Osong Public Health and Research Perspectives

Original Articles

Factors influencing satisfaction with medical services in medically underserved populations: an analytical cross-sectional study at a free medical clinic in the Republic of Korea: Joo Hyun Kim, Yeon Jeong Heo, Jae Bok Kwak, Samil Park, Curie Ahn, So Hee Ahn, Bumjo Oh, Jung Sik Lee, Jun Hyun Lee, Ho Young Lee; Received November 30, 2024 Accepted February 23, 2025 Published online March 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0325 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations.
Methods
We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction.
Results
Perceived support from healthcare providers emerged as the strongest predictor of satisfaction with medical services, demonstrating a significant positive association. While social support was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction.
Conclusion
These findings underscore the importance of healthcare provider and social support in increasing satisfaction with medical services among medically underserved populations. Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

SWOT strategy for future global health security: insights from Indonesia, Cambodia, Vietnam, Dominican Republic, Ghana, and the Republic of Korea using the World Health Organization International Health Regulations monitoring tool: Moonsoo Yoon, Nuha Fairusya, Thao Le Nhu Nguyen, Diomarys Ishaura Jimenez-Baez, Vichuta Prak, Osei Kuffour Afreh, Chaeshin Chu; Received November 11, 2024 Accepted February 16, 2025 Published online March 12, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0314 [Epub ahead of print]

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Abstract PDF: Objectives
The study aimed to analyze the core capacities to implement World Health Organization International Health Regulations (IHR) in 6 countries: Indonesia, Cambodia, Vietnam, the Dominican Republic, Ghana, and the Republic of Korea.
Methods
Secondary data from relevant databases and reports, including the electronic State Party Self-Assessment Annual Reporting mechanism and global health security index, were used to assess health security in these countries. Descriptive statistics summarized the basic features of the scores, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis was subsequently performed to identify factors affecting health security scores while highlighting key similarities and differences between countries.
Results
Early warning and event management emerged as the primary strength in most countries. Common opportunities included international commitments and immunization programs. In contrast, many countries shared weaknesses related to the policy, legal, and normative frameworks for IHR implementation, as well as challenges in human resources, chemical event management, and radiation emergency preparedness. Recurring threats involved issues such as biosafety, biosecurity, dual-use research and the culture of responsible science, infection control practices, coordination between public health and security authorities, laboratory supply chain vulnerabilities, and communication with healthcare workers during public health emergencies.
Conclusion
In order to counter future global health threats, countries should prioritize enhancing surveillance capacity (early warning and event management) as well as the immunization indicator (vaccination rates for human and animal diseases, including the national vaccine delivery system).

Editorial

It is time to hold discussions with policymakers: Jong-Koo Lee; Osong Public Health Res Perspect. 2025;16(1):1-2. Published online February 27, 2025; DOI: https://doi.org/10.24171/j.phrp.2025.0057

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Original Article

Multilevel analysis of individual, household, and community factors influencing COVID-19 vaccination intention: evidence from the 2021 Korea Community Health Survey: Ji-seon Seong, Jong-Yeon Kim; Received September 22, 2024 Accepted January 22, 2025 Published online February 21, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0254 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to investigate the combined effects of individual, household, and community-level factors on coronavirus disease 2019 (COVID-19) vaccination intention using a multilevel analysis.
Methods
This cross-sectional study analyzed raw data from the 2021 Korea Community Health Survey and regional statistics from 255 health centers, with a final sample of 229,216 individuals. Multilevel analysis was conducted, focusing on individual, household, and community-level factors. Individual-level factors included demographics, health status, and COVID-19 concerns; household-level factors included income and marital status; and community-level factors included city type and vaccination rates.
Results
At the individual level, significant differences were observed across all variables. At the household level, higher vaccination intention was associated with households of 4 or more members and a monthly income of 4 million Korean won or more. At the community level, higher flu vaccination rates, greater concern about COVID-19 infection, and higher COVID-19 vaccination rates were linked to increased vaccination intention.
Conclusion
This study highlights that COVID-19 vaccination intention is influenced by factors at the individual, household, and community levels. Vaccination strategies that integrate household and community-level approaches may be more effective. Policymakers should consider both individual and social health factors when designing vaccination policies.

