Epidemiology and Health

Original article

A decision tree model for traffic accident prediction among food delivery riders: Muslimah Molo, Suttida Changsan, Lila Madares, Ruchirada Changkwanyeun, Supang Wattanasoei, Supa Vittaporn, Patcharin Khamnuan, Surangrat Pongpan, Kasama Pooseesod, Sayambhu Saita; Epidemiol Health. 2024;e2024095. Published online November 26, 2024; DOI: https://doi.org/10.4178/epih.e2024095 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Food delivery riders (FDRs) play a crucial role in the food delivery industry but face considerable challenges, including a rising number of traffic accidents. This study aimed to examine the incidence of traffic accidents and develop a decision tree model to predict the likelihood of traffic accidents among FDRs.
METHODS
A cross-sectional study was conducted with 257 FDRs in Chiang Mai and Lampang Province, Thailand. Participants were interviewed using questionnaires and provided self-reports of accidents over the previous 6 months. Univariable logistic regression was used to identify factors influencing traffic accidents. Subsequently, a decision tree model was developed to predict traffic accidents using a training and validation dataset split in a 70:30 ratio.
RESULTS
The results indicated that 45.14% of FDRs had been involved in a traffic accident. The decision tree model identified several significant predictors of traffic accidents, including delivering food in the rain, job stress, fatigue, inadequate sleep, and the use of a modified motorcycle, achieving a prediction accuracy of 66.54%.
CONCLUSIONS
Based on this model, we recommend several measures to minimize accidents among FDRs: ensuring adequate sleep, implementing work-rest schedules to mitigate fatigue, managing job-related stress effectively, inspecting motorcycle conditions before use, and exercising increased caution when delivering food during rainy conditions.; Summary

Systematic review

A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers: Bita Azmi-Naei, Fatemeh Shahbazi, Nazanin Azmi-Naei, Jalal Poorolajal; Epidemiol Health. 2024;e2024094. Published online November 26, 2024; DOI: https://doi.org/10.4178/epih.e2024094 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.
METHODS
We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2 statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio (RR) or odds ratio (OR), accompanied by a 95% confidence interval (CI), using a random-effects model.
RESULTS
From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50-0.59) for cervical cancer, 0.82 (95% CI, 0.77-0.88) for ovarian cancer, and 0.96 (95% CI, 0.89-1.04) for uterine cancer.
CONCLUSIONS
Our findings suggest that experiencing one’s initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.; Summary

Original article

Miscarriage, stillbirth, and mortality risk from stroke in women: findings from the PLCO study: Hui Tang, Zhou Li, Yuan Zhang, Mingjun Dai, Xiaoya Wang, Chuan Shao; Epidemiol Health. 2024;e2024093. Published online November 25, 2024; DOI: https://doi.org/10.4178/epih.e2024093 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Existing evidence suggests that miscarriage and stillbirth are associated with an increased risk of stroke in women. However, the impact of these events on stroke mortality remains unclear. This study aimed to elucidate the potential association between miscarriage and stillbirth and stroke mortality in women.
METHODS
We employed a competing risk model using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between miscarriage/stillbirth and stroke death. Death from other causes was considered as a competing risk, and we conducted a subgroup analysis to explore the potential impact.
RESULTS
Our study included 68,629 women for miscarriage and 65,343 women for stillbirth. No significant association was observed between miscarriage and stroke mortality (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.84-1.10; p=0.58). While a single stillbirth did not show a significant association (HR=1.07; 95% CI, 0.81-1.41, p=0.63), recurrent stillbirth (≥2) was associated with a significantly increased risk of stroke mortality compared to women with no stillbirths (HR=2.24; 95% CI, 1.45-3.46, p<0.001).
CONCLUSIONS
Our findings suggest that recurrent stillbirth, but not single events, is associated with an elevated risk of stroke mortality in women. Further research is warranted to clarify the underlying mechanisms and potential long-term health implications of recurrent pregnancy loss.; Summary

Epidemiologic investigation

Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Republic of Korea: Mingyeol Shim, Soo Hyeon Cho, Seung-eun Lee, Taeyoung Kim; Epidemiol Health. 2024;e2024092. Published online November 24, 2024; DOI: https://doi.org/10.4178/epih.e2024092 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of South Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.
METHODS
We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.
RESULTS
Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had HIV infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.
CONCLUSIONS
In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.; Summary

