Epidemiology and Health

Brief Communication

Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality: Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe; Epidemiol Health. 2024;46:e2024059. Published online July 5, 2024; DOI: https://doi.org/10.4178/epih.e2024059

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Abstract Summary PDF: Abstract
OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in Korea.
METHODS
We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (accessibility vulnerability index, AVI).
RESULTS
The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (CI) was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).
CONCLUSIONS
The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.; Summary

Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.

Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.

Systematic Review

Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis: Hye Ah Lee, Seunghee Jun, Hyesook Park; Epidemiol Health. 2024;46:e2024047. Published online April 24, 2024; DOI: https://doi.org/10.4178/epih.e2024047

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.
METHODS
We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies version 2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.
RESULTS
From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0 to 85.8) and a specificity of 62.9% (95% CI, 56.9 to 68.5). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.
CONCLUSIONS
Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.; Summary

Korean summary
- 본 연구는 체계적 고찰 및 메타 분석을 수행하여 아동 및 청소년의 대사 증후군(MetS) 위험을 감지하기 위한 최적의 악력 임계값을 제안했습니다. - 본 연구 결과는 아동 및 청소년의 대사 증후군(MetS) 위험을 줄이기 위해 근력 관련 활동이 필요한 고위험군을 식별하는 데 사용할 수 있으므로 1차 임상 및 공공 의료에 실용적인 정보를 제공합니다.

Key Message
- This study conducted a systematic review and meta-analysis to propose the optimal handgrip strength (HGS) threshold for detecting the risk of metabolic syndrome in children and adolescents. - The results provide practical information for primary clinical and public healthcare, as they can be used to identify high-risk groups in need of strength-related interventions to reduce the risk of metabolic syndrome in children and adolescents.

Brief Communication

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis: Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo; Epidemiol Health. 2024;46:e2024032. Published online February 21, 2024; DOI: https://doi.org/10.4178/epih.e2024032

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Abstract Summary PDF: Abstract
In 2019, a child’s death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.; Summary

Korean summary
2019년 민식이법 도입 후 소아 교통사고에 미치는 영향을 평가하고자 하였다. 2017-2022 교통사고 분석 시스템 데이터를 통해 그 효과를 평가했고, 학군지역에서 심각한 부상이 월 평균 11건에서 8건으로 감소했다(p=0.017). 또한, 모든 어린이 교통사고 위험 비율도 감소했고(risk ratio, 0.987, 95% CI, 0.977-0.997; p=0.002), 사고 예방에 효과적임을 입증했다. 이 연구는 학군지역 어린이 안전에 법 조치의 긍정적 영향을 강조하며, 지속적인 도로 안전 강화의 중요성을 강조한다.

Key Message
Revised legislation in Korea, following a child’s tragic death, enforced stricter penalties for school zone traffic violations. Analysis of 2017-2022 data showed a significant decrease in severe injuries from 11 to 8 cases monthly (p=0.017). The legislation also reduced the risk of all child traffic injuries (risk ratio, 0.987; 95% CI, 0.977 to 0.997; p=0.002), demonstrating its effectiveness in preventing accidents. This study underscores the legislation’s positive impact on child safety in school zones, emphasizing the importance of ongoing enforcement efforts for road safety.

Original Articles

Associations between adverse childhood experiences and diabetes among middle-aged and older Chinese: a social-ecological perspective: Siyu Zhu, Leying Hou, Jiaying Ma, Shuting Li, Weidi Sun, Wen Liu, Jiajun Hao, Wenhan Xiao, Siqing Cheng, Dexing Zhang, Dong Zhao, Peige Song; Epidemiol Health. 2023;45:e2023071. Published online August 2, 2023; DOI: https://doi.org/10.4178/epih.e2023071

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts.
METHODS
Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status.
RESULTS
Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes.
CONCLUSIONS
ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.; Summary

Key Message
From a social-ecological perspective, this study delineates an association between adverse childhood experiences (ACEs), particularly those originating from the family, and diabetes among middle-aged and older Chinese. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Age at first childbirth and the risk of hypertriglyceridemia among Korean women: Hye Rin Choi, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023010. Published online December 29, 2022; DOI: https://doi.org/10.4178/epih.e2023010

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to investigate the association of age at first childbirth with the risk of hypertriglyceridemia among Korean women.

METHODS

This study used data from the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study. In total, 16,747 women were included in the cross-sectional analysis, and 6,250 women were included in the longitudinal analysis. The participants were divided based on their age at first childbirth (<20, 20-24, 25-29, and ≥30 years). Hypertriglyceridemia was defined as triglyceride levels of ≥150 mg/dL.

