Korean Journal of Family Medicine最新文献

Prolonged or irregular menstrual bleeding is common in women, particularly in the early years after menarche. Over time, menstrual cycles often become regular; however, persistently irregular menstruation warrants further investigation. Serious conditions, such as endometrial cancer, which is often linked to prolonged unopposed estrogen exposure, can be prevented with timely detection. We report a case involving a 27-year-old obese, nulliparous woman with a history of prolonged irregular menstrual bleeding since menarche. She had not undergone regular health checkups and had never been properly evaluated until multiple admissions for severe anemia prompted further investigation, which confirmed the diagnosis of endometrial carcinoma. Delays in seeking care for abnormal menstrual bleeding resulted in serious outcomes. Endometrial carcinoma may significantly reduce future fertility potential. Therefore, primary healthcare providers play a pivotal role in educating and raising public awareness about this frequently under-recognized issue, as timely investigation for early recognition is paramount.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon acquired hematological disease resulting from somatic PIGA gene mutations. These mutations cause a deficiency in glycosylphosphatidylinositol-anchored-anchored proteins such as CD55 and CD59 on blood cell surfaces, leading to uncontrolled complement-mediated hemolysis. Although this condition is typically identified in individuals in their third or fourth decades of life, diagnosis during late adolescence is rare. Renal complications are a known feature of PNH; however, they present more frequently as a gradual decline in function rather than as a severe acute insult. This report describes the unusual case of an 18-year-old male who presented with a 6-month history of intermittent dark urine followed by an acute illness. Laboratory evaluation revealed severe Coombsnegative hemolytic anemia, significantly elevated lactate dehydrogenase levels, and acute kidney injury requiring immediate hemodialysis. Renal biopsy-confirmed pigment nephropathy, and high-sensitivity flow cytometry detected a large PNH clone, establishing the diagnosis of classical PNH. The patient's renal function improved with supportive care, but hemolysis persisted. This case highlights the fact that PNH can manifest in young adults with acute kidney injury as the primary presenting symptom. Including PNH in the differential diagnosis of patients with unexplained hemolytic anemia and renal impairment is crucial, even in atypical age groups. Prompt diagnosis is vital for initiating appropriate management, including supportive measures and the consideration of complementary inhibitor therapy, to improve outcomes.

Background: Sexual and reproductive health remains a significant public health issue, especially in low- and middle-income countries where access to contraception and sexuality education is often limited. This study examined factors associated with the use of condoms and other birth control methods among school-going adolescents in Brunei Darussalam, Indonesia, and Thailand.

Methods: This study utilized cross-sectional data from the Global School-based Student Health Survey conducted in Brunei Darussalam (2019), Thailand (2021), and Indonesia (2023), involving 868 sexually active school-going adolescents. Multivariate logistic regression was applied to assess the association between demographic, psychosocial, and behavioral risk factors with use of condoms and other birth control methods among adolescents who reported being sexually active.

Results: Condom use was significantly higher among adolescents in Thailand than those in Indonesia (adjusted odds ratio [AOR], 8.035); no significant difference was observed in Brunei Darussalam. High parental support was positively associated with condom use (AOR, 1.883). Regarding other birth control methods, adolescents aged 17 years and older were more likely to use contraception than their younger peers (AOR, 1.557). Adolescents in Thailand also demonstrated a higher use of other birth control methods (AOR, 2.132). Additionally, experiencing a single symptom of psychological distress was positively associated with using other birth control methods.

Conclusion: Age, number of sexual partners, psychological distress, parental support, and national context significantly influenced contraceptive use among adolescents in Southeast Asia. Enhancing parental involvement, expanding access to adolescent-friendly health services, and strengthening comprehensive sexuality education are crucial strategies for reducing the risk of unintended pregnancy and sexually transmitted infections among adolescents.

Background: Contraception is essential for women with diabetes to reduce adverse pregnancy outcomes. However, the contraception rate among this high-risk group remains low. This study explored the determinants of contraceptive practices among multi-ethnic Asian women with diabetes.

