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.
Background:Depression is associated with various physical conditions, including bone metabolism. Most previous studies were cross-sectional, and longitudinal findings regarding osteoporosis or fracture risk remain inconsistent. This study examined the association between mild depressive symptoms and annual changes in bone mineral density (BMD) among women undergoing repeated dual-energy X-ray absorptiometry (DEXA). Methods:We retrospectively analyzed 1,629 women aged ≥20 years who completed the Patient Health Questionnaire-9 (PHQ-9) and underwent at least two DEXA scans between 2017 and 2023. Mild depressive symptoms were defined as PHQ-9 scores of 5-9. Annualized BMD changes at the lumbar spine, femoral neck, and total femur were calculated. Multivariable linear regression analyses adjusted for age, body mass index, smoking, alcohol consumption, physical activity, and diabetes. Women with PHQ-9 ≥10, only one DEXA scan, T-score ≤-2.5, or missing PHQ-9 data were excluded. Results:Mild depressive symptoms were not significantly associated with annualized BMD change in the overall cohort. However, among women aged ≥60 years (n=1,047), PHQ-9 scores of 5-9 were associated with more negative annualized BMD changes at the femoral neck (β=-3.26; 95% confidence interval [CI], -5.92 to -0.61; P=0.016) and total femur (β=-2.24; 95% CI, -4.39 to -0.09; P=0.041), but not at the lumbar spine. Conclusion:In women aged ≥60 years, mild depressive symptoms were negatively associated with annual BMD change. Given the close relationship between femoral BMD and hip fracture, even modest negative shifts may be clinically meaningful in older women.
Background:Although family physicians frequently encounter dermatological conditions, the effect of dermatology rotations on their diagnostic competency remains underexplored. We aimed to determine the effect of a mandatory 1-month dermatology rotation on the diagnostic accuracy of family medicine (FM) residents for skin lesions. Methods:We conducted a cross-sectional study among FM residents from September 1 to December 1, 2023. We assessed participants' ability to identify 54 dermatological lesions using a structured, face-to-face questionnaire. A multivariable linear regression model was used to identify independent predictors of diagnostic knowledge scores. Results:A total of 260 residents participated; 121 (46.5%) had completed the dermatology rotation, whereas 139 (53.5%) had not. Mean diagnostic knowledge scores were significantly higher among residents who completed the rotation (79.17±8.69 vs. 73.06±8.94; P<0.001). In the multivariable model, completing the dermatology rotation was the only independent predictor of higher diagnostic scores (P<0.001). Conclusion:Completing a dermatology rotation improves the diagnostic accuracy of FM residents for skin lesions, underscoring the value of structured dermatological training within FM curricula.
The rapid growth of online alcohol sales, delivery services, and digital marketing has increased alcohol availability and heightened public health concerns, particularly among adolescents. However, regulatory responses remain inconsistent and vary significantly across regions. This scoping review synthesizes global regulatory approaches to online alcohol access, encompassing both established Western models and emerging Asian frameworks, and identifies key cross-national patterns and policy gaps. This scoping review followed PRISMA-ScR (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) and Joanna Briggs Institute guidance. Searches of four electronic databases were complemented by a supplementary gray literature search targeting specific Asian jurisdictions to minimize geographic bias. The identified sources included policies and peer-reviewed studies on online alcohol sales, delivery practices, age-verification procedures, and digital marketing regulations. Data were systematically organized by regulatory domain and analyzed using a comparative socio-political framework (liberalism vs. paternalism) to interpret cross-national differences. The analysis of 34 documents across five regulatory domains revealed a distinct global divide. Western nations predominantly rely on co-regulatory models that frequently suffer from significant enforcement gaps, whereas Asian jurisdictions employ strict structural barriers. These include mandatory digital real-name authentication, "Smart Order" systems, and joint platform liability, designed to effectively restrict underage access where Western self-regulation has historically failed. To address global enforcement gaps, future policies must evolve from "soft" co-regulation to "hard" technical mandates. Integrating Asian-style digital identity systems with strict platform liability offers a viable pathway to effectively restrict underage access and reduce alcohol-related harm.