RESULTS

The multivariable-adjusted odds ratio for prevalent hypertriglyceridemia was 1.19 (95% confidence interval [CI], 1.01 to 1.40) in women whose first childbirth was before 20 years of age, compared to those whose first childbirth was at 25-29 years of age, after adjustment for age, study site, body mass index, blood pressure, diabetes, alcohol consumption, carbohydrate intake, income, marital status, education, parity, usage of oral contraceptives, and hormone replacement status. During a median follow-up of 5.2 years, 1,770 women developed hypertriglyceridemia. Compared with women who gave birth to their first child between 25 years and 29 years of age, those giving birth to their first child before 20 years of age had a higher risk for incident hypertriglyceridemia in later life (adjusted hazard ratio, 1.25; 95% CI, 0.99 to 1.57).

CONCLUSIONS

Giving birth to one’s first child before the age of 20 years was associated with an increased risk of hypertriglyceridemia among Korean women.

Summary

Korean summary
한국인유전체역학조사사업의 농촌기반 코호트 자료를 분석한 결과, 20세 이전에 초산을 경험한 한국 여성에서 25-29세에 경험한 군에 비해 고중성지방혈증에 걸릴 위험이 증가하였음 폐경 후 여성을 한정하여 보았을 때도 20세 이전 초산과 고중성지방혈증 간의 유의한 관련성을 보였음 여성의 출산 등 여성력이 심혈관계 질환 발생의 위험요인으로 작용할 수 있으며, 출산력에 따른 혈중 중성지방수치 관리 전략 마련이 필요함

Key Message
Among Korean women, having their first child before the age of 20 was associated with an increased risk of hypertriglyceridemia. Targeted preventive actions should be developed for those women who give birth at an early age in order to manage their blood triglyceride levels.

Citations

Citations to this article as recorded by

Adolescent childbirth and mobility disability among women ages 15–49: an analysis of population health surveys from 14 low-income and middle-income countries
Katherine E Peck, Diego G Bassani, Saionara MA Camara, Marlos R Domingues, Tetine Sentell, Maria P Velez, Catherine M Pirkle
BMJ Open.2023; 13(7): e072535. CrossRef

Parental concerns about COVID-19 vaccine safety and hesitancy in Korea: implications for vaccine communication: Hye-Kyung Cho, Hyunju Lee, Young June Choe, Shinkyeong Kim, Sujin Seo, Jiwon Moon, Eun Hwa Choi, Geun-Yong Kwon, Jee Yeon Shin, Sang-Yoon Choi, Mi Jin Jeong, Myoungsoon You; Epidemiol Health. 2023;45:e2023004. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023004

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Abstract Summary PDF

Abstract

OBJECTIVES
Vaccination is one of the most important strategies to contain the spread of coronavirus disease 2019 (COVID-19). Vaccination in children is dependent on their parents, making it important to understand parents’ awareness and attitudes toward vaccines in order to devise strategies to raise vaccination rates in children.

METHODS

A web-based nationwide survey was conducted among Korean parents of 7-year-old to 18-year-old children in August 2021 to estimate parents’ intention to vaccinate their children against COVID-19 and identify key factors affecting parental acceptance and hesitancy through regression analysis.

RESULTS

Approximately 56.4% (575/1,019) were willing to vaccinate their children against COVID-19. Contributing factors to COVID-19 vaccine hesitancy were being a mother (adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.25 to 0.52), a lower education level (aOR, 0.83; 95% CI, 0.70 to 0.97), hesitancy to other childhood vaccines (aOR, 0.78; 95% CI, 0.64 to 0.96), and refusal to vaccinate themselves (aOR, 0.08; 95% CI, 0.02 to 0.20). Having older children (aOR, 1.20; 95% CI, 1.13 to 1.28), trusting the child’s doctor (aOR, 1.19; 95% CI, 1.07 to 1.32), positive perceptions of the COVID-19 vaccine’s effectiveness (aOR, 2.60; 95% CI, 1.90 to 3.57) and perceiving the COVID-19 vaccine as low-risk (aOR, 1.68; 95% CI, 1.27 to 2.24) were associated with COVID-19 vaccine acceptance. Concerns about adverse reactions were the most common cause of hesitancy.

CONCLUSIONS

Providing parents with accurate and reliable information on vaccine effectiveness and safety is important to increase COVID-19 vaccine uptake in children. Differential or targeted approaches to parents according to gender, age, and their children’s age are necessary for effective communication about vaccination in children.

