Objective:Heated tobacco products (HTPs) and e-cigarettes (ECs) have rapidly expanded in the Republic of Korea. This study aimed to examine differences in comparative risk perceptions of HTPs and ECs relative to cigarettes among Korean adults and to identify factors associated with these perceptions. Methods:Data were drawn from the KRA4-Cohort 3 dataset of the nationally representative International Tobacco Control Korea Survey and were analyzed for respondents who currently used cigarettes, HTPs, or ECs. Two ordinal outcomes measured perceived comparative harm of HTPs and ECs relative to cigarettes. Multivariable Bayesian ordinal logistic regression models were fitted, and robustness was assessed using Bayesian Metropolis-Hastings and frequentist sensitivity analyses. Results:Compared with cigarette-only users, respondents who used both cigarettes and HTPs had lower odds of perceiving HTPs as equally or more harmful than cigarettes (adjusted odds ratio [aOR], 0.43; 95% credible interval [CrI], 0.36 to 0.50). Similarly, respondents who used both cigarettes and ECs had lower odds of perceiving ECs as equally or more harmful than cigarettes (aOR, 0.31; 95% CrI, 0.19 to 0.47). Adults aged 40-59 years had higher odds of perceiving both products as equally or more harmful than cigarettes (HTPs: aOR, 1.35; 95% CrI, 1.12 to 1.61; ECs: aOR, 1.42; 95% CrI, 1.18 to 1.73). Noticing tobacco advertising was associated with lower perceived harm. Findings were consistent across the 3 analytic approaches. Conclusions:Lower perceived harm of HTPs and ECs relative to cigarettes was common among Korean adults who smoked cigarettes, especially among dual-product users and those exposed to marketing. Stronger advertising regulation, standardized warnings, and comparative risk education are needed to address misperceptions about relative harmfulness and support cessation.
Objective:Non-communicable diseases (NCDs) are a leading cause of preventable mortality in Southeast Asia, but population-level evidence linking physical inactivity to NCD burden across Association of Southeast Asian Nations (ASEAN) member states remains limited. This study quantified associations between physical inactivity prevalence and NCD-related disability-adjusted life years (DALYs), cardiovascular mortality, and diabetes prevalence across five ASEAN countries from 2010 to 2021 and projected 2025 NCD burden trajectories under an exploratory business-as-usual scenario. Methods:A longitudinal panel dataset of 60 country-year observations was analyzed using fixed-effects regression with Driscoll-Kraay standard errors, partial least squares structural equation modeling, and XGBoost machine learning with Shapley additive explanations. Missing data (2.1%-6.4%) were handled using multiple imputation by chained equations. Results:Physical inactivity was independently associated with NCD DALYs (β = 0.421; 95% confidence interval: 0.251-0.591; P < 0.001). A significant attenuating interaction with the universal health coverage (UHC) index was observed (β = -0.183; P = 0.041), suggesting that each 10-point increase in the UHC index reduced the inactivity-NCD association by approximately 18%. The structural equation model explained 78.2% of the variance in NCD burden and identified a significant exploratory longitudinal indirect association through health system resilience, with 19.8% of the total association mediated through this pathway. Under the exploratory business-as-usual scenario, NCD DALYs were projected to increase by 7.8%-20.9% by 2025, with Indonesia and the Philippines showing the highest projected increases. Conclusions:UHC expansion may attenuate inactivity-related NCD burden. For ASEAN countries undergoing rapid epidemiological transition, coordinated investment in health system capacity and multisectoral physical activity promotion may help limit projected DALY increases and support progress toward Sustainable Development Goal 3.
