Korean Journal of Family Medicine最新文献

Background: Female workers in Indonesia are vulnerable, because they must work to earn a living while still being responsible for domestic problems. This study analyzes the barriers to the use of modern contraceptives by female workers in Indonesia's urban areas.

Methods: This cross-sectional survey looked at 21,696 female workers. We used modern contraceptive use as a dependent variable, and age, education, wealth, known modern contraceptives, number of live births, ideal number of children, and insurance ownership as independent variables. In the final test, we employed binary logistic regression.

Results: The results showed that women at all age categories were more likely than those aged 15-19 years not to use modern contraceptives, except those aged 35-39 years, who showed no difference. All other marital types were more likely to use modern contraceptives than married individuals. Rich female workers were 1.139 times more likely than poor workers not to use modern contraceptives (adjusted odds ratio [AOR], 1.139; 95% confidence interval [CI], 1.026-1.264). Female workers who did not know about modern contraceptives were 4.549 times more likely than those who did not to use modern contraceptives (AOR, 4.549; 95% CI, 1.037-19.953). Female workers with more than two children were 9.996 times more likely than those with two or fewer children not to use modern contraceptives (AOR, 9.996; 95% CI, 9.1890-10.875).

Conclusion: This study identified five factors associated with the non-use of modern contraceptives by female workers in Indonesia's urban areas: young, unmarried, rich, did not know about modern contraceptives, and had more than two children.

Excess alcohol intake is associated with many negative effects and is a major cause of mortality and morbidity worldwide. World Health Organization has established a global plan with 10 primary policy areas and interventions and six important action areas to reduce alcohol's negative effects. However, alcohol intervention programs face several challenges that can hinder their success in assisting patients with alcohol consumption reduction and cessation. The objective of this scoping review was to identify the barriers to the implementation of alcohol intervention programs. The Joanna Briggs Institute recommendations and PCC (participants, concepts, context) eligibility criteria were used for the review. A combination of search phrases was used to narrow the literature search to 2014-2024 English-language papers and original research articles with full access. After removing duplication, 3,846 articles remained from the 5,128 found. After further exclusions, 19 eligible studies were included in this review. Five main barriers to care were identified: service-level barriers, barriers to care seeking, stigma, socio-cultural barriers, and external barriers. Robust regulations and implementation are necessary to effectively address service levels and external barriers. To enhance help-seeking behaviors, alcohol screening should be implemented, strict management policies for alcohol use disorders should be enforced, and accessible alternatives should be provided. Additionally, public health initiatives should focus on changing societal perceptions to counteract alcohol normalization. These efforts must involve both communities and workplaces.

Background: Smoking is a global health risk known to elevate hemoglobin (HB) levels through its effects on hematopoiesis. Urine cotinine, a metabolite strongly correlated with serum cotinine, serves as an effective biomarker for assessing smoking status. This study aimed to explore the relationship between urinary cotinine levels and both HB and hematocrit (HCT) levels in a Korean population.

Methods: The study analyzed 4,454 healthy participants, categorized into three groups based on urine cotinine tertiles. Steiger's Z tests were used to assess correlations between HB, HCT levels, and urine cotinine. After adjusting for clinical variables, multiple linear regression was employed to evaluate the relationship between urine cotinine levels and HB/HCT. Receiver operating characteristic curves helped determine the cut-off values for urine cotinine in relation to HB and HCT levels.

Results: After adjusting for covariates, a positive correlation was found between urine cotinine and both HB and HCT levels. HB levels were 18% higher in the second tertile and 23% higher in the highest tertile than the lowest. Similarly, HCT levels increased by 44% in the second tertile and 50% in the highest tertile. The highest tertiles of HB and HCT had values of 504.650 and 202.950, respectively, with area under the curve values of 0.634 for HB and 0.616 for HCT. Conclusion: This study demonstrates a significant correlation between urine cotinine levels and elevated HB and HCT levels in a representative Korean population. Clinicians should consider urine cotinine levels when assessing anemia in smokers or individuals exposed to secondhand smoke. Further research is needed to validate these findings.

Background: Early screening and management of metabolic dysfunction-associated steatotic liver disease (MASLD) are essential to prevent progression to fibrosis, cirrhosis, and related chronic diseases. The neck circumference to height ratio (NHtR) is a reliable measure of upper body fat. This study explored the relationship between the NHtR and MASLD in the Korean population, with the aim of validating it as a reliable screening tool.

