Objectives:Handgrip strength is associated with all-cause mortality, but evidence from nationally representative Asian adult populations remains limited. Methods:This study analyzed data from 27,679 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey from 2014 to 2018 and were linked to Cause of Death Statistics from Statistics Korea through 2022. Handgrip strength was categorized into sex-specific quartiles. Cox proportional hazards models assessed the association between handgrip strength and all-cause mortality after covariate adjustment. Sex-stratified and sensitivity analyses, including lagged analyses and time-varying coefficient models, were conducted. Results:During a mean follow-up of 75.6 months, 1,237 deaths occurred. All-cause mortality decreased markedly across increasing handgrip strength quartiles, from 9.2% in quartile 1 (Q1) to 0.6% in Q4. In the fully adjusted model, Q1 was associated with significantly higher mortality risk than Q4 (hazard ratio [HR], 2.9; 95% confidence interval [CI], 2.1 to 3.9). Sex-stratified analyses showed a stronger association in men (Q1 vs. Q4: HR, 3.4; 95% CI, 2.2 to 5.3) than in women (HR, 2.3; 95% CI, 1.5 to 3.5), although the interaction was not statistically significant (p=0.219). Age-stratified sensitivity analyses confirmed the inverse association in younger adults aged <65 years and older adults aged ≥65 years. Conclusion:Lower handgrip strength was independently associated with higher all-cause mortality among Korean adults, and this association persisted after comprehensive covariate adjustment. These findings support the use of handgrip strength as a simple predictor of long-term mortality risk across the adult lifespan in an Asian population.
The Korean Genome and Epidemiology Study (KoGES) is a large prospective cohort study established to investigate determinants of chronic disease. To evaluate overall and cause-specific mortality, KoGES records were linked to the official Causes of Death Statistics compiled by Statistics Korea. Of 211,562 participants the KoGES population-based cohorts, 211,428 were successfully linked to official mortality data through December 31, 2023, using resident registration numbers. Over a mean follow-up of 14.9 years, the linked cohort had an overall mortality rate of 5.8 deaths per 1,000 person-years; the rate was higher among men than among women (9.6 vs. 3.9 deaths per 1,000 person-years). Malignant neoplasms, heart disease, and cerebrovascular disease were the leading causes of death. As the cohort aged, deaths from causes such as pneumonia increased substantially, a pattern consistent with national mortality statistics. This linked dataset provides a basis for longitudinal analyses of chronic disease progression, survival outcomes, and cause-specific mortality using repeated epidemiologic measurements collected over more than 2 decades of follow-up.
Objectives:The contributions of short- and long-term nitrogen dioxide (NO2) exposure to cardiovascular disease (CVD) in rural areas remain unclear. Dietary intake may modify these associations, but this role remains understudied. Methods:We conducted a secondary analysis of a population-based prospective cohort study in 12 rural Japanese municipalities. Adults without CVD enrolled in 1992-1995 were followed until 2005. Daily municipality-level NO2 concentrations were estimated using generalized random forests. The primary outcome was time to first incident CVD (stroke or myocardial infarction). Short-term effects were estimated using extended Cox regression models with daily NO2 exposure, adjusted for confounders and CVD predictors. Long-term effects were estimated using conventional Cox regression models with average follow-up NO2 exposure. Interactions between NO2 exposure and baseline food intake were evaluated. Results:Among 10,032 individuals with complete data (116,759 person-years), 458 incident CVD cases were identified (390 strokes and 68 myocardial infarctions). In the short-term exposure analysis, each 10-ppb increase in daily NO2 exposure was associated with increased CVD risk (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.05 to 1.51; p=0.01). In the long-term analysis, each 1-ppb increase in average NO2 exposure during follow-up was associated with increased CVD risk (HR, 3.18; 95% CI, 1.54 to 6.59). For interactions between NO2 exposure and dietary intake, no associations remained significant after controlling for multiple comparisons using the false discovery rate. Conclusion:This study suggests that short- and long-term NO2 exposure may contribute to CVD risk. Long-term average exposure showed a larger effect estimate than short-term exposure.
