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Systematic Reviews
A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers
Bita Azmi-Naei, Fatemeh Shahbazi, Nazanin Azmi-Naei, Jalal Poorolajal
Epidemiol Health. 2024;46:e2024094.   Published online November 26, 2024
DOI: https://doi.org/10.4178/epih.e2024094
  • 7,985 View
  • 131 Download
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.
METHODS
We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2-statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio or odds ratio, accompanied by a 95% confidence interval (CI), using a random-effects model.
RESULTS
From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50 to 0.59) for cervical cancer, 0.82 (95% CI, 0.77 to 0.88) for ovarian cancer, and 0.96 (95% CI, 0.89 to 1.04) for uterine cancer.
CONCLUSIONS
Our findings suggest that experiencing one’s initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.
Summary
Tea consumption and risk of all-cause, cardiovascular disease, and cancer mortality: a meta-analysis of thirty-eight prospective cohort data sets
Youngyo Kim, Youjin Je
Epidemiol Health. 2024;46:e2024056.   Published online June 21, 2024
DOI: https://doi.org/10.4178/epih.e2024056
  • 29,944 View
  • 185 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Tea consumption has been considered beneficial to human health because tea contains phytochemicals such as polyphenols and theaflavins. We conducted a systematic review and meta-analysis on the association between tea consumption and mortality from all causes, cardiovascular disease (CVD), and cancer to provide a quantitative assessment of current evidence.
METHODS
The PubMed, Web of Science, and Scopus databases were searched through April 2024 to identify eligible studies. Random effects models were used to combine study-specific effect estimates (ESs).
RESULTS
A total of 38 prospective cohort data sets (from 27 papers) with 1,956,549 participants were included in this meta-analysis. The pooled ESs of the highest versus lowest categories of tea consumption were 0.90 (95% confidence interval [CI], 0.86 to 0.95) for all-cause mortality, 0.86 (95% CI, 0.79 to 0.94) for CVD mortality, and 0.90 (95% CI, 0.78 to 1.03) for cancer mortality. In the dose-response analysis, a non-linear association was observed. The greatest risk reductions were observed for the consumption of 2.0 cup/day for all-cause mortality (ES, 0.91; 95% CI, 0.88 to 0.94) and 1.5 cup/day for cancer mortality (ES, 0.92; 95% CI, 0.89 to 0.96), whereas additional consumption did not show a further reduction in the risk of death. A plateau was observed for CVD mortality at moderate consumption levels (1.5-3.0 cup/day), but a sustained reduction in mortality risk was observed at higher intake levels.
CONCLUSIONS
Moderate tea consumption (e.g., 1.5-2.0 cup/day) was associated with lower all-cause, CVD, and cancer mortality compared to no tea consumption. Further well-designed prospective studies are needed for a definitive conclusion.
Summary
Korean summary
차는 전세계적으로 널리 소비되는 음료로 그 공중보건학적 영향력이 크다. 차의 섭취와 만성질환의 관련성은 아직 일관성 있게 결론이 나지 않았는데 최근에 이 주제에 대하여 대규모의 코호트 연구 결과들이 발표된 바 있었다. 38개의 코호트 데이터에 근거한 본 메타분석의 결과는 하루 한 잔 반에서 두 잔의 차를 마시는 것이 총사망위험과 심혈관계질환이나 암으로 인한 사망 위험을 낮추는 것과 관계가 있음을 나타내고 있다.
Key Message
Tea is a commonly consumed beverage worldwide and has a significant public health impact. The association between tea consumption and risk of mortality from chronic disease remains inconsistent, and extensive cohort studies have been published recently. In this meta-analysis, including thirty-eight cohort studies, people who drank one and a half to two cups of tea daily had a lower risk of mortality from all causes, cardiovascular disease, and cancer than those who drank less tea.

Citations

Citations to this article as recorded by  
  • Bioavailability of Tea Polyphenols: A Key Factor in Understanding Their Mechanisms of Action In Vivo and Health Effects
    Mingchuan Yang, Xiangchun Zhang, Chung S. Yang
    Journal of Agricultural and Food Chemistry.2025; 73(7): 3816.     CrossRef
  • Associations of a healthy beverage pattern with all-cause and cause-specific mortality among US adults: a nationwide cohort study
    Yu Feng, Haoming Wang, Kang Wang, Ziyue Li, Bohao Tan, Qirui Li, Fan Ouyang, Zhangling Chen
    Nutrition Journal.2025;[Epub]     CrossRef
  • Color Stability of Three Ceramics After Thermocycling in Coffee, Black Tea, Cola, and Water: An In Vitro Study
    Dina Maleki, Donya Maleki, Arayeh Maleki, Helia Zare, AmirHossein SohrabiFar, Boonlert Kukiattrakoon
    International Journal of Dentistry.2025;[Epub]     CrossRef
  • The Impact of Tea Consumption on Cardiovascular Health
    Farid Aldhuhli, Mohammed Fazal, Gouse Bin Mohammad Shaik, Srijit Das
    The Natural Products Journal.2025;[Epub]     CrossRef
  • Beneficial health effects and possible health concerns of tea consumption: a review
    Mingchuan Yang, Li Zhou, Zhipeng Kan, Zhoupin Fu, Xiangchun Zhang, Chung S. Yang
    Beverage Plant Research.2025;[Epub]     CrossRef
  • Green Tea: A Magical Herb with Miraculous Outcomes
    Suraj Bhagwan Khirodkar, Mr. Vinod Chavre
    International Journal of Advanced Research in Science Communication and Technology.2025; : 612.     CrossRef
  • Molecular mechanisms of action of DIM and its clinical application
    E. A. Nikitina, S. V. Orlova, T. T. Batysheva, N. V. Balashova, M. V. Alekseeva, A. N. Vodolazkaya, E. V. Prokopenko, Kh. A. Magomedova
    Medical alphabet.2024; (19): 9.     CrossRef
Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis
Hye Ah Lee, Seunghee Jun, Hyesook Park
Epidemiol Health. 2024;46:e2024047.   Published online April 24, 2024
DOI: https://doi.org/10.4178/epih.e2024047
  • 10,718 View
  • 138 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.
METHODS
We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies version 2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.
RESULTS
From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0 to 85.8) and a specificity of 62.9% (95% CI, 56.9 to 68.5). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.
CONCLUSIONS
Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.
Summary
Korean summary
- 본 연구는 체계적 고찰 및 메타 분석을 수행하여 아동 및 청소년의 대사 증후군(MetS) 위험을 감지하기 위한 최적의 악력 임계값을 제안했습니다. - 본 연구 결과는 아동 및 청소년의 대사 증후군(MetS) 위험을 줄이기 위해 근력 관련 활동이 필요한 고위험군을 식별하는 데 사용할 수 있으므로 1차 임상 및 공공 의료에 실용적인 정보를 제공합니다.
Key Message
- This study conducted a systematic review and meta-analysis to propose the optimal handgrip strength (HGS) threshold for detecting the risk of metabolic syndrome in children and adolescents. - The results provide practical information for primary clinical and public healthcare, as they can be used to identify high-risk groups in need of strength-related interventions to reduce the risk of metabolic syndrome in children and adolescents.

Citations

Citations to this article as recorded by  
  • Handgrip Strength Thresholds to Detect Cardiometabolic Risk in Youth: Cross‐Sectional Study and Meta‐Analysis
    Antonio García‐Hermoso, Rodrigo Yáñez‐Sepúlveda, Ignacio Hormazábal‐Aguayo, Jacinto Muñoz‐Pardeza, Vicente Martínez‐Vizcaíno, Juan Hurtado‐Almonacid, Yasmin Ezzatvar
    Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
  • Disability-Related Disparities in Preventive Healthcare Access in South Korea: Insights From National Health Insurance Data
    Sujin Kim, Boyoung Jeon
    International Journal of Public Health.2025;[Epub]     CrossRef
  • Trends and distributional characteristics in handgrip strength of 1,082,296 children and adolescents in China: an analysis from five representative cross-sectional surveys from 2000 to 2019
    Ziteng Li, Chengyue Li
    BMC Public Health.2025;[Epub]     CrossRef
The effectiveness of protein supplementation combined with resistance exercise programs among community-dwelling older adults with sarcopenia: a systematic review and meta-analysis
Phatcharaphon Whaikid, Noppawan Piaseu
Epidemiol Health. 2024;46:e2024030.   Published online February 14, 2024
DOI: https://doi.org/10.4178/epih.e2024030
  • 64,465 View
  • 620 Download
  • 19 Web of Science
  • 19 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.
METHODS
We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program.
RESULTS
The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05).
CONCLUSIONS
Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.
Summary
Key Message
Sarcopenia is a significant health concern. Given the contextual variations and the diverse factors that contribute to the prevalence of sarcopenia, delivering precision interventions to older adults diagnosed with sarcopenia who still reside in the community poses unique challenges. Therefore, precision interventions are vital for proper and feasible treatment planning, especially for early management actions, to reduce the impact of sarcopenia and its associated adverse effects in older adults. Our systematic review and meta-analysis showed that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Citations

