The triple burden of communicable and non-communicable diseases and injuries on sex differences in life expectancy in Ethiopia.

BACKGROUND: Ethiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. Despite consistent increases in LE for both males and females in Ethiopia, the country has simultaneously witnessed an increasing discrepancy in LE between males and females. METHODS: This study used Pollard's actuarial method of decomposing LE to compare age- and cause- specific contributions to changes in sex differences in LE between 1995 and 2015 in Ethiopia. RESULTS: Life expectancy at birth in Ethiopia increased for both males and females from 48.28 years and 50.12 years in 1995 to 65.59 years and 69.11 years in 2015, respectively. However, the sex differences in LE at birth also increased from 1.85 years in 1995 to 3.51 years in 2015. Decomposition analysis shows that the higher male mortality was consistently due to injuries and respiratory infections, which contributed to 1.57 out of 1.85 years in 1995 and 1.62 out of 3.51 years in 2015 of the sex differences in LE. Increased male mortality from non-communicable diseases (NCDs) also contributed to the increased difference in LE between males and females over the period, accounting for 0.21 out of 1.85 years and 1.05 out of 3.51 years in 1995 and 2015, respectively. CONCLUSIONS: While injuries and respiratory infections causing male mortality were the most consistent causes of the sex differences in LE in Ethiopia, morality from NCDs is the main cause of the recent increasing differences in LE between males and females. However, unlike the higher exposure of males to death from injuries due to road traffic injuries or interpersonal violence, to what extent sex differences are caused by the higher male mortality compared to female mortality from respiratory infection diseases is unclear. Similarly, despite Ethiopia's weak social security system, an explanation for the increased sex differences after the age of 40 years due to either longer female LE or reduced male LE should be further investigated.

Mind the gaps: age and cause specific mortality and life expectancy in the older population of South Korea and Japan.

BACKGROUND: Recent life expectancy gains in high-income Asia-pacific countries have been largely the result of postponement of death from non-communicable diseases in old age, causing rapid demographic ageing. This study compared and quantified age- and cause-specific contributions to changes in old-age life expectancy in two high-income Asia-pacific countries with ageing populations, South Korea and Japan. METHODS: This study used Pollard's actuarial method of decomposing life expectancy to compare age- and cause-specific contributions to changes in old-age life expectancy between South Korea and Japan during 1997 and 2017. RESULTS: South Korea experienced rapid population ageing, and the gaps in life expectancy at 60 years old between South Korea and Japan were reduced by 2.47 years during 1997 and 2017. Decomposition analysis showed that mortality reductions from non-communicable diseases in South Korea were the leading causes of death contributing to the decreased gaps in old-age life expectancy between the two countries. More specifically, mortality reductions from cardiovascular diseases (stroke, ischaemic and hypertensive heart disease) and cancers (stomach, liver, lung, pancreatic cancers) in South Korea contributed to the decreased gap by 1.34 and 0.41 years, respectively. However, increased mortality from Alzheimer and dementia, lower respiratory tract disease, self-harm and falls in South Korea widened the gaps by 0.41 years. CONCLUSIONS: Age- and cause- specific contributions to changes in old-age life expectancy can differ between high-income Asia-pacific countries. Although the gaps in old-age life expectancy between high-income Asia-pacific countries are primarily attributed to mortality changes in non-communicable diseases, these countries should also identify potential emerging threats of communicable diseases and injuries along with demographic ageing in pursuit of healthy life years in old age.

The impact of perceived discrimination on depressive symptoms and the role of differentiated social support among immigrant populations in South Korea.

BACKGROUND: Previous studies demonstrated a positive association between perceived discrimination and mental health problems among immigrants in countries that traditionally host immigrants. Recent trends in international migration show that there has been a significant increase in immigrant populations in East Asian countries. These newer host countries have different social contexts from traditional ones, yet mental health among these immigrants and its relationship to discrimination are under-researched. Thus, this study aimed to examine the association between perceived discrimination and depressive symptoms among immigrants in one of the newer host countries, South Korea. Moreover, we investigated if differentiated social support (ethnic, host or other support) serves as a moderator of discrimination for depressive symptoms. METHODS: This study used survey data from the 2012 Korean Social Survey on Foreign Residents (N = 1068), restricted to adults 20 years or older. Multiple linear regression models were conducted to estimate the association between perceived discrimination, social support, and depressive symptoms among immigrants in South Korea. RESULTS: Perceived discrimination showed a strong positive association with depressive symptoms among immigrants, and ethnic and host support was directly positively associated with depressive symptoms. Furthermore, ethnic support moderated the effects of perceived discrimination on depressive symptoms. CONCLUSION: Community-level interventions providing immigrants opportunities to increase social networking members from the same country as well as the native-born in a host country may be helpful resources for improving mental health among immigrants in South Korea. Also, raising awareness of racial discrimination among members in South Korea would be crucial.