Background:Recent evidence has underscored the crucial metabolic role of vitamin D. An increased non-high-density lipoprotein (non-HDL)/HDL ratio has been identified as a meaningful marker of metabolic risk. This study aimed to examine the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentration and non-HDL/HDL ratio in a cohort of Korean adults. Methods:For analysis, 10,864 participants aged 19 years or older were selected from the 2022-2023 Korea National Health and Nutrition Examination Survey (KNHANES). Serum 25(OH)D concentrations were classified into three groups: deficient (<20 ng/mL), insufficient (20-30 ng/mL), and sufficient (≥30 ng/mL). Non-HDL/HDL ratio was derived from total cholesterol and HDL cholesterol values. One-way analysis of variance and separate multiple regression analyses were conducted to assess differences in metabolic parameters between the 25(OH)D groups in both the general and diabetes subgroups (glycated hemoglobin ≥6.5%). Results:Triglycerides, low-density lipoprotein cholesterol, and non-HDL/HDL ratio values were significantly lower in the group with sufficient vitamin D levels. Serum 25(OH)D and non-HDL/HDL ratio showed an inverse correlation in both general (r=-0.09) and diabetes (r=-0.15) subgroups. Across all regression models, a statistically significant inverse association persisted even after comprehensive adjustments for potential confounders. Conclusion:A significant inverse correlation exists between serum 25(OH)D concentration and non-HDL/HDL ratio in Korean adults, with a more pronounced effect observed in individuals with diabetes.
Sarcopenia, characterized by the progressive loss of skeletal muscle mass and strength, represents a significant clinical concern among patients undergoing gastric cancer surgery. Postoperative individuals are particularly vulnerable due to gastrointestinal dysfunction, reduced nutrient intake, systemic inflammation, and treatment-induced metabolic stress. This condition is associated with higher complication rates, delayed recovery, chemotherapy intolerance, and decreased survival, underscoring the importance of early detection and effective nutritional management. This narrative review integrates and synthesizes recent evidence from clinical and experimental studies that explore the pathophysiology, diagnosis, and nutritional management of sarcopenia in gastric cancer. The review emphasizes key nutritional risk factors, assessment tools, and intervention strategies applicable to both preoperative and postoperative care. Validated methods such as SARC-F (strength, assistance with walking, rise from a chair, climb stairs, and falls), dual-energy X-ray absorptiometry, and computed tomography imaging play central roles in identifying muscle loss and functional decline. Evidence suggests that protein-enriched diets, branched-chain amino acids, omega-3 fatty acids, and micronutrients such as vitamin D and antioxidants help preserve muscle mass and improve recovery outcomes. Exercise and rehabilitation further enhance these benefits by synergistically promoting muscle protein synthesis and function. Moreover, emerging technologies-including artificial intelligence-assisted nutritional monitoring, nutrigenomics, and biomarker-based personalization-represent promising directions for individualized care. Sarcopenia in gastric cancer is a modifiable and clinically significant condition. Integrating personalized nutrition with structured rehabilitation can markedly enhance functional recovery, treatment tolerance, and quality of life. Future research should aim to develop precision-based nutritional algorithms and standardized diagnostic frameworks to optimize outcomes in this high-risk population.
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: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:Depression frequently affects older adults with chronic illnesses, reducing their quality of life. In Thailand, limited access to mental health services increases the need for preventive interventions. The SMART (Smile, Mindfulness, Attitude, Relax, and Thinking) Elderly Program aimed to assess its effectiveness in preventing depression among older adults. Methods:Quasi-experimental research design with a repeated-measures approach was used with two groups. The study included 80 older adults diagnosed by a physician with noncommunicable diseases and a depression score of 7 to 12 on the Thai Geriatric Depression Scale (TGDS), indicating risk for depression. Participants were assigned to two groups through multi-stage sampling. The intervention group (n=40) participated in a 6-week SMART Elderly Program, while the control group (n=40) received standard treatment and a handbook for depression prevention. Evaluations took place through in-person interviews at baseline, post-intervention, and at a 3-month follow-up. Data were analyzed using descriptive statistics and repeated measures analysis of variance. Results:The analysis showed statistically significant differences in knowledge about depression, attitudes toward depression, and TGDS scores between the intervention and control groups at the 3-month follow-up (P<0.001). In the intervention group, these measures also changed significantly from baseline to the 3-month follow-up (P<0.001). Conclusion:The SMART Elderly Program significantly reduced depressive symptoms in older adults with chronic illnesses. These results support its use in community health practice and inform health policy to improve preventive mental health care for older adults.