Citations to this article as recorded by  
  • Duck-egg white hydrolysate supplementation enhances muscle endurance and fatigue resistance during high-intensity exercise
    Kai-Li Shang, Yi-Ling Lin, Christoper Caesar Yudho Sutopo, Jr-Wei Chen, Yi-Chen Chen
    Poultry Science.2026; 105(1): 106088.     CrossRef
  • 13. Older Adults: Standards of Care in Diabetes—2026
    Mandeep Bajaj, Rozalina G. McCoy, Kirthikaa Balapattabi, Raveendhara R. Bannuru, Natalie J . Bellini, Allison K. Bennett, Elizabeth A. Beverly, Kathaleen Briggs Early, Sathyavathi ChallaSivaKanaka, Justin B. Echouffo-Tcheugui, Brendan M. Everett, Rajesh G
    Diabetes Care.2026; 49(Supplement): S277.     CrossRef
  • A Qualitative Inquiry Into Sarcopenia Among Formerly Homeless Older Thais
    Phatcharaphon Whaikid, Noppawan Piaseu, Tiraporn Junda
    Nursing Open.2026;[Epub]     CrossRef
  • Protein supplementation alone or combined with exercise for sarcopenia and physical frailty: A systematic review and meta-analysis of randomized controlled trials
    Yoshihiro Yoshimura, Ayaka Matsumoto, Tatsuro Inoue, Masatsugu Okamura, Masafumi Kuzuya
    Archives of Gerontology and Geriatrics.2025; 131: 105783.     CrossRef
  • The diagnosis and treatment of sarcopenia and sarcopenic obesity
    Basel Habboub, Robert Speer, Markus Gosch, Katrin Singler
    Deutsches Ärzteblatt international.2025;[Epub]     CrossRef
  • Osteosarcopenia as a risk factor for depression: Longitudinal findings from the SHARE study
    Nicola Veronese, Francesco Saverio Ragusa, Shaun Sabico, Ligia Juliana Dominguez, Mario Barbagallo, Gustavo Duque, Lee Smith, Nasser Al-Daghri
    Bone Reports.2025; 25: 101848.     CrossRef
  • TAVI Success Is More Than Just the Valve: CT‐Derived Sarcopenia as a Major Determinant of Long‐Term Survival
    Nikolaos Schörghofer, Christoph Knapitsch, Gretha Hecke, Nikolaus Clodi, Lucas Brandstetter, Crispiana Cozowicz, Matthias Hammerer, Klaus Hergan, Uta C. Hoppe, Bernhard Scharinger, Elke Boxhammer
    Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
  • The prognostic role of sarcopenia and muscle wasting in adult osteosarcoma patients: A longitudinal CT morphometric analysis
    Julian Kylies, Tobias Malte Ballhause, Jana Striefler, Dominik Kylies, Matthias Priemel
    European Journal of Surgical Oncology.2025; 51(9): 110293.     CrossRef
  • Sarcopenic obesity in the Asia-Pacific region: Epidemiology, risk factors, and management
    Chun-Feng Huang, Chih-Hsing Wu
    Osteoporosis and Sarcopenia.2025; 11(2): 40.     CrossRef
  • Sarcopenia is associated with increased hip fracture risk among middle-aged and elderly Chinese adults in longitudinal analysis of CHARLS data
    Sensen Huang, Le Chang, Zhenyu Cai
    Scientific Reports.2025;[Epub]     CrossRef
  • Symphony of regulated cell death: Unveiling therapeutic horizons in sarcopenia
    Jie Peng, Mi Zou, Qianmingyue Zhang, Dongcan Liu, Shuanghong Chen, Ruiying Fang, Yuan Gao, Xiaohua Yan, Liang Hao
    Metabolism.2025; 172: 156359.     CrossRef
  • Exercise and Nutrition for Sarcopenia: A Systematic Review and Meta-Analysis with Subgroup Analysis by Population Characteristics
    Yong Yang, Neng Pan, Jiedan Luo, Yufei Liu, Zbigniew Ossowski
    Nutrients.2025; 17(14): 2342.     CrossRef
  • Formulation, Phytochemical Characterization, and Clinical Assessment of a Novel Natural Supplement Targeting Body Composition in Physically Active Individuals: A Randomized Clinical Trial
    Tablo Azad Hama salih, Halgord Ali M. Farag
    Kurdistan Journal of Applied Research.2025; 10(2): 12.     CrossRef
  • Food-derived bioactive compounds targeting mitophagy: Emerging nutritional strategies against sarcopenia
    Haozhen Zhang, Laiming Zhang, Donghong Liu, Xingqian Ye, Shiguo Chen
    Trends in Food Science & Technology.2025; 165: 105314.     CrossRef
  • Assessing the risk of sarcopenia among community-dwelling older adults in Israel: a national cross-sectional survey
    Miri Lutski, Ziv Karni-Efrati, Inbar Zucker, Dvora Frankenthal
    European Geriatric Medicine.2025;[Epub]     CrossRef
  • Nutrition in the prevention and treatment of skeletal muscle ageing and sarcopenia: a single nutrient, a whole food and a whole diet approach
    Antoneta Granic, Avan A Sayer, Rachel Cooper, Sian M Robinson
    Proceedings of the Nutrition Society.2025; 84(4): 340.     CrossRef
  • Whole-body vibration training improves muscle mass and strength in older adults through intra- and extra-muscular pathways
    Xiangyang Tian, Shaoting Fu, Jing He, Rui Ma, Rengfei Shi
    Frontiers in Cell and Developmental Biology.2025;[Epub]     CrossRef
  • Muscle Insulin Resistance Elicits Muscle Atrophy in Obesity
    Omid Razi, Nastaran Zamani, Ayoub Saeidi, Marios Hadjicharalambous, Khadija Ayed, Anthony C. Hackney, Juan Del Coso, Ismail Laher, Giovanna Muscogiuri, Hassane Zouhal
    Current Obesity Reports.2025;[Epub]     CrossRef
  • The Impact of Protein in Post-Menopausal Women on Muscle Mass and Strength: A Narrative Review
    Katherine Elizabeth Black, Penelope Matkin-Hussey
    Physiologia.2024; 4(3): 266.     CrossRef
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
  • 26,979 View
  • 383 Download
  • 4 Web of Science
  • 4 Crossref
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.

Citations

Citations to this article as recorded by  
  • Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies
    Sanjan Kumar, Francis Cruz, Zackary Yates, Quratulain Amin, Muhammad Usman Awan, Philip Lee, Sarthak Kumar, Adel Elkbuli
    The American Journal of Surgery.2025; 245: 116385.     CrossRef
  • A DESCRIPTIVE STUDY ON TRIGLYCERIDE AND BLOOD GLUCOSE LEVELS IN THE ELDERLY POPULATION
    Ika Ainur Rofiah, Lasiyati Yuswo Yani
    INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS).2025; 9(1): 102.     CrossRef
  • Prevalence and associated factors of physical-psychological-cognitive multimorbidity in Chinese community-dwelling older adults: a cross-sectional study
    Lin Lin, Di-fei Duan, Linjia Yan, Hai yan He
    PeerJ.2025; 13: e19750.     CrossRef
  • Effectiveness of a resilience-building nursing intervention on psychological well-being in Arab community-dwelling older adults
    Walaa Badawy Mohamed Badawy, Amal Hashem Mohamed, Mostafa Shaban
    Geriatric Nursing.2024; 60: 338.     CrossRef
Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies
Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim
Epidemiol Health. 2023;45:e2023102.   Published online November 30, 2023
DOI: https://doi.org/10.4178/epih.e2023102
  • 21,779 View
  • 263 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.
Summary
Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.
Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.

Citations

Citations to this article as recorded by  
  • Genetic evidence of circulating metabolites linking to gastric cancers: a two-sample Mendelian randomization study
    Yu Haiwen, Liu Yongjian, Xie Penglong, Feng Wanting, Xu Dongchu
    Annals of Medicine & Surgery.2025; 87(2): 571.     CrossRef
  • Lacto-Fermented Fruits and Vegetables: Bioactive Components and Effects on Human Health
    Lei Wei, Wannes Van Beeck, Melanie Hanlon, Erin DiCaprio, Maria L. Marco
    Annual Review of Food Science and Technology .2025; 16(1): 289.     CrossRef
  • Association Between the Korean Healthy Eating Index (KHEI) and Healthcare Costs Among Adults: The Korea National Health and Nutrition Examination Survey (KNHANES) 2016 and 2021
    Soyoung Kim, Minseon Park
    Nutrients.2025; 17(13): 2237.     CrossRef
  • A higher intake of white-edible-colored fruits and vegetables is associated with lower gastrointestinal cancer risk among Korean adults in a prospective cohort study
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Special Article
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiol Health. 2023;45:e2023092.   Published online October 16, 2023
DOI: https://doi.org/10.4178/epih.e2023092
  • 65,535 View
  • 1,055 Download
  • 34 Web of Science
  • 42 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.
METHODS
Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.
RESULTS
Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.
CONCLUSIONS
Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.
Summary
Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.
Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

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Brief Communication
Prevalence and methodological quality of systematic reviews in Korean medical journals
Seong Jung Kim, Mi Ah Han, Jae Hung Jung, Eu Chang Hwang, Hae Ran Kim, Sang Eun Yoon, Seo-Hee Kim, Pius Kim, So-Yeong Kim
Epidemiol Health. 2023;45:e2023017.   Published online February 6, 2023
DOI: https://doi.org/10.4178/epih.e2023017
  • 15,790 View
  • 141 Download
  • 2 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This study aimed to assess and evaluate the prevalence and methodological quality of systematic reviews (SRs) published in major Korean medical journals (KMJs). The top 15 journals with the highest Korean Medical Citation Index, published between 2018 to 2021, were selected. We assessed the methodological quality of SRs using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). In total, 126 SRs were included, with an average of 32 SRs being reported annually. The overall prevalence of SRs in KMJs was 2.8%, with an increase from 2.6% in 2018 to 3.4% in 2021. Overall, the methodological quality of SRs was low (9.5% low, 90.5% critically low). More than 80% of the studies adhered to critical domain items such as a comprehensive literature search and risk of bias assessment, but for items such as protocol registration and listing excluded studies and the justification for exclusion, the adherence rate was less than 15%. While the number of SRs in KMJs steadily increased, the overall confidence in the methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of SRs.
Summary
Korean summary
한국의학저널에서 체계적 문헌고찰의 수는 꾸준히 증가했지만 방법론적 품질은 전반적으로 낮았다. 임상 및 공중 보건 분야에서 의사 결정을 위한 최상의 근거를 제공하기 위해 편집자, 심사자 및 저자는 체계적 문헌고찰의 품질을 개선하는 데 더 많은 관심을 기울여야 할 것이다.
Key Message
While the number of systematic reviews in Korean medical journals steadily increased, the overall confidence of methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of systematic reviews.

