The Association between Social Support, Metabolic Syndrome, and Incidence of Cardio-Cerebrovascular Diseases in Older Adults: The ARIRANG Study.

PURPOSE: We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years. MATERIALS AND METHODS: We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores. RESULTS: During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479-3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95% CI: 1.141-5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance. CONCLUSION: The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

Analysis of digital capacity-related factors influencing health promotion participation and active aging of older adults residing in rural areas in South Korea: A structural equation model.

Objective: This study aimed to identify the correlation between digital capacity, health promotion participation, and active aging of older people living in rural areas in South Korea to assess the factors influencing participation in programs for health promotion and active aging. Methods: Data were collected through a 1:1 face-to-face survey using a structured questionnaire from 13 February to 24 February 2023 during the older individuals' visits in the senior citizen welfare centers and senior citizen centers in the region. The Measuring Digital Skills questionnaire used to assess the digital competence of South Korean individuals was employed in this study. To confirm the structural relationship between digital capacity and health promotion participation and active aging in the older population aged 65 years and older based on the collected data, a structural equation modeling analysis was performed. Results: Active health promotion participation had a positive effect on active aging. The pathway that older adults in Korea can led to participation in health promotion and active aging in the current situation is not mainly through the digital competency whereas mobile internet skill showed positive influneces. Conclusions: In the digital era and super-aged society, various programs are provided to older individuals to enhance the utilization of smartphones. However, education and programs for strengthening digital capacity should be organized to explain the advantages of digital use and to inform of the dangers of addiction to ensure healthy aging through social participation and exchange both online and offline.

Priority analysis of factors affecting family planning practices among Ethiopians using a decision tree analysis.

This study aimed to identify the priorities of the factors affecting family planning practices in Ethiopia, with the ultimate aim of providing evidence to the Ethiopian government and international organizations for establishing family planning policies or family planning-related project plans. Multi-stage, clustered, stratified random sampling was performed on a total of 35,479 men aged above 15 years and women of childbearing age (15-49 years) in two metropolitan cities and five regions of Ethiopia. The survey was conducted by face-to-face interview using Tablet PC, and 25,972 responses, excluding censored data were included in the final analysis. The collected data were first analyzed using the Pearson chi-square test, independent sample t-test, and F-test with the Tukey HSD method as a post-hoc. Second, a decision-making tree analysis was conducted to identify priority factors affecting the decision to implement family planning The primary factor affecting the family planning practice was 'spouse or sexual partner's support for family planning (P <.001)'. 'Region (p <.001)' was the second priority factor for both the group receiving 'support for family planning by spouse or partner' and the group not receiving it. The third priority factors appeared differed by region in both groups. It is necessary to establish family planning policy and program plans targeting both men and women, and participation of religious and community leaders is considered important in the establishment process. In addition, it is considered necessary to enhance the professionalism by dividing the education and evaluation process for HEW to provide high-quality counseling, education, and services on family planning at the community level.

Impact of COVID-19 Fear on COVID-19 Policy Support Among University Students in South Korea.

Objective: As the fourth wave of COVID-19 spread in South Korea in 2022, society experienced various adverse effects, including COVID-19 phobia, depression, and loneliness. Addressing these factors became a vital part of the anti-COVID-19 individual and public mental health efforts, conducted partly by fostering COVID-19 knowledge, attitudes, and compliance with public prevention practice guidelines under the controversial policy of living "with COVID-19". Method: The study used a cross-sectional online survey-based design. Participants comprised a convenience sample of Korean university students (n = 460). A survey was distributed to the participants to measure their agreement/disagreement with the policy "with COVID-19" and a structural equation model and path analysis to examine the impact of the latent variables of COVID-19 phobia and COVID-19 knowledge, attitudes, and practice as of April 2022. Results: The mean COVID-19 phobia score was 48.13/100, with psychological and social phobia scores higher than in previous studies, while psychosomatic and economic phobia scores were lower than in previous research. Higher psychological phobia significantly increased COVID-19 practices and attitudes. Conversely, higher psychosomatic phobia decreased practices and attitudes. Moreover, higher psychological phobia was significantly associated with disagreement with the policy. Conclusion: The results suggest that efforts to increase South Korean university students' acceptance of easing COVID-19 restrictions should focus on mitigating psychological phobia.

