The Southeast Asian Journal of Tropical Medicine and Public Health
A BELIEF-BASED JUMP ROPE INTERVENTION TO PROMOTE LEISURE-TIME PHYSICAL ACTIVITY AMONG INACTIVE UNIVERSITY STUDENTS IN SOUTH KOREA: A PERCEPTION AND PROCESS EVALUATIONef-Based Jump Rope Intervention to Promote Leisure-Time Physical Activity among Inactive University Students: A Process and Outcome Evaluation
Despite persistently low levels of physical activity among university students following the COVID-19 pandemic, theory-driven interventions targeting inactive students remain limited. The study developed, implemented and evaluated a belief-based leisure-time physical activity promotion program for inactive university students. Inactive undergraduate students engaging in less than 150 minutes of physical activity per week were recruited from a South Korean university. A four-week jump rope intervention was implemented. Process evaluations, including reach, dose delivered, dose received, and fidelity, were assessed at the midpoint and the post-intervention stages. Group-by-time effects on leisure-time physical activity-related beliefs, intentions and behaviors were assessed using a generalized linear model with repeated measurements at four time points (pre-intervention, midpoint, post-intervention, and one-month follow-up). Significant changes in the intervention effects were observed for key leisure-time physical activity-related beliefs. Compared with the control group, physically inactive students with high intervention adherence demonstrated greater increases in perceived mental and physical health benefits from the post-intervention period through to the one-month follow-up. Improvements were also observed in the perceived “friends’ approval” and control beliefs related to exercise facilities and exercise partners, particularly at the midpoint assessment. These findings indicate that belief-based leisure-time physical activity interventions informed by empirically identified beliefs can effectively modify targeted beliefs among physically inactive university students. Future studies should determine whether sustained belief changes can translate into longer-term improvements in physical activity behavior.
Copyright (c) 2026 The Southeast Asian Journal of Tropical Medicine and Public Health
GLYCEMIC CONTROL AND BMI AMONG ETHNIC MINORITY OLDER ADULTS IN NORTHERN THAILAND: IMPACT OF HEALTH LITERACY AND SELF-MANAGEMENT
Type 2 diabetes mellitus imposes a disproportionate health burden on older adults of ethnic minorities in northern Thailand. These groups face a “double burden” of geographic isolation and language barrier, the latter stemming from the use of Thai in health information dissemination. The study aimed to examine the predictive relationships of health literacy (HL), diabetes distress and self-management behaviors with clinical outcomes (fasting blood sugar [FBS] and body mass index [BMI]). A cross-sectional predictive correlational study was conducted among 150 ethnic minority older adults recruited from five sub-district health-promoting hospitals in Chiang Rai Province, northern Thailand. Data were collected through face-to-face interviews using the Diabetes Self-Management Questionnaire (DSMQ) and Diabetes Distress Scale (DDS-17). Participants (66 ± 6 years of age) exhibited high vulnerability, namely 70% with no formal education and 58% obesity. Multiple linear regression models revealed that age (β = -0.296, p-value <0.001) and HL (β = -0.263, p-value = 0.001) are significant negative predictors of FBS; whereas self-management is a significant positive predictor of FBS (β = 0.169, p-value = 0.029), suggesting a “reactive management”. Age is the sole significant negative predictor of BMI (β = -0.166, p-value = 0.047). HL acted as a critical determinant of glycemic control, distinct from diabetes distress. The findings indicated that public health interventions should shift from text-based directives to visual, bilingual models to overcome any language barrier.
ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND SARCOPENIA AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA: A CROSS-SECTIONAL STUDY
Physical activity has been reported to be an effective method to reduce the risk of sarcopenia. In this cross-sectional study, we aimed to determine if there is a significant association between physical activity levels and the prevalence of sarcopenia among middle-aged and older adults in China in order to inform efforts to prevent and manage sarcopenia in the study population. The data used in our study were obtained retrospectively from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. The CHARLS assessed physical activity levels among study subjects using the International Physical Activity Questionnaire (IPAQ) asking about activity during the previous week, expressed as metabolic equivalents of task in minutes (MET-minutes) per week. Sarcopenia in our study was defined using the 2019 Asian Working Group for Sarcopenia (AWGS) criteria and classified as possible sarcopenia, sarcopenia and severe sarcopenia. Study subjects were divided into 3 groups based on their physical activity levels following IPAQ criteria as: low (<600 MET-min/week, reference group), moderate (600-3,000 MET-min/week) and high (>3,000 MET-min/week). We used multivariable logistic regression analysis and restricted cubic splines to identify significant associations between physical activity levels and sarcopenia. A total of 8,449 subjects were included in the study: 52.4% (n = 4,426) females. The mean (±standard deviation (SD)) age of study subjects was 66.1 (±8.6) years (range: 45–90 years). The mean (±SD) body mass index (BMI) of subjects was 23.56 (±3.70) kg/m². 1,855 subjects (22.0%) met the 2019 AWGS criteria for having possible sarcopenia and 1,346 (15.9%) met the criteria for sarcopenia and 605 (7.2%) met the criteria for severe sarcopenia. The median (interquartile range (IQR)) physical activity levels among subjects without sarcopenia, those having possible sarcopenia, sarcopenia and severe sarcopenia were: 2,562.00 (933.00-7,337.00), 1,782.00 (462.00-6,716.25), 2,032.50 (309.50-6,318.00) and 1,732.50 (462.00-5,544.00) MET-min/week, respectively. The median IQR among subjects without sarcopenia was statistically higher than among subjects in the other 3 groups (p-value <0.001). After adjusting for age, gender, marital status, location of residence, education level, body mass index, smoking status, alcohol consumption status and retirement status, subjects in the moderate and high physical activity level groups had significantly lower odds of having possible sarcopenia than subjects in the low physical activity group (moderate activity level versus (vs) low activity level: adjusted odds ratio (aOR): 0.791; 95% confidence interval (CI): 0.683-0.915, p-value = 0.002 and high activity level vs low activity level: aOR: 0.679; 95% CI: 0.594-0.776, p-value <0.001). Subjects in the high physical activity level had significantly lower odds of having sarcopenia than subjects in the low activity level group (aOR: 0.745; 95% CI: 0.584-0.950, p-value = 0.017). Subjects in the high physical activity level group had significantly lower odds of having severe sarcopenia than subjects in the low activity level group (aOR: 0.679; 95% CI: 0.499-0.923, p-value = 0.013). Restricted cubic spline analysis showed subjects in the high activity group had significantly lower odds of having possible sarcopenia by overall association than subjects in the low activity group (p-value <0.001) and subjects in the high activity group had significantly lower odds of having possible sarcopenia by nonlinear association than subjects in the low physical activity group (p-value = 0.001). However, subjects in the high activity group did not have significantly lower odds of sarcopenia than subjects in the low physical activity group by overall association or nonlinear association (p-value = 0.560). For severe sarcopenia, the overall association approached significance but was not significant (p-value = 0.054). When all sarcopenia categories were combined, on restricted cubic spline analysis, subjects with high activity levels had significantly lower odds of having any kind of sarcopenia than subjects in the low physical activity group for overall association (p-value <0.001) and nonlinear association (p-value = 0.002). Subgroup analysis revealed subjects who did not smoke and had a high activity level had lower odds of having possible sarcopenia than subjects with a high activity level who did smoke (aOR: 0.644; 95% CI: 0.553-0.750, p-value <0.001). Subgroup analysis also showed subjects who were not retired and who had a high physical activity level had lower odds of having possible sarcopenia than retired subjects who had a high physical activity level (aOR: 0.654; 95% CI: 0.566-0.756, p-value <0.001). No significant differences were found by sarcopenia category (p-value for interaction >0.05). In summary, subjects with higher physical activity levels had significantly lower odds of having possible sarcopenia, sarcopenia and severe sarcopenia than subjects with low physical activity levels. We conclude, moderate to high physical activity levels are recommended for subjects in the study group in order to prevent or manage sarcopenia. Further studies are needed to determine if interventions to increase physical activity are able to prevent or reduce sarcopenia in this population.
LEGIONELLA WATER SURVEILLANCE IN SOUTHEASTERN TURKIYE:A FIVE-YEAR EPIDEMIOLOGICAL EVALUATION
Legionella is a waterborne Gram-negative bacterium transmitted mainly through inhalation of contaminated aerosol from artificial water systems, such as those found in healthcare facilities and hotels. In this study we aimed to determine the prevalence and temporal trends of Legionella in hospitals and hotels in southeastern Türkiye in order to inform prevention strategies at these study sites. Water samples were collected from hot- and cold-water systems from study sites and sent for culture and filtration with acid treatment in order to detect Legionella spp from January 2019 to December 2023. Water samples were collected from faucets, shower heads, storage reservoirs, hot and cold-water tanks and were processed within 24 hours of collection. A total of 67 hospitals and 7 hotels were purposively selected for the study. A total of 7,112 water samples were collected and included in the study; 6,934 (97.4%) from hospitals and 178 (2.6%) from hotels. Of these, 624 samples (8.8%) were positive for Legionella spp; 596 (95.5%), from hospitals and 28 samples (4.5%) from hotels (p-value<0.001). The most common sites with positive specimens were from faucets (n = 327, 52.4%) and shower heads (n = 182, 29.2%). 430 samples (68.9%) were positive for serogroups 2-14 and 182 samples (29.2%) were positive for serogroup 1 (p-value<0.001). The mean bacterial concentration among positive study samples was relatively low (52 CFU/ml). The numbers of positive samples during the Spring, Summer, Winter and Autumn were 130 (20.8%), 205 (32.9%), 111 (17.8%) and 178 (28.5%) samples, respectively (p-value<0.001). In summary, Legionella contamination was widespread in healthcare water systems in Southeast Türkiye with the most common serogroups being L. pneumophila serogroups 2–14. Conclusion, there is a need for improved water management and continuous surveillance at the study sites to reduce the risk of contracting Legionella infection at the study institutions. After implementing these prevention measures further studies are needed to determine their efficacy.
REVIEW OF STREPTOMYCIN-ASSOCIATED OTOTOXICITY IN BRUCELLOSIS CASES
Brucellosis is a zoonotic infectious disease with a worldwide distribution and one of the challenges with its treatment is the risk of ototoxicity associated with aminoglycoside-containing regimens. In this study we aimed to review streptomycin-containing brucellosis treatment cases in order to determine the incidence of streptomycin-induced ototoxicity in the study population in order to inform treatment efforts. We conducted a single-center retrospective cohort study. Study subject inclusion criteria were being aged ≥18 years, having been diagnosed with brucellosis at the study institution during 10 January 2023-31 March 2024, having normal tympanic membranes on otoscopy, receiving a treatment regimen containing streptomycin and having undergone pure tone audiometry assessing air conduction at 500, 1000, 2000 and 4000 Hz. Hearing loss was classified as mild (26-40 dB), moderate (41-55 dB), moderately severe (56-70 dB), severe (71-90 dB) and profound (≥91 dB). Study subject exclusion criteria were pregnancy or lactation, chronic renal failure, receiving ongoing chemotherapy for a malignancy, use of known ototoxic medications (excluding nonsteroidal anti-inflammatory drugs) within the previous 3 months, having the presence of severe hearing loss at baseline prior to treatment and having missing data. A total of 70 subjects were included in our study, 60% (n = 42) females. The mean (±standard deviation (SD)) age of study subjects was 43 (±14) (range: 19-70) years. At baseline the number of subjects with hearing loss was 9 (13%); during treatment 7 (10%); 5 (71%), 1 (14%), 0 (0%), 1 (14%) and 0 (0%) had mild, moderate, moderately severe, severe and profound hearing loss, respectively; at completion 0 subjects (0%) had hearing loss. The mean (±SD) age of subjects who developed temporary high-frequency hearing loss during treatment was 57 (±4) years, significantly higher (p-value = 0.030) than the age of subjects without hearing loss, which was 43 (±2) years. In summary, among our study subjects, streptomycin-associated ototoxicity during standard brucellosis treatment was uncommon and reversible. However, older subjects were at greater risk of developing temporary but reversible ototoxicity. We conclude streptomycin is safe to use in brucellosis-treatment regimens in the study population. However, caution should be used in older adults and may warrant audiological testing during and at the end of treatment among older patients. Further testing is needed to determine at what age such testing may be considered.
ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVELS AND CARDIOMETABOLIC MULTIMORBIDITY IN CHINESE MIDDLE-AGED AND OLDER ADULTS
Physical activity has been reported to be an effective method to reduce the risk of cardiometabolic multimorbidity (CMM). In this prospective cohort study, we aimed to determine if there is a significant association between physical activity levels and the incidence of CMM among middle-aged and older adults in China in order to inform efforts to reduce CMM in the study population. CMM was defined as the concurrent presence of at least two of the following three diseases: heart disease, stroke, and diabetes, based on self-reported physician diagnoses. This study was based on data from the China Health and Retirement Longitudinal Study (CHARLS) conducted during 2015-2020. Study subjects were randomly selected using multistage stratified probability proportional sampling from 28 provinces across China. Inclusion criteria for study subjects were being aged ≥45 years at baseline (2015), having no history of stroke, diabetes or heart disease at baseline, completing all three waves of follow-up, and having complete data regarding physical activity and other study variables. Exclusion criteria for subjects were having CMM at baseline, incomplete follow-up data and missing key variables. Physical activity level was assessed using a standardized questionnaire asking about vigorous, moderate, and light activities during the previous week, expressed as metabolic equivalents of task in minutes (MET-minutes) per week. Study subjects were then equally divided into 4 groups based on their baseline total weekly MET-minutes as follows: Quartile (Q)1 (reference group) (<1,732.5 MET-min/week), Q2 (1,732.5-5,287.5 MET-min/week), Q3 (5,287.5-11,848.5 MET-min/week) and Q4 (≥11,848.5 MET-min/week). We used time-varying Cox proportional hazards regression analysis and restricted cubic splines to identify significant associations between physical activity levels and CMM incidence. A total of 4,516 subjects were included in the study (1,129 subjects in each quartile): 52.8% (n = 2,384) females. The mean (±standard deviation (SD)) age of study subjects was 57.3 (±8.9) years. The mean (±SD) body mass index of subjects was 23.8 (±3.7) kg/m². During the follow-up period, 151 subjects (3.3%) developed CMM. The mean (±SD) physical activity levels were 6,190.8 (±7,106.5) MET-min/week for the CMM group and 7,430.9 (±6,779.4) MET-min/week for the non-CMM group (p-value = 0.036). After adjusting for age, gender, marital status, residence, education, BMI, smoking, drinking, and retirement status, subjects in Q2, Q3, and Q4 had significantly lower hazard ratios (HR) (Q2: HR = 0.537; 95% confidence interval (CI): 0.351-0.821, p-value = 0.004; Q3: HR = 0.490; 95% CI: 0.313-0.767, p-value = 0.002; Q4: HR = 0.479; 95% CI: 0.282-0.814, p-value = 0.007) of developing CMM than subjects in Q1. Subgroup analyses revealed that the protective effects of physical activity were particularly pronounced among non-smokers (Q2: HR = 0.382; 95% CI: 0.230-0.634, p-value <0.001; Q3: HR = 0.475; 95% CI: 0.293-0.772, p-value = 0.003; Q4: HR = 0.522; 95% CI: 0.297-0.918, p-value = 0.024) with a significant interaction (p-value for interaction = 0.006). The protective effects of activity were also significantly greater among overweight and obese participants (Q2: HR = 0.568; 95% CI: 0.337-0.958, p-value = 0.034; Q3: HR = 0.319; 95% CI: 0.168-0.605, p-value <0.001; Q4: HR = 0.433; 95% CI: 0.215-0.869, p-value = 0.019). Restricted cubic spline analysis revealed a significant overall association between total physical activity and CMM risk (p-value for overall = 0.007), although the nonlinear association was not statistically significant (p-value for nonlinear = 0.210). In summary, subjects with higher levels of physical activity had significantly lower risk of developing CMM than subjects in the lowest activity quartile, and this protective effect was particularly evident among non-smokers and overweight and obese individuals. We conclude that higher physical activity levels are associated with reduced CMM risk among study subjects. Further studies are needed to determine if interventions to increase physical activity are able to prevent CMM in this population and to elucidate the mechanisms underlying the differential effects across subgroups.
ROLE OF DIGITAL MEDIA INFLUENCE ON CANCER AWARENESS AMONG UNIVERSITY STUDENTS IN SAUDI ARABIA: A CROSS-SECTIONAL STUDY
Cancer remains a major public health challenge in Saudi Arabia, and university students mainly rely on digital media for health information. Thus, the study evaluated cancer awareness among university students and examined the associations among the types of digital platforms used with their levels of cancer awareness. A cross-sectional study was conducted among 429 university students using a validated self-administered questionnaire to gather sociodemographic characteristics and digital media use for information on cancer. The majority of students reported social media as their primary source for cancer information, followed by online/AI-based platforms and videos. The overall cancer awareness was average, with a better awareness of treatment side-effects compared with other awareness categories. The students’ level of cancer awareness depended on their age, educational program enrolled, residence location (urban or rural), and type/frequency of digital media accessed, with students having a lower general cancer awareness level being more likely to depend on social media for information. These findings indicated that digital media, particularly social media, are significantly associated with the level of cancer awareness among university students. Strengthening trustworthy, youth-friendly cancer awareness online content will help raise cancer understanding among the young population and facilitate adherence to public policies and recommendations on cancer prevention and control.