Methods: This exploratory qualitative study on the preconception care of multi-ethnic, reproductive-age women with diabetes was conducted at four public health clinics in Negeri Sembilan, Malaysia. Semi-structured, in-depth interviews were conducted, audio-recorded, and transcribed. An interpretive thematic analysis was performed on data regarding contraception among 19 women who expressed no desire for pregnancy.

Results: Health concerns, perceived susceptibility to pregnancy, lack of knowledge regarding contraception and conception, and prevailing pregnancy norms influenced contraceptive practices. Many factors affecting pregnancy planning were unrelated to diabetes, such as perceived pregnancy susceptibility, religious orientation, societal norms, husband's preferences, and inadequate contraception knowledge. Conclusion: Family planning and reproductive health must be included in routine clinical consultations for women with diabetes. While this study re-emphasizes the influence of diabetes on women's decisions to use contraception, their choices are also shaped by personal and social factors. Healthcare providers must adopt a more open approach toward women's perspectives on pregnancy planning and further explore their values and underlying issues to promote effective contraception, considering the benefits.

Background: Myofascial pain syndrome is a common condition characterized by localized muscular discomfort and trigger points. Dry needling mechanically disrupts trigger points, while magnesium infiltration relaxes muscles and reduces inflammation. Evidence directly comparing these treatments is scarce. This study aimed to compare their effectiveness in reducing pain, improving quality of life, and alleviating anxiety and depression.

Methods: A randomized controlled trial included 45 patients assigned to dry needling (Group A) or magnesium infiltration (Group B). Interventions were evaluated at baseline, 1, 3, and 6 months. The primary outcome was pain intensity measured with the Visual Analog Scale. Secondary outcomes were physical and mental health (12-Item Short-Form Health Survey) and anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Both treatments significantly improved pain, mental and physical health, and reduced anxiety and depression at 1 and 3 months. By 6 months, improvements were maintained but not statistically significant. No significant differences were observed between groups at any time point.

Conclusion: Dry needling and magnesium infiltration were both effective in the short to medium term for reducing pain and enhancing quality of life in patients with myofascial pain syndrome. Although each treatment improved outcomes, neither demonstrated superior effectiveness. Both approaches remain viable therapeutic options. Further long-term studies are needed to clarify sustained benefits and guide clinical use (trial registration: PACTR202309751113430).

Background: As the global prevalence of diabetes mellitus continues to increase, it is important to identify its risk factors and implement preventive approaches. This study aimed to investigate the association between changes in systolic blood pressure (SBP) and the incidence of diabetes.

Methods: Data from 152,547 participants, who underwent two consecutive health checkups between 2002 and 2003, and 2004 and 2005, and included in the Korean National Health Insurance Service Health Screening Database, were reviewed. Participants were divided into three groups according to change in SBP: decrease (≥10 mm Hg); no change (<10 mm Hg); and increase (≥10 mm Hg). Cox proportional hazard regression models for diabetes incidence were constructed to evaluate adjusted hazard ratio (HR) with corresponding 95% confidence interval (CI).

Results: The median follow-up was 14.3 years, and 26,352 patients with diabetes were identified. Compared to those with no change in SBP, the adjusted HRs for decrease and increase among males were 1.06 (95% CI, 1.02-1.10) and 1.10 (95% CI, 1.06-1.14), and 1.06 (95% CI, 1.00-1.12) and 1.08 (95% CI, 1.02-1.13) for females, respectively. After stratifying data according to SBP at baseline, the HRs for decrease in males and females were as follows: normotensive group, 1.16 (95% CI, 1.08-1.24) and 1.11 (95% CI, 1.02-1.21); and prehypertensive group, 1.14 (95% CI, 1.09-1.20) and 1.19 (95% CI, 1.10-1.29), respectively. Conclusion: Changes in SBP were associated with a risk for diabetes.

Background: Childhood obesity is increasing globally. Primary care doctors are well-positioned to identify children with obesity. This study aimed to assess the usage of clinical practice guidelines (CPG) to determine obesity and the knowledge of primary care doctors regarding childhood obesity.

Methods: An online survey was conducted between November 2023 and February 2024 among primary care doctors in Klang Valley, Malaysia. The questions assessed doctors' knowledge, practices, beliefs, and usage of the CPG in managing childhood obesity.