Objectives:Heart failure (HF), a common comorbidity of chronic obstructive pulmonary disease (COPD), is associated with an increased risk of death among patients with COPD. However, no systematic assessment has quantified the population-level burden of comorbid COPD and HF, hereafter referred to as COPD-HF comorbidity, worldwide. This study assessed the global, regional, and national burden of COPD-HF comorbidity from 1990 to 2021 and projected this burden to 2050. Methods:Data on the non-fatal burden of COPD-HF comorbidity, including prevalence and years lived with disability (YLDs), were obtained from the Global Burden of Disease Study 2021. Temporal trends in age-standardized rates (ASRs) for COPD-HF comorbidity from 1990 to 2021 were examined using joinpoint models. Bayesian age-period-cohort models were used to project ASRs to 2050. Results:From 1990 to 2021, the absolute numbers of prevalent cases and YLDs for COPD-HF comorbidity increased globally, and the ASRs for prevalence and YLDs also increased. These upward trends were projected to continue to 2050. The burden of COPD-HF comorbidity was consistently higher in men than in women and higher in older adults than in younger individuals. By severity level, the burden of COPD-HF comorbidity was mainly attributable to the treated and severe subtypes of HF. The burden varied substantially across regions, with low-development regions having the highest age-standardized burden. Conclusions:The global non-fatal burden of COPD-HF comorbidity was substantial from 1990 to 2021 and may continue to increase to 2050. Public health interventions targeting COPD-HF comorbidity may help reduce this burden.
Objectives:Effective blood pressure management requires sustained medication adherence and health-related behavior change. However, limited research has examined hypertension management from the patient's perspective. This study aimed to evaluate the effect of an educational program based on the Common-Sense Model (CSM) on illness perception among older adults with hypertension. Methods:This randomized controlled clinical trial included 62 patients with hypertension who were referred to Khalil-Azad Health Center in Larestan, Iran, from March to July 2024. Participants were selected and randomly assigned to the intervention group (n = 31) or control group (n = 31). The intervention group participated in a CSM-based educational program consisting of five 45-60-minute sessions over 1 month, whereas the control group received routine care only. Participants completed the Brief Illness Perception Questionnaire before the intervention and 8 weeks after the start of the intervention. Results:Before the intervention, illness perception subscale scores did not differ significantly between the intervention and control groups (P > 0.05). After the intervention, illness perception subscale scores improved in the intervention group compared with the control group, except for illness consequences, illness concern, and emotional representation (P < 0.05 for the remaining subscales). Conclusions:A CSM-based educational program may help nurses and health care providers improve illness perception among patients with primary hypertension.
Objectives:This study examined the association between non-restorative sleep (NRS) and functional limitation among US adults aged 25-74 years, assessed dose-response patterns, and estimated the population attributable fraction (PAF). Methods:This cross-sectional study used nationally representative Midlife in the United States Refresher 2 data from 2022-2024 (n=1,699). NRS was categorized as none or rare (never/rarely), intermediate (sometimes), or frequent (often/almost always). A secondary exposure quantified cumulative sleep burden as the count of 3 problems-trouble falling asleep, night waking, and feeling unrested-reported as often or almost always. Functional limitation comprised difficulty with basic or instrumental activities of daily living. Propensity score matching balanced 15 covariates. The PAF was estimated using a generalized Miettinen approach. Results:Frequent NRS was associated with higher odds of functional limitation than no or rare NRS (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.61 to 3.18). Each 1-category increase was associated with 45% higher odds (OR, 1.45; 95% CI, 1.24 to 1.70). Odds also increased with cumulative sleep problems: 1 problem (OR, 1.66; 95% CI, 1.14 to 2.41), 2 problems (OR, 2.50; 95% CI, 1.63 to 3.81), and 3 problems (OR, 2.50; 95% CI, 1.51 to 4.11), suggesting a plateau at higher burden levels. Under causal assumptions, the PAF was 23.9% (95% CI, 14.3 to 34.3), corresponding to approximately 6.9 million affected US adults. Conclusions:RS and cumulative sleep problems were associated with functional limitation in graded patterns that plateaued at higher levels. Sleep disturbance may represent a scalable target for intervention when addressed in middle adulthood.