Evaluating the Effectiveness of Rural Digital Social Prescribing in Korea: Protocol for a Cohort Study.

BACKGROUND: The UK National Health Service (NHS) has introduced a digital social prescribing (DSP) system to improve the mental health of the aging population. In Korea, an ongoing pilot social prescribing project has been implemented for older individuals in rural areas since 2019. OBJECTIVE: This research aims to develop a DSP program and to evaluate the effectiveness of the digital platform in rural areas of Korea. METHODS: This study was designed as a prospective cohort method for the development and effectiveness evaluation of rural DSP in Korea. The study divided participants into four groups. Group 1 will continuously implement the existing social prescribing program, group 2 implemented the existing social prescribing program but was switched to DSP in 2023, group 3 newly started the DSP, and the remaining group is the control. The research area of this study is Gangwon Province in Korea. The study is being conducted in Wonju, Chuncheon, and Gangneung. This study will use indicators to measure depression, anxiety, loneliness, cognitive function, and digital literacy. In the future, the interventions will implement the digital platform and the Music Story Telling program. This study will evaluate the effectiveness of DSP using difference-in-differences regression and cost-benefit analysis. RESULTS: This study was approved for funding from the National Research Foundation of Korea funded by the Ministry of Education in October 2022. The results of the data analysis are expected to be available in September 2023. CONCLUSIONS: The platform will be spread to rural areas in Korea and will serve as the foundation for effectively managing the feelings of solitude and depression among older individuals. This study will provide vital evidence for disseminating DSP in Asian countries such as Japan, China, Singapore, and Taiwan as well as for studying DSP in Korea. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46371.

COVID-19 Phobia among Korean, Chinese, and Japanese students: An international comparative study.

This study aimed to identify the characteristic differences and potential contributing factors of coronavirus disease 2019 (COVID-19) phobia between undergraduate and graduate students in Korea, Japan, and China. We used the online survey tool, we retained 460 responses from Korea, 248 responses from Japan, and 788 responses from China for analysis. We performed the statistical analysis; ANOVA F-test and Multiple linear regression. We visualized the results of these calculations using GraphPad PRISM 9. The mean COVID-19 phobia score was highest in Japan at 50.5 points. Psychological fear was identically prevalent in Japan and China, at an average of 17.3 points. Psychosomatic fear was highest in Japan at 9.2 points. Further, economic fear was highest in Korea at 13 points, whereas social fear was highest in China at 13.1 points. In Korea, COVID-19 phobia scores were significantly higher among women than in men. In Japan, COVID-19 phobia scores were significantly higher in individuals who complied with social distancing mandates. In China, a lack of previous experience with self-administered testing kits was associated with significantly lower phobia scores. Individuals who were avoiding crowded places had significantly higher scores in 3 countries. This implies that the students knew that it was necessary to comply with COVID-19 preventive behaviors to prevent infections. The findings of this study could be used as a reference when establishing an approach strategy to reduce COVID-19 phobia among Chinese, Japanese, and Korean students.

Global Trends in Social Prescribing: Web-Based Crawling Approach.

BACKGROUND: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing-a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. OBJECTIVE: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. METHODS: Google's searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. RESULTS: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing-related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased "Healthy" terms from 2020, "gardening" prominence in "Program," "community" growth across categories, and "Target" term spikes in 2021. CONCLUSIONS: This study's discussion highlights four key aspects: (1) the "Healthy" category trends emphasize mental health, cancer, and sleep; (2) the "Program" category prioritizes gardening, community, home-schooling, and digital initiatives; (3) "Governance" underscores the significance of community resources in social prescribing implementation; and (4) "Target" focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships.