Study Design for the 2016 Baseline Survey of a Health System Strengthening Project in Quoc Oai District, Hanoi, Vietnam.

BACKGROUND: In order to provide essential scientific evidence on the population's health status and social health determinants as well as the current capacity of the health care system in Vietnam to health policy makers and managers, Vietnam Ministry of Health, Hanoi University of Public Health, Hanoi Medical University, and Ho Chi Minh University of Medicine and Pharmacy collaborated with Seoul National University (Korea) and conducted a health system survey in the Quoc Oai district (of Hanoi capital) that represented northern rural Vietnam. METHODS: The study design was a cross-sectional study. The survey covered different topics (more than 200 questions) and was administered in three separate questionnaires: 1) Basic information of all household members; 2) Household characteristics; and 3) Individual characteristics. Socio-demographic characteristics among the households and individuals were collected from 2,400 households sampled by multi-stage cluster sampling method: more than 200 questions. RESULTS: The household size of Quoc Oai was larger than the national average and there was no significant difference in gender composition. In addition, the proportions of pre-elderly, age 55-64, and elderly group (65 years old and over) were higher than the national population statistics. In this context, demographic transition has begun in Quoc Oai. CONCLUSION: This study design description provides the basic information about a baseline survey of a future prospective cohort (as a part of a collaborative project on strengthening the health system in Vietnam) to the prospective data user of this survey.

Rationale, design, and characteristics of the multimedia family planning campaign for a small, happy, and prosperous family in Ethiopia (SHaPE).

BACKGROUND: Ethiopia, the second most populous country in Africa, has a total fertility rate of 4.6, a decrease from 5.5 in 2000. However, only 35.3% of women in the reproductive age group use modern family planning (FP) methods, and the 22.3% of them who have an unmet need for family planning is among the highest rates in sub-Saharan African countries. The Small, Happy, and Prosperous family in Ethiopia (SHaPE) is one of the country's first comprehensive multimedia family planning campaigns. Its purpose is to increase FP-related knowledge, attitude, and practice of Ethiopians, particularly women of reproductive age. METHODS/DESIGN: The SHaPE campaign has multiple components: (1) a nationwide representative survey, which serves as formative research to identify region-specific and culture-appropriate media, messages, and barriers and determinants of family planning; (2) a multimedia communication campaign intervention, including radio dramas and other interpersonal, community-level, and mass media channels; and (3) campaign evaluation, including pre-, process-, and post-evaluation research using both quantitative and qualitative methodologies. The main target population for SHaPE is reproductive age women and men in three regions: Amhara, Oromia, and Somali. These regions take up about 66.6% of the entire country and have distinct ethnicities, cultures, and languages. DISCUSSION: SHaPE contributes to existing family planning research and intervention because it is theory- and evidence-based, and it employs integrated marketing communications and entertainment-education approaches with key messages that are tailored to audiences within unique cultures. But even within a country, a nationwide campaign with uniform messages is neither possible nor desirable due to different cultures, norms, and languages across regions. Last, media campaigns in developing and underdeveloped countries require constant monitoring of political situations.

Web-based infectious disease surveillance systems and public health perspectives: a systematic review.

BACKGROUND: Emerging and re-emerging infectious diseases are a significant public health concern, and early detection and immediate response is crucial for disease control. These challenges have led to the need for new approaches and technologies to reinforce the capacity of traditional surveillance systems for detecting emerging infectious diseases. In the last few years, the availability of novel web-based data sources has contributed substantially to infectious disease surveillance. This study explores the burgeoning field of web-based infectious disease surveillance systems by examining their current status, importance, and potential challenges. METHODS: A systematic review framework was applied to the search, screening, and analysis of web-based infectious disease surveillance systems. We searched PubMed, Web of Science, and Embase databases to extensively review the English literature published between 2000 and 2015. Eleven surveillance systems were chosen for evaluation according to their high frequency of application. Relevant terms, including newly coined terms, development and classification of the surveillance systems, and various characteristics associated with the systems were studied. RESULTS: Based on a detailed and informative review of the 11 web-based infectious disease surveillance systems, it was evident that these systems exhibited clear strengths, as compared to traditional surveillance systems, but with some limitations yet to be overcome. The major strengths of the newly emerging surveillance systems are that they are intuitive, adaptable, low-cost, and operated in real-time, all of which are necessary features of an effective public health tool. The most apparent potential challenges of the web-based systems are those of inaccurate interpretation and prediction of health status, and privacy issues, based on an individual's internet activity. CONCLUSION: Despite being in a nascent stage with further modification needed, web-based surveillance systems have evolved to complement traditional national surveillance systems. This review highlights ways in which the strengths of existing systems can be maintained and weaknesses alleviated to implement optimal web surveillance systems.