Objectives:This study examined whether engagement with different online community environments moderates the association between social capital and depressive mood. Methods:Using the 2023 Korea Social Integration Survey (n=8,221), a nationally representative survey conducted by the Korea Institute of Public Administration, social capital was measured as an index of participation in 9 types of voluntary and community organizations, and depressive mood was assessed using a single-item measure of day-to-day emotional distress. Ordinary least squares regression models with interaction terms were used to determine whether the association between social capital and depressive mood varied across 3 types of online community environments: messenger services, social networking services (SNS), and membership-based online communities. Results:Higher levels of social capital were associated with higher levels of depressive mood (b=0.327), contrary to the conventional assumption that social participation is uniformly beneficial. Interaction analyses indicated that this association varied across online community environments. Frequent messenger service use was associated with a weaker positive association between social capital and depressive mood (b=-0.084), whereas SNS use showed a smaller and more conditional moderating effect (b=-0.042). Use of membership-based online communities was not a statistically significant moderator. Conclusions:The mental health implications of social participation depend on how social engagement is organized across offline and online contexts. Relationally oriented digital environments, particularly messenger services, may attenuate the emotional burden associated with extensive social participation. These findings underscore the need to consider digitally mediated community environments in public mental health research and interventions.
Objectives:We investigated the interactive effects of parents' ages, as well as the overall effects of paternal age, on adverse birth outcomes using nationwide data from Japan. Methods:Live birth data from the Vital Statistics Surveys in Japan from 2010 to 2023 were analyzed. Preterm birth, low birth weight, macrosomia, small-for-gestational-age (SGA) status, and large-for-gestational-age status were defined as adverse birth outcomes. Log-binomial regression models were used to examine associations between maternal and paternal ages and adverse birth outcomes. In addition to regression analyses using maternal and paternal age groups separately, we conducted regression analyses using combined parental age groups to assess interactive effects. Results:Data from 12,279,842 live births were analyzed. Overall, the risk ratio (RR) increased significantly with an increase in the paternal age categories for all adverse birth outcomes. In contrast, among mothers aged ≥30 years, the RRs for preterm birth, low birth weight, and SGA status were higher for infants of fathers aged <25 years than for those of fathers aged ≥35 years. In particular, the RRs for these outcomes, as well as macrosomia, were highest for the combination of the youngest paternal age group (<25 years) and the oldest maternal age group (≥40 years). Conclusions:Analysis of nationwide birth data indicated that the effects of paternal age on adverse birth outcomes varied according to maternal age, underscoring the importance of assessing pregnancy risk according to combined parental age.
Artificial intelligence (AI) is rapidly transforming cancer care, from diagnosis and risk prediction to treatment planning and drug development. These advances depend on the large-scale integration of genomic, imaging, and clinical data, intensifying privacy and ethical concerns. This study examines emerging challenges in AI-driven precision oncology and explores strategies for protecting patients' informational self-determination through a narrative ethical and policy analysis informed by recent empirical and technical research. Even data considered de-identified, including molecular and imaging profiles, may enable inference of sensitive attributes through machine-learning analytics. Although many patients support the clinical promise of AI, they express concerns about secondary data use without meaningful consent, commercialization, and security breaches. Privacy violations threaten autonomy, confidentiality, and trust and may exacerbate existing inequities. Current regulatory frameworks, including the General Data Protection Regulation and the Health Insurance Portability and Accountability Act, focus primarily on identifiability and the removal of explicit identifiers. However, AI systems generate risks not only through re-identification but also through inferential analytics that derive new privacy-relevant information, such as disease susceptibility or familial risk, from ostensibly anonymized data. Addressing these gaps requires multilayered governance that combines privacy-preserving technologies, dynamic consent, data minimization, transparency, and strengthened legal safeguards to sustain public trust.
Objectives: Dengue fever remains a major public health concern in Malaysia, with marked spatial heterogeneity and evolving temporal dynamics. Although the incidence of dengue has increased substantially in recent years, district-level risk patterns and their changes over time remain insufficiently characterized. This study aimed to assess the spatio-temporal distribution of dengue risk in Peninsular Malaysia.Methods: A retrospective analysis of dengue surveillance data was conducted using district-level monthly case counts from 2022 to 2024. Dengue risk was modeled with Bayesian spatio-temporal models incorporating spatial effects, temporal effects, and space–time interaction terms. Spatial variation was modeled using the Besag–York–Mollié 2 specification, while temporal trends were modeled using a first-order random walk. Competing models were compared using the deviance information criterion (DIC) and Watanabe–Akaike information criterion (WAIC). Relative risk (RR) and exceedance probability maps were generated from the best-fitting model.Results: Dengue incidence increased markedly after 2022, with incidence rates nearly doubling in 2023 and remaining high in 2024. Incidence maps showed pronounced spatial heterogeneity, with persistent high-incidence districts concentrated in urban and peri-urban regions. Spatio-temporal models incorporating space–time interaction substantially outperformed the additive model, with lower DIC and WAIC values. The best-fitting model identified the highest RRs in districts within Selangor, while several districts in Penang, and Johor had high posterior probabilities of elevated risk [P(RR>1)>0.8].Conclusions: This study demonstrates substantial spatial heterogeneity and evolving temporal dynamics in dengue risk across Peninsular Malaysia. Bayesian spatio-temporal disease mapping provides robust, localized, time-specific estimates of dengue risk and may support targeted surveillance and intervention in endemic settings.
