This study deals with the public health effects of a natural disaster and some public health principles that can be applied to disaster risk reduction and management, focusing on earthquake preparedness for Barangay San Jose - Rodriguez, Rizal, Philippines. The study showed that the urban poor community has a weak history of engagement, and it explores whether facilitated community interventions can empower and develop community preparedness. It followed a participatory approach involving community leaders and members. The study indicated that enhancing and modifying interventions that match community needs will develop community preparedness in the community, potentially increasing the chances of surviving an earthquake and minimizing its deleterious and damaging impact. Community preparedness will require continuous involvement and a cooperative approach to working with communities to support equal and harmonized development.
Public health ; Capacity Building ; Risk Reduction Behavior

BACKGROUND: The 2019 novel coronavirus disease (COVID-19) has had a massive impact on public health, resulting in sudden dietary and behavioral habit changes. Frontline epidemic prevention workers play a pivotal role against COVID-19. They must face high-risk infection conditions, insufficient anti-epidemic material supplies, mental pressure, and so on. COVID-19 seriously affects their dietary and behavioral habits, and poor habits make them more susceptible to COVID-19. However, their baseline dietary and behavioral habits before COVID-19 and their willingness to change these habits after the outbreak of COVID-19 remain unclear for these workers in China. This study aimed to explore the baseline dietary and behavioral habits of frontline workers and their willingness to change these habits after the outbreak of the epidemic; in addition, susceptible subgroups were identified by stratified analyses as targets of protective measures to keep them from being infected with COVID-19. METHODS: A cross-sectional study was conducted through an online questionnaire using a sample of 22,459 valid individuals living in China, including 9402 frontline epidemic prevention workers. RESULTS: Before COVID-19, 23.9% of the frontline epidemic prevention workers reported a high-salt diet, 46.9% of them reported a high frequency of fried foods intake, and 50.9% of them smoked cigarettes. After the outbreak of COVID-19, 34.6% of them expressed a willingness to reduce salt intake, and 43.7% of them wanted to reduce the frequency of pickled vegetables intake. A total of 37.9% of them expressed a willingness to decrease or quit smoking, and 44.5% of them wanted to increase sleep duration. Significant differences in the baseline dietary and behavioral habits and the willingness to change their habits were observed between frontline epidemic prevention workers and other participants. Among the frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19, frontline epidemic prevention experience was a promoting factor for adopting worse dietary and behavioral habits, including those in the high-salt intake subgroup (OR, 2.824; 95% CI, 2.341-3.405) and the 11-20 cigarettes/day subgroup (OR, 2.067; 95% CI, 1.359-3.143). CONCLUSIONS The dietary and behavioral habits of frontline epidemic prevention workers were worse than that those of other participants before COVID-19. They had a greater willingness to adopt healthy dietary and behavioral habits after experiencing the outbreak of COVID-19. However, frontline epidemic prevention workers with poor dietary and behavioral habits before COVID-19 continued in engage in these poor habits. Dietary and behavioral intervention policies should be drafted to protect their health, especially frontline epidemic prevention workers with poor habits at baseline.
Adult ; COVID-19/psychology* ; China/epidemiology* ; Cross-Sectional Studies ; Diet/standards* ; Female ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology* ; Humans ; Male ; Risk Reduction Behavior ; SARS-CoV-2 ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.
Atrial Fibrillation ; Follow-Up Studies ; Hemorrhage ; Humans ; International Normalized Ratio ; Prothrombin Time ; Risk Reduction Behavior ; Stroke ; Thromboembolism ; Warfarin

OBJECTIVE: To explore current practice and influencing factors on adoption of the opportunistic salpingectomy (OS), particularly regarding the decision making, to eventually enhance the development and implementation of clear guidelines. METHODS: This nationwide cross-sectional survey study was conducted in all hospitals in the Netherlands. An anonymous online survey was sent to gynecologists with special interest in gynecological oncology, gynecological endoscopy or urogynecology and all Dutch gynecology trainees. The survey mainly focused on current practice regarding OS and identification of influencing factors on the level of innovation, organization, healthcare professional and individual patient. RESULTS: The response rate was 348 out of 597 gynecologists (58.3%) and 142 out of 340 trainees (41.8%). Current practice of discussing and performing the OS varied widely, with ovarian cancer (OC) risk reduction as most important supportive factor on innovation level. Supportive factors on the level of organization and healthcare provider were; working in a non-training hospital, knowledge of current literature and extensive work experience (in years and annual number of hysterectomies). On individual patient level, a vaginal approach of hysterectomy, negative family history for OC and the presence of firm adhesions were suppressive factors for the OS. CONCLUSION: In this study we evaluated the current practice regarding the opportunistic salpingectomy in the Netherlands and identified influencing factors on different levels to raise awareness and attribute to development of a targeted implementation strategy, on both national and international level.
Anonyms and Pseudonyms ; Cross-Sectional Studies ; Decision Making ; Delivery of Health Care ; Endoscopy ; Gynecology ; Health Personnel ; Humans ; Hysterectomy ; Netherlands ; Ovarian Neoplasms ; Primary Prevention ; Risk Reduction Behavior ; Salpingectomy*

