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Systematic Reviews
Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis
Inhye Kim, Hyunseo An, Sohyeon Yun, Hae Yean Park
Epidemiol Health. 2024;46:e2024013.   Published online January 3, 2024
DOI: https://doi.org/10.4178/epih.e2024013
  • 2,522 View
  • 145 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.
METHODS
The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.
RESULTS
Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.
CONCLUSIONS
This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.
Summary
Korean summary
본 연구는 독거 노인들 대상으로 한 지역사회 기반 중재의 효과에 대하여 탐색하고 그 효과 크기를 확인하기 위하여 체계적고찰 및 메타분석을 실시하였다. 영양 및 복합 중재가 특히 효과적이었으며, 이는 건강 행동과 정신건강에 있어 중요한 긍정적 효과를 나타내어 추후 개별적 맞춤 중재의 잠재적 효과성을 나타낸다. 이러한 발견은 독거노인 집단의 웰빙 향상을 위한 프로그램과 정책 입안에 근거로 활용될 수 있다.
Key Message
This systematic review and meta-analysis evaluated the impact of community-based interventions for older adults living alone, incorporating 9 studies to assess effectiveness in areas like nutrition and combined strategies. Results indicated significant benefits, particularly in health behavior and mental health, demonstrating the potential of tailored interventions. These findings support the development of targeted programs and policy decisions aimed at improving the well-being of this demographic.
The status quo of systematic reviews published in high-impact journals in Korea: a study focused on protocol registration and GRADE use
Mi Ah Han, Seong Jung Kim, Eu Chang Hwang, Jae Hung Jung
Epidemiol Health. 2022;44:e2022108.   Published online November 15, 2022
DOI: https://doi.org/10.4178/epih.e2022108
  • 3,140 View
  • 67 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the status quo of systematic reviews published in major journals in Korea from the perspective of protocol registration and adopting the grading of recommendation, assessment, development and evaluation (GRADE) system.
METHODS
We examined systematic reviews published in Korea’s top 15 medical journals from 2018 to 2021. Teams of 2 reviewers assessed the studies’ eligibility criteria and extracted data independently and in duplicate. We collected information on study characteristics, protocol registration, and GRADE use of the included reviews, and reviewed the “Instructions for Authors” of the selected journals to assess any guidance related to systematic reviews.
RESULTS
Out of the 126 identified reviews, 18 (14.3%) reported that they registered or published their protocol. Only 5 (4.0%) rated the certainty of evidence; and all 5 used the GRADE system. Only 6 of 15 journals mentioned systematic reviews in their “Instructions for Authors.” Six journals endorsed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for systematic review reporting (2 mandatory, 3 recommended, and 1 unclear). None of the journals included mentioned protocol registration or certainty of evidence in their authors’ guidelines.
CONCLUSIONS
Overall, the proportion of systematic reviews that had prior protocol registration or used the GRADE approach to rate the certainty of evidence was very low. Our study highlights the need for adherence to systematic review standards in medical journals in Korea, including prior protocol registration and certainty of evidence assessment. Our review will help improve the quality of systematic reviews in Korea.
Summary
Korean summary
한국 의학 저널에서 계획서를 사전에 등록하거나 근거의 확실성을 평가하기 위해 GRADE 접근 방식을 사용한 체계적 문헌고찰의 분율은 낮았다. 우리의 연구는 계획서 등록 및 근거의 확실성 평가를 포함하여 체계적 문헌고찰의 방법론적 표준 준수의 필요성을 강조한다.
Key Message
The proportion of systematic reviews that had prior protocol registration or used the GRADE approach to rate the certainty of evidence was very low in Korean medical journals, and our study highlights the need for adherence to systematic review standards in medical journals in Korea, including prior protocol registration and certainty of evidence assessment.
COVID-19: Editorial
WHO International Health Regulations Emergency Committee for the COVID-19 outbreak
Youngmee Jee
Epidemiol Health. 2020;42:e2020013.   Published online March 19, 2020
DOI: https://doi.org/10.4178/epih.e2020013
  • 24,712 View
  • 878 Download
  • 138 Web of Science
  • 180 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
To discuss whether the coronavirus disease 2019 (COVID-19) outbreak constitutes a Public Health Emergency of International Concern (PHEIC), World Health Organization (WHO) organized the 15-member International Health Regulations Emergency Committee (EC). On January 22-23 and January 30, 2020, EC convened and discussed whether the situation in China and other countries would constitute PHEIC and issued recommendations for WHO, China and the international community. Based on the recommendations of EC, WHO declared the COVID-19 outbreak a PHEIC. One of the purposes of the declaration of PHEIC was to alarm countries with weak public health infrastructures to prepare promptly for emerging infectious diseases (EID) and provide WHO with a framework for proactively supporting those countries. On February 3, 2020, WHO proposed the 2019 COVID-19 Strategic Preparedness and Response Plan, which includes accelerating research and development (R&D) processes as one of three major strategies. On February 11-12, 2020, WHO held the Global Research and Innovation Forum: Towards a Research Roadmap for COVID-19. The fact that a COVID-19 R&D forum was the first meeting convened after the PHEIC declaration testifies to the importance of R&D in response to EID. Korea has demonstrated a remarkable capacity in its laboratory response by conducting high-throughput COVID-19 testing and utilizing innovative drive-through samplings. These measures for early detection and screening of cases should be followed by full efforts to produce research-based evidence by thoroughly analyzing epidemiological, clinical and immunological data, which will facilitate the development of vaccines and therapeutics for COVID-19. It is expected that Korea plays a global partner for COVID-19 research by actively participating in immediate and mid/long-term priorities jointly led by WHO and global partners.
Summary
Korean summary
WHO는 COVID-19 유행이 국제보건규약(IHR)이 규정하는 국제공중보건위기상황(PHEIC)임을 선포했다. PHEIC의 선포는 신종감염병 연구개발을 가속화하는 기회가 되며, 대한민국도 COVID-19 연구개발을 위한 글로벌 노력에 더욱 적극적으로 참여하여야 한다.