Citations

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  • RETRACTED: A methodological framework for rigorous systematic reviews: Tailoring comprehensive analyses to clinicians and healthcare professionals
    Stefano Mancin, Marco Sguanci, Giuliano Anastasi, Lea Godino, Alessio Lo Cascio, Emanuela Morenghi, Michela Piredda, Maria Grazia De Marinis
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  • 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
    Epidemiology and Health.2022; 44: e2022108.     CrossRef
Systematic Reviews
Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies
Jee Yeon Hong, Young Jun Kim, Sanghyuk Bae, Mi Kyung Kim
Epidemiol Health. 2023;45:e2023011.   Published online December 30, 2022
DOI: https://doi.org/10.4178/epih.e2023011
  • 17,850 View
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  • 4 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.
METHODS
Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).
RESULTS
In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).
CONCLUSIONS
A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.
Summary
Korean summary
식이로부터 배출되는 GHG양은 메타분석의 고정 효과 모델과 확률 효과 모델 모두에서 만성 질환 발병률 및 사망 위험과 유의미한 양의 상관 관계를 보여주었습니다. 동물성 식단은 더 높은 GHG 배출량을 나타냈으나, 특정 만성질환에 대한 연구의 수가 적었고 질환 별 하위군 분석에서 유의미한 결과를 보이지 않았습니다. 결론적으로 온실가스 배출량이 많은 식단은 모든 원인으로 인한 사망 위험이 더 큰 것으로 나타났습니다.
Key Message
Daily food consumption contributes a large part of greenhouse gas (GHG) emissions, however, no review study was conducted. This study is the first review paper that reviews the relationship between greenhouse gas (GHG) emissions from daily diet and chronic disease risk and all-cause mortality. GHG emissions from the daily diet were significantly positively associated with disease risk and mortality. Animal-based diets contributed most to diet-derived GHG emissions. Men tended to have diets with higher GHG emissions compared to women. At times when the response to climate change is urgent, this study can help many policymakers and health officials.

Citations

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  • Development of the Food Systems–Related Greenhouse Gas Emissions Factor Database Using the Korea National Health and Nutrition Examination Survey (2016–2018)
    Jee Yeon Hong, Mi Kyung Kim
    Environmental Health Perspectives.2025;[Epub]     CrossRef
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    Emmanuelle Kesse-Guyot, Aurélien Chayre, Elie Perraud, Sylvaine Berger, Annabelle Richard, Justine Berlivet, Mathilde Touvier, Benjamin Allès, Serge Hercberg, Denis Lairon, Philippe Pointereau, Hélène Fouillet, Julia Baudry, Christian Couturier, François
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    Dorota Różańska, Bożena Regulska-Ilow
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    Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P. Singh
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The prevalence of Q fever in the Eastern Mediterranean region: a systematic review and meta-analysis
Mozhgan Ahmadinezhad, Leila Mounesan, Amin Doosti-Irani, Manijeh Yousefi Behzadi
Epidemiol Health. 2022;44:e2022097.   Published online October 28, 2022
DOI: https://doi.org/10.4178/epih.e2022097
  • 24,965 View
  • 199 Download
  • 10 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.
METHODS
Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).
RESULTS
In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).
CONCLUSIONS
Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.
Summary

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    Hassan M. Baroom, Naser A. Alkenani, Bassam O. Al-Johny, Adi A. Almohimeed, Mohammed S. Mohammed, Layla A. Alshehri, Shaker S. Althobaiti, Raga I. Omar, Majed A. Alshaeri, Saleh M. Al-mmaqar
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    Mohamud Sheek-Hussein, Aboma Zewude, Aminu S. Abdullahi, Nabeeha Hassan Abdelgaleel, Hassan Zackaria Ali Ishag, Mohd Farouk Yusof, Mohammed Saleh ALBreiki, Asma Mohamed Abdi Shah, Jamila AlNeyadi, Babiker Osman, Amir Abdullah Hassen, Mervat Mari Al Nuaima
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    Cinzia Santucciu, Maria Paola Giordo, Antonio Tanda, Giovanna Chessa, Matilde Senes, Gabriella Masu, Giovanna Masala, Valentina Chisu
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    Amjad Ahmadi, Rasool Nasiri Kalmarzi, Behzad Mohsenpour, Parisa Esmaeili, Mina Latifian, Ahmad Ghasemi, Rashid Ramazanzadeh, Himen Salimizand, Daem Roshani, Saber Esameili, Ehsan Mostafavi, Rajib Chowdhury
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    Uxía Yáñez, Jacobo Álvarez, Cristina Pisón, Antía Acción, Juan J. Becerra, Antonio Jiménez, Philippe Gisbert, Pedro G. Herradón, Ana I. Peña, Alberto Prieto, José M. Díaz-Cao, Luis A. Quintela
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    Ahmad Enferadi Ghazanabad, Negin Esfandiari, Mohammadreza Najafi, Shahryar Mehrabi, Saeedeh Sarani, Peyman Khademi, Max Maurin
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    Md Ahaduzzaman, Md Moktadir Billah Reza
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    娇 罗
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    Abdelmalik Ibrahim Khalafalla
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Methods
Meta-analysis of diagnostic test accuracy studies with multiple thresholds for data integration
Sung Ryul Shim
Epidemiol Health. 2022;44:e2022083.   Published online September 28, 2022
DOI: https://doi.org/10.4178/epih.e2022083
  • 23,526 View
  • 519 Download
  • 15 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The objective of this study is to introduce methods to use all of the information without omission when individual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration. For diagnostic test meta-analysis, a general performance method for synthesizing data according to one cut value in one study and a performance method for synthesizing data according to two or more cut values in one study were compared and analyzed.
METHODS
As sample data for meta-analysis of DTA studies, 13 DTA studies on prostate cancer (34 effect sizes including total cut-offs) were collected. The summary statistics were calculated and the summary line was analyzed using the “meta”, “mada”, and “diagmeta” packagesof the R software.
RESULTS
The summary statistics of the random effect model univariate analysis of the “meta” package with a single cut-off corresponding to the highest Youden index in a single study and those of the bivariate analysis of the “mada” package were highly similar. However, in the bivariate analysis of the “diagmeta” package including all cut-off values, the sensitivity decreased and the specificity increased as the amount of data increased.
CONCLUSIONS
Considering the heterogeneity of the summary receiver op erating characteristic curve and the use of all given cut-offs, the use of the bivariate analysis model of the “diagmeta” package is recommended. This study focused on practical methods of DTA rather than theoretical concepts for use by researchers whose fields of study are non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.
Summary
Korean summary
본 연구는 진단검사 메타분석시 개별 대상연구가 다수의 기준치 (cut-off value, threshold)에 따른 여러 개의 효과크기를 제공하고 있을 때, 정보의 누락없이 이를 모두 사용하는 방법과 더불어 기존의 수행방법도 비교 분석하였기에 연구에 적합한 모델 선택에 도움이 될 것이다.
Key Message
The objective of this study is to introduce methods to use all of the information without omission when indi¬vidual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration.