Summary

Korean summary
부모에게 백신 효과와 안전성에 대한 정확하고 믿을만한 정보를 제공하는 것이 소아 코로나19 백신 접종률을 높이는데 중요하다. 자녀의 백신 접종에 대한 의사소통을 효율적으로 하기 위해서는 부모의 성별과 연령, 자녀의 연령을 고려한 차별적인 접근 방법이 필요하다.

Key Message
To improve COVID-19 vaccine uptake in children, it's crucial to provide parents with reliable and precise information about vaccine safety and effectiveness. Targeted communication strategies that consider factors such as the age of the parents and their children, as well as gender, may be necessary to effectively convey this information.

Citations

Citations to this article as recorded by

Safety of BNT162b2 mRNA COVID-19 vaccine in children with chronic kidney disease: a national population study from South Korea
Young June Choe, Yo-Han Ahn, Eunsun Gwak, Eunseo Jo, Jinseob Kim, Seung-Ah Choe
Pediatric Nephrology.2024; 39(2): 625. CrossRef
Assessing the determinants of influenza and COVID-19 vaccine co-administration decisions in the elderly
Seunghyun Lewis Kwon, So-Yeon Kim, Minju Song, Hyung-Min Lee, Seon-Hwa Ban, Mi-Soon Lee, Hyesun Jeong
Human Vaccines & Immunotherapeutics.2024;[Epub] CrossRef
Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10–12 years of age—A step toward prevention of future COVID-19 outbreaks in India
Vivek Mehta, Deep Inder, Pawan Kumar, Anupma Raheja
Journal of Family Medicine and Primary Care.2024; 13(5): 2104. CrossRef
Comparative safety of monovalent and bivalent mRNA COVID-19 booster vaccines in adolescents aged 12 to 17 years in the Republic of Korea
Mijeong Ko, Seontae Kim, Seok-Kyoung Choi, Seung Hwan Shin, Yeon-Kyeng Lee, Yunhyung Kwon
Osong Public Health and Research Perspectives.2024; 15(4): 364. CrossRef
Pediatric asthma and COVID-19 vaccination: unveiling patterns of hesitancy and acceptance
Marzieh Tavakol, Saber Gharagozlou, Mohammad Abbasi, Zahra Zamani, Mohammad Gharagozlou
Therapeutic Advances in Vaccines and Immunotherapy.2024;[Epub] CrossRef
Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy
Grazia Miraglia del Giudice, Giorgia Della Polla, Mario Postiglione, Italo Francesco Angelillo
Frontiers in Public Health.2023;[Epub] CrossRef
Associations between Socio-Demographic Characteristics and Maternal Attitudes towards Childhood Vaccination in Cyprus—A Cross-Sectional Survey
Maria Kyprianidou, Georgia Fakonti, Eleana Tzira, Magdalini Pylli, Konstantinos Giannakou
COVID.2023; 3(7): 1042. CrossRef

Maternal pre-pregnancy anemia and childhood anemia in Indonesia: a risk assessment using a population-based prospective longitudinal study: Fadila Wirawan, Dieta Nurrika; Epidemiol Health. 2022;44:e2022100. Published online November 1, 2022; DOI: https://doi.org/10.4178/epih.e2022100

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Anemia in children under 5 years of age is often overlooked despite its detrimental effects. The public health approach to anemia prevention includes the maternal pre-pregnancy phase. This study investigated the association between pre-pregnancy anemia and the risk of anemia in children under 5 years of age.

METHODS

This cohort study included non-pregnant women from the 2007 Indonesian Family Life Survey (IFLS) and their children under 5 in the 2014 IFLS. The anemia status of mothers and children was determined based on hemoglobin (Hb) levels using Hemocue. Mantel-Haenszel adjusted relative risks (aRRs), including risk stratification by covariates, were used for the final risk assessment.

RESULTS

In total, 637 children in the 2014 IFLS were included. The risk of having a child with anemia was 1.71-fold higher in women with pre-pregnancy anemia than in women without pre-pregnancy anemia (aRR, 1.71; 95% confidence interval [CI], 1.03 to 2.85). After risk stratification based on potential confounding variables, maternal pre-pregnancy anemia remained an independent risk factor for anemia in children who still breastfed at the time of data collection (relative risk [RR], 2.11; 95% CI, 1.16 to 3.86), in children who were given water earlier than 6 months of age (RR, 2.08; 95% CI, 1.20 to 3.61), in children of mothers with a normal or underweight pre-pregnancy body mass index (RR, 1.94; 95% CI, 1.20 to 3.14), and in children of mothers without current anemia (RR, 2.20; 95% CI, 1.21 to 3.99).

