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Introduction: The implementation of smoke-free regulations is an effort to create a clean and healthy environment in the Blitar District, Indonesia. The main purpose of this research is to analyze public opinion on the smoke-free regulations drafting in the Blitar District. Methods: To analyze public opinion about the smoke-free regulations, we used a cross-sectional design with a RAPID survey conducted in 2015. The research involved distributing questionnaires to 1,008 respondents, with the sample size proportionally divided across 22 districts. For the implementation of the regulation, we conducted observational research over four years. The effort to draft the smoke-free regulations continued until 2019, and the implementation of the regulations is ongoing until 2023. Results and Discussion: Results showed that 94.5% supported the regulations. The RAPID survey results provided evidence for drafting the smoke-free regulations. This evidence was used to advocate for stakeholder support in drafting and implementing the regulations in the Blitar District. Although the smoke-free regulations were released in 2019, their implementation has been very challenging and requiring significant effort. Conclusion: A RAPID survey showed that almost all people in Blitar support the drafting and implementation of the smoke-free regulations. The implementation requires significant effort to ensure it proceeds smoothly and needs support from all stakeholders in the Blitar District.

Background: Anti-smoking messages (ASM) is a program designed to educate the public about the dangers of tobacco use, aiming to prevent adolescents and young people from smoking cigarettes in any form and to assist smokers in giving up their smoking habit. On the contrary, pro-smoking messages (PSM) is a marketing technique to promote tobacco products. Aims: This study was conducted to describe the exposure to ASM and PSM among Indonesian adolescent smokers (IAS). Methods: This study analyzed secondary data from the 2019 Global Youth Tobacco Survey (GYTS) Indonesia. The outcome variable was the respondent's smoking intensity in the last 30 days. The independent variables were the exposure to ASM and PSM in the various below-the-line media. Results: Most IAS were male (93.4%), mostly in secondary school (60.3%) and spent more than IDR 11,000 per week (71.1%). Adolescent smokers were exposed to ASM at a rate of 92.4%. Furthermore, ASM exposure happened to 60.5% of the low-intensity youth smoker group and 39.5% of the high-intensity youth smoker group. Meanwhile, 93% of adolescent smokers were exposed to PSM, with 40.8% in the high-intensity youth smoker group and 59.2% in the low-intensity youth smoker group. Conclusion: The exposure to ASM and PSM in the adolescent smoker group was relatively the same. Keywords: ASM, PSM, prevention, public health, tobacco control, youth

BackgroundGlobal databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems. ObjectiveThis protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths. MethodsThe Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted. ResultsThe study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education. ConclusionsThe results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents’ resilience skills. International Registered Report Identifier (IRRID)DERR1-10.2196/58681

Background: Pregnant women who experience Chronic Energy Deficiency (CED) will be at risk of decreased muscle strength which will be used in the process of childbirth resulting in the occurrence of various complications such as low birth weight babies, miscarriage, birth defects, premature, and even infant death. The problem of CED among pregnant women requires intervention not only in nutritional aspects but also in socio-economic aspects. Purpose: This study aimed to determine the overview of the chronic energy deficiency among pregnant women in Nusa Tenggara in 2018 and the factors that influence it. Methods: The approach used in this study was ecological analysis methods. All districts and cities in West Nusa Tenggara and East Nusa Tenggara were included in this study. This study looked at the prevalence of CED among pregnant women and 4 other independent variables, namely the percentage of supplementary feeding, the percentage of added blood tablets, poverty rate, and literacy rate. The data were analyzed using cross-tabulation. Results: The results show that supplementary feeding and literacy rates do not affect the incidence of CED. However, other variables such as the provision of blood booster supplements and poverty rate affect the incidence of CED. Conclusion: Health care facilities need to improve services and counseling regarding the importance of nutrition during pregnancy and the need for government support in improving the socio-economic status of the community to reduce the prevalence of CED in Nusa Tenggara.

