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Trends in Sex Ratio at Birth according to Parental Social Positions: Results from Vital Statistics Birth, 1981-2004 in Korea.

Heeran CHUN ; Il Ho KIM ; Young Ho KHANG

Journal of Preventive Medicine and Public Health.2009;42(2):143-150. doi:10.3961/jpmph.2009.42.2.143

OBJECTIVES: South Korea has experienced unprecedented ups and downs in the sex ratio at birth (SRB), which has been a unique phenomenon in the last two decades. However, little is known about socioeconomic factors that influence the SRB. Employing the diffusion theory by Rogers, this study was undertaken to examine the trends in social variations in the SRB from 1981 to 2004 in Korea. METHODS: The data was taken from Vital Birth Statistics for the period from 1981-2004. We computed the annual male proportion of live births according to the parental education (university, middle/high school, primary) and occupation (non-manual, manual, others). Logistic regression analysis was employed to estimate the odds ratios of male birth according to social position for the equidistant three time periods (1981-1984, 1991-1994, and 2001-2004). RESULTS: An increased SRB was detected among parents with higher social position before the mid 1980s. Since then, however, a greater SRB was found for the less educated and manual jobholders. The inverse social gradient for the SRB was most prominent in early 1990s, but the gap has narrowed since the late 1990s. The mother's socioeconomic position could be a sensitive indicator of the social variations in the sex ratio at birth. CONCLUSIONS: Changes in the relationship of parental social position with the SRB were detected during the 1980-2004 in Korea. This Korean experience may well be explained by diffusion theory, suggesting there have been socioeconomic differences in the adoption and spread of sex-detection technology.
Abortion, Induced/trends ; Diffusion of Innovation ; Educational Status ; Female ; Humans ; Korea ; Male ; Occupations ; *Parents ; Pregnancy ; Regression Analysis ; *Sex Ratio ; *Socioeconomic Factors

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An Evaluation of Sampling Design for Estimating an Epidemiologic Volume of Diabetes and for Assessing Present Status of Its Control in Korea.

Ji Sung LEE ; Jaiyong KIM ; Sei Hyun BAIK ; Ie Byung PARK ; Juneyoung LEE

Journal of Preventive Medicine and Public Health.2009;42(2):135-142. doi:10.3961/jpmph.2009.42.2.135

OBJECTIVES: An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. METHODS: We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. RESULTS: Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04% (95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. CONCLUSIONS: The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.
Bias (Epidemiology) ; Cluster Analysis ; Diabetes Mellitus/*epidemiology/prevention & control ; Epidemiologic Methods ; Humans ; Insurance Claim Review ; Korea ; Medical Records ; Sampling Studies

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The Association Between Public Social Expenditure and Suicides: Evidence from OECD Countries.

Yoojin PARK ; Myoung hee KIM ; Soonman KOWN ; Young jeon SHIN

Journal of Preventive Medicine and Public Health.2009;42(2):123-129. doi:10.3961/jpmph.2009.42.2.123

OBJECTIVES: This study aimed to examine the association between public social expenditure (PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development (OECD) from 1980 to 2003. METHODS: The age-standardized suicide rates and their annual change (%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE (% GDP) was used. The covariates included the annual divorce rate (/100,000 population), fertility rate (number of children/woman aged 15 to 49 years), GDP per capita (US$PPP), male unemployment rate (%), life expectancy (years) and alcohol consumption (liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides (Model 1) and the annual percent change (Model 2) were examined (Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. RESULTS: We could not find significant effects of PSE on suicides (Model 1), but we observed significantly negative effects on the annual percent change for men and women (Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger (Model 3). CONCLUSIONS: Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.
Developed Countries/*statistics & numerical data ; Health Expenditures/*statistics & numerical data ; Health Status ; Humans ; *Public Policy ; Social Welfare ; Socioeconomic Factors ; Suicide/prevention & control/*statistics & numerical data

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Prognostic Impact of Charlson Comorbidity Index Obtained from Medical Records and Claims Data on 1-year Mortality and Length of Stay in Gastric Cancer Patients.