CONCLUSIONS

Pre-pregnancy anemia increased the risk of childhood anemia. A public health approach emphasizing pre-conception maternal health would enable better maternal and child morbidity risk prevention.

Summary

Key Message
Pre-pregnancy anemia increased the risk of childhood anemia by 1.7 times compared to without pre-pregnancy anemia, and increased when the child was still breastfed, given water before 6 months of age, and the mother had a normal or underweight pre-pregnancy BMI, regardless of the mother’s current no anemia status.

Citations

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Identification and treatment of iron‐deficiency anemia in pregnancy and postpartum: A systematic review and quality appraisal of guidelines using AGREE II
Victoria Mintsopoulos, Evan Tannenbaum, A. Kinga Malinowski, Nadine Shehata, Melissa Walker
International Journal of Gynecology & Obstetrics.2024; 164(2): 460. CrossRef
Effect of Booklet Education and Cadre Assistance on Iron Tablets Consumption among Anemic Pregnant Women in East Jakarta
Adhila Fayasari, Isti Istianah, Sri Fauziana
Amerta Nutrition.2024; 8(1SP): 19. CrossRef
Prevalence and risk factors of anemia in the mother–child population from a region of the Colombian Caribbean
Lisetta Del Castillo, Nora Cardona-Castro, Denis R. Whelan, John Paul Builes, Héctor Serrano-Coll, Margarita Arboleda, Juan S. Leon
BMC Public Health.2023;[Epub] CrossRef
Iron deficiency anemia in pregnant women
L. D. Belotserkovtseva, L. V. Kovalenko, V. N. Zinin, S. E. Ivannikov, M. R. Keldasova
Ural Medical Journal.2023; 22(5): 140. CrossRef
Safety monitoring of oral iron supplements in pregnant women with anemia: a multi-center observational clinical study
Chang Liu, Qianqian Zhang, Peiye Hui, Yan Wang, Guohui Li, Guangchao Cao, Zicheng Xue, Jing Zhang, Heng Zhang, Xin Huang, Jiyong Wu, Fusehng Sun, Meixing Yan
Therapeutic Advances in Drug Safety.2023;[Epub] CrossRef

Aspergillus sensitization associated with current asthma in children in the United States: an analysis of data from the 2005-2006 NHANES: Hui-Ju Wen, Shu-Li Wang, Ming-Chieh Li, Yue Leon Guo; Epidemiol Health. 2022;44:e2022099. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022099

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the association between allergen sensitization and current asthma in children in the United States using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES).

METHODS

Children who participated in the 2005–2006 NHANES, aged 6 years to 19 years, were included in this study. A structured questionnaire was used to assess asthma status (without asthma, asthma in remission, or current asthma). Nineteen specific immunoglobulin E (sIgE) levels were measured using the Pharmacia Diagnostics ImmunoCAP 1000 System (Kalamazoo, MI, USA). A machine-learning method was applied to select important sIgEs related to childhood asthma. Multivariate regression analysis was used to test this hypothesis.

RESULTS

In total, 2,875 children were recruited. The prevalence of ever having asthma and current asthma was 16.5% and 5.6%, respectively. Six sIgE levels were found to contribute to asthma using bootstrap forest selection. After adjusting for the child’s sex, age, and family income, children with double the sIgE levels of Dermatophagoides farinae, dogs, and Aspergillus were more likely to have current asthma than children without asthma (odds ratio [95% confident interval]: 1.11 [1.04 to 1.19], 1.30 [1.16 to 1.46], and 1.55 [1.39 to 1.72], respectively).

CONCLUSIONS

Our findings suggest that allergen sensitization, especially to Aspergillus, is associated with current asthma in children. Strategies to reduce sensitization may help prevent and manage asthma.

Summary

Key Message
This investigation studied 2,875 children from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, aged less than 19 years, for the association between allergen sensitization and persistent asthma. Six specific IgE levels (i.e. Dermatophagoides farina, Dermatophagoides pteronyssinus, cat, dog, Alternaria, and Aspergillus) were found to contribute to asthma using bootstrap forest selection. Our findings suggested that allergen sensitization, especially to Aspergillus, is associated with asthma persistence in children after adjusting for potential confounders. Strategies to reduce sensitization may help prevent and manage asthma.