Introduction Tobacco advertisement, promotion, and sponsorship (TAPS) in all forms influences youth smoking behaviors. TAPS exposure enhances their smoking frequency and vulnerability. A 2018 Indonesia Ministry of Health (MoH) Survey showed increased smoking prevalence among youth aged 10–18 years. Thus, our objective was to analyze the relationship between TAPS and the increased Indonesian youth smoking behavior. Methods We conducted a secondary analysis of the Indonesian 2019 Global Youth Tobacco Survey. The sample size differed in each variable: current smokers n=3386, ever smoker n=3666, and cigarette consumption per day n=1355. We adjusted for socioeconomic and demographic variables and used logistic regression with youth smoking prevalence as the outcome and TAPS variables as the primary exposures. Results The current male youth smoker prevalence was 38.3%, ever smoker was 67%, and high consumption per day smoker (≥2 cigarettes per day) was 39.1%. Youth respondents exposed to the promotion or sponsorship of cigarette products showed an increase in three smoking behaviors. In particular, when youth respondents were exposed to more than one type of cigarette promotion (AOR=1.67, 95% CI: 1.33–2.09) or noticed one type of cigarette sponsorship (AOR=2.06, 95% CI: 1.44–2.93), their odds of all three smoking behaviors (current smoker, ever smoker, and high consumption smoker) increased. Conclusions TAPS increase smoking behaviors among Indonesian youth. Therefore, to protect Indonesian youth health in the future, strategic action is needed to reduce youth smoking by banning all forms of TAPS in Indonesia. Tob.

Latar Belakang: Perkembangan industri 4.0 memberikan kemudahan untuk mengakses segala hal salah satunya adalah makanan dan minuman. Aplikasi pesan antar makanan secara daring merupakan platform yang sering digunakan saat ini pada kalangan mahasiswa. Pandemi COVID-19 menyebabkan perubahan perilaku pembelian melalui jasa secara online order terutama dengan adanya kebijakan pembatasan aktivitas masyarakat. Minuman kekinian seperti boba, beberapa jenis teh, dan kopi merupakan minuman yang sering dipesan secara online. Jika dikonsumsi dalam jangka waktu lama dan sering dapat menyebabkan peningkatan indeks massa tubuh, obesitas, dan pada akhirnya meningkatkan risiko penyakit tidak menular. Tujuan: Penelitian ini bertujuan untuk mengetahui dampak perkembangan online order terhadap perilaku konsumsi sugar sweetened beverages (SSB) selama pandemi COVID-19 pada mahasiswa di Kota Surabaya, Indonesia. Metode: Penelitian ini merupakan penelitian observasional dengan menggunakan desain penelitian Mixed Method yaitu melalui studi kuantitatif dengan desain penelitian cross sectional dan studi kualitatif melalui kegiatan Focus Group Discussion (FGD). Hasil: Berdasarkan hasil uji deskriptif menunjukkan bahwa teh merupakan jenis SSB yang paling sering dibeli (harian) melalui online order (12,95%). Adanya diskon sangat berpengaruh terhadap alasan responden dalam melakukan pemesanan secara online (68,4%). Melalui FGD, sebagian besar responden menganggap promo menjadi pendorong terbesar untuk memesan makanan secara online. Kesimpulan: Saat ini, minuman kekinian sebagian besar termasuk dalam kategori SSB. Konsumsi SSB dengan frekuensi berulang dalam jangka panjang akan berdampak pada status gizi. Diperlukan kebijakan pemerintah dan pihak terkait untuk meminimalisasi dampak kebiasaan konsumsi SSB terlebih dengan kondisi pandemi seperti saat ini.

Abstract Introduction Various anti-tobacco promotions have emerged in order to reduce the detrimental impacts of tobacco advertising on adolescents. The objective of this study is to explore the relationship between the exposure to anti-smoking messages and Indonesian youth smoking behavior. Method We used secondary data from the Indonesian 2019 Global Youth Tobacco Survey (GYTS). The participants were students from grades seven to twelve. We used multiple logistic regression to assess the relationship of anti-smoking messages exposure on the smoking behavior variable. We used complex samples process logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and controlling for relevant covariables. Results The percentage of the exposure to anti-smoking messages in all types were not more than 25% in each outcome variables. The results also showed that in the current smoker variables, adolescent who exposed to the two variables of anti-smoking messages increased the odds to become current smoker. The variables were anti smoking messages in media (AOR 1.41; 95% CI 1.15–1.73) and in school (AOR 1.26; 95% CI 1.06–1.50). On the other hand, in the smoking susceptibility variables, there were no variables of anti-smoking messages that had relation with it. Conclusions The study concluded that there were only two variables of the anti-smoking messages that had relation with the Indonesian youth smoking behavior, which were current smokers. Unfortunately those variables increased the odds of the respondents to become current smokers. Indonesia government should develop media following international best practices to convey the anti-smoking messages.