READINESS FOR HOSPITAL DISCHARGE AND INFLUENCING FACTORS OF FAMILY CAREGIVERS OF PATIENTS WITH COGNITIVE IMPAIRMENT AFTER TRAUMATIC BRAIN INJURY: A CROSS-SECTIONAL SURVEY FROM WENZHOU, PR CHINA
Traumatic brain injury (TBI) creates substantial challenges for patients and their family caregivers, especially during hospital-to-home transition. Given the family caregivers’ primary role in post-discharge care in PR China, this cross-sectional study enrolled TBI patients and their respective family caregivers (n = 146 for each group) at a tertiary hospital in Wenzhou, Zhejiang to assess the caregivers’ readiness for patients’ discharge and identify predictors of preparedness via several validated questionnaires, namely Readiness for Hospital Discharge Scale (FAM-RHDS), General Self-Efficacy Scale (GSES), Family Needs Questionnaire - Revised (FNQ-R), and Quality of Life after Brain Injury (QOLIBRI). The results showed that 64% of caregivers had high readiness. Multiple regression analysis identified caregiver education level, self-efficacy and family needs, and patient’s age and quality of life as significant predictors, covering 74.6% of variance in discharge readiness. In conclusion, this study showed that a family caregiver readiness for the TBI patient’s hospital discharge was affected by both caregiver- and patient-related factors, highlighting the need for targeted interventions, such as personalized education programs and support services, to enhance caregivers’ readiness and optimize post-discharge outcomes for TBI patients.
EFFECT OF PLAN-DO-CHECK-ACT CYCLE ON CONTROLLING RISK OF MULTIDRUG-RESISTANT ORGANISM INFECTIONS AMONG PATIENTS IN INTENSIVE CARE UNIT, THE SECOND XIANGYA HOSPITAL, CENTRAL SOUTH UNIVERSITY, HUNAN, PR CHINA
Patients in the intensive care unit (ICU) are at a high risk of developing multidrug-resistant organism (MDRO) infections because of their critical condition, frequent invasive procedures and inappropriate use of broad-spectrum antibiotics. This study evaluated the effect of the Plan-Do-Check-Act (PDCA) cycle system on controlling the risk of MDRO infections in ICU patients. Patients who tested negative for bacterial infection upon hospital admission were randomly assigned to control and PDCA groups (n = 64 per group) for routine MDRO prevention and control measures (the former group) and routine measures together with the PDCA cycle-based management (the latter group) during their ICU stay. Patients’ MDRO infection rate, antimicrobial use density, ICU length of stay, total hospitalization stay and ICU MDRO contamination were significantly reduced in the PDCA group compared to the control (p-value <0.050). However, the 28-day mortality was not different between the two groups. In addition, nurses’ hand hygiene behavior was significantly improved in the PDCA group compared to the control (n = 30 per group). The results confirmed the utility of the PDCA cycle system for bacterial infection prevention and control in ICUs. However, its long-term benefits need to be determined through expanding the cohort size and extending the intervention duration.
FACTORS ASSOCIATED WITH COVID-19 OUTBREAK PREVENTION BEHAVIOR AMONG VILLAGE HEALTH VOLUNTEERS IN CHIANG RAI, THAILAND
Coronavirus disease 2019 (COVID-19) remains a public health concern in Thailand, posing significant risks to individuals with chronic illnesses and the elderly. To reduce the spread of COVID-19, village health volunteers (VHVs) play a vital role in preventing and controlling diseases at the community level. The cross-sectional study examined factors associated with COVID-19 prevention behavior among VHVs in Chiang Rai Province. Participants (n = 362) were selected using a two-stage cluster random sampling method, and data were collected between June and August 2022 using a structured questionnaire. The results showed that VHVs had a high level of COVID-19 prevention behavior, which was associated with knowledge of disease, perceived self-efficacy, work motivation, and social support. Female VHVs exhibited significantly better prevention behavior than males (p-value <0.05). To further maintain and reinforce VHVs’ COVID-19 prevention behavior, more training programs should be organized, and initiatives that foster self-efficacy, boost work motivation and offer ongoing social support should be implemented.
BUILT ENVIRONMENT BARRIERS AND FACILITATORS TO PHYSICAL ACTIVITY IN INDIAN CITIES: A SCOPING REVIEW
Extensive research in developed countries confirms the influence of the urban built environment (BE) on physical activity (PA), but similar studies in low- and middle-income countries, such as India, are limited. A scoping review was conducted through a systematic search of the Web of Science, Scopus and PubMed databases, as well as additional sources, to identify articles on BE, PA and BE influence on PA conducted in India up to June 2024. Twenty-seven articles were chosen based on PRISMA-ScR guidelines. Four themes across demographic groups and locations were classified, namely walking and cycling infrastructure, safety from traffic and crime, access to PA resources, and aesthetics and environmental quality, together with age- and gender-specific findings. Several research gaps were also identified, such as reliance on self-reported questionnaires, limited use of objective assessment tools, under-representation of specific demographic groups, and insufficient studies on diverse BE types and PA environments. The scoping review provided a comprehensive synthesis of barriers and facilitators of PA in Indian cities. The findings highlighted the need for context-specific and demographic-sensitive research to assist urban designers in understanding the impact of the built environment on residents’ physical activity.