Citations

Citations to this article as recorded by

Aspergillus‐sensitized asthma in children
Enes Celik, Dilara Kocacik Uygun, Mehmet Akif Kaya, Merve Sibel Gungoren, Ayse Keven, Aysen Bingol
Pediatric Allergy and Immunology.2024;[Epub] CrossRef
Age-related differences in IgE between childhood and adulthood allergic asthma: Analysis of NHANES 2005–2006
Heping Fang, Juan Li, Luo Ren, Enmei Liu
World Allergy Organization Journal.2023; 16(12): 100842. CrossRef

Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019: Suchaorn Saengnipanthkul, Jeeraparn Phosuwattanakul, Kaewjai Thepsuthammarat, Nalinee Chongviriyaphan; Epidemiol Health. 2022;44:e2022047. Published online May 16, 2022; DOI: https://doi.org/10.4178/epih.e2022047

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database.

METHODS

Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63).

RESULTS

Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM.

CONCLUSIONS

Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes.

Summary

Key Message
Malnutrition is common among hospitalized Thai children, particularly protein energy malnutrition; it increases mortality, length of hospital stay, and hospital costs as well as exerts long-term effects on growth and development. Prevalence of overweight and obesity is increasing over the past 5 years, the vast majority involved patients 5 – 13 years of age.

Citations

Citations to this article as recorded by

The Low Sensitivity and Specificity of a Nutrition Screening Tool in Real Circumstances in a Tertiary Care Hospital Setting
Nithit Semsawat, Oraporn Dumrongwongsiri, Phanphen Phoonlapdacha
Children.2023; 10(4): 747. CrossRef

Cohort Profile

The Asenze Cohort Study in KwaZulu-Natal, South Africa: protocol and cohort profile: Chris Desmond, Gabriella A. Norwitz, Jane D. Kvalsvig, Rachel S. Gruver, Shuaib Kauchali, Kathryn G. Watt, Nonhlanhla P. Myeza, Adele Munsami, Leslie L. Davidson; Epidemiol Health. 2022;44:e2022037. Published online April 5, 2022; DOI: https://doi.org/10.4178/epih.e2022037

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Abstract

The Asenze cohort is set in South Africa, a middle-income country impacted by one of the highest global rates of people living with HIV/AIDS and high levels of socioeconomic inequality. This longitudinal population-based cohort of children and their primary caregivers assesses household and caregiver functioning, child health, social well-being, and neuro-development from childhood through adolescence. Almost 1,600 children born at the peak of the human immunodeficiency virus epidemic (2003-2005) were followed (with their primary caregivers) in 3 waves, between 2008 and 2021, at average ages of 5, 7, and 16. Wave 3 is currently underway, having assessed over 1,100 of the original wave 1 children. Wave 4 begins in 2022. The study, with a dyadic structure, uses a broad range of measures, validated in South Africa or recommended for global use, that address physical, social and neuro-development in childhood and adolescence, and the social, health, and psychological status of children’s primary caregivers. The Asenze study deepens our understanding of childhood physical, cognitive, and social abilities and/or disabilities, including risk-taking behaviors, and biological, environmental, and social determinants of health. We anticipate the findings will contribute to the development of community-informed interventions to promote well-being in this South African population and elsewhere.

Summary

Key Message
The Asenze Cohort Study, one of a limited number of population-based studies set in low- and middle-income countries, with a high level of retention, provides an understanding of neuro-developmental, psychosocial, home environmental and economic exposures and outcomes of over 1100 adolescents and their primary caregivers in KwaZulu-Natal, South Africa.

Citations

Citations to this article as recorded by

The social determinants of adolescent anxiety and depression in peri-urban South Africa
Laura Rossouw, Kathryn Watt, Leslie L. Davidson, Chris Desmond, Karli Montague-Cardoso
PLOS Mental Health.2024; 1(6): e0000173. CrossRef
The impact of caregiver mental health on child prosocial behavior: A longitudinal analysis of children and caregivers in KwaZulu-Natal, South Africa
Gabriella A. Norwitz, Chris Desmond, Rachel S. Gruver, Jane D. Kvalsvig, Amaleah F. Mirti, Shuaib Kauchali, Leslie L. Davidson, Giulia Ballarotto
PLOS ONE.2023; 18(10): e0290788. CrossRef

Original Articles

Association between dietary and suicidal behaviors in adolescents in Korea based on the Youth Risk Behavior Survey (2015-2020): Youngrong Lee, Ye Jin Jeon, Jee-Seon Shim, Sun Jae Jung; Epidemiol Health. 2022;44:e2022033. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022033

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Abstract

OBJECTIVES
This study explored the association between dietary and suicidal behaviors of Korean adolescents and investigated differences in this association in children of immigrant parents.

