Asia Pacific Journal of Public Health

Noncommunicable diseases (NCDs) are emerging as an important public health problem in developing countries. The risk factors for NCDs are initiated during childhood and adolescence. The aim of this review was to assess the effectiveness of school-based interventions for prevention of NCD risk factors (physical inactivity, diet, and tobacco consumption), and identify processes that affect the main outcome. The retrieved studies from 2001 to 2010 were analyzed for their methodological quality (using standard guidelines), settings, intervention components, and main outcomes. The literature search identified 37 studies. The proportion of studies showing a positive result was 83% (10/12) among those that involved family, 87%(7/8) that involved both community and family, and 76% (13/17) that involved school only. Overall, 80% of the studies reported at least some evidence of a positive intervention effect. The current literature search supports the effectiveness of school-based interventions for prevention of risk factors associated with NCDs.

The aim of this study was to examine the impact of the most prevalent comorbid chronic diseases in hypertensives on health-related quality of life (HRQOL) in the general representative Korean population using the EuroQOL-5D (EQ-5D) and to assess this impact by sex and after controlling for sociodemographic factors. The effects of hypertension and comorbidity on HRQOL were examined using multiple linear regression models with Fourth Korean National Health and Nutrition Examination Survey data. In a total of 5736 adults, the prevalence of hypertension alone was 20.8%, and the prevalence rates of hypertension comorbid with diabetes mellitus (DM), cardiovascular disease (CVD), and musculoskeletal (MS) disease were 9.5%, 3.8%, and 33.5%, respectively. Females with hypertension and other comorbidity showed worse HRQOL scores, with the exception of hypertension and CVD, where males scored worse for HRQOL. After adjustment, subjects with comorbid DM, CVD, or MS experienced EQ-5D scores decreasing by 0.01, 0.09, and 0.05, respectively. Since comorbidity impairs HRQOL in hypertensives, health providers should consider comorbid diseases in hypertensives when developing methods of intervention to effectively manage hypertension.

This study aimed to compare the process of care and the choice of antihypertensive medications used in both public and private primary care clinics in Malaysia. A cross-sectional survey was completed in 2008 on randomly selected 100 public health clinics and 114 private primary care clinics in Malaysia. A total of 4076 patient records, 3753 (92.1%) from public clinics and 323 (7.9%) from private clinics were analyzed. Less than 80% of the records documented the recommended clinical and laboratory assessments. The rates of documentation for smoking status, family history of premature death, retinal assessment, and urine albumin tests were lower in public clinics. Overall, 21% of the prescription practices were less than optimal. The process of care and the use of antihypertensive medications were not satisfactory in both settings.

Introduction. Many studies have demonstrated a strong relationship between alcohol availability and traffic crashes involving alcohol-impaired drivers. The present analysis focuses on the evaluation of the impact of alcohol availability on the Japanese population by comparing fatal and nonfatal motor vehicle crash rates before and after implementation of the alcohol deregulation policy in 1994. Participants and method. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRRs) in the population. To control for potential confounders, per capita alcohol consumption, unemployment rate, and vehicle miles travelled (VMT) were also added to the model. The exponents of the fitted coefficients are equivalent to the IRRs. Results. Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities and other traffic crashes in Japan. In the overall study results, nighttime fatalities were reduced statistically significantly by 6% since the implementation of the alcohol deregulation policy in 1994. Discussion. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation. Further well-designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.

This study aimed to examine the association between smoking status and quality of life (QOL) in a population-based sample of Iranian adults. The study used data from the Isfahan Healthy Heart Program (IHHP). A total of 5830 participants were included. They were categorized as current, former, or never smokers. QOL was evaluated using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Persian version. Data entry was performed using SPSS (SPSS Inc, Chicago, IL) software version 13.0. QOL was associated with marital status (P = .014), education (P = .001), occupation (P = .007), and income (P < .000) among current smokers. After adjusting for sociodemographic characteristics, smoking decreased QOL among current (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97-0.99) and past (OR = 0.97; 95%CI = 0.95-0.98) smokers relative to never smokers. QOL is lower among Iranian current and past smokers, and the relation is independent of underlying sociodemographic factors.

Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

Poor sexual and reproductive health status has been reported among rural-to-urban migrants in China. Therefore, some effective and feasible interventions are urgently needed. The authors developed a workplace-based intervention to compare 2 young labor migrant service packages (A and B) on the knowledge, attitude related to contraception, and contraceptive use among unmarried male migrants in Chengdu. Fourteen construction sites were randomly assigned to either of the 2 intervention packages. Interventions were completed in 3 months, and data were collected in 2 rounds independently (before and after interventions). After the intervention, the median scores for knowledge and attitude in migrants in package B were significantly higher than in migrants in package A. Although migrants in both packages increased use of condom, the increase was pronounced in migrants in package B, with odds ratio (OR) = 9.65 (95% confidence interval [CI] = 1.41-66.28). The rate of unwanted pregnancies was reduced more significantly in migrants in package B than in migrants in package A (OR = 0.16; 95%CI = 0.03-0.45). Unmarried male migrants who received the comprehensive intervention (package B) were more willing to use condoms and avoid unwanted pregnancies effectively.

The reported rates of HIV/AIDS cases and risky sexual behaviors have increased among adolescents in South Korea. This study reports the presence, impact, and development of optimistic bias toward HIV/AIDS in Korean adolescents. Survey data from 2996 participants were randomly collected from 8 high school and 8 middle school students in Seoul, South Korea. This study found that Korean high and middle school students had greater optimistic bias toward HIV/AIDS compared with their peers (P = .000). Involvement (r = −0.19; P < .01) decreased optimistic bias, whereas self-esteem (r = 0.13; P < .01) and self-control (r = 0.22; P < .01) increased it. Univariate analysis results indicated that gender and academic performance significantly influenced optimistic bias. However, according to hierarchical multiple regression, this significance was lost, and involvement, self-esteem, and self-control exerted a greater effect. Equipping Korean adolescents with involvement, awareness, and tailored interventions will reduce optimistic bias and yield greater protection against HIV/AIDS.

Background. The commencement of methadone maintenance therapy (MMT) in 2005 represents a quantum leap in the management of heroin dependence in Malaysia. Objective. To examine the 2-year outcomes of this modality in the treatment of heroin dependence with respect to the quality of life (QOL), heroin abstinence, and rate of employment among heroin dependants attending the Tengku Ampuan Afzan Hospital (HTAA) MMT clinic. Method. This was an experimental study in which the second QOL assessment was conducted 2 years after treatment initiation. Results. A total of 172 patients enrolled at the point of entry to the MMT program. The authors examined 107 patients who remained in the program 2 years later (62.6% retention rate). A paired t test demonstrated sigsnificant improvements in all 4 domains of QOL (physical, psychological, social relationships, and environment; P < .001). The most marked improvement was noted in the psychological domain. Conclusion. The MMT program at HTAA is effective in improving the QOL among heroin dependants.

This study aims to develop an accessibility index to illustrate the status of the accessibility of primary health care workers in remote and rural areas in China. Relevant county-level data were used to analyze the number and distribution of primary health care workforce in rural China, and relevant provincial-level data were used to analyze the accessibility index. The study found that the development of rural primary health care workers is suboptimal. The rural Primary Health Care Worker Accessibility index shows that the accessibility to primary health care workers in western rural areas is poor. The correlation between PHCWA index and maternal mortality rate is more significant than that between primary health care workers density and maternal mortality rate. In addition to increasing the number of primary health care workers, strategies addressing the challenge of distance are also required.

The Constitution of the World Health Organization (1946) states that the “enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position.” The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea’s Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.

As the frequency and seriousness of natural disasters increase, humanitarian response gains interests. Disaster, as a threat to a society, exposes the weaknesses of that society and aids from agents other than that society are needed in the disaster situation. This nature of humanitarian response makes ethical consideration necessary, but as the context is different, ethical concerns and principles are also different from those of conventional medical ethics. Ethical justification is essential to humanitarian responses, and ethical standards and ideals should be considered during the humanitarian responses.