Letter

Letter to the Editor: Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey: Jinyue Chen, Haozhu Chen; Epidemiol Health. 2024;46:e2024091. Published online November 22, 2024; DOI: https://doi.org/10.4178/epih.e2024091

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Original article

Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study: Wonmook Hwang, Eu Jin Lee`, Jae-Hyeong Park, Soon-Ki Ahn; Epidemiol Health. 2024;e2024090. Published online November 19, 2024; DOI: https://doi.org/10.4178/epih.e2024090 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD.
METHODS
In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic BP (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed.
RESULTS
In total, 111,900 adults (53,420 women, 51.9  6.4 years old) presented with 2 SBP trajectory classes: class 1 (n = 66,935) and class 2 (n = 44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.114; 95% confidence interval [CI], 1.989-2.246, p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in men (HR, 1.093; 95% CI, 1.005-1.189; p=0.037), but not in women (HR, 1.059; 95% CI, 0.947-1.184; p=0.321).
CONCLUSIONS
An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.; Summary

Cohort profile

Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring: Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;e2024089. Published online November 18, 2024; DOI: https://doi.org/10.4178/epih.e2024089 [Accepted]

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Abstract PDF: Abstract
The Korean Atomic Bomb Survivor Cohort (K-ABC) study was designed to investigate the health impacts of atomic bomb exposure on Korean survivors and to explore whether these effects are passed down genetically to their descendants. This paper outlines the study's design, data collection methods, baseline sociodemographic characteristics, exposure status, and disease prevalence among the participants, based on survey responses and health examinations. From 2020 to 2024, a total of 2,544 individuals, comprising 1,109 atomic bomb survivors (G1), 1,193 children of G1 (G2), and 242 grandchildren of G1 (G3), consented to participate in the study. Of these, 1,828 participants (659 in G1, 927 in G2, and 242 in G3) completed the survey and underwent health examinations, representing a participation rate of 71.9%. Exposure information was gathered using a questionnaire and verified through records from the Korean Red Cross and a handbook issued by the Japanese government. Disease prevalence was determined based on participants' self-reported physician diagnoses. This study presents details about the K-ABC study and provides baseline data on the participants recruited. These data will be valuable for interpreting the results of future K-ABC studies.; Summary

Original articles

Importance of younger age group and high inflammatory status in the association between periodontal disease and diabetes mellitus: Hyunmin Lee, Myung-Hee Shin; Epidemiol Health. 2024;e2024088. Published online November 15, 2024; DOI: https://doi.org/10.4178/epih.e2024088 [Accepted]

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1 Crossref

Abstract PDF

Abstract

OBJECTIVES
Although previous studies have demonstrated an association between periodontal disease (PD) and diabetes mellitus (DM), the influence of age and the mediating role of inflammation have seldom been explored. This study investigated this association while considering the modifying effects of age and inflammatory status.

METHODS

This study included 29,491 participants from the 2012-2018 Korea National Health and Nutrition Examination Survey. The community periodontal index (CPI) was assessed by trained dentists using the World Health Organization CPI probe. PD was defined as a CPI score of 3 or 4. Pre-existing and incident DM were identified based on serum glucose levels, a history of DM diagnosis, medication use, and insulin injections. Serum high-sensitivity C-reactive protein (hs-CRP) levels were utilized as an indicator of chronic inflammation.

RESULTS

PD and DM exhibited a significant association, which was more pronounced with incident DM than with pre-existing DM, particularly in individuals younger than 65 years. Among those aged 20-44 years, the odds ratio of incident DM for CPI=4 versus CPI=0 was 2.61 (95% confidence interval, 1.16-6.09). High hs-CRP levels (≥3 mg/L) were also associated with DM, especially in individuals with PD. This association was stronger with incident DM than with pre-existing DM. A notable joint effect was observed in younger individuals and those with PD.

