Background The coronavirus disease 2019 (COVID-19) pandemic in Indonesia has led to an increase in mental health problems, especially among those with comorbid hypertension. Uncontrolled hypertension is the primary comorbidity of COVID-19. Thus, this study aimed to determine the pattern of uncontrolled hypertension at two time points during the pandemic and to confirm its relationship with common mental disorders (CMDs).
Methods This longitudinal study was conducted at two time points (2019 and 2021), and the data of individuals with hypertension was sourced from the Bogor of Noncommunicable Diseases Risk Factors Cohort Study. Data of 1,231 respondents who met the inclusion and exclusion criteria were included in the analyses. The Self-Reported Questionnaire-20 was used to measure CMDs (score of >6). This study used a generalized estimating equation to analyze the data.
Results The percentage of those with uncontrolled hypertension increased from 57.6% to 66.4%, whereas those with CMDs increased from 6.1% to 11.5%, from 2019 to 2021. The risk of uncontrolled hypertension was higher in patients with CMDs than in those without CMDs. The risk of uncontrolled hypertension increased from twice (adjusted odds ratio [aOR], 1.57; 95% confidence interval [CI], 1.071–2.069) in 2019 to 3 times (aOR, 2.765; 95% CI, 2.243–3.287) in 2021.
Conclusion Since stress increases the risk of developing uncontrolled hypertension, individuals with hypertension must be able to manage their stress. Apropos this, the governments should provide mental health consultation services in treating patients with hypertension, especially during adverse events such as pandemics.
Background Interest in healthy aging has grown with the increase in the older population. Nutritional intake is crucial in frailty. Therefore, we aimed to investigate the relationship between frailty and multivitamin and mineral supplements (MVMS), which can easily provide micronutrients.
Methods The Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2018 to 2019 included 3,395 adults aged ≥65 years. Of these, 1,511 who did not consume dietary supplements (DS, non-DS group) and 415 who took MVMS (MVMS group) were included in the study. We modified Fried’s definition of frailty to fit the KNHANES data. Using multivariate logistic regression, we examined the association between MVMS use and frailty, which varied with satisfaction with total energy intake. Additional subgroup analyses were performed based on age, sex, and income.
Results MVMS reduced most micronutrient deficiencies compared to obtaining nutrients solely through food. The overall analysis revealed no association between MVMS use and frailty (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.52–1.09). However, a subanalysis revealed that participants with a low income (≤25%) who took MVMS had decreased odds for frailty (OR, 0.55; 95% CI, 0.35–0.88) compared with the non-DS group. Furthermore, a significant association between using MVMS and frailty was confirmed in the group with low income and energy intake below the recommended daily allowance, with a low OR of 0.52 (95% CI, 0.30–0.90).
Conclusion MVMS use was significantly associated with frailty among the low-income and low-daily energy intake groups.
Background Depression is a prevalent mental health disorder that presents substantial public health challenges. Emerging evidence underscores the role of dietary patterns in mitigating depressive symptoms. This study investigated the association between diet quality, assessed using the Recommended Food Score (RFS), and depressive symptoms, evaluated with the Patient Health Questionnaire-9 (PHQ-9), in a sample of Korean adults.
Methods This cross-sectional study analyzed data from 19,786 participants recruited from a general hospital in Korea, all of whom completed the RFS and PHQ-9 assessments. General characteristics and anthropometric indices were recorded. Statistical analyses included chi-square tests and binary logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for depressive symptoms according to RFS scores, adjusting for potential confounders.
Results Higher RFS scores were associated with reduced odds of depression in univariate (OR, 0.59; P<0.001) and multivariate (OR, 0.72; P<0.001) analyses. Sociodemographic factors, including older age, higher education, marital status, higher income, professional occupation, and regular exercise, were linked to decreased odds of depression. Conversely, female sex, current smoking, and alcohol consumption were associated with increased odds.
Conclusion The findings reveal an inverse relationship between diet quality and depressive symptoms among Korean adults, emphasizing the potential of dietary improvements in mental health promotion. Sociodemographic factors significantly influence depression risk. Future studies should adopt longitudinal designs incorporating a wider range of variables to elucidate these complex interactions.