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Review Paper
Data resource profile: the National Health Insurance Research Database (NHIRD)
Liang-yu Lin, Charlotte Warren-Gash, Liam Smeeth, Pau-Chung Chen
Epidemiol Health. 2018;40:e2018062.   Published online December 27, 2018
DOI: https://doi.org/10.4178/epih.e2018062
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AbstractAbstract PDFSupplementary Material
Abstract
Electronic health records (EHRs) can provide researchers with extraordinary opportunities for population-based research. The National Health Insurance system of Taiwan was established in 1995 and covers more than 99.6% of the Taiwanese population; this system’s claims data are released as the National Health Insurance Research Database (NHIRD). All data from primary outpatient departments and inpatient hospital care settings after 2000 are included in this database. After a change and update in 2016, the NHIRD is maintained and regulated by the Data Science Centre of the Ministry of Health and Welfare of Taiwan. Datasets for approved research are released in three forms: sampling datasets comprising 2 million subjects, disease-specific databases, and full population datasets. These datasets are de-identified and contain basic demographic information, disease diagnoses, prescriptions, operations, and investigations. Data can be linked to government surveys or other research datasets. While only a small number of validation studies with small sample sizes have been undertaken, they have generally reported positive predictive values of over 70% for various diagnoses. Currently, patients cannot opt out of inclusion in the database, although this requirement is under review. In conclusion, the NHIRD is a large, powerful data source for biomedical research.
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Review
Registry-based stroke research in Taiwan: past and future
Cheng-Yang Hsieh, Darren Philbert Wu, Sheng-Feng Sung
Epidemiol Health. 2018;40:e2018004.   Published online February 4, 2018
DOI: https://doi.org/10.4178/epih.e2018004
  • 22,289 View
  • 377 Download
  • 18 Web of Science
  • 16 Crossref
AbstractAbstract PDF
Abstract
Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.
Summary