Assessing the Fear Factor of Coronavirus Disease 2019 (COVID-19) in Korea Using the COVID-19 Phobia Scale: A Cross-Sectional Study.

BACKGROUND: A study on coronavirus disease 2019 (COVID-19) phobia among students revealed that fear of contracting COVID-19 was associated with commuting to school and spending time with others at school. Therefore, it is the need-of-the-hour for the Korean government to identify factors affecting COVID-19 phobia among university students and to consider these factors while framing the policy direction for the process of returning to normalcy in university education. Consequently, we aimed to identify the current state of COVID-19 phobia among Korean undergraduate and graduate students and the factors affecting COVID-19 phobia. METHODS: This cross-sectional survey was conducted to identify the factors affecting COVID-19 phobia among Korean undergraduate and graduate students. The survey collected 460 responses from April 5 to April 16, 2022. The questionnaire was developed based on the COVID-19 Phobia Scale (C19P-S). Multiple linear regression was performed on the C19P-S scores using five models with the following dependent variables: Model 1, total C19P-S score; Model 2, psychological subscale score; Model 3, psychosomatic subscale score; Model 4, social subscale score; and Model 5, economic subscale score. The fit of these five models was established, and a P-value of less than 0.05 (F test) was considered statistically significant. RESULTS: An analysis of the factors affecting the total C19P-S score led to the following findings: women significantly outscored men (difference: 4.826 points, P = 0.003); the group that favored the government's COVID-19 mitigation policy scored significantly lower than those who did not favor it (difference: 3.161 points, P = 0.037); the group that avoided crowded places scored significantly higher than the group that did not avoid crowded places (difference: 7.200 points, P < 0.001); and those living with family/friends scored significantly higher than those in other living situations (difference: 4.606 points, P = 0.021). Those in favor of the COVID-19 mitigation policy had significantly lower psychological fear than those who were against it (difference: -1.686 points, P = 0.004). Psychological fear was also significantly higher for those who avoided crowded places compared to those who did not difference: 2.641 points, P < 0.001). Fear was significantly higher in people cohabitating than those living alone (difference: 1.543 points, P = 0.043). CONCLUSION: The Korean government, in their pursuit of a policy that eases COVID-19-related restrictions, will also have to spare no efforts in providing correct information to prevent the escalation of COVID-19 phobia among people with a high fear of contracting the disease. This should be done through trustworthy information sources, such as the media, public agencies, and COVID-19 professionals.

Digital-Based Policy and Health Promotion Policy in Japan, the Republic of Korea, Singapore, and Thailand: A Scoping Review of Policy Paths to Healthy Aging.

People are living longer, and our life has become more digital. Hence, the benefits from digital technology, including economic growth, increasing labor productivity, and ensuring health equity in the face of an aging population emerged as a vital topic for countries around the world. Japan, the Republic of Korea (ROK), Singapore, and Thailand are in the top ten rankings in terms of information and communication technology (ICT) development within the Asia Pacific Region and all are facing challenges of population aging. Well-designed national ICT policy and health promotion policies enabled the countries to make significant progress and development in terms of digitalization and healthy aging. This paper aims to answer questions regarding digitization and health promotion: when it started, how it is going, what are the achievements, and what it holds for the future, considering healthy aging and digitalization by reviewing the national ICT policy and health promotion policies of Japan, Korea, Singapore, and Thailand. This paper is expected to help readers build a comprehensive understanding of each country's journey towards building a healthy aging digital society. Furthermore, we hope this paper can be a source for countries to exchange experiences and learn from each other with a joint goal of building a healthy aging digital society.

Influencing factor of COVID-19 vaccination trust and hesitancy in Wonju city, South Korea.