Pacific countries are sovereign nations with distinctive histories, ethnicity, customs, primary resources, economies, and health systems. Despite these and other acknowledged differences, similarities exist in many areas such as geography, legal history, and culture. Many share the experience of colonization, with imported British laws and the subsequent experience of independence. Most Pacific countries are also developing countries. This article broadly describes approaches to legislating in public health in Papua New Guinea, Fiji, ¹ Vanuatu, and the Solomon Islands and notes common elements in their public health laws, in particular, in relation to administration, allocation of powers and responsibilities, interaction with local government, communicable disease control, and nuisance. The article concludes that many Pacific public health laws could deliver better support for current health policy, more sensitivity to the culture and customs of the region, and better management of public health risk through laws that are better suited to their Pacific environment, easier to understand, more flexible, and more relevant to current health policy.

At present, the World Health Organization (WHO) is in the process of developing a tool designed to assess the status of public health legislation in a given country. An Expert Consultation on Public Health Law was convened in Manila, Philippines, in May 2011. The participants agreed that the tool could serve as a guide for a regional approach to assist Member States in assessing the scope, completeness, and adequacy of their public health law. Given the broad definition of “public health” and the laws that affect health, directly or indirectly, the participants further agreed to narrow the field to 4 areas based on significant WHO works/policies, each organized into an independent module: (1) International Digest on Health Law, (2) Primary Health Care, (3) International Health Regulations 2005, and (4) Framework Convention on Tobacco Control. The tool would be drafted in a questionnaire format that asks the respondent to determine whether primary and/or subsidiary legislation exists in the country on a specific topic and, if so, to cite the relevant law, describe the pertinent points, and attach and/or link to the full text where available. The participants agreed that the respondents should include government officials and/or academics with legal competency. Version 1 of the tool was piloted in the Philippines, the Republic of Korea, Samoa, and Vanuatu. At a 2nd Expert Consultation on Public Health Law, convened in Incheon, Republic of Korea, in October 2011, in conjunction with the 43rd Conference of the Asia-Pacific Academic Consortium on Public Health, the participants determined that the tool was generally usable, certain concerns notwithstanding, such as the risk of standardizing compliance with WHO policies. The agreed next step is to finalize the analysis tool by August 2012, marking the end of stage I in the development process. Stage II will consist of team building and networking of responsible officers and/or professionals in the countries. The tool will be further developed to reflect specific in-country situations.

The current adverse effects of the health insurance system in Korea are considered to be problems that arise from an insufficient reflection of the notion of respecting human rights. The ethical principles most commonly suggested and used in public health are the 4 principles suggested by Beauchamp and Childress in 1994. From the perspective of the community, these 4 principles of medical ethics can be expanded to resolve problems surrounding existing social systems from a socialistic standpoint. This article describes a flexible, easy-to-use model for incorporating the 4 medical ethics principles into the National Health Insurance System (NHIS). First, the principle of respect for autonomy involves respecting the decision-making capacities of autonomous medical consumers and providers and enabling individuals to make reasoned and informed choices. Second is the principle of good practice. The government and medical institutions should act in a way that benefits the health care consumers. The principle of prohibiting bad practice involves avoiding causing health problems. The National Health Insurance Corporation and health care providers should not harm the health care consumers. Finally, the principle of justice is concerned with distributing benefits, risks, and costs fairly—that is, the notion that patients in similar positions should be treated in a similar manner. If these problems are solved, health system quality could be better and more accessible and sustainable. The ethical assessment of the NHIS could be a trial to match the 4 medical ethics principles and the NHIS. It can be applied internationally to relevant policy makers in different settings.

Facing national implementation of standardized health information exchange (HIE), the need for a robust e-governance system has also been emerging in Korea. Based on the Guidelines for Personal Health Information in Health Care Organizations, this article examines how recent governance encourages meaningful use of HIE technology in health care and suggests legislative directions relevant to appropriate health information sharing and the rights and responsibilities of stakeholders regarding the details of the guidelines.