Objectives:This study aimed to identify sex- and age-specific predictors of the first onset of major chronic disease or cancer among Korean adults using linked National Health Insurance Service (NHIS)-Korean Association of Health Promotion (KAHP) data and a competing risk framework that accounts for death before disease onset. Methods:A total of 102,870 adults who underwent KAHP health examinations in 2013 were followed through NHIS claims data until 2022. Nine major chronic diseases and cancers were identified using International Classification of Diseases, 10th Revision codes and clinical criteria. Sex-specific Fine-Gray subdistribution hazard models were fitted to estimate subdistribution hazard ratios. Model performance was evaluated using the time-dependent area under the receiver operating characteristic curve (AUROC) at 5 and 9.5 years. Results:Age was the strongest predictor of first disease onset in both sexes. Cardiometabolic, inflammatory, liver-related, and lifestyle-related markers showed sex-specific associations. Ischemic heart disease was the most frequent first-occurring disease, accounting for 50.3% and 46.8% of first events in males and females, respectively. Time-dependent AUROC values ranged from 0.72 to 0.73, indicating moderate and stable discrimination. Conclusion:Using linked NHIS-KAHP data and a competing risk framework, this study identified sex-specific predictors of first major chronic disease or cancer onset. The models showed moderate and stable discrimination, supporting the value of sex-specific risk assessment for chronic disease prevention and healthy aging.
Objectives:This study examined the validity and reproducibility of a newly developed 129-item semi-quantitative food frequency questionnaire (FFQ) for Korean adults with obesity. Methods:Ninety-seven Korean adults aged 19-64 years with obesity participated. To assess validity, FFQ estimates were compared with 4 seasonal sets of 3-day dietary records (3DRs). Reproducibility was assessed by administering the FFQ twice, as FFQ1 and FFQ2. Agreement was evaluated using quartile cross-classification, weighted kappa statistics, and crude and energy-adjusted Spearman correlation coefficients. Bland-Altman plots evaluated individual-level agreement. Nutrient and food-group intakes were compared between FFQ1 and FFQ2. Results:The FFQ demonstrated modest relative validity for ranking individuals. Compared with mean 3DR values, same-or-adjacent quartile agreement for energy and 10 nutrients ranged from 68.0% to 82.5%, and crude correlation coefficients ranged from 0.30 to 0.56. Averaging FFQ1 and FFQ2 improved validity metrics, including the energy-adjusted correlation for sugar intake (r=0.54). Bland-Altman plots showed relatively small mean differences for most nutrients, although the limits of agreement were wide and flavonoid intake was generally overestimated. Reproducibility was good, with same-or-adjacent quartile agreement of 81.4% to 90.7% between FFQ1 and FFQ2 and nutrient correlation coefficients of 0.50 to 0.69. Similar consistency was observed for food and dish categories. Conclusion:The tailored 129-item FFQ for Korean adults with obesity showed modest validity for ranking individuals and good reproducibility. Although caution is needed when estimating precise absolute intake at the individual level, this FFQ may support epidemiological studies of diet, obesity, and related chronic diseases in Korean adults.
Objectives:Children from migrant and refugee families may face a double burden of malnutrition, with undernutrition and obesity occurring within the same population. However, evidence on the nutritional status of North Korean refugee (NKR) and immigrant children in South Korea (SK) remains limited. This study compared nutritional status among SK, NKR, and immigrant children. Methods:Data for 2,856 SK children were obtained from the 2021-2023 Korea National Health and Nutrition Examination Survey. Separately, 336 NKR children and 597 immigrant children were recruited between 2021 and 2025. Nutritional status was evaluated using the World Health Organization AnthroPlus software. Results:After adjustment for sex and age, NKR and immigrant children had significantly higher odds than SK children of undernutrition (odds ratio [OR]: 3.18; 95% confidence interval [CI]: 1.90-5.31; and OR: 2.39; 95% CI: 1.50-3.80, respectively), stunting (OR: 5.16; 95% CI: 2.42-10.99; and OR: 4.13; 95% CI: 2.12-8.04, respectively), and obesity (OR: 1.58; 95% CI: 1.16-2.14; and OR: 1.54; 95% CI: 1.21-1.96, respectively). Among first-generation immigrant children, longer residence in SK was associated with higher odds of obesity (OR: 2.08; 95% CI: 1.02-4.24). Second-generation NKR children also had higher odds of obesity than first-generation NKR children (OR: 2.97; 95% CI: 1.61-5.48). Conclusion:NKR and immigrant children showed a double burden of malnutrition, with both persistent undernutrition and elevated obesity. Targeted nutrition interventions are needed to reduce nutritional disparities and improve outcomes among migrant and refugee children in SK.