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Systematic Reviews
Systematic review and meta-analysis of cancer risks in relation to environmental waste incinerator emissions: a meta-analysis of case-control and cohort studies
Kiook Baek, Jong-Tae Park, Kyeongmin Kwak
Epidemiol Health. 2022;44:e2022070.   Published online September 1, 2022
DOI: https://doi.org/10.4178/epih.e2022070
  • 18,010 View
  • 279 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Various toxic substances can be generated from incinerators, exposing nearby residents, and epidemiological studies have shown wide variations in risk estimates for cancer risk in populations living close to incinerators.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search and systematic review were conducted to identify studies conducted on general populations exposed to environmental incinerator emissions and cancer outcomes. Meta-analysis was performed according to the cancer types for which 2 or more studies were reported. Subgroup analysis was done for sex, the exposure estimation method, the study period, and the type of outcome.
RESULTS
Eleven studies were found for the qualitative review and meta-analysis. Seven studies had a case-control design, and 4 had a cohort design. The pooled effect size was not significant for breast, colorectal, liver, lung, lymphohematopoietic, stomach, bladder, central nervous system, and laryngeal cancers, non-Hodgkin lymphoma, sarcoma, leukemia, and all cancers. In the subgroup analysis, the pooled effect size of laryngeal cancer in females was 1.82 (95% confidence interval, 1.10 to 3.01), although only 2 studies were identified.
CONCLUSIONS
The meta-analysis did not provide evidence of an increased risk for any cancer among populations living near waste incinerators, except for laryngeal cancer in females. However, since relatively few studies were reviewed and some cancer types showed significant increases in individual studies, this evidence needs to be updated regularly.
Summary
Korean summary
본 연구에서는 현재까지 소각장 인근 주민들의 암 위험도에 대해 보고된 환자-대조군 연구 및 코호트 연구를 체계적 문헌고찰과 메타분석법을 활용하여 분석하였다. 총 11개의 문헌에서 보고한 암 위험도를 암종별로 분석한 결과 소각장 인근 거주로 인한 암 위험도 상승이 유의하게 상승한 암종은 없었다. 세부 그룹 분석에서 여성의 후두암이 비록 단 2개 문헌에서만 보고하고 있었지만 유의한 상승을 보였다. 본 연구는 현재까지 논란이 많은 소각장 인근 거주와 암 발생 위험도의 증가에 대해 관찰연구로서 생태학적 연구를 배제하고 비교적 역학적 증거로서 가치가 높은 연구방법인 환자-대조군 연구와 코호트 연구를 고찰한 의의가 있으며, 본 연구의 방법론을 활용하면 추후 같은 주제의 증거를 지속적으로 갱신하여 종합할 수 있으리라 기대한다.
Key Message
This meta-analysis showed a lack of evidence of elevated risk of specific cancers after pooling the effect sizes by cancer type, except for laryngeal cancer in women. However, due to the small number of included studies, the evidence needs to be monitored and updated on a regular basis in the future.

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The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis
Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo
Epidemiol Health. 2021;43:e2021090.   Published online October 22, 2021
DOI: https://doi.org/10.4178/epih.e2021090
  • 37,639 View
  • 466 Download
  • 38 Web of Science
  • 50 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Diabetes self-management education (DSME) programs are a strategy to maintain healthy behaviors. Nevertheless, limited evidence has been reported from systematic evaluations of the effects of DSME integrated with peer support on glycemic control. This study aimed to review the effectiveness of DSME interventions integrated with peer support on glycemic control in patients with type 2 diabetes.
METHODS
A systematic search was carried out in electronic databases, including PubMed, Cochrane Library, ProQuest, SpringerLink, ScienceDirect, Scopus, and Google Scholar, for English-language articles published from 2005 until 2020. The effect size was estimated as the standard mean difference (SMD). The Cochrane Collaboration’s Risk of Bias tool was employed to assess the risk of bias.
RESULTS
Twelve studies were included in this study. DSME integrated with peer support effectively reduced glycated hemoglobin A1c (HbA1c) levels, with a statistically significant effect (SMD, -0.41; 95% confidence interval [CI], -0.69 to -0.13; p<0.001). Programs with a sample size <100 (SMD, -0.45; 95% CI, -0.79 to -0.11; p=0.009), duration of intervention ≤6 months (SMD, -0.52; 95% CI, -0.96 to -0.07; p=0.020), baseline HbA1c <8.5% (SMD, -0.42; 95% CI, -0.77 to -0.07; p=0.020), delivery by group (SMD, -0.28; 95% CI, -0.51 to -0.06; p=0.010), and high frequency of contact (SMD, -0.29; 95% CI, -0.48 to -0.10; p=0.003) had statistically significant effects on reducing HbA1c levels in patients with type 2 diabetes.
CONCLUSIONS
DSME integrated with peer support effectively enhances glycemic control in patients with type 2 diabetes. Programs with smaller participants groups, shorter interventions, weekly meetings, and closer group sessions improved glycemic control in patients with type 2 diabetes.
Summary
Key Message
We reviewed and assessed the quality of the twelve articles included in this systematic review and meta-analysis. The findings of this review show that peer support integrated with diabetes self-management education programs can significantly enhance glycemic control in type 2 diabetes patients. Peer support is a critical component of a successful diabetes self-management programme in patients with type 2 diabetes. interventions programme with smaller groups, shorter durations, lower HbA1c baseline levels, group sessions, and high frequencies of sessions significantly enhanced glycemic control.

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COVID-19: Original Article
The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies
Mehmet Onur Kaya, Esra Pamukçu, Burkay Yakar
Epidemiol Health. 2021;43:e2021074.   Published online September 23, 2021
DOI: https://doi.org/10.4178/epih.e2021074
  • 38,713 View
  • 659 Download
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  • 65 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D<20 ng/mL or 50 nmol/L) on COVID-19 infection and outcomes.
METHODS
We searched Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect without any language restrictions for articles published between January 1 and December 15, 2020. We performed 3 meta-analyses (called vitamin D and COVID-19 infection meta-analysis [D-CIMA], vitamin D and COVID-19 severity meta-analysis [D-CSMA], and vitamin D and COV ID-19 mortality meta-analysis [D-CMMA] for COVID-19 infection, severity, and mortality, respectively) to combine odds ratio values according to laboratory measurement units for vitamin D and the measured serum 25(OH)D level.
RESULTS
Twenty-one eligible studies were found to be relevant to the relationship between vitamin D and COVID-19 infection/outcomes (n=205,869). The D-CIMA meta-analysis showed that individuals with low serum vitamin D levels were 1.64 times (95% confidence interval [CI], 1.32 to 2.04; p<0.001) more likely to contract COVID-19. The D-CSMA meta-analysis showed that people with serum 25(OH)D levels below 20 ng/mL or 50 nmol/L were 2.42 times (95% CI, 1.13 to 5.18; p=0.022) more likely to have severe COVID-19. The D-CMMA meta-analysis showed that low vitamin D levels had no effect on COVID-19 mortality (OR, 1.64; 95% CI, 0.53 to 5.06, p=0.390).
CONCLUSIONS
According to our results, vitamin D deficiency may increase the risk of COVID-19 infection and the likelihood of severe disease. Therefore, we recommend vitamin D supplementation to prevent COVID-19 and its negative outcomes.
Summary
Key Message
Although vaccination has started, it seems that Covid-19 will continue to threaten public health for a long time. In addition to the vaccine, the use of supplements to support the immune system may also be important. The purpose of this study is to indicate the possible effect of low serum vitamin D (25(OH)D<20 ng/mL or 50nmol/L) on the Covid-19 infection and outcomes. According to our remarkable results, vitamin D deficiency increases the risk of Covid-19 infection and the potential for the severity of the disease. Therefore, vitamin D supplements should be added to prevention and treatment protocols for Covid-19 disease.

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Brief Communication
A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry
Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee
Epidemiol Health. 2021;43:e2021057.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021057
  • 19,283 View
  • 222 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.
METHODS
Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMR<sub>x</sub>/SMR<sub>not x</sub>) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).
RESULTS
The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).
CONCLUSIONS
Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.
Summary
Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.
Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Citations

Citations to this article as recorded by  
  • The healthy participant effect: insights and results from a population-based case–control study on breast cancer
    Kevin Maldonado-Cañón, Annika Möhl, Nadia Obi, Sabine Behrens, Fabian Flaßkamp, Petra Seibold, Jenny Chang-Claude, Heiko Becher
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COVID-19: Systematic Review
Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence
Md Mahbub Hossain, Abida Sultana, Neetu Purohit
Epidemiol Health. 2020;42:e2020038.   Published online June 2, 2020
DOI: https://doi.org/10.4178/epih.e2020038
  • 65,210 View
  • 1,586 Download
  • 435 Web of Science
  • 301 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
Objectives
Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases.
Methods
We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population.
Results
Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes.
Conclusions
This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.
Summary

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Systematic Review
Risk factors for stomach cancer: a systematic review and meta-analysis
Jalal Poorolajal, Leila Moradi, Younes Mohammadi, Zahra Cheraghi, Fatemeh Gohari-Ensaf
Epidemiol Health. 2020;42:e2020004.   Published online February 2, 2020
DOI: https://doi.org/10.4178/epih.e2020004
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AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This report provides information on 14 behavioral and nutritional factors that can be addressed in stomach cancer prevention programs.
METHODS
PubMed, Web of Science, and Scopus were searched through December 2018. Reference lists were also screened. Observational studies addressing the associations between stomach cancer and behavioral factors were analyzed. Between-study heterogeneity was investigated using the χ<sup>2</sup>, τ<sup>2</sup>, and I<sup>2</sup> statistics. The likelihood of publication bias was explored using the Begg and Egger tests and trim-and-fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model.
RESULTS
Of 52,916 identified studies, 232 (including 33,831,063 participants) were eligible. The OR (95% CI) of factors associated with stomach cancer were as follows: <i>Helicobacter pylori</i> infection, 2.56 (95% CI, 2.18 to 3.00); current smoking, 1.61 (95% CI, 1.49 to 1.75); former smoking 1.43 (95% CI, 1.29 to 1.59); current drinking, 1.19 (95% CI, 1.10 to 1.29); former drinking, 1.73 (95% CI, 1.17 to 2.56); overweight/obesity, 0.89 (95% CI, 0.74 to 1.08); sufficient physical activity, 0.83 (95% CI, 0.68 to 1.02); consumption of fruits ≥3 times/wk, 0.48 (95% CI, 0.37 to 0.63); consumption of vegetables ≥3 times/wk, 0.62 (95% CI, 0.49 to 0.79); eating pickled vegetables, 1.28 (95% CI, 1.09 to 1.51); drinking black tea, 1.00 (95% CI, 0.84 to 1.20); drinking green tea, 0.88 (95% CI, 0.80 to 0.97); drinking coffee, 0.99 (95% CI, 0.88 to 1.11); eating fish ≥1 time/wk 0.79 (95% CI, 0.61 to 1.03); eating red meat ≥4 times/wk 1.31 (95% CI, 0.87 to 1.96), and high salt intake 3.78 (95% CI, 1.74 to 5.44) and 1.34 (95% CI, 0.88 to 2.03), based on two different studies.
CONCLUSIONS
This meta-analysis provided a clear picture of the behavioral and nutritional factors associated with the development of stomach cancer. These results may be utilized for ranking and prioritizing preventable risk factors to implement effective prevention programs.
Summary