BACKGROUND/AIMS: Gallstone disease (GSD) is a common gastrointestinal disorder. Clinical epidemiological studies revealed that alcohol consumption has a preventive effect on the development of GSD. This study aimed to evaluate the relative risks of drinking for GSD development and investigate the dose-response relationships. METHODS: A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases for studies published up to 2018 was performed. All studies that satisfied the following eligibility criteria were included: patients with GSD with or without cholecystitis; and cohort or case-control studies investigating the association between alcohol consumption and GSD development. RESULTS: Sixteen case-control studies including 24,401 gallstone cases and 76,185 controls, and eight cohort studies with 14,693 GSD cases among 2,432,471 person-years were enrolled. Alcohol consumption presented a decreased overall risk of GSD (pooled relative ratio [RR], 0.84; 95% confidence interval [CI], 0.79 to 0.89; p=0.02). Subgroup analyses according to drinking levels indicated a gradual risk reduction for GSD compared to nondrinkers (light: RR, 0.96; 95% CI, 0.94 to 0.99; p=0.75; moderate: RR, 0.80; 95% CI, 0.75 to 0.85; p=0.27; high: RR, 0.66; 95% CI, 0.56 to 0.79; p < 0.01). A nonlinear risk reduction was observed in a dose-response meta-analysis of all the studies (n=14, p < 0.01 for nonlinearity). CONCLUSIONS: In this systematic review with meta-analysis, alcohol consumption could decrease the risk of GSD, and the dose-response analysis revealed a dose-dependent linear risk reduction and a weakened linear trend between alcohol consumption levels less than and greater than 28 g/day.
Alcohol Drinking* ; Case-Control Studies* ; Cholecystitis ; Cohort Studies* ; Drinking ; Epidemiologic Studies ; Gallstones* ; Humans ; Risk Reduction Behavior

Most treatment strategies for asthma currently include inhaled corticosteroids, with the addition of long-acting beta-2-agonists or leukotriene modifiers, if necessary. However, some patients may not respond to conventional treatment. A better understanding of the pathophysiology of asthma has recently led to the development of biological agents, which have shown promising results for symptom control and future risk reduction in severe asthmatics. This article reviews currently available biologic agents, introduces related studies, and describes the subgroup of patients benefitting from each of biologic agents in the view point of precision medicine.
Adrenal Cortex Hormones ; Asthma* ; Biological Factors* ; Biological Therapy ; Humans ; Precision Medicine ; Risk Reduction Behavior

OBJECTIVE: To investigate the relationship between the precursors of high grade serous ovarian cancer (HGSOC) and the characteristics of patients with a low HGSOC risk in terms of the effects of pregnancy. METHODS: We prospectively examined consecutive cases in which the bilateral fallopian tubes were removed during benign gynecological or obstetric surgery and assessed the relationship between the patient characteristics, including parity and pregnancy, and the incidence of HGSOC precursors. All the fallopian tubes were examined by applying the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) Protocol. RESULTS: Of the 113 patients enrolled, 67 were gynecological and 46 were obstetric. The p53 signature was identified in 21 patients. No other precursors were identified. In a comparison of the p53 signature-positive and negative groups, parous women and pregnant women were significantly fewer in the p53 signature-positive group (53% vs. 86%, p=0.002, 10% vs. 47%, p=0.001, respectively). Current pregnancy was also associated with a significantly lower incidence of the p53 signature after multivariate adjustment (odds ratio [OR]=0.112; 95% confidence interval [95% CI]=0.017–0.731; p=0.022). Among gynecological patients, parous women were fewer in the p53 signature-positive group on univariate (47% vs. 73%, p=0.047) and multivariate analysis (OR=0.252; 95% CI=0.069–0.911; p=0.036). No other characteristics were associated with p53 signature positivity. CONCLUSIONS: The incidence of the p53 signature was significantly lower in parous women and pregnant women. This decreased incidence of early phase serous carcinogenesis may be one of the possible mechanisms underlying HGSOC risk reduction among parous women.
Carcinogenesis ; Cystadenocarcinoma, Serous ; Fallopian Tube Neoplasms ; Fallopian Tubes ; Female ; Humans ; Incidence ; Multivariate Analysis ; Obstetric Surgical Procedures ; Ovarian Neoplasms ; Parity ; Pregnancy ; Pregnant Women ; Prospective Studies ; Risk Reduction Behavior ; Tumor Suppressor Protein p53