IMPROVING THE DISASTER PREPAREDNESS AT THE COMMUNITY LEVEL: A SYSTEMATIC REVIEW
The Sendai Framework for Disaster Risk Reduction 2015 adopted “Build Back Better” which involves consideration of the community to be encouraged to use their effort and their resources to participate in disaster risk reduction. Resources devoted to community preparedness can often be minimal and the evaluation of such efforts is not systematic. This study aimed to perform a systematic review of articles that cover the interventions of community disaster preparedness. Articles involving the interventions used to improve disaster preparedness in the community which were published during 2000-2023 and appeared in the international electronic databases, namely PubMed, Science Direct, and Google Scholar, were reviewed. The study quality was assessed with the criteria adapted from the Joana Briggs Institute (JBI) Critical Appraisal Tool. Of 705 publications initially identified, 10 studies (five randomized control trials, three community-engaged research, and two quasi-experimental research design) were eligible to be included in the review. The combination of discussions and disaster drill were the most studied of the interventions, and were therefore the most effective community preparedness intervention. By systematically exploring the type of intervention for disaster preparedness, this systematic review gives essential information to develop an intervention to improve community involvement for disaster risk reduction.
Alfi Nurfita Chasanah Alfi Nurfita Chasanah
Copyright (c) 2023 The Southeast Asian Journal of Tropical Medicine and Public Health
HEAT-RELATED ILLNESS PREVENTION BEHAVIORS AMONG OLDER ADULTS IN SOUTHERN THAILAND: DETERMINANTS BASED ON HEALTH BELIEF MODEL
Global warming poses a major health threat, particularly through heat-related illnesses among vulnerable populations. A cross-sectional analytical study was used to analyze the determinants of heat-related illness (HRI) prevention behaviors among older adults in southern Thailand to assist effective interventions for reducing heat-related morbidity and mortality. A multistage cluster sampling was used to recruit functioning older adults (n = 280, Barthel ADL Index ≥12) residing in five provinces with the highest average temperatures in southern Thailand, namely Krabi, Nakhon Si Thammarat, Phuket, Songkhla, and Surat Thani. Data were collected between June and October using a structured questionnaire based on the Health Belief Model framework. Results revealed that income, perceived susceptibility, perceived severity, perceived benefits, perceived self-efficacy, and cues to action were positively correlated with HRI prevention behavior (p-value <0.01), whereas age and perceived barriers were negatively correlated (r = -0.13 and -0.25, respectively). Among 13 variables entered into a regression model, perceived self-efficacy, cues to action and perceived benefits were significantly associated with HRI prevention behaviors (p-value <0.001), explaining 47% of the variance. Cues to action emerged as the strongest predictor. These findings underscored the crucial role of psychological and motivational factors in shaping heat protection behaviors among older adults in high-temperature regions. Strengthening self-efficacy, enhancing awareness of benefits and promoting cues to action can guide the development of targeted heat illness prevention programs to protect vulnerable older adult populations from escalating heat-related health risks in southern Thailand.
NUTRITIONAL AWARENESS, BEHAVIORS AND BARRIERS RELATED TO SUSTAINABLE HEALTHY DIET AMONG COMMUNITY DWELLING OLDER ADULTS: A CROSS-SECTIONAL STUDY
As the global population ages, promoting healthy, sustainable diets for older adults is vital to prevent age-related diseases and enhance well-being. This study aimed to assess nutritional awareness, sustainable eating behaviors, and barriers among older adults in primary health care centers (PHCCs) in Abha, Saudi Arabia. Community-dwelling adults aged ≥60 years were included in the study. Data was collected using the Nutritional Awareness Scale (NAS), Sustainable Healthy Eating Behaviors Scale (SHEBS), demographics, lifestyle factors, and barriers to sustainable healthy eating. Among participants, 53.5% demonstrated high NAS and 53.8% high SHEBS, with a strong positive correlation (r = 0.641, p < 0.001). Higher NAS was significantly predicted by younger age (p < 0.001), urban residence (p = 0.034), sufficient income (p < 0.001), and physical exercise (p < 0.001), while married status (p < 0.001), chronic illness (p = 0.002), and ordinary diet (p < 0.001) were negative predictors. For SHEB, significant positive predictors included sufficient income (p = 0.029) and physical exercise (p < 0.001), while married status (p < 0.001) and inadequate sleep (p < 0.001) were negative predictors. Although many older adults report high nutritional awareness, barriers still hinder sustainable healthy eating. These findings underscore the importance of targeted public health initiatives enhancing access to affordable, sustainable, and healthy food, thereby promoting healthy aging. Keywords aging, nutrition, health promotion, older people, sustainability
ASSESSMENT OF HEALTH PROFESSIONALS’ PERCEPTIONS OF MEDICAL ERRORS IN PRIMARY CARE SETTINGS: A CROSS- SECTIONAL STUDY FROM ABHA, SAUDI ARABIA
Understanding perceptions and practices of medical errors in primary healthcare facilities is essential for enhancing patients’ safety and fostering a culture of transparency. A descriptive cross-sectional study was conducted regarding frontline healthcare professionals’ perceptions of the identification, reporting and outcome of medical errors within diverse clinical settings. The survey was carried out in Abha health sector, Asir region, Saudi Arabia. Respondents (n = 223) were mainly physicians, nurses and clinical laboratory technicians. Significant associations were observed between biological gender and profession, as well as perceptions of medical errors (p-value <0.05). Female responders were mainly nurses, while male responders were physicians and technicians. Males perceived medical errors as being underreported and reporting procedures unclear and time-consuming, while females perceived a lower frequency of medical errors and less uncertainty about the reporting procedures. Stratification of perceptions of medical errors according to years of work experience revealed, interestingly, no significant differences, but stratification according to sociodemographic parameters showed low perception rating among female respondents and respondents working in rural regions. The findings highlighted the importance of designing target-based interventions in reducing medical errors and impediments to the reporting process.