Social capital (SC) has been documented to effectively reduce the spread of diseases, including COVID-19; however, research pertaining to SC and COVID-19 vaccination in Korea is lacking. This cross-sectional study conducted in the city of Wonju, Gangwon Province, Korea (n = 1,096) examined the differences in COVID-19 vaccine trust and hesitancy considering individual characteristics and investigated the effects of SC on COVID-19 vaccine trust and hesitancy. SC was measured based on 14 items pertaining to social trust, network, and norms. Responses regarding COVID-19 screening history, vaccine trust, and vaccine hesitancy were also assessed. SC scores did not differ between sexes, but differed significantly according to age and household income; thus, adults aged 70-79 years had the highest SC scores, and mean SC score increased significantly with income. COVID-19 vaccine trust differed significantly according to age, average household income, social organization involvement, and SC score. COVID-19 vaccine hesitancy differed significantly with age, SC score, and COVID-19 screening history. In univariate logistic regression, age, average household income, social organization involvement, and SC score were significant predictors of vaccine trust; in multivariable analysis, however, the identified predictors were age and SC. In particular, people with an SC score ≥50 were 2.660 times more likely to trust COVID-19 vaccines than those with lower scores. In multivariable analysis, age and SC were significant predictors of vaccine hesitancy. In particular, people with an SC score ≥50 were 1.400 times more likely not to be hesitant about receiving COVID-19 vaccines than people with lower scores. These results indicate that prioritizing policies to increase SC and trust in the government could boost the COVID-19 vaccination rate.

Effect of a Digital Literacy Program on Older Adults' Digital Social Behavior: A Quasi-Experimental Study.

In South Korea, digital literacy education programs are expected to help its older population participate in online welfare services to increase their social support, self-esteem and well-being. This quasi-experimental study assesses the effects of digital literacy education on digital device usage among rural-dwelling adults aged 65 and above and evaluates the positive effects of digital literacy education on depression, happiness, quality of life, self-efficacy and cognitive function. A digital literacy education program and a customized questionnaire survey were conducted to evaluate smartphone use competency and the program's effects, respectively. We also conducted a chi-square test, paired t-test and difference-in-differences regression analysis. The experimental group showed a significant increase in smartphone usage and video recording capacity than the control group. The happiness and cognitive function scores for dementia screening increased significantly by a mean of 3.7 and 1.1 points, respectively, after digital literacy education. Cognitive function increased significantly by 1.305 points in the experimental group compared to the control group (ß = 1.305, p = 0.05 *). Digital literacy education for older adults in rural areas greatly increased smartphone use, video recording capacity, happiness and cognitive function. Based on these findings, it is recommended that the government should implement digital literacy education for older adults in rural areas to increase their happiness and cognitive function.

High diopter spectacle using a flexible Fresnel lens with a combination of grooves.

In this study, the Fresnel lens was investigated as a potential candidate for vision correction in patients with myopia. A few previous studies have suggested this idea; however, Fresnel lenses are limited by their aesthetics and quality. Therefore, we designed a combination of Fresnel lens grooves with a constant height and pitch of 13 µm and 0.1 mm, respectively, to overcome the limitations caused by ultra-precision machining with a tool nose radius of 30 µm. A thin replicated Fresnel lens with a power of -5 diopter was procured and applied directly as spectacles that are unattached to the normal lens. The optical performance and image quality of the Fresnel lens were compared with those of a conventional lens possessing the same power in both near and far vision. These results extend the applicability for the use of Fresnel lenses as vision-correcting ophthalmological lenses and imaging systems.

Correction: The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis.

[This corrects the article DOI: 10.2196/38896.].

The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis.