Objectives:Community-based meal programs, including senior-center meals, are provided to help meet the nutritional needs of older adults in Korea. However, evidence on how these meals contribute to daily nutrient intake and micronutrient adequacy remains limited, particularly across residential settings. Methods:Using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2016-2023, we analyzed adults aged ≥65 years with a 24-hour dietary recall (n=6,438). Participants were classified as senior-center meal users (SCMU, n=162) or home-only meal users (HOMU, n=6,276), after excluding those who could not be classified into either group. Survey-weighted regression models compared nutrient intake patterns and assessed nutrient inadequacy based on Estimated Energy Requirement (EER), Estimated Average Requirement (EAR), and Adequate Intake (AI) criteria. Survey-weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for nutrient inadequacy according to senior-center meal use and examined effect modification by residential area. Results:SCMU were older and more socioeconomically disadvantaged than HOMU. Although total nutrient intakes were similar, SCMU had higher lunch energy and nutrient intake, reflecting meal redistribution. Overall nutrient inadequacy did not differ. However, SCMU were associated with lower odds of vitamin A inadequacy (OR 0.33, 95% CI 0.14-0.75) and riboflavin inadequacy (OR 0.45, 95% CI 0.22-0.91) among rural, but not urban, residents (both Pinteraction < 0.05). Conclusion:Senior-center meals shifted a greater proportion of daily nutrient intake to lunch without substantially increasing total daily intake. SCMU had lower odds of vitamin A and riboflavin inadequacy among rural older adults.
Objectives:Health-related productivity loss (HRPL) is a comprehensive measure of labor productivity lost because of health problems. This study examined the distribution of HRPL and its associations with a broad range of health conditions and occupational characteristics in a nationally representative sample of Korean workers and quantified the population-level productivity burden associated with each condition. Methods:This cross-sectional analysis included 12,554 workers from the 26th wave (2023) of the Korean Labor and Income Panel Study. HRPL was assessed using the Work Productivity and Activity Impairment Questionnaire-General Health version. Differences in HRPL were evaluated across sociodemographic, health-behavioral, and occupational characteristics. Linear regression models adjusted for age, sex, and occupation were used to estimate mean differences in HRPL associated with 34 self-reported health conditions. The condition-specific burden was calculated as condition prevalence multiplied by the adjusted mean difference in HRPL. Results:The overall mean HRPL was 19.0% and predominantly reflected presenteeism rather than absenteeism. Higher HRPL was observed among older workers and those with lower educational attainment, sleep duration outside the recommended range, lower leisure-time physical activity, higher occupational physical activity, and non-standard employment. The largest adjusted mean differences in HRPL were associated with infertility treatment (52.18 percentage points), anxiety (23.83), depression (20.43), cancer (20.23), and gastroenteritis (18.36). The greatest population-level burdens were associated with low back pain (109.2 burden units), neck or shoulder pain (85.0), upper- or lower-limb joint pain or dysfunction (73.5), and fatigue (61.5). Conclusion:HRPL is substantial among Korean workers and is associated with occupational characteristics and common health conditions.
Objectives:Since heated tobacco products (HTPs) entered the tobacco market, their market share and use have increased, but their implications for tobacco use patterns and cessation remain unclear. This study classified conventional cigarette (CC) and HTP use into detailed subgroups and examined whether tobacco consumption and intention to quit differed across tobacco use types. Methods:Data were analyzed from 40,434 adults who currently used CCs or HTPs in the 2024 Korea Community Health Survey. Tobacco use was classified into 5 groups according to lifetime and current CC and HTP use. Descriptive analyses were performed to assess group distributions, and multinomial and multivariable logistic regression models were fitted to identify associated factors and examine intention to quit within 6 months. Results:Among adults currently using CCs or HTPs, 73.7% reported exclusive CC use, 10.2% reported exclusive HTP use, and 16.1% reported dual use. Overall mean tobacco consumption was 14.4 sticks per day and was highest among dual users (20.7 sticks per day). Compared with the current CC and never HTP group, the current CC and former HTP group had higher odds of intending to quit (adjusted odds ratio [aOR] = 1.19, 95% CI: 1.06-1.34), whereas the current HTP and former CC group had lower odds of intending to quit (aOR = 0.78, 95% CI: 0.67-0.90). Conclusion:Intention to quit varied by tobacco use type. Cessation services should account for differences in tobacco use patterns and intention to quit across tobacco use groups, particularly among people with prior or current HTP use and those who use both CCs and HTPs.