Abstract Background The disadvantaged areas are one of the government’s focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia. Methods The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data. Results The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032–1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639–1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740–0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483–2.537). Conclusion The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.

Background: The negative impact of tobacco, especially second-hand smokers, requires imperative actions. Introducing tobacco control measures helps protect the public health. Data suggest that there were approximately 44 million daily smokers in Indonesia comprising 49.8 million males and 3.9 million females over ten years of age. East Java Province had the biggest number of smokers in Indonesia. To reduce trends in smoking behavior, we need to advocate local government to release and implement smoke-free regulations. Aims: The study aims to do action research through advocacy and communication for the regulation of smoke-free areas in East Java Province. Methods: The action research involved 12 districts of East Java Province, Indonesia. The method used in this study was Focus Group Discussion (FGD), one-on-one meeting, in-depth interviews, public speaking, press conference, and press release. Results: Intensive advocacy and communication worked successfully. Eight districts of East Java Province implemented local regulations of smoke-free areas. The advocacy and communication of the regulations made it possible to be implemented. Conclusion: Intensive advocacy and communication improve the awareness of executive and legislative government about the importance of smoke-free area regulations. It will be successful if regular meetings, discussions, press conferences, public speaking, and team work are conducted with many stakeholders.

Abstract Background Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia. Methods The study population was women aged 15–49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression. Results In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM. Conclusion The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.

Background: Open defecation (OD) is a sanitation problem that can have a negative impact on health. Open defecation can have a bad impact on sanitation this poor sanitation can then trigger various diseases. Objective: This study aims to find out the factors related to the behavior of open defecation (OD) in Regency/City communities of East Java Province in 2018. Methods: Ecological approach based on secondary data published by the Ministry of Health of the Republic of Indonesia, East Java Provincial Health Office, and the Central Statistics Agency of East Java Province of 38 districts/cities in East Java Province were included in this study. This study examined the percentage of healthy latrine users with 4 other independent variables, namely the percentage of facilities that met the available requirements, the percentage of villages that applied Community Led Total Sanitation (CLTS), the prevalence of diarrhea cases, and the percentage of illiteracy rates. Data were analyzed using cross tabulation with SPSS. Results: There were still several districts/cities in East Java Province that had not used latrines when defecating, most of them were in districts/cities with inadequate facilities, low percentage of villages willing to implement CLTS, low percentage of illiteracy, and moderate diarrhea prevalence. Conclusion: Based on these results, it can be concluded that the factors of the availability of facilities, education, compliance with CLTS implementation, and the prevalence of diarrhea have a relationship with the percentage of latrine users in districts/cities in East Java Province. The results of this study can be used by local stakeholders to make health-based policies as an effort to reduce open defecation.

Introduction: This study was aimed to analyze the effectiveness of the emergency activity restriction policy implementation to slow down the daily incidence and mortality of COVID-19 in the East Java Province of Indonesia. Methods: An ecological study design was used for this research as the data were acquired from the daily confirmed cases and mortality reports of COVID-19 in 29 regencies and 9 cities in East Java Province of Indonesia from June 14 to July 25, 2021. Interrupted time series using autoregressive integrated moving average (ARIMA) was used for the analysis. Results: The mean of COVID-19 daily incidence and mortality was increasing during the implementation of emergency public activity restriction. The result of the ARIMA interrupted time series reported that the implementation of emergency public activity restriction significantly (P < 0.05) affects the increase of COVID-19 daily incidence in 18 cities and daily mortality in 9 cities. Analysis on the provincial level showed that there was no reduction both in daily incidence and mortality during the implementation of emergency public activity restriction. Conclusion: The study reported that the implementation of emergency public activity restrictions was not beneficial in reducing COVID-19 daily incidence and mortality in the East Java Province of Indonesia during the 1st month of policy implementation.