Min Ho KYUNG ; Seok Jun YOON ; Hyeong Sik AHN ; Se min HWANG ; Hyun Ju SEO ; Kyoung Hoon KIM ; Hyeung Keun PARK

Journal of Preventive Medicine and Public Health.2009;42(2):117-122. doi:10.3961/jpmph.2009.42.2.117

OBJECTIVES: We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.
Aged ; Comorbidity ; Female ; Humans ; Insurance Claim Review ; *Length of Stay ; Male ; Medical Records ; Middle Aged ; Neoplasm Staging ; Prognosis ; Severity of Illness Index ; Stomach Neoplasms/diagnosis/*mortality

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Effects of Antiretroviral Therapy on the Survival of Human Immunodeficiency Virus-positive Adult Patients in Andhra Pradesh, India: A Retrospective Cohort Study, 2007-2013.

Ram BAJPAI ; Himanshu CHATURVEDI ; Lakshmanan JAYASEELAN ; Pauline HARVEY ; Nicole SEGUY ; Laxmikant CHAVAN ; Pinnamaneni RAJ ; Arvind PANDEY

Journal of Preventive Medicine and Public Health.2016;49(6):394-405. doi:10.3961/jpmph.16.073

OBJECTIVES: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS: The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mm³ vs. >350 cells/mm³), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.
Acquired Immunodeficiency Syndrome ; Adult* ; Body Weight ; CD4 Lymphocyte Count ; Cohort Studies* ; Counseling ; Follow-Up Studies ; HIV ; Humans* ; India* ; Mortality ; Retrospective Studies* ; Survival Analysis ; Survival Rate

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A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran.

Sajad DELAVARI ; Mohammad ARAB ; Arash RASHIDIAN ; Saharnaz NEDJAT ; Rahmatollah Gholipour SOUTEH

Journal of Preventive Medicine and Public Health.2016;49(6):386-393. doi:10.3961/jpmph.16.062

OBJECTIVES: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS: Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS: Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.
Curriculum ; Delivery of Health Care ; Education ; Education, Medical* ; General Practitioners* ; Humans ; Iran* ; Rural Health ; School Admission Criteria ; Telephone

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Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study.

Firooz ESMAEILZADEH ; Abdolhalim RAJABI ; Sajad VAHEDI ; Mohammad SHAMSADINY ; Mousa GHELICHI GHOJOGH ; Nahid HATAM

Journal of Preventive Medicine and Public Health.2017;50(3):210-216. doi:10.3961/jpmph.17.027

OBJECTIVES: One way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxis (PEP). Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delays in PEP initiation. METHODS: This cross-sectional study was conducted in Iran in 2011, and included 7097 cases of animal bites recorded at the Rabies Treatment Center of the Shiraz University of Medical Sciences using the census method. Logistic regression was used to identify factors associated with delays in PEP. RESULTS: Among the patients studied, 5387 (75.9%) were males. The prevalence of animal bites in Fars province was 154.4 per 100 000 people. Dogs were the most frequent source of exposure (67.1%), and the most common bitten part of the body was the hands (45.5%). A delay in the initiation of PEP was found among 6.8% of the studied subjects. This delay was more likely in housewives (odds ratio [OR], 4.66; 95% confidence interval [CI], 2.12 to 10.23) and less likely in people with deep wounds (OR, 0.65; 95% CI, 0.43 to 0.97). CONCLUSIONS: Although all animal bite victims received complete PEP, in some cases, there were delays. Further, the type of animal involved, the depth of the bite, and the patient’s occupation were the major factors associated with a delay in the initiation of PEP for rabies prevention.
Animals* ; Censuses ; Cross-Sectional Studies ; Dogs ; Epidemiology* ; Hand ; Humans ; Iran ; Logistic Models ; Male ; Occupations ; Post-Exposure Prophylaxis* ; Prevalence ; Rabies* ; Vaccination ; Wounds and Injuries

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Current Status of Infection Prevention and Control Programs for Emergency Medical Personnel in the Republic of Korea.