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Method
A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016014.   Published online April 26, 2016
DOI: https://doi.org/10.4178/epih.e2016014
  • 21,710 View
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  • 54 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
It is important to control the quality level of the observational studies in conducting meta-analyses. The Newcastle-Ottawa Scale (NOS) is a representative tool used for this purpose. We investigated the relationship between high-quality (HQ) defined using NOS and the results of subgroup analysis according to study design.
METHODS
We selected systematic review studies with meta-analysis which performed a quality evaluation on observational studies of diet and cancer by NOS. HQ determinations and the distribution of study designs were examined. Subgroup analyses according to quality level as defined by the NOS were also extracted. Equivalence was evaluated based on the summary effect size (sES) and 95% confidence intervals computed in the subgroup analysis.
RESULTS
The meta-analysis results of the HQ and cohort groups were identical. The overall sES, which was obtained by combining the sES when equivalence was observed between the cohort and case-control groups, also showed equivalence.
CONCLUSIONS
The results of this study suggest that it is more reasonable to control for quality level by performing subgroup analysis according to study design rather than by using HQ based on the NOS quality assessment tool.
Summary
Korean summary
관찰연구에 대한 메타분석을 수행할 때, 선정된 논문들의 질적 수준을 통제하기 위해 개발된 Newcastle-Ottawa Scale (NOS)는 평가 항목의 속성상 환자-대조군연구보다는 코호트 연구에서 High quality (HQ) 판정이 될 가능성이 높다. 이에, 식이와 암의 관련성을 연구한 관찰연구에 대한 메타분석에 있어 대부분의 코호트 연구를 HQ로 판정하였기에, HQ 군과 Cohort 군의 메타분석 결과는 동일하였다. 코호트군과 환자-대조군 간의 summary effect size (sES)가 동질성을 보일 경우 이를 합친 Overall sES 또한 동질성을 보였다. 이에, 식이역학에 특화된 질적평가도구가 개발되기 까지는 NOS를 적용하기 보다는 연구설계별로 하부군 분석을 하는 것을 권한다.

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Review
Disadvantages of publishing biomedical research articles in English for non-native speakers of English
Mohsen Rezaeian
Epidemiol Health. 2015;37:e2015021.   Published online May 1, 2015
DOI: https://doi.org/10.4178/epih/e2015021
  • 20,476 View
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AbstractAbstract PDF
Abstract
OBJECTIVES
English has become the most frequently used language for scientific communication in the biomedical field. Therefore, scholars from all over the world try to publish their findings in English. This trend has a number of advantages, along with several disadvantages.
METHODS
In the current article, the most important disadvantages of publishing biomedical research articles in English for non-native speakers of English are reviewed.
RESULTS
The most important disadvantages of publishing biomedical research articles in English for non-native speakers may include: Overlooking, either unintentionally or even deliberately, the most important local health problems; failure to carry out groundbreaking research due to limited medical research budgets; violating generally accepted codes of publication ethics and committing research misconduct and publications in open-access scam/predatory journals rather than prestigious journals.
CONCLUSIONS
The above mentioned disadvantages could eventually result in academic establishments becoming irresponsible or, even worse, corrupt. In order to avoid this, scientists, scientific organizations, academic institutions, and scientific associations all over the world should design and implement a wider range of collaborative and comprehensive plans.
Summary

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Editorial
Korean translation of the CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials
Jun Suh Lee, Soyeon Ahn, Kyoung Ho Lee, Jee Hyun Kim
Epidemiol Health. 2014;36:e2014029.   Published online November 8, 2014
DOI: https://doi.org/10.4178/epih/e2014029
  • 21,019 View
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AbstractAbstract PDFSupplementary Material
Abstract
The Consolidated Standards of Reporting Trials (CONSORT) 2010 Statement, updated in March 2010, includes a 25-item checklist and flow diagram. Adherence to this statement is a minimum requirement for the complete, clear, and transparent reporting of randomized trials. We translated the CONSORT 2010 Statement into Korean to promote the widespread adherence to CONSORT in South Korea and to facilitate the adoption of complete, clear, and transparent reporting. The Korean version of the CONSORT is available at http://www.e-epih.org/.
Summary