Background Menstrual hygiene is crucial to a woman’s physical, social, and mental well-being. The menstrual cup offers a safe and effective solution but still requires wider adoption. This study aims to assess awareness, practices, and barriers regarding the use of menstrual cups among women of reproductive age.
Methods A cross-sectional study was conducted among 246 participants, randomly selected from outpatient settings of a tertiary care hospital in 2022. Non-pregnant menstruating women were included, while those with pelvic infections or cognitive impairments were excluded. After explaining the study’s purpose and ensuring anonymity, data were collected using a structured questionnaire adapted from previous studies conducted in India and abroad. Knowledge and practices were depicted using descriptive statistics, while factors affecting awareness were analyzed using a multivariable binary logistic regression analysis approach.
Results Approximately 64.2% of participants were aware of menstrual cups, but only three were users. Participants living in urban areas, practicing Hinduism, and marrying after the age of 20 years showed higher awareness. Users rated the cup as comfortable, with no skin irritation, foul odor, or dryness. The primary barrier to use was insufficient knowledge.
Conclusion There is a gap in awareness and usage of menstrual cups, especially in low- and middle-income countries like India. Preliminary feedback from users is encouraging, suggesting that menstrual cups could offer a cost-effective, eco-friendly, and sustainable way to improve menstrual hygiene.
Background The liver plays an important role in gonadal steroid hormone metabolism, which can affect reproductive health, including the menstrual cycle. However, evidence from large population-based studies is limited. Therefore, this study aimed to investigate the association between liver function markers and menstrual cycle irregularities in premenopausal Korean women using nationwide data.
Methods This study analyzed Data from the Korea National Health and Nutrition Examination Survey 2010–2011. We investigated 3,045 premenopausal women aged 19–59 years. Liver function markers including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase, and fatty liver index were analyzed. Multivariable logistic regression analysis was performed to investigate the association between liver function markers and menstrual cycle irregularity while adjusting for confounding factors. Values were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analysis was also performed.
Results Baseline characteristic analysis showed that approximately 14.4% of the study population experienced menstrual cycle irregularity. The mean age was 34.5±0.7 years. The highest quartile of serum ALT and AST levels showed significantly higher ORs for menstrual cycle irregularity (adjusted OR, 1.83; 95% CI, 1.26–2.64 and adjusted OR, 1.67; 95% CI, 1.17–2.39, respectively). A similar result was observed in the subgroup analysis.
Conclusion Liver function markers were positively associated with menstrual cycle irregularities. In clinical settings, women of reproductive age with relatively decreased liver function should be considered for regular followup of their reproductive health status.
Metformin is the most widely used antihyperglycemic drug in patients with type 2 diabetes (T2D). Over the past 2 decades, several studies have highlighted a substantial increase in the risk of vitamin B12 deficiency in patients with T2D on metformin therapy. This can lead to several complications and induce or exacerbate peripheral neuropathy. Despite these data, there are no definite guidelines for screening, diagnosing, and treating vitamin B12 deficiency in patients with T2D on metformin therapy. Therefore, in this narrative review, we aimed to suggest a practical diagnostic and therapeutic strategy to address vitamin B12 deficiency in patients with T2D receiving metformin treatment. Clinical evidence supporting an increased risk of vitamin B12 deficiency in patients with T2D on metformin therapy and its risk factors and potential complications are also discussed.
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Background Female workers in Indonesia are vulnerable, because they must work to earn a living while still being responsible for domestic problems. This study analyzes the barriers to the use of modern contraceptives by female workers in Indonesia’s urban areas.
Methods This cross-sectional survey looked at 21,696 female workers. We used modern contraceptive use as a dependent variable, and age, education, wealth, known modern contraceptives, number of live births, ideal number of children, and insurance ownership as independent variables. In the final test, we employed binary logistic regression.
Results The results showed that women at all age categories were more likely than those aged 15–19 years not to use modern contraceptives, except those aged 35–39 years, who showed no difference. All other marital types were more likely to use modern contraceptives than married individuals. Rich female workers were 1.139 times more likely than poor workers not to use modern contraceptives (adjusted odds ratio [AOR], 1.139; 95% confidence interval [CI], 1.026–1.264). Female workers who did not know about modern contraceptives were 4.549 times more likely than those who did not to use modern contraceptives (AOR, 4.549; 95% CI, 1.037–19.953). Female workers with more than two children were 9.996 times more likely than those with two or fewer children not to use modern contraceptives (AOR, 9.996; 95% CI, 9.1890–10.875).