Objectives:This study examined healthcare utilization patterns and health needs among undocumented migrants attending a free clinic in Busan, South Korea. Methods:We retrospectively analyzed clinical records from 750 undocumented migrants who made 2111 clinic visits between 2020 and 2024. The primary outcome was the number of clinic visits. Diagnoses were classified using the International Classification of Primary Care, Second Edition. Mixed-effects negative binomial regression, with nationality specified as a random intercept, was used to model visit counts and to assess interaction effects between gender and other variables. Results:Cardiovascular and endocrine diseases were the most prevalent conditions, with chronic diseases accounting for a substantial proportion of clinic visits. In multivariable analysis accounting for gender-based effect modification (model 2), older age was significantly associated with increased visit frequency (β=0.030; 95% confidence interval [CI], 0.014 to 0.045, p<0.001). The association between chronic disease and visit frequency differed significantly by gender (gender×chronic disease interaction, β=0.488; 95% CI, 0.053 to 0.924, p=0.028). Linear combination testing indicated that men with chronic diseases visited the clinic 1.9 times as frequently as men without chronic disease, whereas chronic disease status showed little association with visit frequency among women. Conclusions:Undocumented migrants attending the free clinic experienced a substantial burden of chronic disease, and healthcare utilization patterns differed by gender. These findings highlight the need for inclusive healthcare policies and targeted interventions for this population.
Objectives:Sedentary behavior has emerged as a health risk factor distinct from insufficient physical activity. This study examined the association between sedentary time and high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, among Korean older adults. Methods:Data were obtained from the 2022 Korea National Health and Nutrition Examination Survey. Among 1667 participants aged 65 years or older with available hs-CRP measurements, 496 with leukocyte counts ≥10 000 cells/mm3 or hs-CRP levels ≥10.0 mg/L were excluded, yielding a final sample of 1171 participants. hs-CRP levels ≥1.0 mg/L were classified as abnormal. Differences in the prevalence of abnormal hs-CRP were assessed using the chi-square test, and multivariable logistic regression analysis was performed to evaluate the association between sedentary time and abnormal hs-CRP after adjustment for covariates. Results:The prevalence of abnormal hs-CRP was higher among participants who did not engage in regular walking (prevalence ratio [PR], 1.24; 95% confidence interval [CI], 1.05 to 1.46) and those with adverse cardiometabolic profiles, including elevated blood pressure, dyslipidemia, and abdominal obesity. It was also higher among participants with sedentary time ≥10 hr/day (PR, 1.20; 95% CI, 1.02 to 1.41). In multivariable logistic regression analysis, prolonged sedentary time remained associated with abnormal hs-CRP levels after adjustment for covariates (odds ratio, 1.31; 95% CI, 1.01 to 1.71). Conclusions:Prolonged sedentary time was independently associated with elevated hs-CRP levels among Korean adults aged 65 years or older. Accordingly, sedentary behavior reduction may be a useful target for chronic disease prevention strategies in older populations.