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Methods
Narrative reviews
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014018.   Published online September 11, 2014
DOI: https://doi.org/10.4178/epih/e2014018
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  • 14 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Although qualitative researches (QR) are invaluable in understanding complex healthcare situations, the quantitative systematic reviews could not treat them. To improve quality of healthcare services, results of QR should be considered in healthcare decision-making processes. Several methods and theories for synthesizing evidences of QR have been developed. In order to activate the narrative reviews and mixed methods reviews in Korean healthcare academies, I arranged the related nomenclatures and suggested some issues to conduct them.
Summary
Korean summary
질적연구는 보건의료의 복잡성을 이해하는데 매우 유용함에도 불구하고, 메타분석을 수행하는 체계적 고찰에서는 다루어지지 않는다. 그렇지만 보건의료의 질적 향상을 도모하려면 질적 연구의 결과를 보건의료 결정과정에서 반영해야 한다. 질적 연구 결과들을 합성하려는 여러 시도들이 있어온 것을 요약하고, 관련한 용어들을 정리하여 질적연구와 이를 합성하는 서술적 고찰이 활성화되는 바탕을 마련코자 한다.

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Original Article
Analysis of Studies on Colorectal Cancers Published in Korean Medical Journals Between 1967 and 2004.
Eunkyoung Paik, Soonduck Kim, Jesuk Lee
Korean J Epidemiol. 2007;29(2):146-154.
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AbstractAbstract PDF
Abstract
PURPOSE
The study analyzed and categorized the colorectal cancers related medical journals published in Korea by the name of the journal, research materials, study method, statistical method and by content of study for the quality improvement of colorectal cancers related studies.
METHODS
The authors reviewed a total of 567 colorectal cancer-related studies published in the Korean medical journals during the period 1967 and 2004 and kept in the National Assembly Library. The distribution of research materials, study method, statistical method and content of these studies were analyzed by the 5 year publication interval.
RESULTS
By study period, the number of published studies steeply increase during the period between 2000 and 2004. As the research materials, hospital patients(64.6%) and In-vitro(16.6%) were the most prevalently used research materials, but health adults were the lowest research materials by only taking up 0.4%. In study methods, patient follow up studies(28.7%) and human in vitro experimental(27.9%) were prevalent, and human in vitro experimental were relatively the most popular performed studies during the years of 1990-1994. As the statistical method, life table and survival analysis(27.0%) were the mostly performed methods, and the use of statistical method was applied in nearly all studies. The contents of the studies mainly focused on the patient prognostic estimations(27.6%) of therapeutic safety & efficacy(25.6%), but only the 4.1% of risk factors studies. Among the 109 studies which analyzed the survival term 78.9% of the studies mainly used the 5 year term in the analysis of survival rates.
CONCLUSION
The results of the study could be utilized as the basic data for the quality improvement of further colorectal cancers related studies.
Summary
Review
Bioethics and Protection of Personal Information in Experimental Studies.
Ock Joo Kim
Korean J Epidemiol. 2007;29(1):1-12.
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AbstractAbstract PDF
Abstract
Experimental studies involve intervention and manipulation of study elements such as randomization of the participating groups. In general, experimental studies involving human are riskier than observational studies, demanding robust ethical vigilance and compliance among such stakeholders as investigators, sponsors, IRBs and health authorities. Social values of research should be counted as a primary ethical consideration in experimental research. It is unethical to put human subjects into uncertain and risky conditions if the study does not pursue valuable knowledge. Sound scientific design is prerequisite for good ethics. Risk-benefit ratio of the study must be carefully evaluated study. Not only risks from physical harms but also socio-economical and psychological harms from the study should be considered as risk of the study. Risks from the design of the study such as randomization and placebo must be carefully examined. Voluntary informed consent is essential in experimental studies involving human. Human subjects, before they decide to participate in the study, must be informed the followings: risks, benefits, experimental procedures, alternative treatment, compensation for injury, and participants' voluntariness and right to withdraw at anytime. Experimental studies are usually required written consent documentation and full institutional review board (IRB) review. Other elements of experimental research ethics includes special protection for high risk groups and various vulnerable groups, and protection of privacy and confidentiality.
Summary

Epidemiol Health : Epidemiology and Health