Citations

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Reviews
The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis
Mahin Ghafari, Samira Bahadivand-Chegini, Tayebeh Nadi, Amin Doosti-Irani
Epidemiol Health. 2019;41:e2019046.   Published online October 27, 2019
DOI: https://doi.org/10.4178/epih.e2019046
  • 27,769 View
  • 264 Download
  • 16 Web of Science
  • 13 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents.
METHODS
PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included.
RESULTS
The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0).
CONCLUSIONS
The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.
Summary

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Meta-analysis of the prevalence of depression among breast cancer survivors in Iran: an urgent need for community supportive care programs
Hassan Ahmadi Gharaei, Mostafa Dianatinasab, Seyyed Mostafa Kouhestani, Mohammad Fararouei, Hossein Moameri, Reza Pakzad, Reza Ghaiasvand
Epidemiol Health. 2019;41:e2019030.   Published online July 4, 2019
DOI: https://doi.org/10.4178/epih.e2019030
  • 26,250 View
  • 308 Download
  • 18 Web of Science
  • 22 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Depression, which is the most common comorbidity in breast cancer (BC) patients, has adverse effects on patients’ quality of life, disease progress, and survival.
METHODS
The protocol of this study was registered in PROSPERO (registration No. CRD42019121494). We electronically searched published studies through January 2019 with the aim of finding articles that investigated the prevalence of depression among BC survivors. Web of Science, Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar were searched to obtain relevant published studies. This review included 14 cross-sectional and 4 cohort studies published from 2000 to 2018. We used a random-effects model to conduct the meta-analysis and generated a summary estimate for the pooled prevalence with 95% confidence intervals (CIs). A subgroup analysis was also conducted based on the depression assessment tool used and the study design.
RESULTS
The total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The pooled prevalence of depression among Iranian women with BC was 46.83% (95% CI, 33.77 to 59.88) with significant heterogeneity (I2 =98.5%; p<0.001). The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90% (95% CI, 91.97 to 99.83). The results of the subgroup analyses suggested that the depression assessment tool, year of publication, and study design were sources of heterogeneity.
CONCLUSIONS
Our findings indicate a high prevalence of depression among BC patients, underscoring the urgent need for clinicians and health authorities to provide well-defined social and psychological supportive care programs for these patients.
Summary

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A systematic review and meta-analysis of the genetic characterization of human echinococcosis in Iran, an endemic country
Abolghasem Siyadatpanah, Davood Anvari, Amir Emami Zeydi, Seyed Abdollah Hosseini, Ahmad Daryani, Shahabeddin Sarvi, Christine M. Budke, Reza Esmaeelzadeh Dizaji, Mohammad Ali Mohaghegh, Mohammad Hasan Kohansal, Samira Dodangeh, Reza Saberi, Shirzad Gholami
Epidemiol Health. 2019;41:e2019024.   Published online June 15, 2019
DOI: https://doi.org/10.4178/epih.e2019024
  • 25,495 View
  • 340 Download
  • 18 Web of Science
  • 17 Crossref
AbstractAbstract PDF
Abstract
Human echinococcosis is an infectious disease caused by tapeworms belonging to the species Echinococcus. This parasite has a worldwide distribution and is considered a neglected tropical disease by the World Health Organization. Due to the diversity of Echinococcus spp. hosts, as well as variation in geographical, climatic, and socio-ethnic conditions, the question of the strains or genotypes of Echinococcus spp. that are involved in human infections is important. The aim of this study was to provide a summary of the available data on genotypes of Echinococcus obtained from the Iranian population. Four international databases (PubMed, Scopus, Science Direct, and Web of Science) and 4 Persian databases (Magiran, Scientific Information Database, Iran Medex, and IranDoc) were searched for cross-sectional studies that reported the genotypes of Echinococcus spp. in human echinococcosis cases using molecular methods in Iran through July 2018. The Newcastle-Ottawa Scale was used to assess the quality of the selected studies. A total of 559 cases of human cystic echinococcosis were reported in the 21 included articles. The majority of cases belonged to genotype G1 (89.2%; 95% confidence interval [CI], 80.1 to 95.8), genotype G6 (8.2%; 95% CI, 2.8 to 15.9), and genotype G3 (2.3%; 95% CI, 1.1 to 3.9). Since genotype G1 of Echinococcus appears to be the most prevalent genotype affecting humans in Iran, disease control initiatives aimed at sheep intermediate hosts may be the most beneficial. In addition, educational programs and serological screening in individuals may help reduce the national impact of the disease.
Summary

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Methods
Network meta-analysis: application and practice using R software
Sung Ryul Shim, Seong-Jang Kim, Jonghoo Lee, Gerta Rücker
Epidemiol Health. 2019;41:e2019013.   Published online April 8, 2019
DOI: https://doi.org/10.4178/epih.e2019013
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this study is to describe the general approaches to network meta-analysis that are available for quantitative data synthesis using R software. We conducted a network meta-analysis using two approaches: Bayesian and frequentist methods. The corresponding R packages were “gemtc” for the Bayesian approach and “netmeta” for the frequentist approach. In estimating a network meta-analysis model using a Bayesian framework, the “rjags” package is a common tool. “rjags” implements Markov chain Monte Carlo simulation with a graphical output. The estimated overall effect sizes, test for heterogeneity, moderator effects, and publication bias were reported using R software. The authors focus on two flexible models, Bayesian and frequentist, to determine overall effect sizes in network meta-analysis. This study focused on the practical methods of network meta-analysis rather than theoretical concepts, making the material easy to understand for Korean researchers who did not major in statistics. The authors hope that this study will help many Korean researchers to perform network meta-analyses and conduct related research more easily with R software.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 네트워크 메타분석 (Network meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

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Intervention meta-analysis: application and practice using R software
Sung Ryul Shim, Seong-Jang Kim
Epidemiol Health. 2019;41:e2019008.   Published online March 28, 2019
DOI: https://doi.org/10.4178/epih.e2019008
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this study was to describe general approaches for intervention meta-analysis available for quantitative data synthesis using the R software. We conducted an intervention meta-analysis using two types of data, continuous and binary, characterized by mean difference and odds ratio, respectively. The package commands for the R software were “metacont”, “metabin”, and “metagen” for the overall effect size, “forest” for forest plot, “metareg” for meta-regression analysis, and “funnel” and “metabias” for the publication bias. The estimated overall effect sizes, test for heterogeneity and moderator effect, and the publication bias were reported using the R software. In particular, the authors indicated methods for calculating the effect sizes of the target studies in intervention meta-analysis. This study focused on the practical methods of intervention meta-analysis, rather than the theoretical concepts, for researchers with no major in statistics. Through this study, the authors hope that many researchers will use the R software to more readily perform the intervention meta-analysis and that this will in turn generate further related research.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 메타분석 (Intervention meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

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Diagnostic test accuracy: application and practice using R software
Sung Ryul Shim, Seong-Jang Kim, Jonghoo Lee
Epidemiol Health. 2019;41:e2019007.   Published online March 28, 2019
DOI: https://doi.org/10.4178/epih.e2019007
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this paper is to describe general approaches of diagnostic test accuracy (DTA) that are available for the quantitative synthesis of data using R software. We conduct a DTA that summarizes statistics for univariate analysis and bivariate analysis. The package commands of R software were “metaprop” and “metabin” for sensitivity, specificity, and diagnostic odds ratio; forest for forest plot; reitsma of “mada” for a summarized receiver-operating characteristic (ROC) curve; and “metareg” for meta-regression analysis. The estimated total effect sizes, test for heterogeneity and moderator effect, and a summarized ROC curve are reported using R software. In particular, we focus on how to calculate the effect sizes of target studies in DTA. This study focuses on the practical methods of DTA rather than theoretical concepts for researchers whose fields of study were non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 진단검사 메타분석 (Diagnostic test accuracy)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

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Dose-response meta-analysis: application and practice using the R software
Sung Ryul Shim, Jonghoo Lee
Epidemiol Health. 2019;41:e2019006.   Published online March 28, 2019
DOI: https://doi.org/10.4178/epih.e2019006
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this study was to describe the general approaches of dose-response meta-analysis (DRMA) available for the quantitative synthesis of data using the R software. We conducted a DRMA using two types of data, the difference of means in continuous data and the odds ratio in binary data. The package commands of the R software were “doseresmeta” for the overall effect sizes that were separated into a linear model, quadratic model, and restricted cubic split model for better understanding. The effect sizes according to the dose and a test for linearity were demonstrated and interpreted by analyzing one-stage and two-stage DRMA. The authors examined several flexible models of exposure to pool study-specific trends and made a graphical presentation of the dose-response trend. This study focused on practical methods of DRMA rather than theoretical concepts for researchers who did not major in statistics. The authors hope that this study will help many researchers use the R software to perform DRMAs more easily, and that related research will be pursued.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 용량-반응 메타분석 (Dose-response meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