Objectives: Although social network services (SNS) are prevalent globally, the relationship between SNS use and loneliness remains complex, particularly regarding qualitative behavioral patterns. This study examined associations between specific SNS behaviors and loneliness among Seoul adults and explored differences by age and digital literacy.Methods: Data from the 2024 Seoul Survey were analyzed (n=34 142; mean age, 52.3 years). Loneliness was assessed with 2 items measuring isolation in family and non-family relationships. Five SNS behavioral domains were examined: active use, information-seeking use, communication priority, social comparison, and exclusionary feeling. Digital literacy was dichotomized using an 8-item scale, with scores ≥6 considered high. Multivariable logistic regression estimated adjusted associations.Results: Overall SNS use was associated with lower odds of loneliness than non-use (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.83 to 0.98). However, higher odds were observed for specific SNS behaviors compared with non-use: active use (aOR, 1.24), communication priority (aOR, 1.26), social comparison (aOR, 1.50), and exclusionary feeling (aOR, 1.66); information-seeking use was not significant (aOR, 1.11). A dose–response pattern peaked at 3 problematic behaviors (aOR, 3.21; 95% CI, 2.82 to 3.65). Associations between SNS behaviors and loneliness were stronger among adults aged ≥60 years and participants with high digital literacy.Conclusions: Although overall SNS use was associated with modestly lower odds of loneliness, qualitative SNS engagement—particularly problematic behaviors—was strongly associated with higher odds. Older adults and participants with high digital literacy appeared particularly vulnerable when performing problematic SNS behaviors, underscoring the need for behavior-focused, population-tailored education and interventions.
East Asian countries had remarkably low coronavirus disease 2019 (COVID-19) mortality in 2020, a pattern widely cited as evidence of effective public health interventions. However, Japan and Korea—often classified as having followed similar early intervention strategies—adopted substantially different approaches. These differences are largely obscured by commonly used stringency indices and policy score analyses. While neither country implemented a lockdown, Korea pursued an aggressive, government-mandated strategy based on extensive testing, isolation, quarantine, and compulsory data collection. In contrast, Japan relied on a voluntary model with limited mass testing, a policy that drew strong criticism during the early phase of the pandemic. Because asymptomatic COVID-19 infection was highly prevalent, these divergent testing policies were particularly important in shaping patterns of community transmission. Using excess mortality as a comprehensive outcome metric, Japan’s outcomes were as favorable as Korea’s through the pre-Omicron period, despite Japan’s limited testing. In 2020, excess mortality was negligible in both countries (−1.7% in Japan vs. +0.3 to +2.1% in Korea). In 2021, excess mortality increased modestly (+2.2% vs. +4.0 to +5.6%). However, in 2022, despite approximately 80% vaccination coverage in both countries, excess mortality reached +7.6% in Japan and about +20% in Korea—three times the Japanese level despite Korea’s much higher booster rate. These patterns of excess mortality in 2 countries with contrasting testing strategies challenge the view that East Asia’s early success stemmed primarily from stringent virus suppression measures. They highlight the need to consider alternative explanations, including the possibility that pre-existing immunity differed substantially across geographical regions.
Objectives: This study aimed to describe the distribution of fall-related injury burden across healthcare stages and age groups in Korea, with particular emphasis on differences between young-old adults (aged 65–74 years) and old-old adults (aged ≥75 years).Methods: Using the 14th Korea National Injury Statistics Report (2022), we analyzed data on fall-related injuries from 5 national sources: the 119 Emergency Medical Services Registry, the National Emergency Department Information System (NEDIS), the Korea National Hospital Discharge In-depth Injury Survey, the Severe Trauma Survey, and cause-of-death statistics. Five age groups (0–6, 7–18, 19–64, 65–74, and ≥75 years) were defined according to the original classifications used in the data sources. Age-specific crude rates were calculated using mid-year population denominators from Statistics Korea.Results: Emergency department (ED) visit rates were highest among children aged 0–6 years (2312/100 000) and adults aged ≥75 years (2121/100 000). Despite comparable ED visit rates, the within-NEDIS ED admission rate increased from 2.6% among children aged 0–6 years to 42.9% among adults aged ≥75 years. The hospitalization rate among adults aged ≥75 years (4852/100 000) was 2.6 times higher than that among adults aged 65–74 years (1832/100 000). Among adults aged ≥75 years, the mortality rate was 32.5/100 000, and this age group accounted for 45.4% of all fall-related deaths.Conclusions: Fall-related injury burden among adults aged ≥75 years was disproportionately concentrated at the hospitalization and mortality stages. These findings suggest that fall prevention strategies for aging populations should consider the downstream burden beyond ED visits.