Objectives:Periodontitis is a prevalent non-communicable disease (NCD), but most risk stratification tools require periodontal examination, limiting use in public health settings. This study developed and externally validated a non-clinical model for identifying prevalent periodontitis using routinely collected NCD surveillance variables. Because survey cycles were cross-sectional, the model was diagnostic rather than prognostic. Methods:Data were obtained from the Korea National Health and Nutrition Examination Survey, a nationally representative survey with a complex sampling design. A survey-weighted multivariable logistic regression model was developed using cycle VII data (2016-2018; n=12,144) and externally validated without re-estimation using non-overlapping cycle VI data (2013-2015; n=12,523). Prevalent periodontitis was defined as a Community Periodontal Index score ≥3 in any sextant. Twelve pre-specified non-clinical predictors spanning demographic, socioeconomic, metabolic, and behavioural domains were entered without data-driven selection. Performance evaluation incorporated discrimination, calibration, reclassification, and decision curve analysis. Reporting followed the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. Results:Discrimination improved from an area under the receiver operating characteristic curve (AUC) of 0.732 for the demographic-only model to 0.755 for the full model. Performance was retained during external validation (AUC, 0.728; calibration slope, 0.984; intercept, -0.106). Decision curve analysis demonstrated a positive net benefit across clinically plausible thresholds in both cohorts. Conclusion:Routinely collected NCD surveillance data can identify adults at high risk of periodontitis with externally reproducible performance. Non-clinical models utilising these data may support periodontal case-finding within NCD screening programmes, particularly in primary care and community settings.
Objectives:No systematic comparison of Korean longitudinal panel surveys has evaluated sampling design, sample-size determination, weighting procedures, and attrition management within a single methodological framework. This review synthesises these features to support the design of community-based ageing panels. Methods:A structured comparative methodological review was conducted using official statistical registries and national research institute databases. Twenty-two eligible Korean longitudinal panel surveys were identified, and nine panels-five directly relevant and four indirectly relevant to older-adult health research-were selected for in-depth analysis. Results:Among the six household- or population-based panels, four used stratified two-stage cluster sampling; the Korea Welfare Panel Study used stratified double sampling, and the Korean Retirement and Income Study used unequal-probability systematic sampling. Among the three registry-based panels, the Panel Survey of Employment for the Disabled and the Disability and Life Dynamics Panel used stratified probability sampling, whereas the sampling procedures of the Panel Study of Workers' Compensation Insurance could not be verified from publicly available documentation. Only the Korean Longitudinal Study of Ageing documented an explicit sample-size determination rationale, and none of the nine panels reported design effects. Weighting typically followed three sequential steps: design-weight derivation, nonresponse adjustment, and post-stratification calibration. Panel-specific refinements included weight trimming in the Korean Longitudinal Survey of Women and Families, combined weights after refreshment-sample integration in the Korea Welfare Panel Study, and separate cross-sectional and longitudinal weights in the Korea Health Panel Study. Percentage-based retention rates were available for six panels; the Korean Retirement and Income Study reported only retained household counts, and the Panel Survey of Employment for the Disabled and the Panel Study of Workers' Compensation Insurance reported no retention figures. Refreshment strategies included periodic supplementation in six panels, no refreshment in the Disability and Life Dynamics Panel, full redesign in the Panel Survey of Employment for the Disabled, and an unclassifiable strategy in the Panel Study of Workers' Compensation Insurance. Conclusion:Korean longitudinal panel surveys have converged on broadly similar sampling and weighting structures, but substantial gaps remain in the reporting of design effects, sample-size rationales, and wave-by-wave retention rates. Future community-based ageing panels should prespecify intracluster correlation coefficients and design effects, provide analysis-specific weights, document attrition-bias diagnostics, and plan refreshment procedures transparently.