Conclusion This study identified five factors associated with the non-use of modern contraceptives by female workers in Indonesia’s urban areas: young, unmarried, rich, did not know about modern contraceptives, and had more than two children.
Background The relationship between weight change and quality of life remains controversial. This study aimed to investigate whether changes in body weight among participants in different baseline body mass index categories are associated with physical and mental health functioning.
Methods We conducted an analysis involving 5,106 adults who participated in the Korean Genome and Epidemiology Study, a cohort comprising Korean adults aged 40 to 69 years. We categorized participants into three groups based on body weight change, and physical and mental health were assessed using the 12-Item Short-Form Health Survey in year 4. We employed logistic regression analysis to assess the association between body weight change and poor functioning at year 4. We also utilized a generalized estimating equation to determine the relationship between weight changes and mental component summary (MCS) scores over the study period for each weight group.
Results Weight gain in both the normal weight (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.13–3.11; P=0.01) and overweight groups (OR, 1.75; 95% CI, 1.05–2.91; P=0.03) was associated with poor MCS. Normal weight weight-losers were associated with a greater increase (2.69 points; 95% CI, 0.50–4.88) in MCS compared to weightmaintainers. Significant differences in mean MCS were observed for overweight weight-losers, obese weight-gainers, and underweight weight-gainers when compared to weight maintainers in each respective weight group.
Conclusion Different patterns of relationships between weight change and mental health-related quality of life were observed. Hence, it is crucial to focus on the mental health of middle-aged and older adults when assessing body weight changes.
Background Adolescence is an essential stage of a child’s development, transitioning them into adulthood. During this time, they are vulnerable to various social issues, such as experimenting with alcohol, among others. Although alcohol consumption was proven to be detrimental to physical and cognitive development toward adulthood, and almost one in 10 Malaysian adolescents aged 13 years and above are current drinkers, studies concerning the driving factors are still scarce. This cross-sectional study aimed to determine alcohol use among 244 adolescents in Nabawan, Sabah.
Methods This study assessed the associations between alcohol use and three potential factors: demographic, environmental, and psychological. Respondents who were selected through stratified proportionate random sampling answered a set of assessment tools.
Results Results showed that 30.7% (95% confidence interval [CI], 24.91–36.48) of Nabawan adolescents use alcohol. Analysis revealed that older age adolescents 18 years and 19 years, respectively (adjusted odds ratio [aOR], 3.93; P=0.021; aOR, 5.38; P=0.003), having parents (aOR, 4.11; P=0.001) and peers (aOR, 11.57; P<0.001) who consume alcohol were significantly associated with alcohol use. Unexpectedly, good parental monitoring (aOR, 2.46; P=0.019) and discussing serious problems with parents (aOR, 3.86; P=0.001) were significantly associated with alcohol use.
Conclusion Conclusively, policies on alcohol-related harm reduction and prevention should be developed, especially school-based programs, programs addressing family functioning, and parent-child communication, among others, should be further looked into. Future research on the school environment, adolescents’ drinking motives, and the development of practical adolescent-friendly alcohol screening tools are recommendations for improvements.
Background The increasing older adult population requires attention in terms of education and health, as higher education levels contribute to cognitive reserve and may protect against age-related cognitive impairment. Cognitive reserve is an individual’s cognitive flexibility in using cognitive functions affected by brain aging, neurological diseases, and injury. Indonesia has a high prevalence of low-educated older adults, which strongly correlates with progressive cognitive impairment. Identifying risk factors for cognitive decline in this population is crucial. This study determines the factors affecting cognitive impairment in low-educated older adults using cross-sectional data from the Indonesian Family Life Survey-5.
Methods This descriptive study analyzed 2,313 low-educated older adults ≥60 years old. Univariate and bivariate analyses were used to describe the sample and identify the relationships between categorical variables. Logistic regression identified the most significant factor affecting cognitive impairment.