CHEMICAL COMPOSITIONS AND ANTIBACTERIAL ACTIVITIES OF ESSENTIAL OILS FROM AQUILARIA AGALLOCHA, ARTEMISIA ABSINTHIUM,HYSSOPUS OFFICINALIS, AND MENTHA PULEGIUM
The study evaluated the chemical composition and antibacterial activity of essential oils from Aquilaria agallocha, Artemisia absinthium, Hyssopus officinalis, and Mentha pulegium. Gas chromatography/gas chromatography mass spectrometry (GC/GC-MS) was used to analyze the essential oils’ volatile components; their antibacterial activity against multidrug-resistant clinical bacterial isolates was assessed using a disk diffusion susceptibility assay together with the determination of minimum inhibitory concentration (MIC). The major volatile chemical compound of Aq. agallocha, Ar. absinthium, H. officinalis, and M. pulegium oils were dimethyl ester dodecanedioic acid (19.65%), β-caryophyllene (18.51%), camphor (14.2%), and pulegone (58.5%), respectively. All essential oils had varying bactericidal activity against the test isolates of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes, but not Pseudomonas aeruginosa. The essential oil with the overall highest antibacterial activity was that of M. pulegium, followed by H. officinalis, Aq. agallocha and Ar. absinthium. The findings confirm that medicinal plant essential oils can play a role as an alternative treatment option against current clinical multidrug-resistant microorganisms.
Copyright (c) 2025 The Southeast Asian Journal of Tropical Medicine and Public Health
EPIDEMIOLOGY OF SCHISTOSOMA HAEMATOBIUM INFECTION AMONG SCHOOLCHILDREN IN NORTHERN SUDAN
Schistosomiasis is a major public health problem in endemic regions, particularly among school-aged children exposed to contaminated freshwater. In this study, we aimed to determine the prevalence of and sociodemographic factors associated with Schistosoma haematobium infection among primary school students in Alhafeer, Northern State, Sudan in order to inform efforts to control S. haematobium infection in the study population. Study subjects were randomly selected from 4 randomly selected study schools in the study area. Inclusion criteria for study subjects were being aged 7-14 years, attending a study school during the study period and being willing to participate in the study. Exclusion criteria for study subjects were not meeting inclusion criteria, failing to complete the study questionnaire or failing to provide the required study sample. The minimum number of subjects determined to be needed for the study was 365. Each subject was asked to complete the study questionnaire asking about demographics, paternal education and occupation, contact with bodies of water, toileting habits and the presence of a toilet at home. Each subject was also asked to provide a urine sample for microscopy to detect S. haematobium. All subjects positive for S. haematobium infection were treated. Chi-square and multivariate logistic regression analysis were used to determine associations between positive cases and selected independent variables, with statistical significance set at p-value ≤0.05. A total of 463 subjects were included in the study, 52.6% (n = 244) males. 202 subjects (43.6%) tested positive for S. haematobium infection. Of the subjects who tested positive, 135 (66.8%) were male. 109 subjects aged 7-10 years (54.0%) and 93 subjects aged 11-14 years (33.5%) tested positive for S. haematobium infection. 235 subjects (50.8%) swam in the canal and of these 135 (57.0%) tested positive for S. haematobium infection. 176 subjects (38.0%) urinated in the canal and among these 94 (53.4%) tested positive for S. haematobium infection. 130 subjects (28.1%) did not have a toilet in the house and among these 115 (88.5%) tested positive for S. haematobium infection. 333 subjects (71.9%) did have a toilet in the house and among these 87 (26.1%) tested positive for S. haematobium infection. The factors significantly associated with S. haematobium infection on the Chi-square test were swimming in the canal (p<0.0001), urinating in the canal (p<0.0001) and not having a toilet in the house (p<0.0001). The factors significantly positively associated with S. haematobium infection on multivariate logistic regression analysis were male gender (adjusted odds ratio (aOR) = 2.78; 95% confidence interval (CI): 1.90-4.06, p=0.0001) and a paternal education level of university level (aOR = 2.75; 95%CI: 1.40-5.40, p=0.010). In summary, the prevalence of S. haematobium infection among study subjects was high and more common among swimming in the canal, urinating in the canal, not having a toilet in the house, being a male and having a father with a university level education. We conclude, efforts to control S. haematobium infection should focus on preventing swimming and urinating in the canal, having a toilet in the house and should target males and those with a father with a university level education. Further studies are needed to determine what types of programs are needed to make these changes and reduce the proportion of subjects with S. haematobium infection in the study population.
SHORT REPORT ANTIMICROBIAL EFFICACY OF PULPOTOMY MATERIALS AGAINST CARIOGENIC BACTERIA: AN IN VITRO COMPARATIVE STUDY
The presence of cariogenic bacteria adversely affects pulp therapy outcome by directly influencing the healing process and long-term prognosis of treated teeth. This study compared the antimicrobial efficacy of five commonly used pulp therapy materials, namely formocresol (FC), NeoMTA®, NeoPUTTY™, ProRoot® MTA, and zinc oxide-eugenol (ZOE), against four cariogenic bacteria, Actinomyces viscosus, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Streptococcus mutans. All five materials exhibited antibacterial activity against the test bacteria. FC demonstrated the most potent bactericidal property, particularly against L. acidophilus and S. mutans, followed by ZOE, then the mineral trioxide aggregate (MTA)-based materials. However, other properties, such as bioactivity and biocompatibility, must also be considered before recommending the use of these materials in pulpotomy.