METHODS

The sample (n=368,138) was collected from the Korea Youth Risk Behavior Survey from 2015 to 2020. Participants who agreed to provide family information (n=313,689) were classified according to their parents’ nationality. The study variables were 11 self-reported dietary behaviors, and their composite dietary behaviors (i.e., nutrient deprivation and unhealthy food consumption) that resulted from principal component analysis. The association between study variables and suicide-related outcomes (i.e., suicidal ideation, suicide planning, and suicide attempts) was analyzed by multiple logistic regression with adjustment for covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

Participants who skipped key meals and foods were more likely to have attemped suicide (aOR [95% CI]: skipping breakfast ≥5 days/wk, 1.28 [1.21 to 1.35]; consuming fruits <1 times/wk: 1.42 [1.32 to 1.52]; consuming vegetables <1 times/wk: 1.72 [1.53 to 1.93]; consuming milk <3 times/wk: 1.07 [0.99 to 1.16]). The associations were prominent in third culture kids (TCKs) (aOR [95% CI]: 2.23 [1.61 to 3.09]; 2.32 [1.61 to 3.35]; 2.63 [1.50 to 4.60]; 1.69 [1.09 to 2.63], respectively). Participants who consumed unhealthy foods (fast food, caffeinated and sugary drinks) more frequently were more likely to have attempted suicide (aOR, 1.55; 95% CI, 1.38 to 1.73). This association was also more prominent in TCKs (aOR, 2.08; 95% CI, 1.08 to 4.01).

CONCLUSIONS

Our findings indicate a positive association between unfavorable dietary behaviors and outcomes related to suicide, and this association appears to be notable in adolescents with immigrant parents.

Summary

Korean summary
• 한국 청소년의 식이 행동과 자살 행동 사이의 연관성과 한국인 부모와 이민자 부모 자녀에서 위의 연관성 차이를 조사하였다. • 청소년의 결식 빈도 증가, 과일, 야채, 우유 섭취 감소는 자살 행동과 유의한 연관성이 있었으며 이민자 부모를 둔 청소년에서 연관성의 크기가 더 컸다. • 패스트푸드, 카페인, 가당 음료, 인스턴트 음식을 더 자주 섭취하는 청소년은 자살을 시도할 가능성이 더 높았으며 이민자 부모를 둔 청소년에서 더 큰 연관성을 보였다.

Key Message
The study found positive associations between undesirable dietary behaviors (e.g., skipping breakfast, increased consumption of fast food or instant food product) and outcomes related to suicide (i.e., suicide ideation, planning, and attempt) in Korean adolescents, and these associations appear to be prominent in adolescents with immigrant parents than those with Korean parents.

Citations

Citations to this article as recorded by

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017–2021: focusing on the comparisons before and during the COVID-19 pandemic
Mi-Sun Lee, Dong Jun Kim, Hooyeon Lee
Frontiers in Public Health.2023;[Epub] CrossRef
Association between body shape misperception and unhealthy eating behaviors among Korean adolescents
Yejin Kim, Bomgyeol Kim, Vasuki Rajaguru, Sang Gyu Lee, Tae Hyun Kim
Nutrition Research and Practice.2023; 17(6): 1143. CrossRef

Age-specific effects of ozone on pneumonia in Korean children and adolescents: a nationwide time-series study: Kyoung-Nam Kim, Youn-Hee Lim, Sanghyuk Bae, In Gyu Song, Soontae Kim, Yun-Chul Hong; Epidemiol Health. 2022;44:e2022002. Published online December 28, 2021; DOI: https://doi.org/10.4178/epih.e2022002

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Abstract

OBJECTIVES
The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents.

METHODS

We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants.

RESULTS

A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls.

CONCLUSIONS

Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.

Summary

Korean summary
-어린이와 청소년에서 대기오염물질인 오존에 단기 노출되었을 때 폐렴으로 인한 입원 위험이 증가하는지를 건강보험공단 청구자료를 이용하여 구축한 시계열자료로 분석하였다. -0-4세, 5-9세 군에서는 오존 단기 노출 시 폐렴으로 인한 입원 위험이 증가하였으나 10-14세, 15-19세 군에서는 입원 위험 증가가 관찰되지 않았다.

Key Message
• The effects of ozone levels on hospital admissions for pneumonia were evaluated. • We used quasi-Poisson time-series models and a difference-in-differences method. • Ozone levels increased hospital admissions for pneumonia at ages 0–4 and 5–9 years. • Evidence for the effects of ozone levels on pneumonia was not found at older ages.