CONCLUSIONS

The association between PD and DM was more pronounced in younger age groups and those with higher levels of inflammation. Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Summary

Citations

Citations to this article as recorded by

Resveratrol supplementation as a non-surgical treatment in periodontitis and related systemic conditions
Caterina Vinciguerra, Loredana Bellia, Graziamaria Corbi, Sandro Rengo, Alessandro Cannavo
Journal of Traditional and Complementary Medicine.2024;[Epub] CrossRef

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Republic of Korea: Sunghee Hong, Jihye Kim, Soo-Nam Jo, Jong-Hun Kim, Boyoung Park, Bo Youl choi; Epidemiol Health. 2024;e2024087. Published online November 8, 2024; DOI: https://doi.org/10.4178/epih.e2024087 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data.
METHODS
Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included.
RESULTS
Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas Plasmodium malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021.
CONCLUSIONS
Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.; Summary

An outbreak of Clostridium perfringens infection on a training ship anchored in Busan, Korea: Seonmi Kim, Hyunjin Son; Epidemiol Health. 2024;e2024086. Published online November 7, 2024; DOI: https://doi.org/10.4178/epih.e2024086 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
In September 2023, an outbreak of food-borne disease occurred among students on a training ship docked in Busan. This was an epidemiological investigation with the aim of improving infection prevention activities and group meal service practices on board ships.
METHODS
In this study, a case was defined as an individual who experienced diarrhea more than twice a day during their training period aboard the training ship. A total of 171 exposed individuals including 6 food handlers was well-defined; therefore, a retrospective cohort study was conducted. We administered a questionnaire and conducted laboratory tests including 38 rectal swab samples. Relative risk (95% confidence interval) for each food item was calculated.
RESULTS
Of the 165 students and school staff members, 41 met the case definition, resulting in an attack rate of 24.8%; all cases were students. The shape of the epidemic curve was unimodal, with the peak from 0:00 to 06:00 on September 7, 2023. Clostridium perfringens was detected in 9 cases, and no other pathogens were found. Significant relative risk was shown in 11 different food items.
CONCLUSIONS
Clostridium perfringens was the causative pathogen of this outbreak on the training ship. Due to the lack of preserved food samples, the exact source of infection could not be confirmed. Ships are not classified as collective dining facilities, leaving them in a management blind spot. Therefore, specialized guidelines, voluntary inspections by the operating entities, and continuous education for managers and staff are necessary.; Summary

Original Articles

Associations between taxi drivers’ aggressive driving behavior and sleep, cognition, and psychological factors in Korea: negative binomial regression analysis: Jong Sun Ok, Hyeongsu Kim, Soo Young An, Mi Young Kim; Epidemiol Health. 2024;46:e2024085. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024085

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Abstract Summary PDF: Abstract
OBJECTIVES
Aggressive driving behavior is a significant predictor of traffic accidents. In particular, the driving behavior of taxi drivers is a critical issue that can impact the safety of both drivers and passengers. This study explored the sleep, cognitive, and psychological factors associated with taxi drivers’ aggressive driving behavior.
METHODS
In this descriptive study, a self-report questionnaire was distributed to taxi drivers in Seoul and Gyeonggi Province from August 22, 2022 to December 30, 2022. In all, 992 respondents were analyzed using negative binomial regression.
RESULTS
The mean score for aggressive driving behavior among taxi drivers was 13.76±11.47, with sub-scores of 3.46±3.48 for lapse, 3.31±3.16 for error, and 6.99±5.76 for violation. Contributing factors included sleep disorders, cognitive decline, and psychological factors. A higher score for aggressive driving behavior was associated with an increased severity of insomnia and daytime sleepiness, higher rates of cognitive failure, and elevated levels of depression and stress.
CONCLUSIONS
Our findings highlight the importance of addressing the sleep, cognitive, and psychological factors associated with aggressive driving behaviors among taxi drivers. Further study is needed to evaluate the causal relationship. In addition, it is imperative to develop educational programs and interventions to manage these issues effectively.; Summary

Korean summary
택시 기사의 안전운전 행동은 교통사고, 운전자와 승객의 안전과 연결된 이슈이다. 기존 연구에서 택시 기사의 가파른 고령화와 열악한 직업 환경 등이 과격한 운전행위의 영향요인으로 보고하고 있다. 이 연구에서 택시기사의 수면, 인지기능 및 심리적인 요인도 과격한 운전행위와 관련이 있음으로 보여주고 있다.