Results The prevalence of cognitive impairment in low-educated older adults is 22.6%. The chi-square test revealed significant relationships between those who are aged 75 years, a status other than married, female, living in rural areas, and not participating in social activities. Age is the most prominent factor affecting cognitive impairment in such adults (P<0.001; adjusted odds ratio, 3.232; 95% confidence interval, 2.500–4.180).
Conclusion Cognitive impairment in the aforementioned adults is associated with being ≥75 years old, being a status other than married, being female, living in rural areas, and not participating in social activities. After controlling other variables, low-educated older adults who participated in at least ≥1 social activity in the last 12 months experienced cognitive impairment 0.64 times compared to those who did not participate in social activities.
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Background Sickness presenteeism (SP) refers to the phenomenon where employees attend work while sick, a decision that impacts both their physical and mental well-being and can lead to burnout. This study aimed to determine the prevalence of and factors influencing SP among Thai and foreign teachers following the end of the coronavirus disease 2019 public health emergency of international concern (PHEIC).
Methods A sample of 400 individuals was analyzed using chi-square tests and logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CI).
Results Post-PHEIC, a significant proportion of teachers (51.9%) perceived an increase in their workload, and 62.1% reported having taken health-related leave of absence. The prevalence of SP was high (35.0%). Factors significantly associated with SP (P<0.05) included being younger than 37 years (OR, 1.825; 95% CI, 1.108–3.006), facing monthly financial challenges (OR, 1.627; 95% CI, 1.028–2.575), doing school-related work on holidays (OR, 1.920; 95% CI, 1.180–3.122), and experiencing sleep disturbances owing to work-related stress (OR, 1.910; 95% CI, 1.203– 3.033). No discernible difference existed in SP rates between Thai and foreign teachers.
Conclusion As a course of action, we recommend the provision of appropriate financial planning resources for teachers. Policywise, school events and activities should be scheduled on working days to ensure that teachers maintain a work-life balance. Additionally, task allocation that caters to individual strengths and limitations can mitigate the effects of SP.
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Background This study explored the approaches of Jordanian community pharmacists to identifying and counseling breastfeeding mothers regarding medication usage.
Methods This cross-sectional study used self-administered questionnaires. A convenience sample (n=381) of Jordanian community pharmacists was recruited through social media. The responses were statistically analyzed using IBM SPSS ver. 25.0 (IBM Corp., USA).
Results The majority of recruited pharmacists were female (n=329, 86.4%). Asking every woman was Jordanian pharmacists’ preferred approach to identifying breastfeeding women (n=211, 55.4%). The study showed that around one-third of the pharmacists (n=128, 33.6%) reported that they currently experienced queries regarding medication use during breastfeeding on a daily basis. Additionally, the majority (n=325, 85.3%) of pharmacists reported feeling confident, and 67.2% of them (n=256) reported feeling comfortable while giving advice to breastfeeding women. The surveyed pharmacists relied on different resources during their course of practice to answer queries related to medicine usage by breastfeeding mothers.
Conclusion Community pharmacists have continuous interactions with breastfeeding women. Pharmacists require reliable and updated data access to answer queries related to medication use while breastfeeding.
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Background The Web is an important source of health information, but the quality of such online information is highly variable. This study evaluates the quality of health articles published on Naver News, Korea’s most popular portal, using the Health Information Quality Assessment Tool (HIQUAL).
Methods We collected 712 health-related articles published on Naver News from May 1 to 7, 2023. After applying exclusion criteria, we selected 116 articles for analysis. Two clinicians independently assessed the quality of these articles using the HIQUAL, which scores articles based on five domains: “reliability,” “usefulness,” “understandability,” “sufficiency,” and “transparency.”
Results Overall article quality was generally considered recommendable (mean±standard deviation: 7.52±2.00). “Usefulness,” one item of “reliability,” and “understandability” were the three items with the highest levels of satisfaction. “Sufficiency” criteria for costs, risks, and benefits received low scores. Quality scores for articles focused on health risk factors and intervention showed a statistically significant difference.
Conclusion While the overall quality of health information in Korean online newspaper articles is acceptable, room for improvement remains in some areas, particularly with regard to the fair presentation of costs, risks, and benefits. The study highlights the need for ongoing quality improvement and evaluation initiatives for online health information.