Citations

Citations to this article as recorded by

Challenges of Air Pollution and Health in East Asia
Xihao Du, Renjie Chen, Haidong Kan
Current Environmental Health Reports.2024; 11(2): 89. CrossRef
Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China
Jiahong Ren, Lifeng Zhu, Yachen Li, Haiyi Li, Qian Hu, Jian Zhu, Qingyan Zhang, Yunquan Zhang
Environmental Science and Pollution Research.2023; 30(30): 74853. CrossRef

Cohort Profile

Cohort profile: the Ewha Birth and Growth Study: Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Jeong Choi, Ui Jeong Kim, Hyun Jin Park, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eui-Jung Kim, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2021;43:e2021016. Published online February 22, 2021; DOI: https://doi.org/10.4178/epih.e2021016

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Abstract

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Summary

Korean summary
이화영아성장코호트는 만성질환 예방을 위한 생애초기 위험인자에 대한 근거를 제공하기 위해 2001년에 시작되었습니다. 이화영아성장코호트는 국내에서 선도적인 장기 추적관찰 연구로, 소아기 건강과 관련된 산전 및 출생 시 특징, 소아기 대사와 관련된 유전적 혹은 후성학적 특성, 내분비 장애물질 노출에 따른 영향, 소아기의 식이패턴과 같은 다양한 연구결과들을 발표하였습니다. 추후 청년기의 자료 수집을 계획하고 있으며, 우리의 연구결과는 만성질환 예방을 위한 중재 개발에 기여할 것으로 기대됩니다.

Key Message
To provide evidence of early life risk factors for the prevention of chronic diseases, the Ewha Birth and Growth Study was started in 2001. The Ewha Birth and Growth cohort is a leading long-term follow-up study in Korea, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. We are planning to collect data for early adulthood, and our findings will contribute to the development of interventions to prevent chronic diseases.

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Prospective association between phthalate exposure in childhood and liver function in adolescence: the Ewha Birth and Growth Cohort Study
Seonhwa Lee, Hye Ah Lee, Bohyun Park, Hyejin Han, Young Sun Hong, Eun Hee Ha, Hyesook Park
Environmental Health.2023;[Epub] CrossRef
BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
Ui-Jeong Kim, Eun Jeong Choi, Hyunjin Park, Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eun Hee Ha, Seungyoun Jung, Hyesook Park
Pediatric Research.2023; 94(1): 153. CrossRef
The Effect of Childhood Obesity or Sarcopenic Obesity on Metabolic Syndrome Risk in Adolescence: The Ewha Birth and Growth Study
Hyunjin Park, Seunghee Jun, Hye-Ah Lee, Hae Soon Kim, Young Sun Hong, Hyesook Park
Metabolites.2023; 13(1): 133. CrossRef
Synergistic effect of serum uric acid and body mass index trajectories during middle to late childhood on elevation of liver enzymes in early adolescence: Findings from the Ewha Birth and Growth Study
Sung Hee Lee, Eun Jeong Choi, Ui Jeong Kim, Hyunjin Park, Bomi Park, Hye Ah Lee, Hyesook Park, Linglin Xie
PLOS ONE.2023; 18(4): e0282830. CrossRef
The association between urinary cotinine level and metabolic syndrome profiles among adolescents: findings from the Ewha Birth and growth study
Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Seunghee Jun, Bomi Park, Hye Ah Lee, Hae Soon Kim, Hyesook Park
BMC Public Health.2023;[Epub] CrossRef
The Mediating Effect of Inflammation between the Dietary and Health-Related Behaviors and Metabolic Syndrome in Adolescence
Ui-Jeong Kim, Eun-Jeong Choi, Hyunjin Park, Hye-Ah Lee, Bomi Park, Haesoon Kim, Youngsun Hong, Seungyoun Jung, Hyesook Park
Nutrients.2022; 14(11): 2339. CrossRef
Precision medicine via the integration of phenotype-genotype information in neonatal genome project
Xinran Dong, Tiantian Xiao, Bin Chen, Yulan Lu, Wenhao Zhou
Fundamental Research.2022; 2(6): 873. CrossRef
Association of participation in the Northern Finland Birth Cohort 1986 with mental disorders and suicidal behaviour
Martta Kerkelä, Mika Gissler, Juha Veijola
Epidemiology and Health.2022; 44: e2022005. CrossRef
Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence
Eun Jeong Choi, Hye Ah Lee, Bomi Park, Bohyun Park, Hae Soon Kim, Young Sun Hong, Hyesook Park
Scientific Reports.2021;[Epub] CrossRef

Original Articles

Risk factors for low back pain among elementary school students in western Iran using penalized logistic regression: Forouzan Rezapur-Shahkolai, Elham Gheysvandi, Leili Tapak, Iman Dianat, Akram Karimi-Shahanjarini, Rashid Heidarimoghadam; Epidemiol Health. 2020;42:e2020039. Published online June 2, 2020; DOI: https://doi.org/10.4178/epih.e2020039

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Abstract PDF

Abstract

OBJECTIVES
This study investigated the prevalence of low back pain (LBP) and its risk factors among elementary-school students.