Objectives:The aim of this study was to examine associations between preparation methods for animal-based foods and urinary concentrations of bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS) in Korean adults. Methods:We analysed data from 4,201 adults who participated in the Korean National Environmental Health Survey (2018-2020). Urinary BPA, BPF, and BPS concentrations were measured and standardised for urinary dilution using the covariate-adjusted standardisation method. Preparation methods were categorised as rarely consumed, raw, grilled/roasted, boiled/steamed, or fried/stir-fried. Survey-weighted logistic regression was used to estimate odds ratios (ORs) for high exposure, defined as concentrations at or above the 75th percentile, stratified by sex. Results:Among men, poultry consumption was associated with higher odds of elevated BPA across grilled/roasted (OR, 2.51; 95% CI: 1.28-4.92), boiled/steamed (OR, 2.62; 95% CI: 1.58-4.36), and fried/stir-fried preparations (OR, 2.22; 95% CI: 1.32-3.75). Pork consumption showed inverse associations with BPA. Among women, fried/stir-fried poultry was associated with higher BPF concentrations (OR, 1.85; 95% CI: 1.09-3.12). Sensitivity analyses supported the main findings, particularly the poultry-related associations with BPA among men and BPF among women. Conclusion:Preparation patterns for animal-based foods were associated with urinary bisphenol concentrations in Korean adults. Poultry-related associations were observed for BPA among men and BPF among women; however, the cross-sectional design and the lack of direct information on food sources, processing, and packaging preclude causal or packaging-specific interpretations.
Objectives:Accurate blood pressure (BP) measurement is essential for reliably estimating hypertension prevalence in population-based surveys. However, evidence supporting the use of oscillometric BP devices in pediatric populations remains limited. This study compared BP measurements obtained using an oscillometric device (OD) and an auscultatory device (AD) and evaluated inter-device agreement and the impact of device choice on hypertension prevalence estimates. Methods:BP was measured sequentially with the AD and OD in 251 children and adolescents participating in the Korea National Health and Nutrition Examination Survey. Inter-device agreement was assessed using mean differences, limits of agreement, concordance correlation coefficients (CCCs), and regression analyses. Differences in prevalence estimates for elevated BP (EBP) and hypertension were also examined. Results:Mean inter-device differences were minimal for systolic BP (SBP) (0.2 ± 5.9 mmHg) but negative for diastolic BP (DBP) (-1.5 ± 6.1 mmHg), with larger discrepancies in older girls. Agreement was moderate to good for SBP (CCC = 0.79) and weaker for DBP (CCC = 0.60). Nevertheless, more than 85% of paired measurements were within ±10 mmHg. Prevalence estimates for EBP (11.6% vs. 10.0%) and hypertension (4.8% vs. 4.4%) were comparable between devices, with relatively high negative agreement and overall agreement. Conclusion:Despite modest underestimation of DBP in specific subgroups, oscillometric BP measurement showed acceptable agreement with the auscultatory method and yielded similar hypertension prevalence estimates. These findings suggest that oscillometric devices may be useful for pediatric BP measurement in public health surveillance systems.
The Airborne Hazards and Open Burn Pit Registry (AHOBPR) was established by the Department of Veterans Affairs and Department of Defense in response to United States Public Law 112-260 (2013). This registry ascertains and monitors health effects among veterans and service members who may have been exposed to airborne hazards during their military deployments.AHOBPR allows researchers to monitor health effects among veterans possibly exposed to airborne hazards during deployment and explore health effects with the goal of improving veteran care. Eligibility is limited to Veterans and service members who served in combat theaters specified in law, including areas relevant to perations: Desert Shield and Desert Storm; Iraqi Freedom; Enduring Freedom; and New Dawn. This cohort profile includes data on Veterans and service members (n=497,208) who enrolled in the AHOBPR and completed the online questionnaire 6/1/2014 - 9/20/2024. The online questionnaire captured deployment information, exposure and health concerns, health history, activity limitations, and additional risk factors that may affect a service member's health. The optional medical evaluation by a clinician documenting health status and concerns in a note template in the electronic medical record was completed for 174,247 (40.2%) participants.