PSYCHOMETRIC PROPERTIES TESTING OF PARENT MEDIA ADDICTION AND PARENT MEDIA DEPENDENCY TOOLS IN BAHASA MALAYSIA
The rapid integration of screen-based media into daily life has altered parent-child interactions, raising concerns about its impact on early childhood development. To measure parent media addiction and dependency, two English-language instruments, namely the ‘Parent Problematic Digital Technology Use Scale’ and the ‘Media and Technology Usage and Attitudes Scale’ were translated to Bahasa Malaysia and cross-culturally adapted in this study. A cross-sectional study was conducted in a district of Selangor, Malaysia, among parents and caretakers with normal children 18 and 36 months of age to test the Bahasa Malaysia version of instruments’ content validity, internal consistency, and floor ceiling effect involving 100 participants and test-retest reliability involving 60 participants. The Cronbach’s Alpha value of 0.734 was reported for ‘Parent Problematic Digital Technology Use Scale’ and 0.839 for the Media and Technology Usage and Attitudes Scale. The items in the scales correlate adequately in the construct and lack of discriminant validity was reported to be unlikely. Thus, the Bahasa Malaysia scales provide an effective method for measuring parent media addiction and dependency, crucial factors in understanding the impact of smartphone and online use on parent-child interaction. This validated instrument should enable further exploration into the role of digital technology on parent behavior and its influence on early child development, and may guide programs and policies fostering healthier media habits in Malaysian families.
EFFECT OF RENAL DIALYSIS DURATION ON PATIENT PHYSICAL PERFORMANCE AND BLOOD METABOLITES
Maintenance hemodialysis (MHD) is a common method for preventing complications of end-stage renal disease (ESRD) and physical performance serves as an important indicator of patient health. In this cross-sectional study, we aimed to determine what the effects of extended hemodialysis (HD) sessions and long-term MHD had on subject physical performance and laboratory testing in order to determine what was the best length of a HD session that could optimize subject physical performance and laboratory tests and identify possible problems associated with the length of HD sessions. Study subjects were chosen randomly from 7 HD centers in Shanghai, People’s Republic of China during July 2020-March 2023. The minimum number of subjects determined to be needed for the study was 350. Inclusion criteria for study subjects were being aged ≥40 years, undergoing maintenance hemodialysis for ≥3 months and giving consent to be included in the study. Exclusion criteria for study subjects were being unwilling to participate in the study, not completing the required questionnaire, physical performance assessment or laboratory testing or having a serious health condition that could interfere with the physical performance assessment or blood tests. Subjects were categorized based on duration of each dialysis session into a conventional group (duration of each HD session of ≤4 hours or having ≤3 HD sessions per week) and extended group (duration of each HD session of >4 hours or having >3 HD sessions per week). Subjects were also classified by total length of time they had been undergoing MHD into a short-term group (total duration of ≤12 months) and a long-term group (total duration of >12 months). Each subject completed a questionnaire asking their age, gender, education level, alcohol consumption level and smoking status. The following physical performance tests were performed in each subject: grip strength categorized into low (males <28 kg and females <18 kg) and normal (males ≥28 kg and females ≥18 kg), a 4-meter walk test categorized into slow speed (<1.0 m/s) and normal speed (≥1.0 m/s), a knee-extension strength test categorized into weak (males <0.5×their body weight and females <0.4×their body weight) and normal (male ≥0.5×their body weight, female ≥0.4×their body weight). Subject heights and weights were checked and the body mass index (BMI) of each subject was calculated as weight in kilograms divided by height in meters squared (kg/m²). The following laboratory tests were performed on each subject: total cholesterol (TC) (normal: ≤5.2 g), triglycerides (TG) (normal: ≤1.7 mmol/l ), high-density lipoprotein-cholesterol (HDL-C) (normal:<1.04 mmol/l), low-density lipoprotein-cholesterol (LDL-C) (normal:<3.12 mmol/l), hemoglobin (HGB) (normal: 120-160 g/l for males and 110-150 g/l for females), serum albumin (ALB) (normal: 35-55 g/l) and β2-microglobulin (β2-MG) (normal: 1.28-1.95 mg/l). Statistical analyses were performed using non-parametric tests and subgroup comparisons were made. A total of 875 subjects were included in the study, 586 (67%) males. The mean (±standard deviation) age of subjects was 59 (±13) (range: 40-80) years. Of these, 512 (58.5%) were in the conventional group for duration of each dialysis session and 363 (41.5%) were in the extended group for duration of each dialysis session. Subjects in the extended group compared to the conventional group had significantly lower (p-value <0.010) (both males and females) mean grip strength (24.3 kg vs 19.4 kg), significantly lower (p-value = 0.010) overall knee extension strength (21.5 kg vs 17.0 kg), significantly lower (p-value <0.010) overall 4-meter walk speeds (1.0 m/s vs 0.7 m/s), significantly lower (p-value = 0.014) overall TG levels (2.4 mmol/l vs 1.7 mmol/l) and significantly lower (p-value <0.010) overall β2-MG levels (35.1 mg/l vs 20.5 mg/l), respectively. Subjects in the long-term treatment group compared to subjects in the short-term group had a significantly lower (p-value <0.010) overall mean grip strength (25.0 kg vs 23.8 kg), a significantly lower (p-value = 0.004) overall mean knee extension strength (21.4 kg vs 21.3 kg), a significantly lower (p-value <0.010) overall mean BMI (23.9 vs 20.2) and a significantly lower (p-value <0.05) overall mean β2-MG level (35.8 mg/l vs 28.1 mg/l). In summary, in our study population, subjects with extended HD sessions and long-term MHD both had significantly lower grip strength, knee extension strength, 4-meter walk speeds and TG and β2-MG levels and subjects with long-term MHD had significantly lower BMIs. We conclude having extended HD sessions and long term MHD resulted in poorer performance and malnutrition showing conventional HD sessions are preferred over extended HD sessions. Subjects having extended HD and with long term MHD need to have strength and nutritional assessments and possibly counseling to prevent or manage problems in these areas. Further studies are needed to determine what methods should be employed to improve and prevent deterioration in physical performance and nutrition.