Results: There were 246 participants during the study period. Among the doctors, 101 (41%) knew the correct definition of "childhood overweight" while 120 (49%) doctors used the CPG. Doctors using the CPG had higher odds of knowing the correct management (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.30-5.41; P=0.006). Doctors using the CPG had higher odds of screening for childhood obesity complications and measuring body mass index (BMI), blood pressure, and pubertal status. Multivariate analysis showed that doctors working in government clinics (OR, 3.56; 95% CI, 2.01-6.32; P<0.001), having postgraduate training (OR, 3.95; 95% CI, 2.08-7.51; P<0.001) and having worked less than 5 years (OR, 4.53; 95% CI, 1.85-11.08; P<0.001) had higher odds of using the CPG. Doctors working in government clinics (OR, 5.93; 95% CI, 1.95-18.05; P=0.002) and used the CPG (OR, 7.26; 95% CI, 2.09-25.27; P=0.002) had higher odds of measuring the BMI.

Conclusion: Knowledge regarding diagnosis and management of childhood obesity among primary care doctors is still lacking. CPG on childhood obesity could be a useful tool for improving the diagnosis, management, and screening of childhood obesity.

Background: Smoking affects human health and healthcare systems worldwide, particularly in Indonesia. We used secondary data from the 2021 Global Adult Tobacco Survey (GATS) to analyze Indonesian smoking cessation determinants.

Methods: We analyzed data from 2,877 individuals aged 15 years and older from the 2021 GATS Indonesia, selected through multistage clustering. We used multiple logistic regression analysis adjusted for the complex survey in STATA 17.0 to examine Indonesian smokers' intention to quit including age, sex, education, occupation, household wealth, place of residence, perceptions that smoking causes serious illness, efforts to stop smoking in the past, abstinence days in the past, health-related reason, social reason, environmental reason, and financial reason).

Results: Weighted adult intention to quit smoking within 12 months was 17.8%. Factors associated with intention to quit smoking among current smokers in Indonesia included adults age 45 years or older (adjusted odds ratio [AOR], 1.69; 95% confidence interval [CI], 1.12-2.54), completed higher education (AOR, 1.85; 95% CI, 1.01-3.42), working status (AOR, 0.72; 95% CI, 0.55-0.96), perception that smoking causes serious illness (AOR, 2.88; 95% CI, 1.96-4.22), abstinence days in the past >30 days (AOR, 3.10; 95% CI, 2.18-4.41), social reason (AOR, 1.48; 95% CI, 1.05-2.09), and environmental reason (AOR, 1.67; 95% CI, 1.23-2.28).

Conclusion: Intention to quit smoking depends on several factors. Smoking cessation guidelines must be widely and often implemented, especially for high-risk smokers. Pharmacological and non-pharmacological smoking cessation strategies require cooperation among healthcare providers, public health actors, and the government.

Russell body gastritis (RBG) is a rare gastric inflammatory lesion characterized by dense infiltration of plasma cells containing Russell bodies (RBs) known as Mott cells. Here, we report a case of RBG that showed resolution 2 months after Helicobacter pylori eradication. A gastric biopsy revealed numerous eosinophilic globular RBs and signet ring cell-like Mott cells. H. pylori infection was identified on the surface of foveolar epithelial cells. Alcian blue staining was negative for RBs. Periodic acid-Schiff staining showed that most RBs were negative, with only a few RBs and Mott cells showing weak positivity. Immunohistochemical staining for immunoglobulin G (IgG), kappa, and lambda light chains was performed on paraffinembedded tissue. Plasma and Mott cells were positive for CD79a, CD138, IgG, kappa, and lambda. However, despite being traditionally considered as aggregates of immunoglobulin molecules, the majority of RBs are negative for IgG and light chain determinants. The marked reduction in RBs and reappearance of normal plasma cells following H. pylori eradication suggest that RB formation is a reversible and reactive process. However, the lack of staining in certain immunohistochemical analyses indicated the presence of unexpected alterations in immunoglobulin composition. The precise biochemical nature and fate of RBs warrant further investigation.