Background: Stroke is a disease condition caused by the sudden stopping of the blood supply to the brain, either because of a blockage or ruptured blood vessels. The prevalence of stroke in Indonesia based on Basic health research in 2013 was 7‰ and increased in 2018 to 10.9‰. Purpose: This research aims to determine the effect of smoking behaviour on the prevalence of stroke in Surabaya, Indonesia. Methods: It was a cross-sectional study. The study population included all visitors to nerve poly at Haji Hospital Surabaya. Data were collected from respondents through interviews and patient medical record data from August to September 2019. Univariate and bivariate analyses were done to identify the association between smoking and stroke incidence. Results: A total of 187 people participated in the study. The majority of them were aged ≥ 55 years (78.16%), with 55.17% being male. There is 32.18% active smoker and 28.74% passive smoker for stroke patients. There is an association of the type of non-filter cigarettes with the prevalence of stroke p = 0.01, PR = 4.02; 95% Cl = 1.38-11.67), and duration of exposure ≥30 years (p = 0.01, PR = 7.84; 95% Cl = 2.75-22.32) Conclusion: there is an influence of types of non-filter cigarettes and exposure time ≥ 30 years with the incidence of stroke in the city of Surabaya.

Background: Stunting in early life will have adverse functional consequences, including poor cognition and low levels of education. The study aimed to determine the determinants of stunting toddlers in East Java. Methods: The study uses secondary data from the 2017 PSG. Using the multi-stage cluster random sampling method, a sample of 10,814 toddlers aged 0-59 months was taken. The analyzed variables consisted of the dependent variable nutritional status of toddlers, 7 independent variables: residence, toddler age, mother's age, marital status of mothers, mother's education level, and working status of mothers. Determination of determinants using the Binary Logistic Regression test. Results: Toddlers living in urban areas were 0.855 times more at risk of stunting compared to toddlers living in rural areas (OR 0.885; 95% CI 0.798-0.980). Toddlers who have mothers with elementary education and below 2.206 times have more risk of stunting compared to toddlers who have mothers with college education (OR 2.206; 95% CI 1,835-12,651). Toddlers who have mothers with junior high school education were 1,676 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1.676; 95% CI 1.395-2.015). toddlers who have mothers with high school education are 1,266 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1,266; 95% CI 1,058-1,514). Conclusion: There were 4 variables that have proven to be significant as determinants of stunting in East Java Province, namely residence, age of toddler, age of toddler mother, and mother's level of education ABSTRAK Latar Belakang: Stunting dalam kehidupan awal akan mempunyai konsekuensi fungsional yang merugikan, termasuk kognisi yang buruk dan tingkat pendidikan yang rendah. Variabel ini perlu diperhatikan karena menurut Unicef, ada faktor sosial budaya yang berperan dalam terjadinya permasalahan stunting. Penelitian ditujukan untuk menentukan determinan balita stunting di Jawa Timur. Metode: Penelitian menggunakan data sekunder survei Pemantauan Status Gizi tahun 2017 (PSG 2017). Dengan metode multi-stage cluster random sampling, diambil sampel 10.814 balita berusia 0-59 bulan. Varibel yang dianalisis terdiri dari variabel dependen status gizi balita, 7 variabel independen: tempat tinggal, umur balita, umur ibu balita, status perkawinan ibu balita, tingkat pendidikan ibu balita, dan status bekerja ibu balita. Penentuan determinan dengan menggunakan uji Regresi Logistik Biner. Hasil: Balita yang tinggal di daerah perkotaan 0,855 kali lebih memiliki risiko stunting dibandingkan dengan balita yang tinggal di daerah pedesaan (OR 0,885; 95% CI 0,798-0,980). Balita yang memiliki ibu dengan pendidikan SD ke bawah 2,206 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 2,206; 95% CI 1,835-12,651). Balita yang memiliki ibu dengan pendidikan SLTP 1,676 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,676; 95% CI 1,395-2,015). balita yang memiliki ibu dengan pendidikan SLTA 1,266 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,266; 95% CI 1,058-1,514). Kesimpulan: Ada 4 variabel yang terbukti signifikan sebagai determinan kejadian stunting di Provinsi Jawa Timur, yaitu tempat tinggal, umur balita, umur ibu balita, dan tingkat pendidikan ibu balita.

