; Humans ; Patient Participation ; Personal Autonomy

OBJECTIVES: The purpose of this study was to establish a basis for improving or strengthening the preventive strategy against scrub typhus in Korea by comparing and analyzing the difference of prevention behaviors contributing to the occurrence of scrub typhus in Japan and Korea. METHODS: The survey was carried out in Jeollabuk-do, which is a high risk and high incidence area, and Fukuoka Prefecture, which is a high risk and low incidence area. The study included 406 Korean farmers and 216 Japanese farmers. Data were collected through face-to-face surveys by interviewers who had completed standardized education. RESULTS: Korean farmers have a higher percentage of agricultural working posture that involved contact with weeds than Japanese farmers (p < 0.05). The frequency and proportion of weeding were lower in Korean farmers than in Japanese farmers (p < 0.05). The level of knowledge about scrub typhus was significantly higher among Korean farmers than among Japanese farmers (p < 0.05). Mostly, the behavior of agriculture work was more appropriate for Japanese farmers than for Korean farmers (p < 0.05). The total average level of agricultural work was lower in Korea than in Japan, lower in men than women, and lower in part-time farmers than full-time farmers (p < 0.05). CONCLUSIONS: This study suggests that it is reasonable to develop and provide a program that can improve the level of preventive behavior taking into consideration the characteristics of the subject in order to reduce the incidence of diseases in high-risk areas for scrub typhus.
Agriculture ; Asian Continental Ancestry Group ; Education ; Farmers ; Female ; Humans ; Incidence* ; Japan* ; Jeollabuk-do ; Korea* ; Male ; Posture ; Scrub Typhus*

This study aims to provide a systematical introduction of age-period-cohort (APC) analysis to South Korean readers who are unfamiliar with this method (we provide an extended version of this study in Korean). As health data in South Korea has substantially accumulated, population-level studies that explore long-term trends of health status and health inequalities and identify macrosocial determinants of the trends are needed. Analyzing long-term trends requires to discern independent effects of age, period, and cohort using APC analysis. Most existing health and aging literature have used cross-sectional or short-term available panel data to identify age or period effects ignoring cohort effects. This under-use of APC analysis may be attributed to the identification (ID) problem caused by the perfect linear dependency across age, period, and cohort. This study explores recently developed three APC models to address the ID problem and adequately estimate the effects of A-P-C: intrinsic estimator-APC models for tabular age by period data; hierarchical cross-classified random effects models for repeated cross-sectional data; and hierarchical APC-growth curve models for accelerated longitudinal panel data. An analytic exemplar for each model was provided. APC analysis may contribute to identifying biological, historical, and socioeconomic determinants in long-term trends of health status and health inequalities as well as examining Korean's aging trajectories and temporal trends of period and cohort effects. For designing effective health policies that improve Korean population's health and reduce health inequalities, it is essential to understand independent effects of the three temporal factors by using the innovative APC models.
Aging ; Cohort Effect* ; Cohort Studies* ; Health Policy ; Korea ; Methods ; Socioeconomic Factors

OBJECTIVES: This study aimed to identify the characteristics of social networking service (SNS) users and to assess the relationship of those factors to user satisfaction with the SNSs of the National Cancer Information Center (NCIC) in South Korea. METHODS: A Web-based survey was completed by 1,670 users of the NCIC SNSs, who provided data on the sources they consulted for information about cancer, determinants of SNS use, sources of NCIC SNS awareness, the time of day they used the SNS, and their satisfaction level. RESULTS: Facebook users mainly became aware of the NCIC SNSs through an acquaintance's recommendation, while Twitter was accessed through other SNSs or blogs. Users in their 30s were less satisfied with the NCIC SNSs than those in their teens and 20s. Browsing for cancer-related information on the Internet, prioritizing information quality, and engaging in active use were related to a high level of satisfaction with the NCIC SNSs. Individuals who were exposed to the NCIC SNSs through other SNSs or printed materials were less satisfied with their experience of the NCIC SNSs than those who received a recommendation from an acquaintance. CONCLUSIONS: These findings may act as a catalyst to guide public health agencies to enhance their use of SNSs.
Adolescent ; Blogs ; Humans ; Information Centers* ; Internet ; Korea* ; Public Health