Commentary

Polycystic ovary syndrome, cardiovascular risk, and coffee: a complex interplay: Anna Vittoria Mattioli; Osong Public Health Res Perspect. 2025;16(1):89-90. Published online February 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2025.0004

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Original Articles

Effectiveness of a brain exercise program using game-based cognitive enhancement to reduce mild cognitive impairment among older adults in Pathum Thani Province, Thailand: a quasi-experimental study: Panida Kunrit, Phannathat Tanthanapanyakorn, Nonlapan Khantikulanon, Sootthikarn Mungkhunthod, Chaninan Praserttai, Sasipa Rungrungrueang, Wanwisa Phonmamuang; Osong Public Health Res Perspect. 2025;16(1):59-71. Published online February 17, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0267

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Graphical Abstract Abstract PDF: Objectives
Mild cognitive impairment (MCI) is prevalent among older adults and may progress to dementia. This study evaluated the effectiveness of a game-based brain exercise program in reducing MCI among older adults.
Methods
A quasi-experimental study was conducted with 2 groups of older participants in Pathum Thani Province, Thailand. A total of 96 individuals with Thai mental state examination (TMSE) scores between 12 to 23, indicating MCI but no dementia diagnosis, were recruited. Using multi-stage sampling, participants were divided into an intervention group (n=48) and a control group (n=48). The intervention group participated in a 6-week game-based brain exercise program, while the control group received a self-administered brain exercise manual. Face-to-face interviews assessed outcomes at baseline, post-intervention, and 3-month follow-up. Data were analyzed using descriptive statistics and repeated-measures analysis of variance.
Results
Significant differences were observed in mean TMSE scores and MCI knowledge between the intervention and control groups at the 3-month follow-up (p<0.001). The intervention group showed significant increases in TMSE scores and MCI knowledge post-intervention and at 3-month follow-up (p<0.001).
Conclusion
The findings suggest that a game-based brain exercise program can improve cognitive function in older adults. Healthcare professionals can implement such programs to reduce MCI by addressing planning, management, and related issues in the future.

Excess mortality in older adults and cumulative excess mortality across all ages during the COVID-19 pandemic in the 20 countries with the highest mortality rates worldwide: Chiranjib Chakraborty, Manojit Bhattacharya, Sang-Soo Lee; Osong Public Health Res Perspect. 2025;16(1):42-58. Published online February 13, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0186

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Graphical Abstract Abstract PDF Supplementary Material: Objectives
Mortality statistics during the coronavirus disease 2019 (COVID-19) pandemic are crucial for the allocation of medical care resources and public health decision-making. This study was initiated to investigate the excess mortality among older adults during the pandemic. Our research focuses on 2 primary areas. First, we analyzed the cumulative excess mortality across all age groups to assess the global impact and specifically examined the top 20 countries with the highest mortality rates during the pandemic. Second, we explored excess deaths among older adults by categorizing data from the years 2020 and 2021 into age groups: 65–74, 75–84, and above 85.
Methods
We analyzed data from the top 20 countries with the highest mortality rates globally, focusing on 3 components: all-cause mortality means, expected deaths mean, and excess deaths mean for both older men and women.
Results
Although excess mortality is higher among older men and women across all 3 age groups (65–74, 75–84, and >85), the highest mean excess mortality was observed in women over the age of 85.
Conclusion
The results indicate that the severe acute respiratory syndrome coronavirus 2 virus had a disproportionately intense impact on older women. We developed 2 types of statistical models using the data: a binomial distribution model and a correlation coefficient model, both considering the mean excess deaths in older men and women across these 3 age groups. Estimating the excess mortality among older adults will aid in the formulation of healthcare policies for this demographic.

Review Article

The global prevalence of autism spectrum disorder in children: a systematic review and meta-analysis: Alwin Issac, Kurvatteppa Halemani, Asha Shetty, Latha Thimmappa, VR Vijay, Kiranmayi Koni, Prabhaker Mishra, Vishwas Kapoor; Osong Public Health Res Perspect. 2025;16(1):3-27. Published online February 10, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0286

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Graphical Abstract Abstract PDF Supplementary Material: Objectives
The objective of this review was to analyze quantitative data on autism spectrum disorder (ASD) and to increase the accuracy of estimates of the prevalence of ASD.
Methods
This review, which was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, included studies conducted from January 2008 to June 2024 on children aged 3 to 18 years that used standardized measurement tools and reported cut-off scores for ASD. The prevalence of ASD was the primary outcome analyzed in this review. The PubMed, Clinical Key, Scopus, Embase, CINAHL, and Web of Science databases were reviewed for relevant studies. The review protocol was registered with PROSPERO and followed the Cochrane collaboration guidelines.
Results
A total of 66 studies reported on the prevalence of ASD, screening 21,313,061 children worldwide. Among these, 25 studies were conducted in Europe, 22 in Asia, and 13 in America. Additionally, 3 studies each were reported from Africa and Australia. According to a meta-analysis, 0.77% of children globally are diagnosed with ASD, with boys comprising 1.14% of this group. Notably, Australia showed the highest prevalence rate, with an effect size of 2.18, highlighting it as a critical area for public health focus.
Conclusion
ASD represents a significant global health burden. Early detection, increased awareness among parents, and prompt intervention are crucial for mitigating developmental problems in children later in life. It is essential for health policymakers to acknowledge the prevalence and growing trends of ASD in order to implement effective interventions.