Methods: We analyzed data from the 2019 to 2021 Korea National Health and Nutrition Examination Survey, including 11,414 participants aged 40 years or older. The association between the NHtR and MASLD was evaluated using logistic regression analysis, while predictive accuracy was evaluated using receiver operating characteristic curve analysis.

Results: A total of 11,414 participants aged 40 years or older were included in the study. Participants in the highest NHtR quartile had higher levels of metabolic risk markers, including body mass index, waist circumference, glucose, hemoglobin A1c, and homeostatic model assessment of insulin resistance (P<0.001). In logistic regression analysis, the odds ratio for MASLD in quartile 4 compared to quartile 1 was 1.77 (95% confidence interval [CI], 1.31-2.40; P<0.001) in the fully adjusted model. The area under the curve and 95% CI of NHtR for MASLD were 0.749 (95% CI, 0.740-0.758), demonstrating superior accuracy compared with other indicators. The optimal NHtR cut-off for MASLD was 21.564, with a sensitivity and specificity of 0.726 and 0.644, respectively. Conclusion: NHtR is a more effective predictor of MASLD than other measures, highlighting its potential as a valuable screening tool in clinical and self-care settings.

Background: Indonesia faces significant maternal and child health challenges, including a high maternal mortality ratio. The country's vast geography results in disparities in healthcare facility availability. This study aimed to identify factors influencing maternal delivery choices in health facilities across Indonesia's rural and urban areas.

Methods: This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. The study population included women aged 15-49 who had given birth within 5 years preceding the survey. A total of 14,162 women were included, with 6,339 from urban and 5,009 from rural areas. Logistic regression was performed to identify factors associated with maternal delivery locations.

Results: The findings showed that 91.37% of urban and 69.33% of rural mothers delivered in healthcare facilities. All analyzed variables were significantly correlated with maternal delivery in health facilities across both areas. In rural areas, the sex of the household head (adjusted odds ratio [AOR], 1.32; 95% confidence interval [CI], 1.02-1.71; P=0.031) and the absence of barriers to healthcare access (AOR, 1.31; 95% CI, 1.07-1.60; P=0.008) were significant factors. Conversely, in urban areas, only maternal age was significantly associated with delivering in health facilities.

Conclusion: Determinants of maternal delivery choices vary between rural and urban settings. In rural areas, healthcare access and household head sex are key factors, while maternal age is significant in urban areas. The government should prioritize equitable healthcare facility distribution, particularly in rural areas, and promote family involvement, especially among husbands, during antenatal care to encourage facility-based deliveries.

Background: Hormonal and physical changes during pregnancy affect mothers' mental health. Because depression during pregnancy is closely associated with poor pregnancy outcomes, treatment is important for pregnant women with depression. This study aimed to identify barriers to treatment-seeking behaviors among pregnant women with depression in Indonesia.

Methods: Data from the 2018 Indonesian Basic Health Research were used, which focused on pregnant women aged 15-54 years who exhibited depressive symptoms. The Mini-International Neuropsychiatric Interview was used to assess depression. Logistic regression analysis was conducted to explore the factors affecting treatment-seeking behaviors.

Results: Among the pregnant women in Indonesia, 7.9% experienced depression; however, only 11.4% sought treatment. Higher transportation costs to the clinic were associated with 41% lower odds of seeking treatment (adjusted odds ratio [AOR], 0.59; 95% confidence interval [CI], 0.37-0.95; P=0.029). Women in their second and third trimesters had 48% (AOR, 0.52; 95% CI, 0.28-0.98; P=0.042) and 54% (AOR, 0.46; 95% CI, 0.24-0.89; P=0.022) lower odds of seeking treatment, respectively, than those in their first trimester.

Conclusion: Financial barriers and the challenges of late pregnancy hinder treatment-seeking behaviors for depression in pregnant women. Therefore, there is an urgent need for affordable and accessible mental health care for vulnerable populations.

Background: Circadian misalignment is associated with metabolic syndrome. This study aimed to examine the association between circadian rhythm-disturbing factors and metabolic syndrome.

Methods: We used data from the 7th and 8th Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020, which surveyed 16,253 individuals. Circadian rhythm-disturbing factors were defined as follows: sleep duration outside the reference group (6-8 hours), irregular breakfast, shift work, and physical inactivity. The adjusted odds ratio (aOR) for metabolic syndrome was calculated based on the number of circadian rhythm-disturbing factors present in adults over the age of 19 years.