PURPOSE: Morbid obesity is a well-known risk factor for cardiovascular disease (CVD). This study aimed to quantitatively evaluate the effects of bariatric surgery on CVD risk reduction in Korean obese patients by using three CVD risk prediction models (Framingham General Cardiovascular Risk Score [FRS], Pooled Cohort Equation [PCE], and Korean Risk Prediction Model [KRPM]), and to investigate which procedure between laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) is a better option for CVD risk reduction. MATERIALS AND METHODS: We retrospectively reviewed all obese patients who underwent bariatric surgery at a single institution from October 2009 to May 2016. Of the 1034 patients reviewed, 83 patients (6.5%) who met the criteria for calculating the FRS, PCE, and KRPM scores and had a follow-up of at least 1 year were included in this study. RESULTS: The FRS, PCE, and KRPM scores were significantly decreased at postoperative 1 year (10.47±7.30% to 6.33±4.59%, P=0.000; 5.45±6.25% to 2.75±2.75%, P=0.000; and 4.53±2.96% to 3.49±2.13%, P=0.000, respectively) in LRYGB. The PCE and KRPM scores were significantly decreased (4.13±3.63% to 2.42±2.45%, P=0.004 and 4.14±1.95% to 3.22±1.94%, P=0.000, respectively) in LSG, but not the FRS (9.43±3.58% to 5.63±3.24%, P=0.118). There was no difference in absolute risk reduction in FRS, PCE, and KRPM between LRYGB and LSG (4.13±5.08% and 3.80±3.50%, P=0.788; 2.70±0.52% and 1.72±0.49%, P=0.799; and 1.03±1.85% and 0.92±0.97%, P=0.776, respectively). CONCLUSION: LRYGB and LSG can equally significantly decrease the CVD risk in the Korean population, based on FRS, PCE, and KRPM.
Bariatric Surgery ; Cardiovascular Diseases ; Cohort Studies ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Humans ; Numbers Needed To Treat ; Obesity, Morbid ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Risk Reduction Behavior

In the ranking of cancer incidence in the year, female breast cancer was the highest cancer after thyroid cancer in 2004–2015, and became the most common cancer in 2016, exceeding the cases of thyroid cancer. The incidence rates of breast cancer have increased steadily over the past two decades and are expected to continue to increase in the next decades, although the incidence rates of all other cancers has declined in Korea. Most of the established risk factors of breast cancer are primarily related to female sex hormones. Other known risk factors are alcohol drinking, a family history of breast cancer, genetic predisposition, and benign breast conditions. Some risk factors, such as physical activity, breastfeeding, and number of children, are modifiable factors that can be targeted for risk reduction. This article summarizes the descriptive epidemiological characteristics of breast cancer in Korea that have been reported and identifies the specific characteristics and secular trends in incidence, mortality, and survival rates of breast cancer up to the present day. It is uncertain whether the risk factors established in western populations will also be valid for the Korean population. To explore this question, we summarize the results from international collaborative studies and meta-analyses of risk factors of breast cancer published to date. The results for Koreans are summarized and described based on results from population-based or nested case-control studies, hospital case-community control studies, cohort studies, and meta-analyses conducted in Korea. This study will be helpful for risk assessment, interventions, and prevention of breast cancer.
Alcohol Drinking ; Breast Feeding ; Breast Neoplasms ; Breast ; Case-Control Studies ; Child ; Cohort Studies ; Epidemiology ; Female ; Genetic Predisposition to Disease ; Gonadal Steroid Hormones ; Humans ; Incidence ; Korea ; Mortality ; Motor Activity ; Risk Assessment ; Risk Factors ; Risk Reduction Behavior ; Survival Rate ; Thyroid Neoplasms

BACKGROUND: Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy. METHODS: Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery. RESULTS: Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h. CONCLUSIONS: Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.
Acute Pain ; Anesthetics, Local ; Double-Blind Method ; Fentanyl ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Nephrectomy ; Pain, Postoperative ; Pneumoperitoneum ; Postoperative Nausea and Vomiting ; Risk Reduction Behavior ; Shoulder Pain ; Tissue Donors ; Walking