Short Communication

Characteristics and trends of severe/critical COVID-19 cases in the Republic of Korea (January 2020 to August 2023): Se-Jin Jeong, Shin Young Park, Boyeong Ryu, Misuk An, Jin-Hwan Jeon, So Young Choi, Seong-Sun Kim; Osong Public Health Res Perspect. 2025;16(1):81-88. Published online February 7, 2025; DOI: https://doi.org/10.24171/j.phrp.2024.0295

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Graphical Abstract Abstract PDF Supplementary Material: Objectives
We analyzed the demographic and clinical characteristics of patients diagnosed with coronavirus disease 2019 (COVID-19), focusing specifically on severe/critical cases, and assessed the trends and rates of severity and fatality among these patients in the Republic of Korea.
Methods
Clinical data on patients with COVID-19 from January 20, 2020 to August 30, 2023 were collected from the Korea Disease Control and Prevention Agency’s database. We identified patients who progressed to severe/critical conditions and analyzed their demographic and clinical profiles. Severity and fatality rates were calculated and compared annually to track the disease progression over time.
Results
During the surveillance period, 34,572,554 COVID-19 cases were confirmed, among whom 38,112 (0.11%) progressed to severe/critical conditions. Most severe/critical cases occurred in individuals aged ≥60 years, with a notable increase in patients aged ≥80 years from 2022. The overall severity rate was 0.19%, with a fatality rate of 0.10%. However, the severity of cases gradually diminished during the study period. In 2022, the severity and fatality rates decreased to 0.14% and 0.09%, respectively. In 2023, while the severity rate remained stable at 0.15%, the fatality rate further decreased to 0.06%. Notably, throughout the study period, individuals aged ≥80 years had a significantly higher severity rate (2.44%), with a fatality rate of 1.75%.
Conclusion
These findings underscore the importance of prioritizing protection and management strategies for older adults and high-risk groups to mitigate the impact of COVID-19. Continued surveillance and analysis are essential to effectively control COVID-19 and minimize its burden on public health.

Editorial

The urgency of improving research infrastructure and institutional frameworks for the next pandemic: Jong-Koo Lee; Osong Public Health Res Perspect. 2024;15(6):477-478. Published online December 30, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0361

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Review Article

The prevalence of tobacco, alcohol, stimulant, khat, and cannabis use among school-going students in African and Arab countries: a systematic review and meta-analysis: Chaimaa El Moubchiri, Mohamed Chahboune, Morad Guennouni, Abderraouf Hilali; Osong Public Health Res Perspect. 2025;16(1):28-41. Published online December 13, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0204

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Graphical Abstract Abstract PDF Supplementary Material: Objectives
The objectives of this review and meta-analysis were twofold: first, to determine the prevalence of substance use among school-going children in Arab and African countries; and second, to highlight the considerable influence of variables such as the nation’s region and the timeframe of the study on the prevalence of substance use.
Methods
Research was sourced from Science Direct, Scopus, Web of Science, Google Scholar, and PubMed. Thirty-seven articles were incorporated in accordance with the PRISMA guidelines. This review included studies published from 2013 to 2023. The statistical meta-analysis was performed using Comprehensive Meta-Analysis ver. 3 software. Across 37 studies, the total number of study participants was 73,508.
Results
The meta-analysis revealed that tobacco was the most commonly used substance, with a prevalence of 16% (95% confidence interval [CI], 12.7%–20.02%). This was closely followed by alcohol, which had a prevalence of 15% (95% CI, 10.5%–22.8%), stimulants at 11.4% (95% CI, 7.4%–17%), khat at 10% (95% CI, 5.7%–15%), and cannabis at 8% (95% CI, 3.3%–18.4%). Notably, alcohol was the only substance that showed an increasing trend in prevalence from before to after 2019, rising from 13.3% (95% CI, 6.2%–26.1%) to 17% (95% CI, 10.2%–27%) (p<0.001). Additionally, the prevalence of substance use varied significantly between Arab and African countries (p<0.001).
Conclusion
Although the prevalence of substance use among school-going populations has significantly decreased over time, with the exception of alcohol, it is imperative that both African and Arab countries implement comprehensive measures and stringent laws to address the production and marketing of substances.