METHODS

In this cross-sectional study, 693 elementary students from Hamadan city, western Iran, were selected by multistage stratified cluster sampling. Data were collected through interviews using questionnaires. Posture and psychosocial elements were assessed using the observational Rapid Upper Limb Assessment (RULA) checklist and the standard Strengths and Difficulties Questionnaire, respectively. Penalized logistic regression with the group smoothly-clipped absolute deviation regularization method was used for variable selection and data analysis (α=0.05). The chi-square test was also used.

RESULTS

In total, 26.6% of the students (7-12 years old) reported LBP in the last month. Older age (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.80 to 5.26), watching TV for more than 3 hours a day (OR, 2.62; 95% CI, 1.46 to 4.68), very short seat backrests (OR, 3.08; 95% CI, 1.61 to 5.90), excessively curved seat backrests (OR, 4.36; 95% CI, 2.08 to 9.13), very short desks (OR, 3.44; 95% CI, 1.61 to 7.35), a family history of LBP (OR, 2.49; 95% CI, 1.58 to 3.91), carrying a school bag on one shoulder (OR, 1.91; 95% CI, 1.03 to 3.54), and RULA scores of 3 (OR, 2.26; 95% CI, 1.13 to 4.50) or 4 (OR, 2.85; 95% CI, 1.37 to 5.91) were associated with LBP.

CONCLUSIONS

A high prevalence of LBP was found among elementary-school students. This study underscores the importance of recognizing vulnerable children and teenagers and developing interventional health promotion programs to prevent LBP based on an appropriate consideration of its contributory factors.

Summary

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Cultural appropriateness of interventions to prevent and reduce musculoskeletal disorders among students: a systematic review
Maryam Afshari, Elham Gheysvandi, Rohollah Norian, Mehdi Kangavari
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Frequency of back pain occurrence among high school youth including their physical activity
Ewelina ŁEBEK, Józefa DĄBEK, Magdalena SZYNAL, Andrzej KNAPIK
Minerva Pediatrics.2024;[Epub] CrossRef
Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis
Laura R C Montgomery, Michael Swain, Amabile B Dario, Mary O'Keeffe, Tie P Yamato, Jan Hartvigsen, Simon French, Christopher Williams, Steve Kamper
British Journal of Sports Medicine.2024; : bjsports-2024-108648. CrossRef
Prevalence of chronic pain and contributing factors: a cross-sectional population-based study among 2,379 Iranian adolescents
Maryam Shaygan, Azita Jaberi, Marziehsadat Razavizadegan, Zainab Shayegan
The Korean Journal of Pain.2023; 36(2): 230. CrossRef
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Association between Physical Fitness and Low Back Pain: The Pepe Cross-Sectional Study
Aina M. Galmés-Panadés, Josep Vidal-Conti
Children.2022; 9(9): 1350. CrossRef
Prevalence of Low Back Pain among Primary School Students from the City of Valencia (Spain)
Vicente Miñana-Signes, Manuel Monfort-Pañego, Antonio Hans Bosh-Bivià, Matias Noll
Healthcare.2021; 9(3): 270. CrossRef
Identification of factors related to behaviors associated with musculoskeletal pain among elementary students
Forouzan Rezapur-Shahkolai, Elham Gheysvandi, Akram Karimi-Shahanjarini, Leili Tapak, Rashid Heidarimoghadam, Iman Dianat
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef
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Dijana Laštro, Mirsad Muftić, Nenad Ponorac, Dubravko Bokonjić
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Riska Ayu Yulianingtyas, Dani Nasirul Haqi
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Massimiliano Polastri, Julie Swann
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Fabíola Unbehaun Cibinello, Jessica Caroliny de Jesus Neves, Mônica Yosino Leão Carvalho, Paola Janeiro Valenciano, Dirce Shizuko Fujisawa
Motriz: Revista de Educação Física.2020;[Epub] CrossRef

Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study: Mekonen Adimasu, Girum Sebsibie, Fikrtemariam Abebe, Getaneh Baye, Kerebih Abere; Epidemiol Health. 2020;42:e2020003. Published online February 2, 2020; DOI: https://doi.org/10.4178/epih.e2020003

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Abstract PDF

Abstract

OBJECTIVES
Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.

METHODS

A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.

RESULTS

The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).

CONCLUSIONS

The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

Summary

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