Estimating Influenza Outbreaks Using Both Search Engine Query Data and Social Media Data in South Korea.

BACKGROUND: As suggested as early as in 2006, logs of queries submitted to search engines seeking information could be a source for detection of emerging influenza epidemics if changes in the volume of search queries are monitored (infodemiology). However, selecting queries that are most likely to be associated with influenza epidemics is a particular challenge when it comes to generating better predictions. OBJECTIVE: In this study, we describe a methodological extension for detecting influenza outbreaks using search query data; we provide a new approach for query selection through the exploration of contextual information gleaned from social media data. Additionally, we evaluate whether it is possible to use these queries for monitoring and predicting influenza epidemics in South Korea. METHODS: Our study was based on freely available weekly influenza incidence data and query data originating from the search engine on the Korean website Daum between April 3, 2011 and April 5, 2014. To select queries related to influenza epidemics, several approaches were applied: (1) exploring influenza-related words in social media data, (2) identifying the chief concerns related to influenza, and (3) using Web query recommendations. Optimal feature selection by least absolute shrinkage and selection operator (Lasso) and support vector machine for regression (SVR) were used to construct a model predicting influenza epidemics. RESULTS: In total, 146 queries related to influenza were generated through our initial query selection approach. A considerable proportion of optimal features for final models were derived from queries with reference to the social media data. The SVR model performed well: the prediction values were highly correlated with the recent observed influenza-like illness (r=.956; P<.001) and virological incidence rate (r=.963; P<.001). CONCLUSIONS: These results demonstrate the feasibility of using search queries to enhance influenza surveillance in South Korea. In addition, an approach for query selection using social media data seems ideal for supporting influenza surveillance based on search query data.

Fatal and non-fatal occupational injuries and diseases among migrant and native workers in South Korea.

BACKGROUND: Migrant workers now represent an increasing percentage of workers in Korea, but few studies have evaluated work-related health risks in this population. In this study, we explored the relative risk of occupational injuries and diseases in migrant workers compared with native Korean workers. METHOD: An analysis of work-related injuries and diseases among migrant workers in Korea during 2005-2007 was conducted in each industrial subsector using nationwide data. RESULTS: Risks of fatal and non-fatal occupational injuries for migrant workers were considerably higher than their Korean counterparts. The industry-adjusted standard mortality ratios of fatal occupational injuries were 1.89 (1.45-2.47), 2.29 (1.81-2.88), and 1.73 (1.36-2.22) for 2005, 2006, and 2007, respectively. CONCLUSIONS: A greater proportion of migrant workers is exposed to higher risks of occupational safety and health issues than their Korean counterparts, demonstrating that the occupational safety and health of migrant workers requires more attention than that of Korean workers.

Differentiated effects of social participation components on suicidal ideation across age groups in South Korea.

BACKGROUND: Suicide among adults in the Korean population merits study to improve the understanding of the salient risk and protective factors because suicide rates in Korea have increased dramatically over the past 20 years. However, the association between social participation and suicidal ideation is poorly understood. Thus, this study aimed to identify the components of social participation in Korean society and to examine the processes through which the components of social participation influence the degree of suicidal ideation people experience across age groups. METHODS: This study used survey data from the 2010 Seoul Welfare Panel Study. The sample population was restricted to adults aged 20 or older and was categorised into three groups by respondents' ages. The groups were defined as 'young adults' (aged 20-39), 'middle-aged adults' (aged 40-64) and 'the elderly' (age 65 or more). Three dimensions of social participation were identified by factor analysis--friendship network and hobby group, religious involvement, and instrumental social participation. RESULTS: In the young adult group, only instrumental participation was statistically significant (-0.10, p = 0.06). In the middle-aged adult group, only friendship network and hobby group had a strong association with suicidal ideation (-0.11, p = 0.01). Interestingly, for the elderly, religious involvement was related to suicidal ideation, but in a positive way (0.26, p = 0.02). CONCLUSION: The study results supported the theory that different components of social participation are associated with a lower risk of suicidal ideation in different stages of adulthood.

Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993-2010) in Korea.

BACKGROUNDS: This study examines social inequalities in life expectancy and mortality during the transition period of the Korean economic crisis (1993-2010) among Korean adults aged 40 and over. METHODS: Data from the census and the national death file from the Statistics Korea are employed to calculate life expectancy and age-specific-death-rates (ASDR) by age, gender, and educational attainment for five years: 1993, 1995, 2000, 2005, and 2010. Absolute and relative differences in life expectancy and Age-Specific Death Rates by educational attainment were utilized as proxy measures of social inequality. RESULTS: Clear educational gradient of life expectancy was observed at age 40 by both sexes and across five time periods (1993, 1995, 2000, 2005, and 2010). The gradient became notably worse in females between 1993 and 2010 compared to the trend in males. The educational gradient was also found for ASDR in all five years, but it was more pronounced in working age groups (40s and 50s) than in elderly groups. The relative disadvantage of ASDR among working age Korean adults, both males and females, became substantially worse over time. CONCLUSIONS: Social inequalities in life expectancy and ASDR of the working age group across socioeconomic status over time were closely related to the widening of the social difference created by the macroeconomic crisis and the expansion of neo-liberalism in Korea.

Relationship between socioeconomic variables and obesity in Korean adolescents.

BACKGROUND: Despite the importance of obesity and its association with socioeconomic status, little is known about this condition in Korean adolescents. We examined the relationship between obesity in Korean adolescents and several socioeconomic variables and compared the association of obesity with conventional and subjective indicators of socioeconomic status. METHODS: The study comprised 60 643 Korean adolescents aged 12 to 18 years who participated in the 2007 Korea Youth Risk Behavior Web-Based Survey. The dependent variable, obesity, and the independent variables of parental education levels, family affluence scale, subjective family economic status, and subjective school achievement were collected by using a self-administered anonymous questionnaire. Data on behavioral and psychological characteristics were also collected and used as confounding factors. Multivariate logistic regression was conducted to identify associations between socioeconomic status and obesity. RESULTS: In the descriptive analysis, adolescents with low parental education, low family affluence level, low subjective family economic status, and low subjective school achievement were more likely to be obese. However, after controlling for other risk factors in multivariate analysis, only the associations with subjective family economic status and subjective school achievement remained statistically significant. CONCLUSIONS: Our results provide further evidence that the prevalent pattern of obesity in Korean adolescents-i.e., the inverse relationship between obesity and socioeconomic status-is similar to that in developed countries. In addition, these findings support the hypothesis that, as compared with objective socioeconomic status, subjective social status is more closely related to obesity.

Late childbearing and changing risks of adverse birth outcomes in Korea.

This study aimed to examine whether the relative importance of maternal age as a correlate of adverse birth outcomes has changed and to investigate if social inequalities in birth outcomes have widened during the past decade when the marriage and fertility related social environment has undergone tremendous change in Korea. Probabilities of adverse birth outcomes (prematurity and intrauterine growth retardation [IUGR]) were estimated with multinomial logistic regression models, utilizing the Korean birth registration data of 1995 and 2005. The main effects of maternal age and parental socioeconomic characteristics were compared between two study years, net of infant sex, birth order, and plurality. The association between maternal age and adverse birth outcomes, relative to the maternal and parental social characteristics, has clearly diminished between 1995 and 2005. During this period, differences in prematurity and IUGR by maternal age have also diminished, while those by parental social characteristics, particularly maternal education, have substantially widened. The intensified overall socioeconomic polarization since the economic crisis of the late 1990s is most likely responsible for the increased social inequality in adverse birth outcomes in Korea. A massive structural change in macro-economic conditions and culture during the study period may have modified the relationship between maternal age and birth outcomes.

Social isolation and vulnerability to heatwave-related mortality in the urban elderly population: A time-series multi-community study in Korea.