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Review
Freshwater snails as the intermediate host of trematodes in Iran: a systematic review
Samira Dodangeh, Ahmad Daryani, Mehdi Sharif, Shirzad Gholami, Elham Kialashaki, Mahmood Moosazadeh, Shahabeddin Sarvi
Epidemiol Health. 2019;41:e2019001.   Published online January 7, 2019
DOI: https://doi.org/10.4178/epih.e2019001
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AbstractAbstract PDFSupplementary Material
Abstract
Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.
Summary

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Brief Communication
Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials
Jong-Myon Bae
Epidemiol Health. 2018;40:e2018043.   Published online August 29, 2018
DOI: https://doi.org/10.4178/epih.e2018043
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The 2017 guideline for the prevention of travelers’ diarrhea (TD) by the International Society of Travel Medicine suggested that ‘there is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat TD.’ However, a meta-analysis published in 2007 reported significant efficacy of probiotics in the prevention of TD (summary relative risk [sRR], 0.85, 95% confidence interval [CI], 0.79 to 0.91). This study aimed to synthesize the efficacy of probiotics on TD by updating the meta-analysis of double-blind, placebo-controlled, randomized human trials.
METHODS
The search process was conducted by the adaptive meta-analysis method using the ‘cited by’ and ‘similar articles’ options provided by PubMed. The inclusion criteria were double-blind, placebo-controlled, randomized human trials with hypotheses of probiotics as intervention and TD as an outcome. The adaptive meta-analysis was conducted using Stata software using the csi, metan, metafunnel, and metabias options.
RESULTS
Eleven articles were selected for the meta-analysis. The sRR was 0.85 (95% CI, 0.79 to 0.91) and showed statistical significance. There was no heterogeneity (I-squared=28.4%) and no publication bias.
CONCLUSIONS
Probiotics showed statistically significant efficacy in the prevention of TD.
Summary
Korean summary
활생제가 여행자설사를 예방하는 효과가 있는가에 대한 기존 메타분석결과들과 지침간의 괴리가 확인되어서 갱신용 메타분석을 수행하였다. 총 11편의 무작위배정, 위약대조비교 임상시험결과에 대한 메타분석결과 통계적으로 유의한 효과가 있는 것으로 산출되었다 (summary relative risk =0.85; 95% confidence interval: 0.77-0.91).

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Methods
Network meta-analysis: application and practice using Stata
Sungryul Shim, Byung-Ho Yoon, In-Soo Shin, Jong-Myon Bae
Epidemiol Health. 2017;39:e2017047.   Published online October 27, 2017
DOI: https://doi.org/10.4178/epih.e2017047
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This review aimed to arrange the concepts of a network meta-analysis (NMA) and to demonstrate the analytical process of NMA using Stata software under frequentist framework. The NMA tries to synthesize evidences for a decision making by evaluating the comparative effectiveness of more than two alternative interventions for the same condition. Before conducting a NMA, 3 major assumptions—similarity, transitivity, and consistency—should be checked. The statistical analysis consists of 5 steps. The first step is to draw a network geometry to provide an overview of the network relationship. The second step checks the assumption of consistency. The third step is to make the network forest plot or interval plot in order to illustrate the summary size of comparative effectiveness among various interventions. The fourth step calculates cumulative rankings for identifying superiority among interventions. The last step evaluates publication bias or effect modifiers for a valid inference from results. The synthesized evidences through five steps would be very useful to evidence-based decision-making in healthcare. Thus, NMA should be activated in order to guarantee the quality of healthcare system.
Summary
Korean summary
같은 치료 목적을 가진 여러 치료법들 간의 효과를 상호 비교한 결과들을 통합하기 위해 개발된 네트워크 메타분석 (NMA) 결과는 의사결정의 우선순위를 정하는데 있어 가장 상위의 과학적 설득력을 갖는다. STATA 통계프로그램에서 제공하는 빈도주의 틀에 기반한 NMA를 수행하는데 점검해야 할 가정들과 실제 적용 과정을 소개한다.

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Meta-analysis for genome-wide association studies using case-control design: application and practice
Sungryul Shim, Jiyoung Kim, Wonguen Jung, In-Soo Shin, Jong-Myon Bae
Epidemiol Health. 2016;38:e2016058.   Published online December 18, 2016
DOI: https://doi.org/10.4178/epih.e2016058
  • 29,480 View
  • 396 Download
  • 4 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This review aimed to arrange the process of a systematic review of genome-wide association studies in order to practice and apply a genome-wide meta-analysis (GWMA). The process has a series of five steps: searching and selection, extraction of related information, evaluation of validity, meta-analysis by type of genetic model, and evaluation of heterogeneity. In contrast to intervention meta-analyses, GWMA has to evaluate the Hardy–Weinberg equilibrium (HWE) in the third step and conduct meta-analyses by five potential genetic models, including dominant, recessive, homozygote contrast, heterozygote contrast, and allelic contrast in the fourth step. The ‘genhwcci’ and ‘metan’ commands of STATA software evaluate the HWE and calculate a summary effect size, respectively. A meta-regression using the ‘metareg’ command of STATA should be conducted to evaluate related factors of heterogeneities.
Summary
Korean summary
오늘날 활발히 수행되고 있는 유전체역학연구는 재현성의 문제, 대상자 크기의 한계 등으로 유전체 메타분석 연구가 요구되고 있다. 유전체 메타분석의 전반적인 수행 단계는 약물, 수술 등의 중개연구의 메타분석처럼 5 단계를 밟아 수행된다. 그러나, 유전체 메타분석은 3번째 과정에서 Hardy–Weinberg equilibrium (HWE) 검정과 4번째 과정에서 5가지 가능한 유전형 모델에 따라 메타분석이 이루어진다는 점에서 중개연구의 메타분석과 차이가 있다.

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Review
Dietary intakes of citrus fruit and risk of gastric cancer incidence: an adaptive meta-analysis of cohort studies
Jong-Myon Bae, Eun Hee Kim
Epidemiol Health. 2016;38:e2016034.   Published online July 25, 2016
DOI: https://doi.org/10.4178/epih.e2016034
  • 36,323 View
  • 313 Download
  • 28 Web of Science
  • 35 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In the context of supplementary antioxidants having no anticancer effect, it is important to update the meta-analysis to evaluate whether there is an association between intake of citrus fruit and gastric cancer risk.
METHODS
The list of articles to be searched was established using citation discovery tools provided by PubMed and Scopus. The effect size of each article to be used in meta-analysis was calculated using the interval-collapse method. Summary effect size (sES) and 95% confidence intervals (CI) were obtained by conducting this meta-analysis. Random effect dose–response meta-regression (DRMR) was performed to investigate the dose–response relationship.
RESULTS
A total of five cohort studies were selected. The result was 13% reduction of gastric cancer according to the intake of citrus fruit (sES, 0.87; 95% CI, 0.76 to 0.99; I-squared=69.6%). In subgroup analysis, it was found that the intake of citrus fruit inhibited cardia gastric cancer (CGC) (sES, 0.67; 95% CI, 0.55 to 0.81; I-squared=46.1%) and as a result of DRMR, 100 g of citrus fruit intake per day inhibits CGC by 40% (relative risk, 0.60; 95% CI, 0.44 to 0.83).
CONCLUSIONS
It is suggested that the intake of citrus fruit inhibits the development of CGC. This conclusion can be used as a primary prevention measure in the future when the incidence of CGC may be on the rise.
Summary
Korean summary
항산화제 첨가제가 항암효과가 없다는 결론이 난 상황에서, 감귤섭취가 위암발생을 억제한다는 기존의 체계적 고찰연구에 대한 갱신 메타연구를 수행하였다. PubMed와 Scopus에서 제공하는 citation discovery tools를 활용하여 총 5편의 코호트 연구 논문을 선정하였다. 감귤섭취에 따라 위암발생을 13% 억제하며 (sES=0.87, 95% CI: 0.76-0.99, I-squared: 69.6%), 특히 위문부 위암을 억제한다고 나왔다 (sES= 0.67, 95% CI: 0.55-0.81, I-squared=46.1%), 또한, 하루 100 gram 감귤섭취를 하면 CGC 를 40% 억제하는 것으로 나왔다 (RR=0.60, 95% CI: 0.44-0.83).

