Korean Journal of Family Medicine最新文献

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.

Background: Gestational diabetes can lead to complications in pregnant women and neonates. Maternal glycated albumin levels during late pregnancy may help predict complications in both mothers and neonates.

Methods: This study was conducted in 120 singleton pregnant women diagnosed with gestational diabetes who visited Trinium Woman's Hostipal between July 1, 2020, and June 30, 2022. In this study, the patients' medical records were retrospectively analyzed. Gestational diabetes was diagnosed using a two-step testing method, and glycated albumin tests were performed during the third trimester of pregnancy. The optimal cutoff value of glycated albumin for predicting maternal complications during pregnancy and neonatal complications was determined using the receiver operating characteristic curve.

Results: A total of 45 patients developed maternal complications, with cesarean section (39 patients) due to fetal cephalopelvic disproportion being the most common. As for the neonatal complications, eight neonates were macrosomic or overweight, while 15 neonates required neonatal intensive care unit admission. Additionally, 13 patients had concurrent complications affecting both the mother and neonate. The glycated albumin level in patients with complications was 12.87%, which was significantly higher than that in patients without complications (glycated albumin, 11.67%) (P<0.001). The optimal cutoff value of glycated albumin for predicting maternal and neonatal complications was 12.45%. The sensitivity, specificity, and Youden index were 66.7 %, 86.7%, and 0.534, respectively.

Conclusion: The third trimester glycated albumin test in mothers with gestational diabetes provides limited predictive value for maternal and neonatal complications.

Background: Osteoporosis and hearing impairment are known to be associated, but specific data regarding gender, bone mineral density (BMD) measurement sites, and hearing frequency ranges remain unclear. This study aimed to clarify the relationship between hearing loss and BMD in adults over the age of 50. Additionally, the study sought to determine the frequency ranges of pure tone audiometry (PTA) related to osteoporosis, identify BMD measurement sites, and investigate gender differences.

Methods: A total of 1,523 adults (651 men and 872 women) over the age of 50, who participated in a medical health check-up at a university hospital, were included. PTA was conducted to assess hearing, and BMD was measured using dual-energy X-ray absorptiometry at the lumbar vertebrae (LV) and femur.

Results: In women over the age of 50, a significant association was observed between hearing impairment and osteoporosis (P<0.01), but no such association was found in men. Lumbar BMD (L1-4) in women was significantly associated with hearing loss at 4,000 and 8,000 Hz (both P<0.05), whereas femoral neck and total femur BMD showed no significant relationship. In multiple logistic regression analysis, the odds ratio (OR) between osteoporosis and hearing threshold at 4,000 Hz (OR, 2.078; 95% confidence interval [CI], 1.092-3.954) and 8,000 Hz (OR, 2.648; 95% CI, 1.543-4.544) remained statistically significant in women after adjusting for age and other risk factors.

Conclusion: In women over the age of 50, low BMD at the LV is significantly associated with hearing impairment, particularly at the high frequencies of 4,000 and 8,000 Hz.

Background: Family caregivers should focus on maintaining independence when assisting older adults with mobility. This may, however, bring about a counterproductive effect, namely Informal Caregiver-induced Forced Immobility (ICFI). This study explored the perceptions and experiences of older adults and their informal caregivers regarding ICFI.

Methods: This qualitative study used a conventional content analysis approach and was conducted from January to September 2023 in Tabriz, Iran. Twenty older adults (aged 60 years and above) who had used a mobility aid, such as a cane or walker, and 14 informal caregivers were purposefully (purposive sampling) selected to participate in the study. Individual semi-structured interviews were conducted until data saturation was achieved. MAXQDA ver. 20.0 software (VERBI Software, Germany) was used to manage and analyze the data.

Results: Based on the participants' perceptions, ICFI means that for an older adult, "social interaction/social participation is limited," "performing activities of daily living is disallowed," and "engaging in physical activities and exercising is prohibited."

Conclusion: Our findings revealed the concept of ICFI from various perspectives in Iranian families with older adults, leading to a clearer understanding of this phenomenon. This aspect should be considered when developing intervention strategies for the care of older adults in home and residential care settings by, health practitioners, gerontologists, and policymakers. This research can serve as a foundation for future studies to develop pertinent indicators and tools for measuring ICFI in the hope of providing sufficient evidence to support interventions that aim to prevent or stop ICFI.