Results: Among a total of 16,253 participants (mean age 48.2±15 years), metabolic syndrome was found in 5,237 participants (29.3%). The participants were classified into three categories based on the number of circadian rhythm-disturbing factors as follows: 2,627 (15.6%) did not have any factors, 6,406 (38.13%) had one factor, and 7,220 (46.3%) had two or more factors. Participants with a single circadian rhythm-disturbing factor were 21% more likely to have metabolic syndrome (aOR, 1.21; 95% confidence interval [CI], 1.08-1.36), and participants with two or more factors were 27% more likely to have metabolic syndrome (aOR, 1.27; 95% CI, 1.12-1.43).

Conclusion: Circadian rhythm-disturbing factors were significantly associated with the prevalence of metabolic syndrome in Korean adults. This finding has potential clinical implications for maintaining circadian rhythms by avoiding certain factors to prevent metabolic syndrome. Further studies are required to confirm these findings.

Allogeneic stem cells derived from umbilical cord tissue, placenta, and umbilical cord blood have shown potential in treating delayed systemic aging and aging-related diseases. Aging induces cellular senescence, oxidative stress, chronic inflammation, and stem cell depletion, all of which contribute to tissue damage and functional decline. Recent advances in regenerative medicine suggest that allogeneic stem cells can mitigate these aging processes through immunomodulation and tissue regeneration. In particular, umbilical cord-derived mesenchymal stem cells have gained attention for clinical applications owing to their strong immunomodulatory properties and low immunogenicity. These cells can repair damaged tissues and enhance metabolic and cognitive function by secreting various cytokines, growth factors, and exosomes, offering potential treatment for aging-related conditions such as osteoporosis and neurodegenerative disorders. Both clinical and preclinical studies indicate that allogeneic stem cells play a critical role in alleviating these diseases, including osteoporosis, osteoarthritis, cardiovascular diseases, and neurodegenerative disorders. Despite their therapeutic potential, challenges remain, such as immune compatibility, long-term safety, and the lack of standardized protocols for large-scale production. This review outlines the biological mechanisms by which allogeneic stem cells contribute to delayed aging, summarizes current clinical research, and explores future prospects. Allogeneic stem cells may offer novel strategies for delaying aging and extending lifespan.

Background: Obesity, sarcopenia, and sarcopenic obesity are increasingly prevalent in older adults and negatively affect health-related quality of life (HRQOL). While EuroQol-5 Dimension and Short Form-36 Health Survey are widely used HRQOL measures, they have limitations in sensitivity and cultural relevance. In contrast, the Health-related Quality of Life Instrument with 8 Items (HINT-8) is a preference-based instrument developed specifically for the Korean population, offering finer discrimination of physical, emotional, and social health domains.

Methods: This study analyzed data from 1,387 older adults (≥65 years) from the 2023 Korea National Health and Nutrition Examination Survey. Obesity was defined as body mass index ≥25 kg/m 2 , sarcopenia by Asian Working Group for Sarcopenia 2019 criteria, and sarcopenic obesity as having both conditions. Multiple linear regression was used to examine their independent effects on HRQOL, adjusting for potential confounders.

Results: Of the participants, 54.2% were classified as normal, 34.9% as obese, 9.8% with sarcopenia, and 1.1% with sarcopenic obesity. All three conditions were significantly associated with greater difficulty in stair climbing: obesity (B=0.223, P<0.001), sarcopenia (B=0.242, P<0.001), and sarcopenic obesity (B=0.338, P=0.048). Sarcopenia was also linked to impaired working ability and higher total HINT-8 scores. Sarcopenic obesity was associated with greater pain. And obesity was linked to slightly lower depression scores.

Conclusion: Obesity, sarcopenia, and sarcopenic obesity negatively impact HRQOL in older adults. Early detection and intervention are essential to improve quality of life and extend health-adjusted life expectancy.

Ketone bodies produced by sodium-glucose cotransporter 2 (SGLT2) inhibitors can be advantageous, providing an efficient and stable energy source for the brain and muscles. However, in patients with diabetes, ketogenesis induced by SGLT2 inhibitors may be harmful, potentially resulting in severe diabetic ketoacidosis (DKA). During fasting, ketone body production serves as an alternative and efficient energy source for the brain by utilizing stored fat, promoting mental clarity, and reducing dependence on glucose. The concurrent use of SGLT2 inhibitors during perioperative fasting may further elevate the risk of euglycemic DKA. We describe a case of DKA that occurred during perioperative fasting in a patient receiving empagliflozin, an SGLT2 inhibitor. This case underscores the importance of recognizing the potential risk of DKA in patients with diabetes using SGLT2 inhibitors during perioperative fasting.