Background This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents.
Methods A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi.
Results Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father’s educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness.
Conclusion Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.
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Background Men with low testosterone levels are at an increased risk of developing metabolic syndrome, irrespective of age or obesity. However, the relationship between metabolic syndrome and testosterone levels in women remains unclear. We compared the total testosterone concentrations between premenopausal obese women with and without metabolic syndrome and identified the factors affecting these concentrations.
Methods A single-center retrospective analysis was conducted using the medical records of 580 premenopausal women with obesity. The diagnostic criteria for metabolic syndrome were established using the National Cholesterol Education Program Adult Treatment Panel III guidelines.
Results The mean±standard deviation age, weight, and body mass index were 38.8±8.4 years, 78.0±11.8 kg, and 30.0±4.1 kg/m2, respectively. The mean total testosterone concentration was lower in the metabolic syndrome group than in the non-metabolic syndrome group (n=385 vs. n=195; 0.22±0.10 ng/mL vs. 0.24±0.11 ng/mL; P<0.001). In a model adjusted for age, body mass index, skeletal muscle mass, body fat mass, and body fat percentage, the odds ratio for metabolic syndrome with respect to the total testosterone level was 0.128 (P=0.028). Testosterone concentration was negatively correlated with age (r=-0.334), systolic blood pressure (r=-0.084), and triglyceride concentration (r=-0.093) but positively correlated with weight (r=0.144), body mass index (r=0.140), waist circumference (r=0.133), body fat mass (r=0.167), and body fat percentage (r=0.167). Stepwise regression analysis revealed that age (β=-0.004, P<0.001), body mass index (β=0.003, P=0.004), and high-density lipoprotein cholesterol concentration (β=0.001, P=0.019) were independently associated with total testosterone concentration (adjusted R2=12.6%).
Conclusion Metabolic syndrome and obesity may be independently associated with testosterone levels in premenopausal women with obesity.
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Background Predicting the risk of osteoporotic fractures is vital for prevention. Traditional methods such as the Fracture Risk Assessment Tool (FRAX) model use clinical factors. This study examined the predictive power of the FRAX score and machine-learning algorithms trained on FRAX parameters.
Methods We analyzed the data of 2,147 female participants from the Ansan cohort study. The FRAX parameters employed in this study included age, sex (female), height and weight, current smoking status, excessive alcohol consumption (>3 units/d of alcohol), and diagnosis of rheumatoid arthritis. Osteoporotic fracture was defined as one or more fractures of the hip, spine, or wrist during a 10-year observation period. Machine-learning algorithms, such as gradient boosting, random forest, decision tree, and logistic regression, were employed to predict osteoporotic fractures with a 70:30 training-to-test set ratio. We evaluated the area under the receiver operating characteristic curve (AUROC) scores to assess and compare the performance of these algorithms with the FRAX score.
Results Of the 2,147 participants, 3.5% experienced osteoporotic fractures. Those with fractures were older, shorter in height, and had a higher prevalence of rheumatoid arthritis, as well as higher FRAX scores. The AUROC for the FRAX was 0.617. The machine-learning algorithms showed AUROC values of 0.662, 0.652, 0.648, and 0.637 for gradient boosting, logistic regression, decision tree, and random forest, respectively.
Conclusion This study highlighted the immense potential of machine-learning algorithms to improve osteoporotic fracture risk prediction in women when complete FRAX parameter information is unavailable.
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Background In patients with breast cancer, a healthy diet can help reduce breast cancer-specific recurrence, mortality, and comorbid chronic disease rates. There have been few studies on dietary habits immediately after breast cancer diagnosis, especially those involving the Asian population. Therefore, this study aimed to compare the nutritional habits of newly diagnosed patients with breast cancer and the general population without cancer in Korea using propensity score (PS) matching.
Methods We conducted a case-controlled study of 157 patients with breast cancer and 2,363 cancer-free control participants from the Korea National Health and Nutrition Examination Survey. The PS values for the predicted probability of patients with breast cancer and the general population were estimated using logistic regression analysis, including age and body mass index. The dietary patterns were assessed using a 24-hour recall of 1 day and the Food Frequency Questionnaire.