Original Articles

Altered eotaxin-1 and interleukin-34 levels in obsessive-compulsive disorder: a case-control observational study in Bangladesh: Syed Ishtiaque Hossain, Rapty Sarker, Sardar Mohammad Ashraful Islam, Mohiuddin Ahmed Bhuiyan, MMA Shalahuddin Qusar, Md. Rabiul Islam; Osong Public Health Res Perspect. 2025;16(1):72-80. Published online December 12, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0222

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Graphical Abstract Abstract PDF

Objectives
Obsessive-compulsive disorder (OCD) is a prevalent mental health condition that impacts daily life. It is thought to be associated with genetic, biological, and structural brain changes, serotonergic abnormalities, altered neuromodulation, and environmental factors. Limited observational studies have examined cytokines in Bangladeshi patients with OCD. This study aimed to assess the levels of eotaxin-1 and interleukin (IL)-34 in individuals with this disorder.
Methods
This case-control observational study included 58 patients with OCD and 30 healthy controls (HCs) matched for age, sex, and body mass index. The severity of OCD was assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). Psychiatrists evaluated participants according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Serum levels of eotaxin-1 and IL-34 were measured using enzyme-linked immunosorbent assay kits.
Results
Patients with OCD exhibited significantly higher serum eotaxin-1 levels (121.13±7.84 pg/mL) than HCs (85.52±9.42 pg/mL). Conversely, IL-34 levels were considerably lower in patients than in HCs (119.02±14.53 pg/mL vs. 179.96±27.88 pg/mL). The Cohen d values for eotaxin-1 and IL-34 were 0.55 and −0.48, respectively. Among patients with OCD, a significant positive correlation was found between serum eotaxin-1 level and Y-BOCS score, along with a negative correlation between serum eotaxin-1 and IL-34 levels.
Conclusion
The findings suggest that altered eotaxin-1 and IL-34 levels may be associated with OCD. These chemokines and cytokines could serve as primary tools for assessing the risk of OCD, warranting further clinical investigation. This could potentially support more extensive research and the development of diagnostic and therapeutic strategies targeting these pathways.

Citations

Citations to this article as recorded by

Unraveling Gender Differences in Obsessive-Compulsive Disorder: A Focus on Key Micronutrients
Sultana Algin, Mohammad Waliul Hasnat Sajib, Sumaiya Nausheen Ahmed, Md Raihan Siddique , Md Munim Reza, Nusrat Jahan Tanzilla, Tanbir Ahmed, Md Kamrul Islam, Pratiksha Patel, Mainul Haque
Cureus.2025;[Epub] CrossRef

Factors associated with malaria infection in under-5 children in Papua Province, Indonesia: an observational study: Betty Roosihermiatie, Gurendro Putro, Arga Setyo Adji, Windy Tri Yuana, Selma Arsit Selto Siahaan, Rukmini Rukmini, Rustika Rustika; Osong Public Health Res Perspect. 2024;15(6):508-520. Published online November 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0152

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Graphical Abstract Abstract PDF: Objectives
Malaria remains a serious public health challenge in tropical and subtropical regions, including Indonesia. Children under 5 years old face particular risk of contracting malaria due to low immunity. We examined potential factors associated with malaria infection among under-5 children in Papua Province, Indonesia.
Methods
The study utilized secondary data from Indonesia Basic Health Research 2018. Multistage random sampling was employed, from the province level to census blocks (CBs). In Papua Province, interviews were conducted in 928 CBs. All 2,745 under-5 children were selected. The dependent variable was laboratory-confirmed malaria positivity; independent factors included residential area, socioeconomic characteristics, and behaviors such as sleeping under an insecticide net impregnated ≤3 years ago and the use of ventilation barriers. We also examined the conditions of the bedroom, kitchen, and living room according to the frequency of window-opening, proportion of ventilation area to the floor, and radiance.
Results
Not sleeping under an insecticide net impregnated within the last 3 years (adjusted odds ratio [aOR], 0.518; 95% confidence interval [CI], 0.391–0.685; p<0.001); having a kitchen without windows (aOR, 0.491; 95% CI, 0.285–0.844; p=0.01); rarely opening the living room window (aOR, 2.804; 95% CI, 1.232–6.383; p=0.01), and having a windowless living room (aOR, 3.027; 95% CI, 1.369–6.696; p=0.01) displayed significant relationships with malaria infection among under-5 children.
Conclusion
Not using an insecticide-treated net impregnated ≤3 years ago, along with opening the living room window daily and having a kitchen without windows, appear preventive of malaria infection among under-5 children.