Background: Humans daily activities are inseparable from public places. Public places are facilities used for communal public activities, such as buying and selling in supermarket. The management of supermarkets have to ensure clean, healthy, safe, and comfortable facilities which do not give disadvantages for health. In responding this issue, health promotion is required in public places to get rid of environmental pollution and disease transmission. Objective: This study described health promotion in public places as found in Sakinah Supermarket. Method: This study was descriptive research with a quantitative approach. Data were categorized into primary data through observation and in-depth interview, as well as secondary data through Sakinah Supermarket’s document. The analysis was explored by using Ottawa Charter's 5 means of action as basic health promotion tool. Results: Health promotion in Sakinah Supermarket was still lacking. Health promotion efforts that have been done well are the concept of a No-Smoking Area, where Sakinah Supermarket did not sell cigarettes and did not provide smoking area. Conclusion: Sakinah Supermarket has not supported healthy public places since it does not give adequate information to improve individual’s awareness of health.

Background: The percentage infants with complete basic immunization is still below the minimum target of immunization coverage. The immunization coverage survey showed that complete basic immunization and valid dose immunization status in Surabaya City is still below the international averages. Purpose: The purpose of the study was to describe the knowledge and attitudes of cadres and mothers with under two years child (Baduta) towards My Village My Home (MVMH) in the City of Surabaya, Indonesia Methods: Sampling was done by simple random sampling method. Samples were grouped into exposed groups and unexposed groups. The sample comparison was 1: 2. The respondents of the exposed group were 20 cadres and 20 mothers who had received MVMH training. The respondents of the unexposed group were 40 cadres and 40 mothers who did not receive training. Data collection was done using interviews. The study was conducted in 30 Health Centers. Results: Most cadres in the group who had received training or had not received training had good knowledge, but in the group that had not received training there were 5% of cadres who had poor knowledge. Both mothers in the group of cadres who had received training or had not, had good knowledge, but in the group of cadre that had not received training as much as 10% of mothers had poor knowledge. Both cadres and mothers had a good attitude. Conclusion: Both cadres and mothers in two groups had good knowledge and attitude. Cadres who have good knowledge and attitude towards MVMH have the potential to apply MVMH to the community.

Background: Previous studies have provided evidence of inequalities in the coverage of COVID-19 vaccination. However, evidence of such inequalities in delays in vaccinations is lacking. Our study examined the socioeconomic and geographic disparities in terms of days to get the first and second dose of COVID-19 vaccinations in Indonesia. Methods: We conducted a cross-sectional study using the WhatsApp messaging app and social media platforms during December 2021–February 2022. We distributed the questionnaire through our university network to reach all regions. We included 3592 adults aged 15+ years in our analysis. We used two main dependent variables: days to receive the first dose (after national vaccine rollout) and days to receive the second dose (after receiving the first dose). We examined a range of socioeconomic and geographic indicators, including education level, income level, formal employment, working in health facilities, being a health worker, and region. We controlled for sex, age, religion, and urbanicity. We performed multivariate logistic regressions in STATA 15. Results: Our findings show considerable delays in getting the first dose among participants (160.7 days or about 5.4 months on average) from Indonesia’s national COVID-19 vaccination rollout on 13 January 2021. However, we found a shorter period to receive the second dose after receiving the first dose (41.1 days on average). Moreover, we found significant socioeconomic (i.e., education, income, formal employment, working in health facilities, and being a health worker) and geographic (i.e., in and out of the Java region) inequalities in terms of delays in getting the first dose. However, we did not find significant inequalities in getting the second dose for most inequality indicators, except for working in health facilities. By region, we found that participants living in more deprived areas (out of the Java region) received the second dose 4.9 days earlier. One of the study’s key limitations is that there may be an inherent bias with respect to socioeconomics factors since it was conducted online (web-based). Conclusions: While there were considerable delays in getting the first dose, especially among those of a lower socioeconomic status and those in more deprived areas, the waiting time for the second dose was relatively similar for everyone once they were in the system. Effective efforts to address inequalities are essential to ensuring the effectiveness of the national COVID-19 vaccination rollout.

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed.