Objectives: To identify behavioral segments of integrative care use among older adults with knee osteoarthritis in a rural district in Northern Thailand and to compare these segments according to PRECEDE-related factors and baseline characteristics.Methods: This analytical cross-sectional study included 302 community-dwelling older adults with primary knee osteoarthritis in Thoen District, Lampang Province, Northern Thailand. Data were collected through face-to-face interviews using a structured questionnaire that assessed demographic and health characteristics, PRECEDE-related factors, and behaviors across 3 care domains: professional medical care, traditional medicine, and community-based medicine. Standardized behavioral domain scores were analyzed using hierarchical cluster analysis, followed by k-means clustering. Differences among segments were examined using chi-square tests, one-way analysis of variance, or Kruskal-Wallis tests, as appropriate.Results: Three behavioral segments were identified: high engagement (20.9%), intermediate engagement (48.0%), and low engagement (31.1%). The 3 behavioral domains differed significantly across segments (all p<0.001; η2=0.400–0.535). Baseline demographic and health characteristics did not differ significantly among segments. In contrast, significant differences among segments were observed for the total enabling score, access, decision-making, total reinforcing score, social support, and attitude, whereas perceived information showed no significant difference.Conclusions: Older adults with knee osteoarthritis were not behaviorally homogeneous in their use of professional, traditional, and community-based care. Segment differences were more pronounced for enabling and reinforcing conditions than for perceived information alone. These findings support segment-informed health promotion strategies in primary care and community settings.
Objectives:Occupational noise exposure is a widespread hazard across multiple industries. However, the association between occupational noise exposure and cardiovascular health outcomes remains inconclusive. This study aimed to compare cardiovascular function between workers exposed and unexposed to occupational noise and to compare lipid profiles between these groups. Methods:A Comparative cross-sectional study was conducted in a denim garment manufacturing facility in Ismailia, Egypt. Two equal groups of workers exposed to occupational noise (≥85 A-weighted decibels; dB[A] for ≥3 years, n=213) and unexposed workers (<85 dB[A], n=213) were recruited using systematic sampling, but three unexposed workers dropped out. Data collection included structured interviews, clinical examinations, 12-lead electrocardiography (ECG), blood pressure measurements, and laboratory lipid profile analyses. Noise exposure was assessed using both environmental and personal integrated sound level meters. Multiple logistic regression analysis was performed to identify potential predictors of ECG abnormalities. Results:The mean ages of the noise-exposed and unexposed groups were 34.5±9.8 years and 33.3±7.7 years, respectively, and females accounted for 67.6% and 66.2% of the groups, respectively. Noise-exposed workers had significantly higher pulse pressure, systolic blood pressure, low-density lipoprotein cholesterol, total cholesterol, triglyceride levels, and prevalence of dyslipidemia (59.2 vs. 48.6%, p<0.05). ECG abnormalities were more prevalent in the noise-exposed group than in the unexposed group (30.0 vs. 8.1%, p<0.001), with P mitrale and right bundle branch block being the most frequent findings. Duration of noise exposure, personal noise level, age, and systolic blood pressure were independent predictors of ECG abnormalities. Body mass index and duration of noise exposure were significant predictors of dyslipidemia. Conclusions:Chronic occupational noise exposure was associated with elevated blood pressure, dyslipidemia, and ECG abnormalities. Longer duration and higher intensity of noise exposure were also associated with increased cardiovascular risk indicators. These findings support workplace noise-control measures, periodic cardiovascular screening, and improved use of personal protective equipment in similar garment manufacturing settings.
Fine particulate matter (PM2.5; aerodynamic diameter ≤2.5 μm) is a leading contributor to the global burden of disease and is associated with substantial morbidity and mortality. However, its health effects are often evaluated within single-exposure frameworks, limiting causal inference and reducing the translational relevance of evidence for policy development. In this study, we reconceptualise PM2.5 within the exposome framework by integrating external exposures, internal biological responses, and structural determinants of health across the life course. PM2.5 comprises a complex and dynamic mixture of pollutants from ambient and household sources, including biomass combustion, traffic emissions, and industrial activities. After inhalation, PM2.5 particles can penetrate the respiratory tract, and finer fractions may enter the systemic circulation, where they induce oxidative stress, inflammation, epigenetic dysregulation, and endocrine disruption. These mechanisms contribute to a broad spectrum of adverse health outcomes, including cardiovascular, respiratory, metabolic, and neurodegenerative diseases as well as cancers. The multi-level and temporally accumulated nature of these effects highlights the limitations of reductionist exposure assessment and underscores the need for integrative, systems-based approaches. Integrating cumulative impact assessment with exposome-wide approaches that leverage satellite, clinical, land-use, urban planning, and socioeconomic data can improve the characterization of context-specific cumulative health effects. Positioning PM2.5 as a sentinel indicator of cumulative environmental risk provides a unifying framework for exposome-informed science and supports the development of more precise, equitable, and policy-relevant interventions.
