Background:Indonesia continues to encounter a significant public health crisis due to stunting. Maternal knowledge is the key driver of nutritional practices and outcomes. This study aimed to develop a maternal/caregiver stunting knowledge index (SKI), analyze disparities in urban-rural knowledge, and identify the key determinant factors driving these disparities. Methods:This cross-sectional study analyzed data points from the 2024 Indonesian Nutritional Status Survey, involving 294,538 mothers and caregivers. Data regarding stunting knowledge, sociodemographic, maternal, and caregiver characteristics, child characteristics, area of residence, and variables related to maternal health knowledge and utilization were collected via interviews conducted with mothers. Height-for-Age Z-score (HAZ) was calculated using age and height measurements. Knowledge level was measured using a constructed SKI categorized as low, moderate, or high. Chi-square tests and multivariate logistic regression were used to identify the predictors of low SKI and risk(s) for stunting. Results:The prevalence of low SKI scores was significantly higher in rural areas, and maternal education was the strongest determinant of low SKI scores in both regions. In rural areas, limited access to formal health information (e.g., lack of a Maternal and Child Health book) was a major predictor. Low SKI was associated with higher odds for stunting risk (urban: adjusted odds ratio [aOR], 1.617; rural: aOR, 1.576), whereas high awareness of the long-term impacts of stunting provided a significant protective effect. Conclusion:Urban-rural knowledge disparities were concentrated among caregivers with lower education and limited health service utilization. Interventions should be tailored regionally, targeting caregivers with low education levels and emphasizing the long-term consequences of stunting to promote preventive behaviors.
The primary care system (PCS) is an essential national health infrastructure defined by the delivery of comprehensive, integrated, and accessible services that serve as the patient's first and sustained point of contact with the healthcare system. A comparative review was performed through searches of PubMed, KoreaMed, and J-STAGE databases using terms including "primary care," "general practitioner," "family physician," "gatekeeping," "Korea," and "Japan." Gray literature from the Japan Medical Association, Korea Medical Association, and OECD (Organisation for Economic Co-operation and Development) was also reviewed. Clinical case examples from one author's practice were included to illustrate real-world general practitioner (GP) challenges. Both Japan and South Korea feature universal health insurance but differ substantially in physician training pathways, gatekeeping enforcement, and community care integration. Japan is transitioning toward a kakaritsuke-i (registered home doctor) model with a nascent GP specialty board, whereas South Korea relies primarily on specialist-led private clinics for primary care delivery. International evidence suggests that structured, continuous family physician (FP) training is associated with improved chronic disease management, preventive care utilization, and patient satisfaction. Strengthening South Korea's PCS requires a clearly defined mandatory FP residency framework, reinforced gatekeeping mechanisms, and greater investment in community-based integrated care. Japan's ongoing reforms offer a useful regional comparator, while international FP models provide a proven evidence base for structural improvement.
Background:The nutritional status of older adults is closely related to their living arrangements and reflects social support and food accessibility. This study aimed to compare dietary intake between older adults living alone and those living with others and to identify the key socioeconomic, behavioral, and psychosocial determinants influencing nutrient intake. Methods:Data were obtained from the 2019, 2021, and 2023 Korea National Health and Nutrition Examination surveys. Older adults aged ≥65 years were classified according to their living arrangements (living alone vs. living with others). Dietary intake was assessed using 24-hour dietary recall data. Group differences in daily energy and nutrient intake were analyzed using analysis of covariance, adjusted for age. Differences in energy and nutrient intake and their associated factors were examined according to the living arrangement (living alone vs. living with others). Results:Older adults living alone had significantly lower daily energy and carbohydrate, protein, fat, and calcium intake than those living with others (all P<0.05). In the non-living-alone group, smoking status, quality of life, and food abundance were the key determinants of energy and nutrient intake. Among adults living alone, economic activity, smoking status, and food abundance were the most influential factors. Conclusion:Living arrangements are a crucial contextual factor influencing dietary intake among older Koreans. Nutritional programs that improve food security and social participation may mitigate these disparities and support healthy aging.
Background:Indonesia has one of the highest smoking prevalence rates worldwide; smoking initiation often occurs during adolescence or childhood. This study aimed to identify factors associated with loss of autonomy among adolescent smokers in Indonesia. Methods:This cross-sectional study analyzed data from the 2019 Indonesia Global Youth Tobacco Survey (GYTS). The sample comprised students who reported smoking within the past 30 days. The primary outcome variable was loss of autonomy. Multivariate analysis utilized modified Poisson regression with backward elimination. Results are presented as adjusted prevalence ratios (APRs) with a significance level of P<0.05. Results:Among 1,129 student smokers, only 27.44% retained their autonomy. A total of 61.20% reported a strong urge to smoke and an inability to resist doing so. Factors significantly associated with loss of autonomy included electronic cigarette use (APR, 1.08; 95% confidence interval [CI], 1.01-1.17), cigarette accessibility near schools (APR, 1.11; 95% CI, 1.04-1.19), and peer cigarette offers (APR, 1.39; 95% CI, 1.23-1.57). Higher daily cigarette consumption was also associated with a greater likelihood of loss of autonomy. Conclusion:Loss of autonomy among adolescent smokers indicates nicotine dependence and difficulty quitting. Daily cigarette consumption, peer influence, cigarette accessibility near schools, and electronic cigarette use are key contributing factors. Essential policy recommendations include strengthening youth-focused tobacco regulations and incorporating smoking prevention and cessation programs into school curricula.
Background:Although obesity is a known risk factor for pancreatic cancer, the role of dynamic weight fluctuations remains unclear. We examined whether body mass index (BMI) variability is associated with pancreatic cancer risk in a large South Korean cohort. Methods:We analyzed data from 232,322 participants in the Korean National Health Insurance Service database who underwent three health examinations between 2002 and 2007. Participants were followed from 2008 until pancreatic cancer diagnosis, death, or the end of the study period in 2019. BMI variability, assessed using average successive variability, was categorized into tertiles. We used Cox proportional hazards models to calculate adjusted hazard ratios and 95% confidence intervals after adjusting for potential confounders. Sensitivity analyses were performed to verify the robustness of our findings. Results:In the overall cohort, BMI variability showed no significant association with pancreatic cancer risk. However, a statistically significant interaction by sex was observed (P for interaction=0.029), yielding higher risk estimates among male participants. Conclusion:Although BMI variability lacked a significant overall association with pancreatic cancer risk, the attenuation of this risk after longer washout periods suggests the potential influence of preclinical weight changes. Nevertheless, the observed effect modification by sex indicates that BMI variability may retain clinical relevance for specific demographic groups, particularly male participants. Therefore, BMI variability should be interpreted not as a direct causal risk factor or intervention target, but as a potential clinical marker that warrants closer monitoring in these specific groups.
