Korean Journal of Family Medicine最新文献

Background: Substance use is prohibited in Indonesia; however, adolescents continue to consume these substances, creating a significant public health challenge. This study examines behavioral and demographic factors associated with general drug use, including cannabis and amphetamine use, among Indonesian adolescents, using nationally representative data.

Methods: A cross-sectional study used data from the 2023 Indonesia Global School-based Student Health Survey, which included 10,059 students aged 13 to 17 years. A two-stage cluster sampling was applied, and descriptive and regression analyses were conducted to identify factors associated with substance use.

Results: Overall, 3.03% of students reported drug use, 1.45% reported cannabis use, and 1.33% reported amphetamine use. Age and school level were not significantly associated with substance use. However, male sex, residence outside the Java-Bali region, alcohol use, and tobacco use were consistently linked to higher odds of drug, cannabis, and amphetamine use. Alcohol consumption was the strongest predictor for all types of substance use. These findings indicate that risky behaviors tend to cluster, supporting the pattern of polysubstance use among youth.

Conclusion: The study findings highlight the need for risk-specific, gender-responsive, school-based prevention programs that actively involve parents and regulate adolescents' access to alcohol and tobacco. Enhancing life skills and character education in both school and family settings may also help students avoid risky behaviors.

Background: Recently, the triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio and pericardial adipose tissue (PAT) have emerged as important indicators of metabolic syndrome (MS). We aimed to evaluate the relationship between the TG/HDL ratio and PAT.

Methods: We retrospectively analyzed the data of 627 patients who underwent coronary multidetector computed tomography to assess metabolic parameters. Subjects were stratified into two groups based on the PAT volume cutoff associated with MS, specifically 142.2 cm3, and metabolic parameters were compared between these groups. The TG/HDL ratio was divided into tertiles according to the logarithm of TG/HDL, and differences in PAT-related parameters among the tertiles were assessed using analysis of variance. Logistic regression was performed to estimate the odds ratios (ORs) for high PAT (≥142.2 cm3) across tertiles and receiver operating characteristic (ROC) analysis was performed to determine the optimal TG/HDL ratio cutoff for linking with high PAT.

Results: The mean TG/HDL ratio in the high PAT group was 3.6. The TG/HDL ratio demonstrated a strong positive correlation with several metabolic parameters. Individuals in the higher log (TG/HDL) tertiles exhibited a greater prevalence of metabolic disturbances, including increased PAT, and displayed higher ORs for high PAT (second tertile OR, 3.51; third tertile OR, 3.26) after adjusting for age, sex, smoking, hypertension, type 2 diabetes, and dyslipidemia status. ROC analysis identified a TG/HDL ratio of 1.918 (P<0.001) as the threshold for elevated PAT levels.

Conclusion: The TG/HDL ratio was positively correlated with high PAT volume, and the TG/HDL ratio cutoff for association with high PAT was determined to be 1.918.

Background: The disease burden of metabolic syndrome (MetS) is increasing with increasing prevalence. Economic deprivation is a risk factor for MetS and contributes to the overall mortality. Therefore, this study aimed to investigate the association between economic status and mortality in patients with MetS.

Methods: Overall, 83,786 patients with MetS were included from the Korean National Health Insurance Service-Health Screening Database. They were divided into three economic levels (low, medium, and high) based on the health insurance premiums charged according to the annual household income. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality were calculated using Cox proportional hazards regression models.

Results: The median follow-up duration was 10.0 years. Kaplan-Meier plots showed that the mortality rate was highest in males with a low economic status (P<0.001, log-rank test). Compared with that of the high economic status group, unadjusted HRs (95% CIs) of the middle and low economic status groups for all-cause mortality were 1.44 (1.32-1.57) and 1.88 (1.72-2.06), respectively, in males, and 0.84 (0.76-0.93) and 0.99 (0.89-1.10), respectively, in females. However, in the fully adjusted model, the corresponding HRs (95% CIs) were 1.23 (1.13-1.48) and 1.35 (1.23-1.48), respectively, in males and 1.17 (1.06-1.30) and 1.25 (1.12-1.39), respectively, in females.

Conclusion: Among South Korean adults with MetS, the economically deprived population was significantly associated with higher mortality rates than those of wealthier groups.

Background: Diet and physical activity influence sleep duration; however, the association between energy intake expenditure balance (EIEB) and sleep duration has not been fully investigated. This study examined the relationship between EIEB and sleep duration among Korean adults.

Methods: This cross-sectional study included 13,164 adults aged ≥19 years (5,707 males and 7,457 females) from the 2019, 2020, and 2022 Korea National Health and Nutrition Examination Surveys. EIEB was defined as the difference between daily energy intake and energy expenditure. Energy intake was assessed using a 24-hour dietary recall, and energy expenditure was calculated by summing basal metabolic rate and physical activity. Participants were categorized into sex-specific EIEB quartiles (Q1-Q4). Logistic regression analyses were performed to evaluate the association between EIEB quartiles and short sleep duration (≤6 hours), adjusting for socioeconomic status, body mass index, lifestyle factors, and comorbidities.

Results: Among women, those in the Q2 EIEB group (-260.45 to 90.81 kcal) had a significantly lower risk of short sleep (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.60-0.84). Reduced odds were also observed in Q3 (OR, 0.75; 95% CI, 0.63-0.91) and Q4 (OR, 0.76; 95% CI, 0.62-0.94), with a significant trend across quartiles (P for trend=0.03). No significant associations were observed among men.

Conclusion: A balanced EIEB was inversely associated with short sleep duration in women but not in men, suggesting that sex-specific strategies for energy balance may be needed to support adequate sleep.

