Summary
Epidemiologic investigation
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Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in the Republic of Korea
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Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, JungSub Park, Ji-Hyuk Park
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Epidemiol Health. 2024;e2024036. Published online March 7, 2024
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DOI: https://doi.org/10.4178/epih.e2024036
[Accepted]
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Abstract
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Abstract
OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.
METHODS
Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.
RESULTS
In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.
CONCLUSIONS
The outbreaks were caused by Salmonella Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of Salmonella, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent Salmonella infections.
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Summary
Original articles
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Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study
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Khongorzul Ganbat, Bayarmaa Nasan Ulzii, Sangah Shin
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Korean J Epidemiol. 2024;e2024035. Published online February 28, 2024
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DOI: https://doi.org/10.4178/epih.e2024035
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Abstract
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Abstract
OBJECTIVES
This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.
METHODS
The study included 12,356 male participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.
RESULTS
The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3, HR=0.801; 95% CI, 0.689–0.930, p for trend=0.0105). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR=0.740; 95% CI, 0.588–0.931; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m² and a waist circumference ≥90 cm.
CONCLUSIONS
This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.
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Summary
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Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans
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Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park
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Epidemiol Health. 2024;e2024034. Published online February 27, 2024
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DOI: https://doi.org/10.4178/epih.e2024034
[Accepted]
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Abstract
OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.
METHODS
The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.
RESULTS
The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1, reference; quartile 2, 1.71 [1.59–1.82]; quartile 3, 2.41 [2.25–2.58]; and quartile 4, 3.46 [3.23–3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.
CONCLUSIONS
The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.
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Summary
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Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic
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Jan Bělobrádek, Luděk Šídlo, Tom Philipp
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Epidemiol Health. 2024;e2024033. Published online February 23, 2024
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DOI: https://doi.org/10.4178/epih.e2024033
[Accepted]
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Abstract
OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017‒2021, focusing on differences between urban and rural practices.
METHODS
We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Co-operation and Development typology.
RESULTS
We observed minimal declines in 2020 in the rate of prescribing (-1%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners.
CONCLUSIONS
Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
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Summary
Brief communication
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Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones: an interrupted time series analysis
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Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo
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Epidemiol Health. 2024;e2024032. Published online February 21, 2024
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DOI: https://doi.org/10.4178/epih.e2024032
[Accepted]
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Abstract
In 2019, a child's death in Korea led to stricter penalties for school zone traffic violations. We assessed the impact using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a decline in severe injuries in school zones (11 → 8 cases per month, P=0.017). Legislation correlated with reduced risk of all child traffic injuries (RR=0.987, 95% CI, 0.977-0.997, P=0.002), indicating efficacy in curbing accidents.
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Summary
Original article
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Association of insomnia and daytime napping with metabolic syndrome and its components in a Korean population: an analysis of data from the Korean Genome and Epidemiology Study
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Da-Been Lee, DAE WUI YOON, Inkyung Baik
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Epidemiol Health. 2024;e2024031. Published online February 20, 2024
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DOI: https://doi.org/10.4178/epih.e2024031
[Accepted]
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Abstract
OBJECTIVES
We investigated the association between metabolic syndrome (MetS) and the coexistence of insomnia and daytime napping, because limited data have been reported regarding this association.
METHODS
The study population was 8,440 participants aged 40-65 years, who were from the Korean Genome and Epidemiology Study. Self-reported information on insomnia symptoms and nap duration was used to define exposure variables. Data on waist circumference (WC), blood pressure (BP), and fasting blood glucose (FBG), triglyceride (TG) and high-density lipoprotein cholesterol levels in blood were used to define MetS. Multivariate logistic regression analysis was performed to obtain odds ratio (OR) and 95% confidence interval (CI).
RESULTS
In multivariate logistic regression analysis, the coexistence of insomnia and napping was not significantly associated with MetS. However, the insomnia and non-napping group showed higher ORs of high TG (OR=1.19; 95% CI, 1.02-1.39) and high BP (OR=1.28; 95% CI, 1.10-1.49) than the non-insomnia and non-napping group. The combination of non-insomnia and napping and that of insomnia and napping showed higher ORs of high TG (OR=1.13; 95% CI, 1.00-1.29) and high FBG (OR=1.59; 95% CI, 1.14-2.21), respectively. In analyses of insomnia symptoms, only the combination of difficulty in maintaining sleep (DMS) and non-napping showed a higher OR for MetS (OR=1.25; 95% CI, 1.03-1.52) than the non-DMS and non-napping group.