BACKGROUND: With rapidly aging populations in most parts of the world, it is only natural that the need for caregivers for older adults is going to increase in the near future. Therefore, most technologically proficient countries are in the process of using artificial intelligence (AI) to build socially assistive robots (SAR) to play the role of caregivers in enhancing interaction and social participation among older adults. OBJECTIVE: This study aimed to examine the effect of intervention through AI SAR on the cognitive function of older adults through a systematic literature review. METHODS: We conducted a meta-analysis of the various existing studies on the effect of AI SAR on the cognitive function of older adults to standardize the results and clarify the effect of each method and indicator. Cochrane collaboration and the systematic literature review flow of PRISMA (Preferred Reporting Item Systematic Reviews and Meta-Analyses) were used on original, peer-reviewed studies published from January 2010 to March 2022. The search words were derived by combining keywords including Population, Intervention, and Outcome-according to the Population, Intervention, Comparison, Outcome, Time, Setting, and Study Design principle-for the question "What is the effect of AI SAR on the cognitive function of older adults in comparison with a control group?" (Population: adults aged ≥65 years; Intervention: AI SAR; Comparison: comparison group; Outcome: popular function; and Study Design: prospective study). For any study, if one condition among subjects, intervention, comparison, or study design was different from those indicated, the study was excluded from the literature review. RESULTS: In total, 9 studies were selected (6 randomized controlled trials and 3 quasi-experimental design studies) for the meta-analysis. Publication bias was examined using the contour-enhanced funnel plot method to confirm the reliability and validity of the 9 studies. The meta-analysis revealed that the average effect size of AI SAR was shown to be Hedges g=0.43 (95% CI -0.04 to 0.90), indicating that AI SAR are effective in reducing the Mini Mental State Examination scale, which reflects cognitive function. CONCLUSIONS: The 9 studies that were analyzed used SAR in the form of animals, robots, and humans. Among them, AI SAR in anthropomorphic form were able to improve cognitive function more effectively. The development and expansion of AI SAR programs to various functions including health notification, play therapy, counseling service, conversation, and dementia prevention programs are expected to improve the quality of care for older adults and prevent the overload of caregivers. AI SAR can be considered a representative, digital, and social prescription program and a nonpharmacological intervention program that communicates with older adults 24 hours a day. Despite its effectiveness, ethical issues, the digital literacy needs of older adults, social awareness and reliability, and technological advancement pose challenges in implementing AI SAR. Future research should include bigger sample sizes, pre-post studies, as well as studies using an older adult control group.

Determinants of modern family planning methods in Ethiopia: A community-based, cross-section mixed methods study.

In 2019, Ethiopia had a total fertility rate of 4.2 births per woman with the rates varying significantly across regions. The Federal Ministry of Health of Ethiopia announced "Ethiopia FP 2020" to address the high fertility rate, aiming to reduce it to 3.0 by 2020. This study aimed to identify the determinants of the use of modern family planning services in the Amhara, Oromia, and Somali regions. A community-based, cross-sectional mixed methods study was conducted, using quantitative and qualitative surveys. The quantitative survey data were subjected to binary logistic regression analyses. Participants included over 4117 married men and women aged 15-65 years old. This study found that participants in Oromia were 8.673 times more likely to have modern family planning methods than those in Somali. Participants in Amhara were 5.183 times more likely to have modern family planning methods than their Somali counterparts. Women, married respondents, and recipients of media messages were more likely to have family planning experience. Family planning discussions with health extension workers and health professionals played a significant role in modern family planning. These findings show that establishing a family planning strategy that considers the sociocultural characteristics of each region help address regional contexts. Everyone in Somali-especially husbands and religious leaders-must be educated in family planning and funds be made available to deploy advanced measures for the same.

Imaging performance of an ultra-precision machining-based Fresnel lens in ophthalmic devices.