Results PS matching showed that patients with breast cancer consumed fewer calories and carbohydrates; however, they consumed more protein and fat compared to the general population. Compared to the general population, patients with breast cancer consumed more healthy foods such as fish, seaweed, vegetables, fruit, mixed-grain rice, and nuts; however, they also consumed more soup, stew, and red meat.
Conclusion Newly diagnosed patients with breast cancer have some healthy dietary habits compared to the general population. However, there is considerable room for improvement in their diet quality. Our results support the need to develop tailored dietary recommendations for patients with breast cancer during the diagnostic and posttreatment periods to improve their diet quality.
Background Alternative and complementary medicines are widely used to treat migraine headaches. This review aimed to determine the effectiveness of essential oils as an alternative treatment approach.
Methods A structured search was conducted to identify randomized trials comparing essential oils with a placebo for migraine headaches, using databases (MEDLINE and CENTRAL) to search for articles published between 1966 and 2021. We included trials involving adult males and females diagnosed with migraine headaches according to the International Headache Society. The outcomes included number of attacks, headache severity, associated symptoms, number of days of limited activity, headache duration, use of analgesics, and adverse effects. Seven trials were included with a total of 558 participants.
Results No difference was observed in the number of migraine headache attacks compared to placebo (mean difference [MD], -1.34; 95% confidence interval [CI], -3.31 to 0.64; I2=94%; P=0.190; four trials, 242 participants; moderate- quality evidence). There was no difference in this outcome between the essential oils treated group and the placebo (MD, -0.38; 95% CI, -1.76 to 0.99; I2 statistics=86%; P=0.580; five trials, 240 participants; moderate-quality evidence).
Conclusion We found no significant difference between the use of essential oils and placebo in managing migraine headaches.
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Elderly abuse and neglect are among the primary public health problems linked to global demographic changes in the population, impacting not only the well-being of the elderly but also the growth of the nation or economy. This article discusses the effects of elder abuse and neglect on population health from the national and international perspectives through a narrative review of previously published articles on the concept of aging, the prevalence of elderly abuse and neglect, its risk factors and effects, and finally measures, legal perspectives, and recommendations to curb it. Interventions in Malaysia and selected nations, including Indonesia, South Korea, the United States, Australia, and Hong Kong, are examined. This issue is important as the majority of countries are moving toward being elderly populations. Improving global surveillance and the monitoring of instances is essential to inform policy actions to prevent elder abuse. In addition, a thorough assessment of the identified risk factors for violence and steps to prevent violence is required.
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Background Over the last decade, Iran has experienced a declining birth trend. Identifying the proximate determinants of fertility intentions among married women is informative for population studies. This study aimed to examine the importance of three immediate antecedents of fertility intention.
Methods We invited 1,100 married women to complete a well-validated questionnaire based on the theory of planned behavior (TPB). The sampling framework consisted of visitors attending hospitals in two cities in southeastern Iran. Intention for having children was measured using the item “Do you intend to have a/another child during the next 3 years?” Attitude, subjective norms, and perceived behavioral control were measured using eight, three, and three items, respectively. Structural equation modeling was used to specify the model and to test the predictive ability of the TPB constructs.
Results The response rate was 90.7% (N=998), and the mean±standard deviation age of the respondents was 34.8±7.4 years. More than 50% of the respondents reported intending to have a child in the next 3 years. All three TPB model constructs showed significant associations with fertility intentions. The standardized beta coefficients for attitudes, subjective norms, and perceived behavioral control were 0.74, 0.41, and 0.55, respectively.
Conclusion The TPB model showed that psychological mechanisms play an important role in predicting the childbearing intentions of married women in Iran. Of the three TPB constructs, attitude was the strongest predictor of the intention to have a child.