Although several studies have reported that social isolation is one of the important health risk factors in the elderly population living in urban areas, its effects on vulnerability to heatwaves have been studied relatively less than climatic and other socio-economic factors. Thus, we investigated the association between social isolation levels and heatwave-related mortality risk in the elderly population in 119 urban administrative districts in Korea, using a time-series multi-city dataset (2008-2017). We used a two-stage analysis. In the first stage, we estimated the heatwave-related mortality risk in the elderly population (age ≥ 65) for each district using a time-series regression with a distributed lag model. Subsequently, in the second stage, we applied meta-regressions to pool the estimates across all the districts and estimate the association between social isolation variables and heatwave-related mortality risk. Our findings showed that higher social gathering and mutual aid levels were associated with lower heatwave-related mortality risk. Further, the lower percentage of single elderly households living in detached houses was also related to higher heatwave-related mortality risk. The associations were generally more evident in males compared to females. Our findings suggest that vulnerability to heatwave-related mortality among the urban, city-dwelling, elderly population may be amplified by higher isolation indicators.

Health behaviors and health status of Korean middleaged men by marital status: Korea Community Health Study, 2015.

OBJECTIVES: Previous studies have shown that marital status is associated with household composition and living arrangements, which partially explain observed differences in health status according to marital status. However, due to the rapid socioeconomic and demographic transformations of the last few decades, the distribution of marital status among middle-aged adults has become more diverse. Therefore, this study aimed to obtain up-to-date information on the associations between marital status and health and to investigate the implications of these findings for conventional explanations of the health effects of marriage. METHODS: The data for this study were obtained from the 2015 Korean Community Health Study. We compared 4 modifiable lifestyle behaviors-smoking, alcohol consumption, physical activity, and self-rated health status-as outcome variables in association with marital status in Korean middle-aged men (age 40-44) living in Seoul and other regions. RESULTS: Married men showed the lowest cigarette smoking prevalence and the highest subjective health status both before and after adjusting for education and income. The odds of engaging in vigorous physical activity did not show a major difference before and after adjustment for income and education. CONCLUSIONS: In married men, the prevalence of cigarette smoking was lowest and subjective health status was highest, similar to previous studies. However, the prevalence of engaging in physical activity was highest in divorced/widowed/separated men. The health behaviors and health status of Korean middle-aged adults should be more closely followed, since they are representative of demographic changes in the Korean population.

NDE Detection Techniques and Characterization of Aluminum Wires Embedded in Honeycomb Sandwich Composite Panels Using Terahertz Waves.

For many years, scientists have been aware of the importance of terahertz waves (T-rays), which have now emerged as an NDE (nondestructive evaluation) technique for certain ranges of the electronic spectrum. The present study deals with T-ray scanning techniques of honeycomb sandwich composite panels with a carbon-fiber-reinforced plastic (CFRP) skin as well as the refractive index (n), and the electrical conductivity (α) of glass fiber-reinforced plastic (GFRP) composites. For this experiment, the degree of penetration to FRP composites is investigated for the THz transmitted power based on the angle in the electric field (E-field) direction vs. the direction of the unidirectional carbon fibers. Also, when CFRP skin honeycomb sandwich panels are manufactured for use in aerospace applications, aluminum wires are twisted together into the one-sided surface of the honeycomb sandwich panels to protect against thunderstorms. The aluminum wires are partly visible because they are embedded in the CFRP skin on the honeycomb sandwich panels. After finishing work with a paintjob, the wires become invisible. Thus, detecting the aluminum wires is a key issue for product monitoring. Based on a simple resistor model, an optimal scanning method is proposed to determine the preferred scan orientation on the baseline of the E-field in the direction of fibers to evaluate the level of transmission of T-rays according to the frequency bandwidth. Thus, the combination of angles required to detect the aluminum wires embedded with carbon fibers on the surface of the composite panels can be determined.

Decomposition of Ethiopian life expectancy by age and cause of mortality; 1990-2015.

