Choe SA, et al. J Korean Med Sci. 2017 Nov;33(4):e23. https://doi.org/10.3346/jkms.2018.33.e23

This systematic review aimed to examine the associations between health-related outcomes and the built environment (BE) characteristics of compact metropolitan cities in Korea using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searching the three Korean academic databases and PubMed, two independent reviewers identified 27 empirical articles published between 2011 and 2016. Data extracted for review included the study characteristics, the variables and measurement methods related to the BE and health-related outcomes, and the findings on the associations between the BE characteristics and health-related outcomes. Vote counting was used to assess the consistency of associations and the direction of associations between the BE characteristics and health-related outcomes. All of the reviewed studies used cross-sectional designs. The objective BE qualities were commonly examined. The BE characteristics associated with health-related outcomes in the reviewed articles included land use, street environment, transportation infrastructure, green and open spaces, and neighborhood facilities. Street environment, transportation infrastructure, and green and open spaces had consistent positive associations with physical health. Mixed land use and neighborhood facilities, however, had inconsistent associations with physical health. Generally, insufficient findings were reported in the association between the BE characteristics and mental and social health. The accessibility of the BE in a compact urban environment was the prominent attribute related to health promotion, health challenges, and health equity. An international comparative analysis of compact cities with different urban contexts and scale is required. Interdisciplinary urban health strategies are recommended based on the associations between the BE characteristics and health-related outcomes.

Background: The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective: We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods: This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results: A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions: mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration: ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283

Cycling provides opportunities to promote healthy and sustainable cities. However, few studies examine cyclists’ perceived attributes of a bicycle-friendly environment in relation to compact urban contexts. This study explored the attributes of perceived bikeability and urban context related to the cycling experience in Seoul, Korea. Purposive sampling with public recruitment and a snowball technique was used to recruit twenty-two cyclists and three bicycle-related community service providers from a bikeable environment. Qualitative multi-methods, including semi-structured interviews and bicycle tours with a GPS device, were adopted. The main themes of perceived bikeability were derived through thematic analysis. Cyclists perceived the attributes of a bicycle-friendly physical environment as essential components of bikeability. In urban environments where cycling is not yet recognized as the main transportation mode, internal conflict among cyclists and external conflicts between cyclists and other transportation users were evident. A supportive community system included developing an appropriate environment, providing information, and expanding riding opportunities. A bicycle-friendly culture accumulated over a long period influenced the initiation and maintenance of cycling and contributed to a more bikeable community environment. Cyclists’ attitude, behaviors, and perceived environment differed according to purpose. Policy, system, and environmental changes are required to promote cycling in compact urban contexts.

There is an increased prevalence of housing poverty among urban young adults; however, research on housing poverty and health is lacking. This study examined the effects of housing poverty on the health concepts of young people living alone. In-depth interviews were conducted with 20 single-person households, with individuals aged 19–39 years, living in Seoul, the demographic group with the highest housing poverty rate in South Korea. Data were analyzed using the constant comparison method. Based on the health concepts of the respondents, housing poverty negatively affected health in terms of “the occurrence and continuation of anxiety,” “the increase and continuation of lethargy,” “the difficulty in managing daily life and taking care of health,” “the lack of a dependable support person,” and “the difficulty in preventing and treating disease.” The majority of young people experienced difficulties responding to their situations, and their housing poverty was hard to overcome. This study suggests the need to expand healthy housing policies, strengthen housing safety nets, and enhance access to public resources needed for a healthy living.