Key Message
It is important to predict taxi drivers’ aggressive driving behavior to decrease the traffic accidents that result from such be- havior. Previous studies have shown that general and occupational characteristics have a significant impact on aggressive driving behavior, whereas research on the psychological factors is limited. Our comprehensive investigation of the psycho- logical factors as well as the sleep factors and cognitive functions of taxi drivers (as part of a rapidly aging population) showed a significant relationship between these factors and aggressive driving behavior.

The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey: Sun Hee Na, Joong Sik Eom, Sun Bean Kim, Hyung Jin Yoon, So Yeon Yoo, Kyeong Sook Cha, Jong Rim Choi, Ji Youn Choi, Si Hyeon Han, Jin Ju Park, Tark Kim, Jacob Lee; Epidemiol Health. 2024;46:e2024084. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024084

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Abstract Summary PDF: Abstract
OBJECTIVES
Long-term care facilities (LTCFs) are communal environments for patients with chronic diseases or older adults, making them particularly susceptible to significant harm during infectious disease outbreaks. Nonetheless, LTCFs have historically been subject to less stringent infection prevention and control (IPC) mandates. This study aimed to assess the current state of LTCFs and to develop an IPC system tailored for these facilities following the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We conducted an online survey of 11,366 LTCFs in Korea from December 30, 2022 to January 20, 2023, to evaluate the components of IPC in LTCFs. The infectious diseases targeted for IPC included COVID-19, influenza, and scabies. Additionally, we compared institution-based and home-based long-term care insurance facilities.
RESULTS
Overall, 3,537 (31.1%) LTCFs responded to the survey, comprising 1,819 (51.4%) institution-based and 1,718 (48.6%) home-based facilities. A majority (87.4%, 2,376/2,720) of these facilities experienced COVID-19 outbreaks. However, only 42.2% of home-based facilities, in contrast to 90.6% of institution-based facilities, were equipped to manage concurrent COVID-19 cases. Similarly, while 92.1% of institution-based facilities were capable of managing influenza, only 50.5% of home-based facilities could do the same. The incidence of scabies was significantly higher in institution-based facilities than in home-based ones (26.1 vs. 4.3%). Additionally, 88.7% of institution-based facilities managed scabies cases effectively, compared to only 42.1% of home-based facilities.
CONCLUSIONS
Approximately half of the LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capabilities between institution-based facilities and home-based facilities.; Summary

Korean summary
장기요양기관을 대상으로 실태조사가 시행되었습니다. 50% 기관에서 감염병에 대한 기본 대응능력을 가지고 있었지만 시설급여기관과 재가급여기관 사이 대응능력에 차이가 있었습니다.

Key Message
A survey of long-term care facilities (LTCFs) was conducted. Fifty per cent of LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capacity between institution-based and home-based facilities.

Original articles

Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study: Hye Won Woo, Sangmo Hong, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2024;e2024083. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024083 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.0173). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.0066), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.0014 and 0.0112, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.; Summary

Association between the safety climate and occupational injury in the Korean working population: a cross-sectional study: Jeehee Min, Tae-Won Jang, Hye-Eun Lee, Mo-Yeol Kang, Seong-Sik Cho; Epidemiol Health. 2024;e2024082. Published online October 1, 2024; DOI: https://doi.org/10.4178/epih.e2024082 [Accepted]

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Abstract Summary PDF: Abstract
OBJECTIVES
Preventing occupational injuries remains a significant challenge in Korea. A positive safety climate can contribute to reducing workplace injuries. However, the impact of safety climate on preventing occupational injuries among the Korean workforce has not been adequately explored. Therefore, this study aimed to investigate the relationship between the perceived safety climate and occupational injuries within the Korean working population.
METHODS
This study used baseline data from the Korean Work, Sleep, and Health Study (KWSH). The safety climate was measured using the brief version of the Nordic Safety Climate Questionnaire. Occupational injury was determined by whether injuries or accidents had occurred at workplaces in the past year. Logistic regression analysis was performed to examine the association between the safety climate and occupational injury.
RESULTS
Participants who reported an unfavorable workplace safety climate were more likely to experience occupational injuries. Multiple logistic regression analysis revealed that the adjusted odds ratio (OR) for occupational injuries in an unfavorable safety climate was 2.20 (95% confidence interval [CI], 1.38–3.51) compared to a favorable safety climate. Specifically, factors such as “not encouraging employees to follow safety rules when on a tight schedule” (OR, 2.02; 95% CI, 1.25–3.24) and “not helping each other work safely” (OR, 1.98; 95% CI, 1.17–3.25) were significantly associated with occupational injuries.
CONCLUSIONS
An unfavorable safety climate was associated with increased occupational injuries among Korean workers. Improving the safety climate in the workplace may reduce occupational injuries in Korea.; Summary