Background: The relationship of consanguineous marriage (CM) with cardiovascular conditions, particularly structural congenital heart diseases, has been well established. Although CM may influence genetic predisposition by increasing oligogenicity and genetic homogeneity, its association with coronary artery disease (CAD) remains uncertain. This study aimed to investigate the relationship between parental CM and the prevalence, age of onset, and severity of CAD.

Methods: In this cross-sectional study conducted between May 2021 and August 2022, a total of 13,151 patients undergoing coronary angiography at the Tehran Heart Center were enrolled. A structured questionnaire was used to collect demographic and anthropometric data, medical history, cardiovascular risk factors, previous angiographic findings, and parental kinship information. Analyses were performed using IBM SPSS ver. 23.0.

Results: Among 11,986 participants, 66.0% were male, with a mean age of 58.9±10.7 years. CAD was diagnosed in 9,083 individuals (75.8%). In total, 1,515 participants (12.6%) reported a history of parental CM. The prevalence of CAD was 3.2 percentage points higher in individuals with parental CM (P<0.001). Additionally, parental CM was associated with an earlier CAD by 2.4 years. However, no significant correlation was observed between parental CM and CAD severity.

Conclusion: Parental consanguinity is associated with a higher prevalence and earlier onset of CAD. These findings suggest that parental CM may be relevant in the context of CAD risk and should be considered in comprehensive CAD risk assessments, particularly in regions where consanguinity is common.

Background: This study investigates disparities in the utilization of primary health care (PHC) between urban and rural populations in Indonesia, focusing on socioeconomic and demographic determinants. Understanding these patterns is essential for promoting equity under the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program.

Methods: Data were obtained from the 2023 National Socioeconomic Survey, which included 334,887 individuals. Binary logistic regression was used to examine the association between individual characteristics and PHC utilization.

Results: Overall utilization rates were similar across urban and rural areas, but significant disparities were observed. Women were more likely to use PHC than men (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10-1.13). The association between higher education and PHC utilization was negative (OR, 0.78; 95% CI, 0.75-0.81), while access to information technology slightly reduced utilization (OR, 0.98; 95% CI, 0.96-0.99). Wealth effects diverged sharply: affluent urban residents were less likely to use PHC (OR, 0.84; 95% CI, 0.81-0.87), whereas wealthier rural residents were more likely to utilize PHC (OR, 1.09; 95% CI, 1.05-1.13). Dual insurance ownership had a strong positive effect in rural areas (OR, 1.56; 95% CI, 1.25-1.94). Conclusion: These findings highlight structural inequalities in PHC utilization. Policy efforts must prioritize enhancing the quality and attractiveness of PHC in urban areas, improving financial protection and infrastructure in rural areas, and addressing the digital divide. Such targeted measures are essential for achieving equitable and inclusive health coverage under JKN.

Background: The availability of health information through media has raised public awareness of health literacy (HL). HL is essential for medication adherence and self-management in individuals with chronic diseases, and for those without chronic conditions, HL is important for promoting health and engaging in preventive behaviors. This study examined the role of having a regular physician in improving HL among Korean adults, both with and without chronic diseases.

Methods: We conducted a retrospective, cross-sectional analysis using data from 8,322 participants in the 2021 Korea Health Panel Study. HL was measured with the 16-item European Health Literacy Survey Questionnaire. To identify factors associated with HL categories and to calculate adjusted mean HL scores, we used multiple logistic regression and weighted linear regression.

Results: Among participants with chronic diseases (n=4,627), 56.6% reported having a regular physician, with the largest group (42.7%) showing inadequate HL. After adjustment, age 75 years or older and lower education were significantly linked to lower HL levels, regardless of chronic disease status. Having a regular physician was significantly associated with higher HL levels in participants with chronic diseases (adjusted odds ratio, 1.94; 95% confidence interval, 1.42-2.63), but not in those without chronic diseases. Participants with chronic diseases who had a regular physician showed higher mean HL scores across all HL competencies and domains.

Conclusion: Although access to health information has increased, the risk of encountering conflicting or misleading content has grown. These findings emphasize the importance of regular physicians in guiding patients and improving HL, especially among individuals with chronic diseases.

Background: Childhood obesity is a growing health concern that increases the risk of cardiometabolic disorders. This study investigated family and lifestyle factors that contribute to overweight in schoolchildren.

Methods: This case-control study of 1,016 children (6-12 years) in Palembang was conducted using questionnaires and anthropometry. Multivariable logistic regression analysis was used to assess the association between selected variables and overweight, reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results: Frequent consumption of carbohydrate-rich foods, such as noodles or pasta, was associated with a higher risk of overweight (AOR, 1.76; 95% CI, 1.11-2.78; P=0.014). Limited protein 1 time per a day (AOR, 3.30; 95% CI, 2.00-5.43; P<0.001), flavored cow's milk (AOR, 1.76; 95% CI, 1.06-2.95; P=0.029), and snacking (≥5 times per week) (AOR, 1.57; 95% CI, 1.04-2.39; P=0.031) also increased the risk. Conversely, daily fruit consumption reduced the risk (AOR, 0.66; 95% CI, 0.45-0.95; P=0.027). Family-related factors such as formal maternal employment (AOR, 1.57; 95% CI, 1.06-2.33; P=0.023), eating together less than 5 times per a week (AOR, 1.78; 95% CI, 1.04-3.04; P=0.032), and not bringing lunch to school (AOR, 1.96; 95% CI, 1.15-3.31; P=0.012) significantly increased the risk.

Conclusion: Several factors are associated with overweight among schoolchildren, including high intake of noodles or pasta, limited protein consumption, flavored milk, frequent snacking, low fruit intake, maternal employment, infrequent family meals, and not bringing food to school.