Pada tahun 2014, pernikahan dini di Banyuwangi sebanyak 22% dari jumlah pasangan yang menikah. Salah satu penyebabnya adalah kurangnya pengetahuan tentang kesehatan reproduksi. Upaya peningkatan pengetahuan yang efektif dapat dilakukan melalui pendidikan sebaya. Penelitian ini bertujuan mengetahui pengaruh pendidikan sebaya terhadap pengetahuan kesehatan reproduksi remaja. Jenis penelitian adalah eksperimen dengan desain penelitian quasi eksperimeni pre-post with kontrol design. Penelitian dilakukan pada remaja karang taruna Tamansari, Licin, Banyuwangi tahun 2015. Subjek dalam penelitian ini dipilih secara convenient sampling dan terbagi dalam dua grup yaitu remaja karang taruna yang mendapat pendidikan sebaya (13 orang) dan remaja yang tidak mendapat pendidikan sebaya (17 orang). Hasil penelitian menunjukkan bahwa sebagian peserta pada kelompok perlakuan berjenis kelamin perempuan (76,92%) sedangkan pada kelompok kontrol berjenis kelamin laki-laki (56,25%). Rata-rata umur pada kedua kelompok adalah 17 tahun dan berpendidikan tinggi (76,92% dan 56,25%), terdapat perbedaan pengetahuan sebelum dan sesudah perlakuan antara kelompok kasus dan kontrol (p=0,04 dan p=0,001). Pengetahuan sebelum dan sesudah pada kelompok kasus dan kontrol juga berbeda (p=0,04 dan p=0,01). Sehingga ada perbedaan pengetahuan sebelum dan sesudah perlakuan antara kelompok perlakuan dan kontrol namun tidak ada pengaruh pendidikan pada peningkatan pengetahuan.

Objectives Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI. Methods This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants’ confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test. Results In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p

Background: Restricting community mobility during COVID-19 can potentially trigger anxiety, depression and stress in the community. The study aims to analyze variables associated with the community psychosocial burden (anxiety level) during the co-19 pandemic in Indonesia. Methods: This study collected data (n = 8,031) online. Psychosocial burden was measured based on the anxiety level which include 5 aspects, such as economic, religious, educational, employment, and social issues. Each question used a Likert scale. Six independent were examined, such as age, gender, religion, marital, education, and employement. In the final stage, a multivariate test was performed using a multinomial logistic regression. Results: Someone older experienced less high anxiety. The age group of 20–29 years was 4,330 times likely to experience higher anxiety than the age group of ≥50 years. While, those in the age group of 40–49 years weer 2,322 times more likely to have higher anxiety than those in the age group of ≥50 years. Male respondents had lower possibility of medium to high anxiety than females. Respondents with secondary and lower education had 3,117 times possibilities to experience higher anxiety than those with high education level. Conclusion: Four variables affected the psychosocial burden i.e, anxiety level of community in Indonesia. These involved age, gender, education, and employement.

Background: The percentage of complete immunization in urban areas is higher than rural areas. The purpose of the study was to analyze the relationship between ownership of Maternal and Child Health (MCH) books with Complete Basic Immunization (CBI) coverage in slums and poor areas. Design and Methods: A rapid survey was conducted in selected slums and poor groups based on medical records from Public Health Center. Informants were mothers with a sample of 325 infants aged 12 to 23 months. Results: The lowest coverage of CBI for slum and poor residents is Pasuruan, which is 55.4%. The results of statistical analysis showed that there was a significant relationship between ownership of MCH books and the complete coverage of basic immunization in Malang (P=0.000; PR=3.682); Pasuruan (P=0.002; PR=1.854); Sidoarjo (P=0.000; PR=4.042); Surabaya (P=0.000; PR=2.425). Conclusions: It is recommended that the government should improve access to complete immunization programs in slums and poor population.