Korean summary
한국 노동인구집단에서도 안전풍토는 직업성 손상과 관련성이 관찰되었다. 이 같은 결과는 작업장의 안전풍토를 개선함으로써 직업성 손상을 예방할 수 있음을 시사한다.

Key Message
Safety climate was related to occupational injuries in the Korean working population. This result may indicate that occupational injuries can be prevented by improving the workplace safety climate. Workplace safety should be a high priority goal for management, and workers need to help each other for workplace safety.

COVID-19: Original Article

Analyzing the dynamics of complicated and uncomplicated appendicitis during the COVID-19 pandemic in Seoul, Korea: a multifaceted time series approach: Kiook Baek, Chulyong Park; Epidemiol Health. 2024;46:e2024081. Published online October 1, 2024; DOI: https://doi.org/10.4178/epih.e2024081

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated control strategies on the incidence of appendicitis in Seoul, using data from 2018 to 2020 from Korea’s National Health Insurance.
METHODS
We analyzed records of total, complicated, and uncomplicated appendicitis cases, as well as the ratio of complicated to uncomplicated appendicitis, using natural spline and piecewise regression models to identify trends and breakpoints. Bayesian structural time-series (BSTS) models were used to evaluate the causal impact of social distancing on appendicitis incidences.
RESULTS
The spline regression analysis indicated decreasing trends in both total and uncomplicated appendicitis cases. Conversely, the incidence of complicated appendicitis and the ratio of complicated to uncomplicated cases increased. Breakpoints for a decline in uncomplicated appendicitis and a rise in the ratio occurred at 31 weeks in 2020 (95% confidence interval [CI], 23.2 to 38.8) and at 33.9 weeks (95% CI, 28.3 to 39.6), respectively. The BSTS model demonstrated a 7.8% reduction in total appendicitis cases (95% credible interval [CrI], -12.1 to -3.3). It also showed a 17.4% decrease in uncomplicated cases (95% CrI, -22.2 to -12.3) and increases of 12.8% (95% CrI, 4.9 to 22.0) in complicated cases and 39.0% (95% CrI, 27.0 to 53.3) in the ratio of complicated to uncomplicated appendicitis.
CONCLUSIONS
The COVID-19 pandemic resulted in a decrease in both total and uncomplicated appendicitis cases, while the number of complicated cases increased. Reduced medical visits likely accounted for these changes. Strategies are needed to manage changes in disease pathophysiology resulting from altered healthcare utilization during health crises.; Summary

Korean summary
-여러 연구에서 COVID-19 유행기간에 급성 충수염의 역학에 대한 변화가 있었다는 보고가 있어 국내 건강보험 청구 자료를 사용하여 확인하고자 하였다. -시계열 데이터로 역학의 변동 시점에 대한 분석을 수행한 결과, 유의미한 합병증이 없는 충수염의 감소와, 합병증을 동반한 충수염의 비율 변동이 시작된 시점은 사회적 거리두기를 한 시점과 유사한 것으로 나타났다. -사회적 거리두기를 한 시점 전후의 급성 충수염 역학을 비교하였을 때, 총 급성 충수염 및 합병증이 없는 충수염은 감소하는 경향이, 합병증을 동반한 충수염은 증가하는 경향이 유의하게 보였다.

Key Message
Several studies have reported changes in the epidemiology of acute appendicitis during the COVID-19 pandemic; this study aimed to confirm these findings using national health insurance claims data. Time-series analysis of the epidemiological shift points showed that the decrease in uncomplicated appendicitis cases and the shift in the proportion of complicated appendicitis cases occurred around the time social distancing measures were implemented. When comparing the epidemiology of acute appendicitis before and after the onset of social distancing, there was a significant decrease in the incidence of total acute appendicitis and uncomplicated cases, with a significant increase in complicated appendicitis cases.

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