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This study aimed to identify the indices/indicators used for evaluating the “creating supportive environments” mechanism of the Ottawa Charter for Health Promotion, with a focus on built environments, in different settings. A search for literature with no time limit constraint was performed across Medline (via PubMed), Scopus, and Embase databases. Search terms included “Ottawa Charter,” “health promotion,” “supportive environments,” “built environments,” “index,” and “indicator.” we included the studies conducted on developing, identifying, and/or measuring health promotion indices/indicators associated with “built environments” in different settings. The review articles were excluded. Extracted data included the type of instrument used for measuring the index/indicator, the number of items, participants, settings, the purpose of indices/indicators, and a minimum of two associated examples of the indices domains/indicators. The key definitions and summarized information from studies are presented in tables. In total, 281 studies were included in the review, within which 36 indices/indicators associated with “built environment” were identified. The majority of the studies (77%) were performed in developed countries. Based on their application in different settings, the indices/indicators were categorized into seven groups: (1) Healthy Cities (n=5), (2) Healthy Municipalities and Communities (n=18), (3) Healthy Markets (n=3), (4) Healthy Villages (n=1), (5) Healthy Workplaces (n=4), (6) Health-Promoting Schools (n=3), and (7) Healthy Hospitals (n=3). Health promotion specialists, health policymakers, and social health researchers can use this collection of indices/indicators while designing/evaluating interventions to create supportive environments for health in various settings.
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Assessment of the risk of bias is an essential component of any systematic review. This is true for both nonrandomized studies and randomized trials, which are the main study designs of systematic reviews. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was developed in 2013 and has gained wide usage as a risk-of-bias assessment tool for nonrandomized studies. Four risk-of-bias assessment experts revised it by reviewing existing assessment tools and user surveys. The main modifications included additional domains of selection and detection bias susceptible to nonrandomized studies of interventions, a more detailed consideration of the comparability of participants, and more reliable and valid outcome measurements. A psychometric assessment of the revised RoBANS (RoBANS 2) revealed acceptable inter-rater reliability (weighted kappa, 0.25 to 0.49) and construct validity in which intervention effects of studies with an unclear or high risk of bias were overestimated. The RoBANS 2 has acceptable feasibility, fair-to-moderate reliability, and construct validity. It provides a comprehensive framework for allowing authors to assess and understand the plausible risk of bias in nonrandomized studies of interventions.
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With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.
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Background This study aimed to examine the association between coffee or green tea consumption and ferritin or hemoglobin levels in premenopausal women.
Methods We used the fifth Korea National Health and Nutrition Examination Survey (2010–2012), and a total of 4,322 individuals were surveyed. In women of reproductive age, average ferritin and hemoglobin levels were calculated according to coffee or green tea consumption. Covariates included in the analysis were demographic variables, such as age, body mass index, education, drinking, smoking, history of hypertension, history of diabetes diagnosis, physical activity, total energy intake, and daily iron intake.
Results In 4,322 participants, the average hemoglobin level was 12.90±0.02 g/dL, and the average level of ferritin was 31.95±0.67 ng/mL. As a result of testing, correlation between ferritin and coffee intake and difference in ferritin levels according to coffee consumption was significant (P<0.05). In this study, a post hoc test indicated that ferritin level significantly differed between one and two cups, two and three cups, and three and one cup groups (overall P<0.001). Additionally, there was a negative correlation between ferritin level and coffee intake; ferritin level decreased by 2.09 ng/mL with a one-cup increase in daily coffee consumption.
Conclusion In premenopausal women, coffee intake is associated with low serum ferritin levels. Our results indicate that drinking >2 cups of coffee significantly affect ferritin levels in Korean premenopausal women.
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Background Oxidative stress plays an essential role in bone health among postmenopausal women. This study aimed to compare the oxidative stress biomarkers among postmenopausal women aged 50–65 years with normal bone mineral density, osteopenia, and osteoporosis.
Methods In this observational study, 120 women with normal bone mineral density, 82 with osteopenia, and 86 with osteoporosis were selected based on the densitometry data obtained from the dual-energy X-ray absorptiometry method. The serum total antioxidant capacity (TAC), superoxide dismutase (SOD) activity, and malondialdehyde (MDA) levels were measured using biochemical methods. A binary logistic regression model adjusted for confounders was used to estimate the risk of osteopenia and osteoporosis. The P-value of <0.05 was considered statistically significant.