Action of personal hygiene is one of the efforts that can be done to maintain health in Islamic boarding school environment. In the implementation there are many female students who ignore it by exchanged personal items. This research purposed to determine association knowledge and attitude as predisposing factors, towards action of personal hygiene female students which supported by infrastructure and facilities of boarding school as enabling factor, and hygiene regulation as reinforcing factor in X Jombang Islamic boarding school. This research was an analytical study with cross sectional design. The population was 90 female students then obtained 48 female students as sampling by used simple random sampling. Independent variables studied included knowledge and attitudes about personal hygiene. While the dependent variable studied the action of personal hygiene female students. Instruments used a questionnaire. Data analysis techniques performed by using the chi square test to see whether or not an association between knowledge and attitude with action of personal hygiene. Variables studied and have a relationship with action of personal hygiene female students if fulfi ll the requirement p

Abstract Background Nutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition. Methods NEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2–5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child’s height-for-age z-score (HAZ) and maternal body mass index (BMI). Discussion Because previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy may be enhanced through vicarious and active mastery of experiences gained during six sessions of nutrition education and verbal persuasion during home visits. Trial registration The Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is allocated the registration number: ACTRN12615001243505 on 12 November 2015.

Diseases due to the degeneration of the liver and various other internal organs were the major cause of the exceedingly high chick mortality in lesser black-backed gulls (Larus fuscus fuscus) in the centralGulf of Finland, Baltic Sea, during 1991/1993. The same symptoms were found in chicks of common gulls (Larus canus) and herring gulls (Larus argentatus) from the same focal area, although at a much lower frequency. We found disproportionately high concentrations of polychlorinated biphenyls (PCBs) in liver relative to leg muscle in lesser black-backed chicks compared with common gull and herring gull chicks. The causality between PCB residues and chick diseases remains unknown.No signs of chick edema disease or abnormal frequency of embryonic deaths, commonly associated with organochlorines in biota, were found.It is concluded that studies made in a very small geographical area may not give a good correlation between dose and effect due to an even greater variation in tolerance. Another explanation is that the diseases may not have been PCB-induced. [ABSTRACT FROM AUTHOR]

In long-lived species, adult survival is the population parameter having the highest elasticity, and therefore, it can be expected to be least affected by climatic variations. We studied the dynamics and survival of breeding female common eiders Somateria mollissima mollissima in the Baltic Sea from 1960 to 2007. Using nest censuses and capture-recapture methods, we investigated: (1) the annual apparent survival (phi) of breeding females, (2) the survival-mediated population fluctuation, (3) weather effects on survival, and (4) long-term population trends. Based on capture histories of 6,393 females, average phi was 0.882 (95% confidence interval 0.864, 0.899). We found no relationship between population growth rate and survival. Furthermore, the highest ranking models, based on Akaike's information criterion, indicated no effect of the North Atlantic Oscillation index on the phi of eider females. Population size, assessed from nest counts, has been steadily declining since 1985. Despite the long time series (48 years), the overall variation in the phi rates remained comparatively narrow, at maximum ranging only 10% between 2 consecutive years. Results imply that declining female survival is not the driving force behind the population decline, and we hypothesize that the overall poor fledging success and the consequent low recruitment explain the decreasing trend of nest densities since 1985.

Common eiders nesting in the Baltic Sea are exposed to generally high levels of contaminants including potentially genotoxic polycyclic aromatic hydrocarbons and organochlorines. Blood samples were collected from eiders at eight sites in the Baltic Sea and two sites in the Beaufort Sea. DNA content variation was estimated using the flow cytometric method, and subsequently utilized as a biomarker of genetic damage. We observed no significant differences in genetic damage among populations within either the Baltic or Beaufort Seas. However, eider populations from the Baltic Sea had significantly elevated estimates of genetic damage compared to populations from the Beaufort Sea.

The population decline of the nominate lesser black-backed gull Larus fuscus fuscus in the Gulf of Finland (northern Baltic) is caused by an exceedingly high chick mortality due to diseases. The chick diseases include degeneration in various internal organs (primarily liver), inflammations (mainly intestinal), and sepsis, the final cause of death. The hypothesis of starvation causing intestinal inflammations (leading to sepsis) was tested by attempting to reproduce lesions in apparently healthy herring gull L. argentatus chicks in captivity. The herring gull chicks were provided a similar low food-intake frequency as observed for the diseased chicks in the wild. However, empty alimentary tract per se did not induce the intestinal inflammations and therefore, inflammations seem to be innate or caused by other environmental factors in the diseased lesser black-backed chicks. They had very high concentrations of PCB in their liver; but the concentrations were not significantly higher than those of the healthy herring gull chicks, indicating a common exposure area for both species (i.e. the Baltic Sea). When compared to NOEL and LOEL values for TEQs in bird eggs our TEQ levels clearly exceed most or all of the values associated with effects. Compared with published data on fish-eating waterbirds, the DDE concentrations in the diseased lesser black-backed chicks were well above the levels previously correlated with decreased reproduction, while the residues in apparently healthy herring gulls were below those levels. The DDE/PCB ratio in lesser black-backs was significantly elevated, indicating an increased exposure to DDTs as compared with most other Baltic and circumpolar seabirds. The possible exposure areas of DDT in relation to differential migration habits of the two gull species are discussed.