Factors influencing intentional self-harm in Chungcheongbuk Province relative to the Seoul region in the Republic of Korea: a retrospective study: Hyun-Ju Lee; Osong Public Health Res Perspect. 2024;15(6):497-507. Published online November 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0112

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Graphical Abstract Abstract PDF: Objectives
This study investigated factors influencing intentional self-harm in Chungcheongbuk Province (hereinafter, Chungbuk) compared to Seoul in the Republic of Korea.
Methods
Raw data from the Discharge In-depth Injury Survey conducted by the Korea Disease Control and Prevention Agency were utilized. From 2,329,149 cases recorded over 9 years (2013–2021), 911 were identified as intentional self-harm cases (248 from Chungbuk and 633 from Seoul). We analyzed the differences in and influencing factors of intentional self-harm in Chungbuk relative to Seoul using the independent sample t-test, chi-square test, and binomial logistic regression analysis.
Results
Intentional self-harm was found to be 1.232 times more prevalent among females than males (p<0.05); 2.327 times more prevalent among middle-aged and older adults, ages 50 to 64, compared to those under 50 years old (p<0.01); 8.603 times more prevalent among those using hospitals with fewer than 500 beds compared to those with 500 beds or more (p<0.001); 2.412 times more prevalent among individuals using hospitals in different regions compared to those within the same region (p<0.01); 2.217 times more prevalent among those attempting intentional self-harm during daily activities compared to other specified activities (p<0.01); and 6.987 times more prevalent among those using pesticides or herbicides compared to other poisons (p<0.001) in Chungbuk relative to Seoul.
Conclusion
In the Chungbuk region, intentional self-harm prevention programs should be implemented, specifically targeting women, particularly those aged 50 to 64. Additionally, due to the high incidence of intentional self-harm involving pesticides or herbicides in Chungbuk, these substances should be stringently monitored to restrict access.

Effects of green coffee supplementation on paraoxonase-1 activity and malondialdehyde levels in Iranian women with polycystic ovary syndrome: a randomized clinical trial: Azam Ildarabadi, Marzieh Vahid-Dastjerdi, Mina Ghorbanpour, Ahmad Mousavi, Mehrnoush Meshkani, Mirsaeed Yekaninejad, Ahmad Saedisomeolia; Osong Public Health Res Perspect. 2024;15(6):521-532. Published online November 20, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0187

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Graphical Abstract Abstract PDF

Objectives
Polycystic ovary syndrome (PCOS) is a common, heterogeneous clinical syndrome affecting women. Investigating oxidative stress in women is crucial, as it is linked to insulin resistance and endothelial dysfunction. Chlorogenic acid, a bioactive component found in green coffee, has numerous documented health benefits. This study aimed to assess the beneficial effects of green coffee consumption on paraoxonase-1 (PON-1) activity and malondialdehyde (MDA) levels in women with PCOS.
Methods
This study was a double-blind randomized clinical trial that included 44 patients with PCOS. Participants were randomly assigned to either the intervention or control group. For 6 weeks, the intervention group (n=22) received 400 mg of green coffee supplements, while the control group (n=22) received 400 mg of a starch-based placebo. Anthropometric indices, dietary assessments, and physical activity levels were evaluated before and after the 6-week intervention period. Additionally, blood samples were collected for laboratory analysis.
Results
Supplementation with green coffee increased PON-1 levels by 3.5 units, a significant finding (p=0.038). Additionally, the intake of green coffee supplements significantly reduced blood cholesterol levels by 18.8 units (p=0.013) and triglyceride levels by 6.1 units (p=0.053). However, no significant differences were observed in the levels of MDA, high-density lipoprotein, low-density lipoprotein, fasting blood sugar, insulin, or homeostatic model assessment of insulin resistance as a result of the intervention.
Conclusion
Supplementation with green coffee alters PON-1 activity and cholesterol levels in women with PCOS. However, it has no significant impact on MDA levels or glycemic status.

Citations

Citations to this article as recorded by

Polycystic ovary syndrome, cardiovascular risk, and coffee: a complex interplay
Anna Vittoria Mattioli
Osong Public Health and Research Perspectives.2025; 16(1): 89. CrossRef

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