Results There were significant differences between the three groups in age, menopausal age, body mass index, and education (P<0.05). According to the binary logistic regression model, higher SOD activity and serum TAC levels were associated with a lower risk of osteoporosis (adjusted odds ratio [aOR], 0.991; 95% confidence intervals [CI], 0.986 to 0.996; and aOR, 0.373; 95% CI, 0.141 to 0.986, respectively). MDA was a significant risk factor for osteopenia in postmenopausal women (aOR, 1.702; 95% CI, 1.125 to 2.576).
Conclusion Higher SOD activity and serum TAC levels in the studied postmenopausal women were associated with a significantly lower risk of osteoporosis. Moreover, the risk of osteopenia increased significantly with higher serum MDA levels.
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Methods We performed a 3-month intervention study involving partial meal replacement. Forty-nine participants completed the study. Correlations between changes in TSH levels and other body composition parameters were determined. The subjects were divided into two groups according to their body fat reduction (>1 kg, n=20; <1 kg, n=29). The changes in metabolic parameters, including TSH levels, were compared. For significant values, a multivariate analysis was performed after adjustment to evaluate the relationship between TSH changes and body fat reduction.
Results The 3-month intervention caused favorable changes in body proportions and metabolic parameters. TSH levels changed significantly only after changes in total body fat, showing a partial correlation. Changes in TSH levels were significantly different between groups (P=0.014). Moreover, the change in TSH levels was significantly different after adjustment (P=0.012).
Conclusion A body fat reduction, especially >1 kg, can reduce serum TSH concentrations in subjects with metabolic syndrome after short-term body weight intervention.
Background The association between a history of pregnancy and liver fibrosis remains unclear. Herein, we investigated the association between reproductive factors, including a history of pregnancy and liver fibrosis, in postmenopausal Korean women.
Methods This study used nationally representative, population-based data collected from the Korea National Health and Nutrition Examination Survey 2008–2017. Of 14,624 women with natural menopause, 11,085 with no previous history of any type of cancer, hepatitis, or chronic heavy alcohol consumption were enrolled. We investigated the reproductive factors, including a history of pregnancy, total reproductive years, age at menarche and menopause, and oral contraceptive use. Liver fibrosis was defined as a Fibrosis-4 index score ≥2.67 kg/m2.
Results Of the study participants, 372 (3.3%) had advanced liver fibrosis. Multivariable logistic regression analysis showed that women with a history of more than one pregnancy were associated with a lower risk of liver fibrosis compared to women who had never been pregnant, after adjusting for potential confounders (adjusted odds ratio, 0.30; 95% confidence interval, 0.15–0.59). The risk of liver fibrosis did not increase significantly with an increasing number of pregnancies (P for trend=0.135). Other reproductive factors, including total reproductive years, age at menopause and menarche, and oral contraceptive use, were not significantly associated with liver fibrosis.
Conclusion Postmenopausal women who had experienced one or more pregnancies had a reduced risk of liver fibrosis. Our findings reveal a potential protective role of pregnancy against liver fibrosis.
Background Although numerous studies have indicated that lower levels of physical activity correlate with a higher risk of depression, an association between the type of physical activity and depression has not been identified in Korea. This study aimed to examine whether the type and intensity of physical activity are associated with depression in Korean adults.
Methods This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES). A total of 11,679 individuals were analyzed using multiple logistic regression analyses to identify any association between the type of physical activity and depressive disorders in the sample subjects.
Results Measured weekly in units of energy expenditure, known as metabolic equivalents (METs), the amount of work-related physical activity was higher in individuals with depression according to the Patient Health Questionnaire- 9 than the participants without depression (386.7 vs. 206.7 MET-min/wk, P=0.01). Those diagnosed with depression tended to engage in less recreational activity per week (143.7 vs. 316.3 MET-min/wk, P<0.001) than those without depression. After controlling for covariates, the risk of depression among all participants was 1.012 times higher with a 100-unit increase in total work-related activity measured in METs (95% confidence interval [CI], 1.006–1.017; P<0.001) and 0.962 times lower with a 100-unit increase in total leisure activity measured in METs (95% CI, 0.937–0.987; P=0.003).
Conclusion Different types of physical activity were shown to be differently associated with depressive disorders in Korean adults. This study might guide in reducing work-related physical activity and increasing leisure activity to prevent the occurrence of depression.
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