Samples of brain, intestine, liver, lung, spleen, and bursa of Fabricius were collected from five common eider (Somateria mollissima) duckling carcasses during a die-off in the western Gulf of Finland (59 degrees 50'N, 23 degrees 15'E) in June 1996. No viral activity was observed in specific-pathogen-free chicken embryos inoculated with tissue suspensions, but samples of bursa of Fabricius from three birds were positive when inoculated into Muscovy duck (Cairina moschata) embryo fibroblasts. The isolates were characterized as nonenveloped RNA viruses and possessed several characteristics of the genus Orthoreovirus. Virus particles were icosahedral with a mean diameter of 72 nm and were stable at pH 3.0; their genome was separated into 10 segments by polyacrylamide gel electrophoresis. Mallard (Anas platyrhynchos) ducklings experimentally infected with the eider reovirus showed elevated serum activities of aspartate aminotransferase, creatine kinase, and lactate dehydrogenase enzymes and focal hemorrhages in the liver, spleen, and bursa of Fabricius. During 1997-99, the prevalence of neutralizing antibodies to the isolated virus ranged from 0 to 86% in 302 serum samples collected from incubating eider hens at three nesting areas along coastal Finland. The highest seroprevalence was found in Hanko in 1999, just weeks before reports of an uninvestigated mortality event resulting in the death of an estimated 98% of ducklings at that location. These findings raise the question of potential involvement of the virus in poor duckling survival and eider population declines observed in several breeding areas along coastal Finland since the mid-1980s.

During 1997-1999, we collected serum samples from 156 common eider (Somateria mollissima) females incubating eggs in the Finnish archipelago of the Baltic Sea. We used serum chemistry profiles to evaluate metabolic changes in eiders during incubation and to compare the health and nutritional status of birds nesting at a breeding area where the eider population has declined by over 50% during the past decade, with birds nesting at two areas with stable populations. Several changes in serum chemistries were observed during incubation, including (1) decreases in serum glucose, total protein, albumin, beta-globulin, and gamma-globulin concentrations and (2) increases in serum uric acid, creatine kinase, and beta-hydroxybutyrate concentrations. However, these changes were not consistent throughout the 3-yr period, suggesting differences among years in the rate of carbohydrate, lipid, and protein utilization during incubation. The mean serum concentrations of free fatty acids, glycerol, and albumin were lowest and the serum alpha- and gamma-globulin levels were highest in the area where the eider population has declined, suggesting a role for nutrition and diseases in the population dynamics of Baltic eiders.

Eight common eider (Somateria mollissima) ducklings were experimentally infected from 1 June through 13 June, 1995 with acanthocephalans (Polymorphus minutus) by allowing the birds to feed on Gammarus spp. (Gammarus oceanicus, G. salinus, G. zaddachi, and G. lacustris) containing acanthocephalan cystacanths. Uninfected Gammarus spp. were fed to a control group of seven ducklings. No mortality of ducklings occurred during the experiment. However, the infected ducklings gained weight more slowly than the control birds. After the 2 wk study period, the mean serum concentrations of total protein, albumin, beta-globulin, gamma-globulin, fructosamine and creatine kinase were lower in the infected group than in the controls. The mean (+/-SE) number of acanthocephalans in the intestine of the infected ducklings was 21 (+/-4). The parasites were attached to the mucosa of the posterior small intestine of the infected ducklings with a mixed inflammatory reaction consisting of heterophils and mononuclear lymphocytes surrounding the attachment sites.