Objectives:This study assessed the prevalence of adequate knowledge, positive attitudes, and good practices regarding myopia prevention among fourth- and fifth-grade students and investigated the relationships between these knowledge, attitude, and practice domains and student characteristics in a resource-constrained setting. Methods:This cross-sectional study included fourth- and fifth-grade students at Nguy Nhu Primary School, Kon Tum City, Kon Tum Province, Vietnam, in 2023. Data were collected using a structured self-administered questionnaire. A total of 545 students were included in the final analysis. Results:The proportion of participants with previously diagnosed myopia was 21.1%. Regarding myopia prevention, 66.6% of students had adequate knowledge, 35.6% had positive attitudes, and 56.7% demonstrated good practices. Female students were more likely than male students to have adequate knowledge (adjusted prevalence ratio [aPR], 1.46; 95% confidence interval [CI], 1.29 to 1.65) and positive attitudes (aPR, 2.24; 95% CI, 1.72 to 2.92). Adequate knowledge was associated with higher prevalences of both positive attitudes (aPR, 8.57; 95% CI, 4.51 to 16.57) and good practices (aPR, 1.96; 95% CI, 1.59 to 2.42). Conclusion:Categorical analysis suggested a mediating role for positive attitudes, but continuous sensitivity analysis indicated that this pathway was not statistically robust. The findings suggest that accurate procedural knowledge was the most direct and consistent correlate of good preventive practices, although cognitive overlap between knowledge and attitudes is expected in this age group. Interventions should prioritize actionable health literacy.
Objectives:This study aimed to evaluate the psychometric properties of the French and English versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ -C30) and Functional Assessment of Cancer Therapy-General (FACT -G) among adults with cancer in Cameroon. Methods:We conducted a secondary analysis of a hospital-based, multicenter cross-sectional study carried out between December 2024 and August 2025 at three public oncology centers in Yaoundé. Adults with a confirmed cancer diagnosis completed a questionnaire package that included the EORTC QLQ-C30 and FACT-G. We assessed content validity, floor and ceiling effects, internal consistency, construct validity, measurement invariance across language groups, convergent and discriminant validity, and concurrent criterion validity. Sensitivity analyses were performed by re-estimating FACT-G models after excluding misfitting items. Results:Data from 507 participants were analyzed. Both instruments showed good content validity and excellent overall internal consistency. The EORTC QLQ-C30 had a well-supported factor structure and full measurement invariance across language groups, although several subscales and items showed pronounced floor and ceiling effects. The FACT-G showed poor structural fit, driven largely by low-loading items, particularly in the social/family well-being subscale. Excluding all problematic items improved confirmatory factor analysis fit and yielded satisfactory cross-language invariance for a modified FACT-G. Concurrent criterion validity was moderate to strong overall. Conclusion:For health-related quality-of-life assessment in Cameroonian oncology settings, the EORTC QLQ-C30 should be preferred over the FACT-G, despite substantial floor and ceiling effects that warrant caution when interpreting responsiveness and sensitivity to change. Future studies should extend the measurement range of the EORTC QLQ-C30, strengthen the conceptual equivalence of the FACT-G, and assess longitudinal validity in this setting.
Objectives:In August 2024, a large outbreak of gastrointestinal illness was reported among workers at a workplace in Daejeon, Republic of Korea, where bulk meals were served. This study investigated the epidemiological and microbiological characteristics of the outbreak to identify the causative pathogen, the infection source, and possible contamination routes. Methods:A comprehensive epidemiological investigation was conducted, including case identification, retrospective cohort analysis, laboratory confirmation, and pulsed-field gel electrophoresis (PFGE). Attack rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated. Environmental and distribution chain assessments were also performed to trace the sources and transmission pathways. Results:A total of 75 individuals developed gastrointestinal symptoms, of whom 27 had laboratory-confirmed enterotoxigenic Escherichia coli (ETEC) O159 infection. The mean and median incubation periods were 70.5 and 72.0 hours, respectively. The attack rate was significantly higher among kimchi consumers than among non-consumers (RR, 1.47; 95% CI, 1.08 to 2.00). PFGE identified ETCX01.332 as the predominant pattern among patient and kimchi isolates. Distribution tracing indicated that the implicated kimchi was produced at a factory in Gyeonggi Province and supplied to multiple catering facilities, leading to additional outbreaks in Seoul and Gyeonggi Province. However, the exact contamination point(s) during production or distribution remained undetermined. Conclusion:This outbreak was attributed to ETEC O159, with kimchi suspected as the infection source. These findings provide rare evidence implicating non-heated fermented foods in ETEC transmission and highlight the need for strengthened hygiene standards and real-time monitoring throughout the production, distribution, and handling of fermented foods.