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Brief Communication
Reinterpretation of the results of a pooled analysis of dietary carotenoid intake and breast cancer risk by using the interval collapsing method
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016024.   Published online June 2, 2016
DOI: https://doi.org/10.4178/epih.e2016024
  • 24,311 View
  • 225 Download
  • 10 Web of Science
  • 12 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
A pooled analysis of 18 prospective cohort studies reported in 2012 for evaluating carotenoid intakes and breast cancer risk defined by estrogen receptor (ER) and progesterone receptor (PR) statuses by using the “highest versus lowest intake” method (HLM). By applying the interval collapsing method (ICM) to maximize the use of the estimated information, we reevaluated the results of the previous analysis in order to reinterpret the inferences made.
METHODS
In order to estimate the summary effect size (sES) and its 95% confidence interval (CI), meta-analyses with the random-effects model were conducted for adjusted relative risks and their 95% CI from the second to the fifth interval according to five kinds of carotenoids and ER/PR status.
RESULTS
The following new findings were identified: α-Carotene and β-cryptoxanthin have protective effects on overall breast cancer. All five kinds of carotenoids showed protective effects on ER− breast cancer. β-Carotene level increased the risk of ER+ or ER+/PR+ breast cancer. α-Carotene, β-carotene, lutein/zeaxanthin, and lycopene showed a protective effect on ER−/PR+ or ER−/PR− breast cancer.
CONCLUSIONS
The new facts support the hypothesis that carotenoids that show anticancer effects with anti-oxygen function might reduce the risk of ER− breast cancer. Based on the new facts, the modification of the effects of α-carotene, β-carotene, and β-cryptoxanthin should be evaluated according to PR and ER statuses.
Summary
Korean summary
Carotenoids 가 항암기전이 있다면 steroid hormone에 무관한 estrogen receptor negative (ER-) 혹은 progesterone receptor negative (PR-) 유방암의 발생을 억제할 것이란 가설에 따라, 18개의 코호트에 대한 pooled analysis 결과가 2012년도에 발표되었다. 이를 재분석한 결과, 5 종류의 carotenoids 모두 ER- 유방암 억제하는 것을 확인하였다.

Citations

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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
  • 37,922 View
  • 278 Download
  • 82 Web of Science
  • 87 Crossref
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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Methods
Comparison of methods of extracting information for meta-analysis of observational studies in nutritional epidemiology
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016003.   Published online January 11, 2016
DOI: https://doi.org/10.4178/epih.e2016003
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
A common method for conducting a quantitative systematic review (QSR) for observational studies related to nutritional epidemiology is the “highest versus lowest intake” method (HLM), in which only the information concerning the effect size (ES) of the highest category of a food item is collected on the basis of its lowest category. However, in the interval collapsing method (ICM), a method suggested to enable a maximum utilization of all available information, the ES information is collected by collapsing all categories into a single category. This study aimed to compare the ES and summary effect size (SES) between the HLM and ICM.
METHODS
A QSR for evaluating the citrus fruit intake and risk of pancreatic cancer and calculating the SES by using the HLM was selected. The ES and SES were estimated by performing a meta-analysis using the fixedeffect model. The directionality and statistical significance of the ES and SES were used as criteria for determining the concordance between the HLM and ICM outcomes.
RESULTS
No significant differences were observed in the directionality of SES extracted by using the HLM or ICM. The application of the ICM, which uses a broader information base, yielded more-consistent ES and SES, and narrower confidence intervals than the HLM.
CONCLUSIONS
The ICM is advantageous over the HLM owing to its higher statistical accuracy in extracting information for QSR on nutritional epidemiology. The application of the ICM should hence be recommended for future studies.
Summary
Korean summary
영양역학과 관련하여 관찰연구 결과를 체계적 고찰을 할 때, 통상적으로 섭취가 가장 낮은 군을 기준으로 하여 가장 높은 군의 effect size (ES) 정보를 추출하는 Highest versus Lowest Method (HLM)을 적용한다. 그러나 주어진 정보를 최대한 활용한다는 점에서 구간의 정보들을 통합한 ES 정보로 메타분석에 적용하는 Interval Collapse Method (ICM)법이 제안되었다. HLM에 비하여 더 많은 정보를 활용한 ICM 적용을 한 결과, ES 뿐만 아니라 SES에서도 일치성을 보이면서 표준오차가 작아지는 현상을 확인하였다. 영양역학의 메타분석을 위해 추출하는 방법 중 정보를 보다 더 많이 활용하는 ICM이 HLM에 비하여 통계적 정확성의 이득을 더 갖기 때문에, 향후 적극 활성화할 필요가 있다.

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Review
Human papillomavirus infection and risk of lung cancer in never-smokers and women: an ‘adaptive’ meta-analysis
Jong-Myon Bae, Eun Hee Kim
Epidemiol Health. 2015;37:e2015052.   Published online November 17, 2015
DOI: https://doi.org/10.4178/epih/e2015052
  • 28,834 View
  • 196 Download
  • 10 Web of Science
  • 15 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The incidence of lung cancer in Koreans is increasing in women and in both men and women with a never-smoking history. Human papillomavirus (HPV) infection has been suggested as a modifiable risk factor of lung cancer in never-smokers and women (LCNSW). This systematic review (SR) aimed to evaluate an association between HPV infection and lung cancer risk in LCNSW.
METHODS
Based on a prior SR and some expert reviews, we identified refereed, cited, or related articles using the PubMed and Scopus databases. All case-control studies that reported the odds ratio of HPV infection in LCNSW were selected. An estimate of the summary odds ratio (SOR) with 95% confidence intervals (CI) was calculated.
RESULTS
A total of four case-control studies were included. The fixed-effect model was applied because of homogeneity (I-squared=0.0%). The SORs in women and in never-smokers were 5.32 (95% CI, 1.75 to 16.17) and 4.78 (2.25 to 10.15) respectively.
CONCLUSIONS
These results showed a significant effect of HPV infection in LCNSW. It is evident that developing a preventive plan against LCNSW may be necessary.
Summary

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Hypothesis
Modifiable risk factors of lung cancer in “never-smoker” women
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015047.   Published online October 29, 2015
DOI: https://doi.org/10.4178/epih/e2015047
  • 28,507 View
  • 223 Download
  • 2 Web of Science
  • 11 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Korean women with a history of never smoking and with adenocarcinoma showed an increasing trend in lung cancer occurrence during 2002 to 2012. The two modifiable factors of never-smoker lung cancer in women are hormone and oncogenic virus infection. Based on previous studies, hormone replacement therapy (HRT) and human papillomavirus (HPV) infection might afford protection or be a risk factor, respectively. It is necessary to perform a pooled analysis of cohort studies to evaluate HRT and never-smoker lung cancer in women and a systematic review of case-control studies to determine the association between HPV infection and never-smoker lung cancer.
Summary
Korean summary
2002년에서 2012년간 폐암 통계를 살펴보면 비흡연 여성에서 선암종의 발생이 크게 증가하는 것으로 확인된다. 이렇게 여성에서 비흡연 폐암발생과 관련한 요인들로는 호르몬 대체요법 (HRT)과 인유두종바이러스 (HPV) 감염이 알려져 있다. 환자-대조군연구를 이용한 메타분석에 따르면 호르몬대체요법은 폐암발생을 억제하는 것으로 나왔다. HPV에 대한 메타분석은 아직 없는 가운데 위험요인으로 의심하고 있다. 따라서 HRT에 대하여는 코호트 연구 결과를 이용한 연합분석 (pooled analysis)이 필요하며, HPV에 대하여는 환자-대조군연구 결과를 이용한 메타분석이 수행될 필요가 있다.

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Review
Do the tuberculin skin test and the QuantiFERON-TB Gold in-tube test agree in detecting latent tuberculosis among high-risk contacts? A systematic review and meta-analysis
Erfan Ayubi, Amin Doosti-Irani, Ehsan Mostafavi
Epidemiol Health. 2015;37:e2015043.   Published online October 3, 2015
DOI: https://doi.org/10.4178/epih/e2015043
  • 29,728 View
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AbstractAbstract PDF
Abstract
OBJECTIVES
The QuantiFERON-TB Gold in-tube test (QFT-GIT) and the tuberculin skin test (TST) are used to diagnose latent tuberculosis infection (LTBI). However, conclusive evidence regarding the agreement of these two tests among high risk contacts is lacking. This systematic review and meta-analysis aimed to estimate the agreement between the TST and the QFT-GIT using kappa statistics.
METHODS
According to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, scientific databases including PubMed, Scopus, and Ovid were searched using a targeted search strategy to identify relevant studies published as of June 2015. Two researchers reviewed the eligibility of studies and extracted data from them. The pooled kappa estimate was determined using a random effect model. Subgroup analysis, Egger’s test and sensitivity analysis were also performed.
RESULTS
A total of 6,744 articles were retrieved in the initial search, of which 24 studies had data suitable for meta-analysis. The pooled kappa coefficient and prevalence-adjusted bias-adjusted kappa were 0.40 (95% confidence interval [CI], 0.34 to 0.45) and 0.45 (95% CI, 0.38 to 0.49), respectively. The results of the subgroup analysis found that age group, quality of the study, location, and the TST cutoff point affected heterogeneity for the kappa estimate. No publication bias was found (Begg’s test, p=0.53; Egger’s test, p=0.32).
CONCLUSIONS
The agreement between the QFT-GIT and the TST in diagnosing LTBI among high-risk contacts was found to range from fair to moderate.
Summary

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Hypothesis
The necessity of an observational study on the interactions between allergic history and citrus fruit intake for the prevention of pancreatic cancer
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015028.   Published online June 16, 2015
DOI: https://doi.org/10.4178/epih/e2015028
  • 27,041 View
  • 169 Download
  • 1 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
While the main product of Jeju Island is citrus fruit and the prevalence of atopic dermatitis among the students who live there is relatively high, the incidence of pancreatic cancer is lowest in Korea. Systematic reviews reporting allergic history and intake of citrus fruit as protective factors against pancreatic cancer (PCC) were published in 2005 and 2008, respectively. Although there were discrepancies in the results of the subgroup analyses between case-control and cohort studies, it is necessary to evaluate an interaction effect between allergic history and intake of citrus fruits on PCC risk.
Summary
Korean summary
췌장암 발생과 관련한 요인들의 규명이 절실한 상황에서, 알레르기 질환과 감귤섭취 각각이 발생억제 효과가 있다는 체계적 고찰연구가 있다. 그러나 코호트 연구들만으로 메타분석을 하였을 때는 두 억제 요인 모두 통계적 유의성이 없는 것으로 나왔다. 한편 지역별 췌장암 발생률에서 낮은 수준을 보이는 제주도는 주요 감귤생산지이면서, 초중고등학생의 아토피 유병률이 상대적으로 높은 것으로 알려져 있다. 이런 사실들에 근거할 때 췌장암 발생에 있어 알레르기질환과 감귤섭취의 상호작용을 규명하는 코호트 연구를 제안한다.