Objectives: Thailand is rapidly transitioning to an aged society. Lower limb muscle weakness among older adults is associated with increased fall risk, loss of independence, and reduced quality of life (QoL). Although exercise can improve strength and mobility, many community-dwelling older adults face barriers to participation. We evaluated the effectiveness of an innovative leg support ring for lower limb muscle rehabilitation among older adults in Eastern Thailand.Methods: This randomized controlled trial, repeated-measures study included 64 adults aged 60 years or older with lower limb muscle weakness and activities of daily living (ADL) scores of 9–11. The intervention group (n=32) used the leg support ring for 12 weeks (3–5 day/wk), while the control group (n=32) received standard care and continued usual physical exercise. Leg motor power, range of motion (ROM), ADL, and QoL were assessed at baseline, immediately post-intervention, and at the 3-month follow-up. Data were analyzed using repeated-measures analysis of variance.Results: Compared with control participants, the intervention group showed significantly greater improvements in motor power of the quadriceps, hamstrings, hip flexors, ankle dorsiflexors, and ankle plantar flexors (p<0.001) and ROM for hip flexion, hip extension, knee flexion, and ankle plantar flexion (p<0.05). ADL and QoL also demonstrated significantly greater improvements (p<0.001). These improvements were sustained or further increased at the 3-month follow-up.Conclusions: The leg support ring program was associated with improvements in lower limb strength, mobility, functional independence, and QoL among older adults. Its simplicity and accessibility may support integration into community-based health promotion programs for active aging.
Objectives:Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023-2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia. Methods:This study used a cross-sectional design and analyzed data from the 2023-2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication. Results:A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%). Conclusions:Under-reporting of childhood TB was significantly associated with both age group and type of health facility.
Objectives Ischemic stroke is influenced by long-term metabolic and renal deterioration; however, many risk prediction frameworks rely on single time-point measurements. We examined whether multi-period patterns in national health screening indicators are associated with incident ischemic stroke in Korea. Methods Using customized National Health Insurance Service data with 3 biennial screenings (P1: 2013–2014; P2: 2015–2016; P3: 2017–2018), we identified incident ischemic stroke during 2019–2023 (Korean Standard Classification of Diseases-7 I63). After applying eligibility criteria and excluding individuals with missing screening values, we performed 1:1 propensity score matching on sex, 1-year age strata, and insurance type (97 454 matched pairs; n=194 908). Multi-period indicators included waist circumference increase ≥10%, sustained blood pressure ≥130/80 mmHg, sustained fasting glucose ≥126 mg/dL, proteinuria progression, and creatinine elevation in ≥2 periods (sex-specific thresholds). Associations were evaluated using conditional logistic regression; a comparator model used P3-only indicators. Results In the multi-period model, stroke was associated with waist circumference increase ≥10% (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), sustained blood pressure ≥130/80 mmHg (OR, 1.34; 95% CI, 1.31 to 1.37), sustained fasting glucose ≥126 mg/dL (OR, 1.66; 95% CI, 1.60 to 1.73), creatinine elevation in ≥2 periods (OR, 1.08; 95% CI, 1.06 to 1.10), and proteinuria progression (OR, 1.36; 95% CI, 1.32 to 1.39). In the P3-only model, all single-time-point indicators were associated with incident stroke (ORs, 1.08 to 1.47). Conclusions Multi-year patterns in metabolic screening indicators were associated with incident ischemic stroke. Repeated health screening measurements may complement single time-point assessments and support continuous risk-factor monitoring and patient-centered prevention.