CONCLUSIONS
Individuals with insomnia, particularly those who do not take naps, were disproportionately likely to have MetS components, especially TG or BP. Information on these variables may help predict individuals’ vulnerability to specific MetS components.
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Summary
Systematic review
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The Effectiveness of Protein Supplementation Combined with Resistance Exercise Program Among Community-Dwelling Older Adults with Sarcopenia: A Systematic Review and Meta-analysis
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Phatcharaphon Whaikid, Noppawan Piaseu
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Epidemiol Health. 2024;e2024030. Published online February 14, 2024
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DOI: https://doi.org/10.4178/epih.e2024030
[Accepted]
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Abstract
OBJECTIVES
ImprovingThe combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance through protein supplementation combined with resistance exercise is promising in older adults with sarcopenia. The objective of the presentThis systematic review isaimed to examineevaluate the effects of protein supplementation combined with resistance exercisethis combination on muscle mass, muscle strength, and physical performance amongin community-dwelling older adults with sarcopenia.
METHODS
ComprehensiveWe conducted a comprehensive search across fourof 4 electronic databases,includes: PubMed, Scopus, Embase, and the Medline library, spanningMEDLINE Library. The search covered literature from January 2013 to January 2023, following and followed the Preferred Reporting Items for Systematic ReviewReviews and Meta-AnalysisAnalyses (PRISMA) guidelines. Two independent reviewers evaluateassessed the methodological quality and individualof each study using the standard critical appraisal instrumenttool from the Johanna Briggs Institute (JBI. The meta). Meta-analysis was performed usingwith the JBI Sumari program.
RESULTS
A total of The review included 7 randomized controlled trials and 1 quasi -experimental study consisting, encompassing a total of 854 older adultsparticipants aged 60 years and above were included in this review. The duration of the studies. The study durations ranged from 10 to 24 weeks. TheAn analysis using aof standardized mean difference (SMD) revealeddifferences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD=0.95 (; 95% CI:, 0.13,-1.78),; p< 0.05),) and muscle strength (SMD=0.32 (; 95% CI: 0.08, 0.08-0.56),; p< 0.05).
CONCLUSIONS
The smallAlthough the limited number of RCTs constrains the strengthrandomized controlled trials restricts the robustness of our conclusions. Nevertheless, our findings indicate, the evidence suggests that protein supplementation combined with resistance exercise effectively enhancesis effective in enhancing muscle mass and strength amongin community-dwelling older adults with sarcopenia.
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Summary
Original articles
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Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey
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Wonseok Jeong, Seungju Kim
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Epidemiol Health. 2024;e2024029. Published online February 13, 2024
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DOI: https://doi.org/10.4178/epih.e2024029
[Accepted]
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Abstract
OBJECTIVES
Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in South Korean dual-, electronic cigarette-, conventional cigarette-, and non-smokers.
METHODS
Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor’s diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socio-economic groups.
RESULTS
Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.19–1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (OR = 1.15, 95% CI = 1.01–1.32). Lastly, dual smokers had the highest OR for diabetes among other smoking behavior groups (OR = 1.39, 95% CI = 1.22–1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups.
CONCLUSIONS
This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.
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Summary
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Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents
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Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae
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Epidemiol Health. 2024;e2024028. Published online February 13, 2024
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DOI: https://doi.org/10.4178/epih.e2024028
[Accepted]
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Abstract
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Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011–2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13–18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were elevated blood pressure (EBP) and hypertension. Statistical analyses were conducted using SAS 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean (SD) participant age was 15.3 (1.7) years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2090 (83.0%). Analysis of the 2518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an elevated odds of BP of 3.00 (95% CI: 1.14–7.89). The odds of hypertension were 3.61 (95% CI: 1.13–11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents' blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.
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Summary
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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
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Minjun Kim, Joonwoong Kim, Inhwan Lee
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Epidemiol Health. 2024;e2024027. Published online February 2, 2024
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DOI: https://doi.org/10.4178/epih.e2024027
[Accepted]
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Abstract
OBJECTIVES
This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.
METHODS
Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.
RESULTS
Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β: 0.005; 95% CI: 0.000–0.010) and WC and KL grade (β: 0.002; 95% CI: 0.001–0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.
CONCLUSIONS
The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.
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Summary