OBJECTIVES: The COVID-19 pandemic had direct effects on population health through infection and morbidity, as well as indirect effects on population mental health. We estimated the network structure of post-traumatic stress symptoms (PTSS) and depressive symptoms throughout the pandemic in South Korea and aimed to identify the most central and bridging symptoms. METHODS: Participants aged 30–64 years completed mental health surveys across 3 phases of the COVID-19 pandemic: March 2020 (N=1,925), February–March 2021 (N=1,754), and December 2021–January 2022 (N=1,595). Using PTSS and depressive symptom data, we conducted network analyses, and the primary measures of symptom importance (centrality) were expected influence and bridge expected influence.RESULTS: In the comorbidity network, although the most central symptoms fluctuated over the course of the pandemic, sleep problems were consistently identified as the most influential bridge symptoms throughout. The symptom network structure differed between the subacute and chronic phases of the pandemic. CONCLUSIONS: We found evidence of changes in the network structure of PTSS and depressive symptoms, even as sleep problems retained a consistent role as a bridging symptom. Although overall network structures varied across phases of the pandemic, the bridging role of sleep-related symptoms remained consistently strong, suggesting that sleep problems may represent a general and enduring mechanism underlying PTSS–depression comorbidity. During future pandemics, prompt screening for sleep problems may help prevent the development of comorbidity between PTSS and depressive symptoms.
Objectives:Facility-based delivery is essential for reducing maternal and infant mortality, particularly in low- and middle-income countries. However, evidence remains limited on how structural and socioeconomic inequalities shape access to delivery services in Indonesia. Based on Andersen's health services utilization framework, this study examined structural and individual determinants of facility-based delivery in Indonesia using nationally representative data, with particular attention to access-related and socioeconomic inequalities. Methods:This cross-sectional study analyzed nationally representative data from the 2023 Indonesian Health Survey and included 68,884 women aged 10-54 years who had given birth. Predisposing, enabling, and need factors were analyzed according to Andersen's framework. Univariate, bivariate, and multivariate analyses were performed, and multiple logistic regression was used to identify factors associated with non-facility delivery. Results:Substantial inequalities in facility-based delivery were observed. Overall, 7.2% of women in Indonesia delivered outside a health facility. After adjustment, rural residence (adjusted odds ratio [AOR] = 1.980; 95% CI: 1.715-2.287), lower education (AOR = 2.236; 95% CI: 2.010-2.547), longer travel time to health facilities (AOR = 2.292; 95% CI: 2.000-2.634), lack of health insurance (AOR = 2.253; 95% CI: 1.983-2.560), and inadequate antenatal care (AOR = 2.786; 95% CI: 2.461-3.154) were strong predictors of non-facility delivery. Conclusion:Facility-based delivery in Indonesia was shaped by contextual and enabling factors, rather than by individual characteristics alone. Integrated policies are needed to improve geographic access, increase health insurance coverage, strengthen community-based health education, and improve antenatal care programs, particularly in rural areas, to expand access to delivery services at health facilities.
OBJECTIVES:This study examined temporal trends and geographic variation in sudden infant death syndrome (SIDS) incidence in Korea. METHODS:We analyzed a nationwide cardiac arrest registry to identify SIDS cases from 2013 to 2023. The study period was divided into 3 phases: pre-pandemic (2013-2019), pandemic (2020-2021), and post-pandemic (2022-2023). Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, whereas standardized incidence ratios (SIRs) and 95% credible intervals (CrIs) were derived from Bayesian spatial models across all administrative districts. Spatial clustering was evaluated using Moran's I. RESULTS:Overall, 884 eligible cases were identified: 575 in the pre-pandemic period, 172 in the pandemic period, and 137 in the post-pandemic period. SIDS incidence increased significantly from the mid-2010s onward, with an annual increase of approximately 8-9%. Compared with the pre-pandemic period, SIDS incidence was significantly higher during the pandemic period (IRR, 1.52; 95% CI, 1.28 to 1.80) and the post-pandemic period (IRR, 1.34; 95% CI, 1.11 to 1.61). Spatial clustering of SIDS incidence increased progressively across the 3 periods (Moran's I: 0.359, 0.654, and 0.952, respectively; p<0.001). Pyeongtaek-si, Gyeonggi-do, was the only district with a significantly increased SIR in the pre-pandemic period (posterior mean, 1.602; 95% CrI, 1.007 to 2.424); no district met the significance thresholds in the subsequent periods. CONCLUSIONS:SIDS incidence in Korea has increased significantly since the mid-2010s, with progressive spatial clustering toward southwestern regions across the 3 study periods. The emergence of high-incidence and low-incidence clusters underscores the need for targeted interventions.