This study aims to resolve the trade-off between the constraints and capabilities of ultra-precision machining to achieve ophthalmic Fresnel lenses. A general Fresnel lens pattern has a narrow variable pitch and curved grooves. However, we obviate the limitations of the tool nose radius constraint and the long tool path via ultra-precision machining of the modified Fresnel lens, ensuring a constant pitch of 0.1 mm and varying the height of straight grooves from 0 to 11 µm. Photorealistic raytracing visualization and MTF simulation verified the compatibility of the lens pattern with human perception sensitivity. Copper-coated mold was fabricated using a diamond tool with a tool nose radius of 5 µm. The replicated flexible Fresnel lens demonstrated a relative MTF imaging performance of 89.1% and was attached to the goggles for the qualitative assessment. The proposed Fresnel lens design and fabrication approach can be extended to applications in the visual and infrared ranges as well.

COVID-19 Vaccine Perception in South Korea: Web Crawling Approach.

BACKGROUND: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. OBJECTIVE: This study aimed to investigate Korean citizens' perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. METHODS: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens' perception of COVID-19 vaccines. The keywords searched were "vaccine," "AstraZeneca," and "Pfizer." In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. RESULTS: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with "vaccine," "good" ranked first, with a frequency of 13.43% (312/2323). Meanwhile, "side effect" ranked highest, with a frequency of 29.2% (163/559) for "AstraZeneca," but 0.6% (4/673) for "Pfizer." With "vaccine," positive words were more frequently used, whereas with "AstraZeneca" and "Pfizer" negative words were prevalent. CONCLUSIONS: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires.

Social determinants of overweight and obesity in Paraguayan adults using quantile regression.

BACKGROUND: The World Health Organization (WHO) defines the double burden of malnutrition as the new face of malnutrition. This is a serious problem in Latin American countries, especially Paraguay, which has a high obesity rate. This study aimed to gather data to inform a national strategy for confronting the double-burden challenge in Paraguay by 1) identifying whether the body mass index (BMI) of study subjects differed significantly according to social determinants, and 2) assessing the factors affecting BMI and the extent of their impact according to BMI quantile levels. DESIGN AND METHODS: Data were collected using a questionnaire adapted from the WHO World Health Survey. We collected 2,200 responses from September 16 to October 7, 2018. After excluding the questionnaires with missing data, we analyzed 1,994 respondents aged 17 years and older living in Limpio, Paraguay. The analyses included t-test and chi-squared test to identify significant differences and 10th quantile regression to assess associations. RESULTS: Analyses showed significant differences in participants' BMI levels based on age and diagnoses of diabetes or hypertension. In quantile regression analyses, age was significantly associated with BMI quantiles at all but one level. Educational attainment was significantly associated with the 10%-40% and 60%-70% quantiles of BMI. CONCLUSIONS: Age, education level, diabetes, and hypertension were significant predictors of obesity. Obesity programs that focus on people aged more than 60 years are required. In addition, targeted nutritional education may be a useful intervention.

Which Group Should be Vaccinated First?: A Systematic Review.

BACKGROUND: Since the supply of coronavirus disease 2019 (COVID-19) vaccines will be limited worldwide, it is essential to prioritize vaccination based on scientific evidence. Although several frameworks and studies on vaccine distribution have been published, no published systematic review has evaluated the prioritization of the COVID-19 vaccine. MATERIALS AND METHODS: We searched 4 different databases, PubMed, SCOPUS, Web of Science, and EMBASE for articles published between January 2019 and December 31, 2020. Studies were included if they contained the primary search terms "vaccine", "COVID-19", and "prioritization". In addition, we manually included reports from national and international websites. RESULTS: Thirteen studies met the inclusion criteria. In these studies, older adults were the most frequently mentioned group, and healthcare workers (HCWs) were mentioned as the 1st priority group. HCWs and patients with comorbidities were the 2nd and 3rd most frequently mentioned groups in the reviewed papers. Reducing severe COVID-19 was the most frequently mentioned goal. CONCLUSION: Since vaccination programs have been initiated in several countries, scientific evidence on vaccination prioritization is needed to increase our knowledge of general vaccine prioritization and improve vaccine acceptance. Our results showed that HCWs and older adults were the most frequently valued in studies.