Citations

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  • Citation Discovery Tools for Conducting Adaptive Meta-analyses to Update Systematic Reviews
    Jong-Myon Bae, Eun Hee Kim
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    Jong-Myon Bae, Eun Hee Kim
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    Jong-Myon Bae, Eun Hee Kim
    Epidemiology and Health.2015; 37: e2015052.     CrossRef
  • Hormone Replacement Therapy and Risk of Breast Cancer in Korean Women: A Quantitative Systematic Review
    Jong-Myon Bae, Eun Hee Kim
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Review
Human papillomavirus 16 infection as a potential risk factor for prostate cancer: an adaptive meta-analysis
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015005.   Published online February 11, 2015
DOI: https://doi.org/10.4178/epih/e2015005
  • 31,522 View
  • 192 Download
  • 30 Web of Science
  • 27 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although an expert review published in 2013 concluded that an association between human papillomavirus (HPV) infection and prostate cancer (PCa) risk had not yet been firmly established, a 2011 systematic review of 14 articles revealed an increased prevalence of HPV-16 DNA in PCa tissues. Another meta-analysis of the related articles is needed to evaluate the potential link between HPV infection and PCa risk.
METHODS
A snowballing search strategy was applied to the previously cited articles in the above-mentioned expert review and systematic review. Additional articles selected for this meta-analysis should fulfill all following inclusion criteria: (a) evaluation of detected HPV-16 DNA in tissue samples and the PCa risk and (b) report of the HPV-16 prevalence in both cancer and control tissues. Estimated summary odds ratios (sOR) with 95% confidence intervals (CI) were calculated using fixed effect or random-effect models.
RESULTS
Hand searching identified 16 new articles. The sOR of the total 30 articles indicated a significant HPV-16 infection-related increase in the PCa risk (sOR, 1.851; 95% CI, 1.353 to 2.532, I2=37.82%).
CONCLUSIONS
These facts provide additional supportive evidence for a causal role of HPV-16 infection in prostate carcinogenesis. As the PCa incidence rates have increased rapidly in Asian countries, including Korea, during the last several decades, further studies of HPV-related PCa carcinogenesis may be necessary.
Summary
Korean summary
전립선암의 교정가능한 위험요인으로 만성재발성 염증을 야기하는 HPV 감염이 주목받고 있다. 지금까지의 체계적 고찰과 전문가 종설은 뚜렷한 인과성이 없다고 결론내고 있다. 이에 새로이 발표된 관련 논문들을 확보하여 메타분석을 다시 수행하였다. 총 30개의 대상논문에 대한 메타분석을 시행하였을 때, HPV 16 감염이 위험요인임을 확인하였다. (sOR = 1.851, 95% CI: 1.353 – 2.532, I2=37.82%).

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    Journal of Preventive Medicine and Public Health.2016; 49(2): 129.     CrossRef
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    Jong-Myon Bae, Eun Hee Kim
    Journal of Preventive Medicine and Public Health.2016; 49(2): 97.     CrossRef
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    Jong-Myon Bae, Eun Hee Kim
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    Journal of Preventive Medicine and Public Health.2015; 48(6): 280.     CrossRef
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Methods
Meta-epidemiology
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014019.   Published online September 25, 2014
DOI: https://doi.org/10.4178/epih/e2014019
  • 30,459 View
  • 210 Download
  • 14 Web of Science
  • 19 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The concept of meta-epidemiology has been introduced with considering the methodological limitations of systematic review for intervention trials. The paradigm of meta-epidemiology has shifted from a statistical method into a new methodology to close gaps between evidence and practice. Main interest of meta-epidemiology is to control potential biases in previous quantitative systematic reviews and draw appropriate evidences for establishing evidence-base guidelines. Nowadays, the network meta-epidemiology was suggested in order to overcome some limitations of meta-epidemiology. To activate meta-epidemiologic studies, implementation of tools for risk of bias and reporting guidelines such as the Consolidated Standards for Reporting Trials (CONSORT) should be done.
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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Narrative reviews
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014018.   Published online September 11, 2014
DOI: https://doi.org/10.4178/epih/e2014018
  • 37,406 View
  • 252 Download
  • 19 Web of Science
  • 19 Crossref
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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    Jong-Myon Bae
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An overview of systematic reviews of diagnostic tests accuracy
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014016.   Published online August 29, 2014
DOI: https://doi.org/10.4178/epih/e2014016
  • 30,520 View
  • 201 Download
  • 16 Web of Science
  • 17 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The Cochrane Collaboration says that the Cochrane handbook for diagnostic test accuracy reviews (DTAR) is currently in development as per the Cochrane Collaboration. This implies that the methodology of systematic reviews (SR) of diagnostic test accuracy is still a matter of debate. At this point, comparison of methodologies for SR in case of interventions as against diagnostics would be helpful to understand DTAR.
Summary
Korean summary
코크란연합은 진단검사의 정확도 평가를 위한 방법론을 현재 개발 중이라고 한다. 이는 해당 방법론 개발에 있어 적극적인 이해가 있어야 한다는 뜻이다. 진단검사의 정확도 평가를 위한 체계적 고찰 수행에 관한 내용을 보다 쉽게 이해하기 위하여, 이미 정립되어 적극 활용되고 있는 개입효과 평가를 위한 체계적 고찰의 수행 과정별로 비교하여 살펴보았다.

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Original Articles
Green Tea Consumption and Stomach Cancer Risk: A Meta-Analysis
Hyunseok Kang, Sun Young Rha, Kyung Won Oh, Chung Mo Nam
Epidemiol Health. 2010;32:e2010001.   Published online April 26, 2010
DOI: https://doi.org/10.4178/epih/e2010001
  • 31,890 View
  • 138 Download
  • 30 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>Green tea has been suggested to have a chemopreventive effect against various cancers including stomach cancer. The aim of this study is to elucidate the relationship between green tea consumption and stomach cancer risk by meta-analysis.</p></sec><sec><title>METHODS</title><p>Eighteen observational studies were identified using MEDLINE, THE COCHRANE LIBRARY, RISS, and a manual search. Summary relative risks/odds ratios (RR/ORs) for the highest versus non/lowest green tea consumption levels were calculated on the basis of fixed and random effect models. Subgroup analyses were used to examine heterogeneity across the studies.</p></sec><sec><title>RESULTS</title><p>The combined results indicate a reduced risk of stomach cancer with intake of green tea (RR/OR=0.86, 95% CI=0.74-1.00). Subgroup analysis with six studies that reported differences between the highest and lowest consumption levels equal to or greater than five cups/day revealed a statistically significant protective effect (RR/OR=0.68, 95% CI=0.53-0.87).</p></sec><sec><title>CONCLUSION</title><p>Green tea appears to play a protective role against the development of stomach cancer. The results also suggest that a higher level of green tea consumption might be needed for a clear preventive effect to appear. This conclusion, however, should be interpreted with caution because various biases can affect the results of a meta-analysis.</p></sec>
Summary

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Diagnostic accuracy of conventional Pap test, liquid-based cytology and human papillomavirus DNA testing in cervical cancer screening in Korea: a meta-analysis.
Jin Kyoung Oh, Hai Rim Shin, Gyungyub Gong, Jin Hee Sohn, Shin Kwang Khang
Korean J Epidemiol. 2008;30(2):178-187.   Published online December 31, 2008
DOI: https://doi.org/10.4178/kje.2008.30.2.178
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AbstractAbstract PDF
Abstract
Objective: The aim of this study was to compare the diagnostic accuracy of the Pap test, liquid-based cytology (LBC), and human papillomavirus (HPV) testing used as screening methods for the early detection of cervical cancer in Korea. Materials and Methods: Articles reporting the sensitivity and specificity of each screening method that were published between 1995 and March 2008 were retrieved from MEDLINE and KoreaMed. A meta-analysis was conducted to calculate pooled estimates for the sensitivity and specificity of each method. Only cases with histological confirmation were included, and cervical cancer was defined as samples exhibiting cervical intraepithelial neoplasia 2 or worse. In cytological tests, findings of atypical squamous cells of undetermined significance or worse were considered positive.
Results
Of the 24 studies, 15 studies of the Pap test, 3 studies of LBC, and 4 studies of HPV met the inclusion criteria and were included in the meta-analysis. The meta-analysis showed that the sensitivity was highest for LBC (92%), followed by HPV testing (83%) and the Pap test (76%), and the specificity of LBC was the highest (79%), followed by the Pap test (76%) and HPV testing (59%). However, except for the sensitivity of LBC (heterogeneity p-value = 0.682), significant heterogeneity was found among the results of the studies (heterogeneity p-value < 0.0001).
Discussion
Due to the significant heterogeneity among the studies, the results of this meta-analysis are limited in representing the accuracy of each test method. The accuracy and cost-effectiveness of cervical cancer screening methods should be further evaluated.
Summary

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