Ethiopia's average life expectancy has improved by more than 18 years from 1990 to 2015. This initiated interest to study the gain in life expectancy with respect to age structure and cause of death. Applying a life expectancy decomposition technique on secondary data obtained from the Institute of Health Metrics and Evaluation, the study found that the burden of disease in Ethiopia has declined from 626.18 in 1990 to 225.69 in 2015 per 1000 population measured in age-standardized rate of life years lost. The major causes of burden in 1990; namely lower respiratory tract infections, neonatal disorders, diarrheal diseases and neglected tropical diseases at rates of 89.2, 63.2, 61.2, and 42.2 age-standardized years of life lost per 1000 population respectively; have shown a fast decline in 2015. Deaths from neglected tropical disease showed 94.95% reduction, contributing to 5.71(27.30%) years gain in life expectancy followed by lower respiratory tract infection and diarrheal disease contributing about 4.65 years (22.23%) and 1.48 years (7.10%) respectively. On the other hand, about 3.3 (15.73%) years and 6.4 (30.71%) years of increase in life expectancy are achieved through improved longevity in infants and children aged 1-4 years respectively. In conclusion, the study found that reductions in under-five child mortality and decline in burden of major communicable diseases could explain the major gain in life expectancy. However, findings also revealed that the prevalence of non-communicable diseases and injuries are on the rise calling for the need to be addressed by the public health system.

mHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping.

BACKGROUND: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology. OBJECTIVE: The purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum. METHODS: A systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis. RESULTS: Of the 18 studies, 5 (28%) evaluated prevention interventions, 6 (33%) assessed diagnostic accuracy, and 7 (39%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research. CONCLUSIONS: This review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews.

Identification of Keywords From Twitter and Web Blog Posts to Detect Influenza Epidemics in Korea.

OBJECTIVE: Social media data are a highly contextual health information source. The objective of this study was to identify Korean keywords for detecting influenza epidemics from social media data. METHODS: We included data from Twitter and online blog posts to obtain a sufficient number of candidate indicators and to represent a larger proportion of the Korean population. We performed the following steps: initial keyword selection; generation of a keyword time series using a preprocessing approach; optimal feature selection; model building and validation using least absolute shrinkage and selection operator, support vector machine (SVM), and random forest regression (RFR). RESULTS: A total of 15 keywords optimally detected the influenza epidemic, evenly distributed across Twitter and blog data sources. Model estimates generated using our SVM model were highly correlated with recent influenza incidence data. CONCLUSIONS: The basic principles underpinning our approach could be applied to other countries, languages, infectious diseases, and social media sources. Social media monitoring using our approach may support and extend the capacity of traditional surveillance systems for detecting emerging influenza. (Disaster Med Public Health Preparedness. 2018; 12: 352-359).

Does Unstable Employment Have an Association with Suicide Rates among the Young?

Although a growing body of literature has indicated that unemployment has a positive association with suicide, the dynamic aspects of unstable employment have not yet been considered in suicidology. This study explored the association between employment stability and completed suicide among people aged 25-34 years in 20 OECD (Organization for Economic Cooperation and Development) countries with time-series data (1994-2010). In order to consider the different aspects of unstable employment, we tested the impacts of employment protection legislation indicators as another proxy of job insecurity (employed, but unstable) apart from unemployment rates. Covariates, including economic growth rates, GDP per capita, fertility rates, and divorce rate, were controlled for. The analysis was designed to be gender- and age-specific, where observations with ages of 25-29 were separated from those with ages of 30-34. Random effect models were applied to examine changes over time in suicide rates, and other models were presented to check robustness. The results showed that it is a low level of employment protection, rather than unemployment itself, that was associated with increased suicide rates among all of the studied populations. The magnitude of the effect differed by gender.

The unrealized potential: cohort effects and age-period-cohort analysis.

This study aims to provide a systematical introduction of age-period-cohort (APC) analysis to South Korean readers who are unfamiliar with this method (we provide an extended version of this study in Korean). As health data in South Korea has substantially accumulated, population-level studies that explore long-term trends of health status and health inequalities and identify macrosocial determinants of the trends are needed. Analyzing long-term trends requires to discern independent effects of age, period, and cohort using APC analysis. Most existing health and aging literature have used cross-sectional or short-term available panel data to identify age or period effects ignoring cohort effects. This under-use of APC analysis may be attributed to the identification (ID) problem caused by the perfect linear dependency across age, period, and cohort. This study explores recently developed three APC models to address the ID problem and adequately estimate the effects of A-P-C: intrinsic estimator-APC models for tabular age by period data; hierarchical cross-classified random effects models for repeated cross-sectional data; and hierarchical APC-growth curve models for accelerated longitudinal panel data. An analytic exemplar for each model was provided. APC analysis may contribute to identifying biological, historical, and socioeconomic determinants in long-term trends of health status and health inequalities as well as examining Korean's aging trajectories and temporal trends of period and cohort effects. For designing effective health policies that improve Korean population's health and reduce health inequalities, it is essential to understand independent effects of the three temporal factors by using the innovative APC models.