Hyang Soon OH ; Dong Choon UHM

Journal of Preventive Medicine and Public Health.2015;48(6):330-341. doi:10.3961/jpmph.15.058

OBJECTIVES: Emergency medical personnel (EMPs) are pre-hospital emergency responders who are at risk of exposure to infections and may also serve as a source for the transmission of infections. However, few studies of infection control have specifically addressed EMPs in the Republic of Korea (hereafter Korea). The goal of this study was to assess the current status of infection prevention and control programs (IPCPs) for EMPs in Korea. METHODS: A cross-sectional survey was conducted to quantitatively assess the resources and activities of IPCPs. A total of 907 EMPs in five metropolitan cities completed a structured questionnaire from September 2014 to January 2015. The data were analyzed using descriptive statistics, multi-response analysis, and the chi-square test. RESULTS: The mean age of the participants was 34.8+/-15.1 years. IPCPs were found to have weaknesses with regard to the following resources: the assignment of infection control personnel (ICP) (79.5%), hand hygiene resources such as waterless antiseptics (79.3%), the use of paper towels (38.9%), personal protective equipment such as face shields (46.9%), and safety containers for sharps and a separated space for the disposal of infectious waste (10.1%). Likewise, the following activities were found to be inadequately incorporated into the workflow of EMPs: education about infection control (77.5%), post-exposure management (35.9%), and the decontamination of items and spaces after use (88.4%). ICP were found to have a significant effect on the resources and activities of IPCPs (p<0.001). The resources and activities of IPCPs were found to be significantly different among the five cities (p<0.001). CONCLUSIONS: IPCPs for EMPs showed some limitations in their resources and activities. IPCPs should be actively supported, and specific IPCP activities for EMPs should be developed.
Adult ; Cross Infection/*prevention & control ; Cross-Sectional Studies ; Emergency Medical Services ; Female ; Hand Hygiene ; Health Personnel/*psychology ; Humans ; *Infection Control ; Male ; Medical Waste Disposal ; Middle Aged ; Protective Devices ; Republic of Korea ; Self Report ; Surveys and Questionnaires

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Factors Determining Children's Private Health Insurance Enrolment and Healthcare Utilization Patterns: Evidence From the 2008 to 2011 Health Panel Data.

Jawoon SHIN ; Tae Jin LEE ; Sung Il CHO ; Seung Ah CHOE

Journal of Preventive Medicine and Public Health.2015;48(6):319-329. doi:10.3961/jpmph.15.057

OBJECTIVES: Parental socioeconomic status (SES) exerts a substantial influence on children's health. The purpose of this study was to examine factors determining children's private health insurance (PHI) enrolment and children's healthcare utilization according to PHI coverage. METHODS: Korea Health Panel data from 2011 (n=3085) was used to explore the factors determining PHI enrolment in children younger than 15 years of age. A logit model contained health status and SES variables for both children and parents. A fixed effects model identified factors influencing healthcare utilization in children aged 10 years or younger, using 2008 to 2011 panel data (n=9084). RESULTS: The factors determining children's PHI enrolment included children's age and sex and parents' educational status, employment status, and household income quintile. PHI exerted a significant effect on outpatient cost, inpatient cost, and number of admissions. Number of outpatient visits and total length of stay were not affected by PHI status. The interaction between PHI and age group increased outpatient cost significantly. CONCLUSIONS: Children's PHI enrolment was influenced by parents' SES, while healthcare utilization was affected by health and disability status. Therefore, the results of this study suggest disparities in healthcare utilization according to PHI enrollment.
Adolescent ; Ambulatory Care ; Child ; Child, Preschool ; Cross-Sectional Studies ; Databases, Factual ; Female ; Health Status ; Humans ; Infant ; *Insurance, Health ; Male ; Odds Ratio ; *Patient Acceptance of Health Care ; Republic of Korea ; Social Class

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The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea.

Jin Hee SHIN ; Matthew E DUPRE ; Truls OSTBYE ; Gwen MURPHY ; Mina SILBERBERG

Journal of Preventive Medicine and Public Health.2015;48(6):310-318. doi:10.3961/jpmph.15.001

OBJECTIVES: Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase. METHODS: Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761). RESULTS: Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period. CONCLUSIONS: These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.
Adult ; Aged ; Exercise ; Female ; *Health Behavior ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/epidemiology ; Odds Ratio ; Overweight/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; *Socioeconomic Factors

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