EVALUATION OF ASSOCIATIONS BETWEEN DIET AND GASTROINTESTINAL DISORDERS IN SAUDI ARABIA
Gastrointestinal (GI) disorders are a public health problem in Saudi Arabia and diet may influence these conditions. In this study we aimed to evaluate associations between diet and GI disorders among Saudi adults in order to inform efforts to control and prevent these conditions. Study subjects were recruited from the Aseer Region, Saudi Arabi using online surveys distributed via social media platforms and institutional mailing lists of King Khalid University. Inclusion criteria for study subjects were: being aged ≥18 years, living in the Aseer Region, being willing and giving consent to participate in the study. Exclusion criteria for study subjects were: being unwilling to participate in the study, not completing the required questionnaire and having a serious health condition that could confound the dietary assessment. The minimum number of study subjects calculated to be needed for the study was 423. Each subject was asked to complete a self-administered questionnaire that was previously validated, adapted and pilot tested among 20 residents from the study area who met inclusion and exclusion criteria for study subjects. This cross-sectional study was conducted during January-June 2025. The questionnaire asked about consumption of fruits, vegetables, grains, dairy products, proteins/meats, sugary foods, fats and fast food. It also asked about physical activity level, smoking status, weight and height. A body mass index (BMI) was calculated from the weight and height. Dietary intake of each of the recorded items was classified as never, low (1-2 times/week), moderate (3-6 times/week) and high (≥7 times/week) following Food and Agricultural Organization (FAO), World Health Organization (WHO) guidelines. Consumption of sugary items, fats and fast food were categorized into low/healthy, moderate and high/unhealthy consumption. Physical activity was categorized as low, moderate, or high following WHO recommendations, with thresholds based on weekly minutes of moderate and vigorous activity. BMI was categorized as underweight (<18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30.0 kg/m²). Subjects were asked if they had been diagnosed with any of the following gastrointestinal (GI) disorders: constipation, functional dyspepsia, gastritis, gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD Crohn’s or ulcerative colitis), irritable bowel syndrome (IBS), and peptic ulcer disease (PUD). Associations between diet and these specific GI disorders were assessed using multivariable logistic regression analysis and reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). A total of 430 subjects were included in the study, 256 (59.5%) females. The mean (±standard deviation) age of study subjects was 36.9 (±10.8) (range: 18-65) years. Twenty-seven subjects (6.3%) never consumed fruit. 328 (76.3%), 58 (13.5%) and 17 (3.9%) had low, moderate and high fruit intake, respectively. 15 (3.5%) never consumed vegetables. 272 (63.3%), 99 (23.0%) and 44 (10.2%) had low, moderate and high vegetable intake, respectively. Three subjects (0.7%) never consumed grains. Eighty (18.6%), 191 (44.4%) and 156 (36.3%) had low, moderate and high grain intake, respectively. Nine subjects (2.1%) never consumed protein/meat. 132 (30.7%), 188 (43.7%) and 101 (23.5%) had low, moderate and high protein/meat intake, respectively. Nine subjects (2.1%) never consumed dairy products. 262 (60.9%), 121 (28.2%) and 38 (8.8%) had low, moderate and high dairy intake, respectively. Fifteen subjects (3.5%) never consumed sugary foods. 222 (51.7%), 127 (29.5%) and 66 (15.3%) had low, moderate and high sugary food intake, respectively. Eight subjects (1.9%) never consumed fat. 234 (54.4%), 138 (32.1%) and 50 (11.6%) consumed low, moderate and high fat intake; thirty-two subjects (7.4%) never consumed fast-food. 309 (71.9%), 81 (18.8%) and 8 (1.9%) had low, moderate and high fast-food intake, respectively. 117 subjects (27.2%) reported having been diagnosed with a GI disorder: 12 (2.8%) had constipation, 9 (2.1%) had functional dyspepsia, 55 (12.8%) had gastritis, 17 (4.0%) had GERD, 1 (0.2%) had IBD, 18 (4.2%) had IBS and 5 (1.2%) had PUD. Subjects with low fruit intake were significantly more likely to have a GI disorder than those on a moderate to high fruit diet (aOR = 0.685, 95%CI: 0.497-0.945, p-value = 0.021). Females were significantly less likely than males to have a GI disorder (aOR = 0.490; 95%CI: 0.273-0.878, p-value = 0.017). Insummary, subjects with a low fruit diet were significantly more likely to have a GI disorder and females were significantly less likely to have a GI disorder. We conclude, subjects with a low fruit diet and males in the study population should be encouraged to consume more fruit. Further studies are needed to determine if people with a low fruit diet and males consume more fruit if this will reduce the chance of developing a GI disorder.
PREVALENCE AND DETERMINANTS OF INTERNET GAME ADDICTION AND PSYCHOLOGICAL EFFECTS AMONG MALE STUDENTS IN HEALTH SCIENCE PROGRAMS AT JAZAN UNIVERSITY, SAUDI ARABIA
The internet has become a common means of communication, education, research, business, entertainment, and games. An excessive use of the latter has led to a disorder termed Internet Gaming Addiction (IGA). A cross-sectional study assessed the prevalence of IGA based on the Internet Gaming Disorder-20 test among male health science students (n = 486), 18-35 years of age, enrolled at Jazan University, Saudi Arabia, in 2023. Data were collected via a Google Form of a validated Arabic version of a close-ended self-answered questionnaire on the students’ sociodemographic background, academic discipline and performance, mental health, lifestyle, and recreational activity. Using univariate statistics followed by multiple logistic regression modeling, two independent risk factors were identified associated with IGA, namely, prior psychological diagnosis and internet gaming as a recreational activity. The study findings should prompt educators, health providers and administrators at colleges and universities in Saudi Arabia to implement educational programs promoting responsible gaming behavior.
ASSESSING THE HEALTH AND NUTRITION OF CHILDREN FROM LOW-INCOME HOUSEHOLDS IN RURAL PANDEGELANG, BANTEN, INDONESIA
Undernutrition is linked to food insecurity, which is brought on by low income, restricted access to wholesome food, low educational attainment, and poor hygiene habits, all of which contribute to the development of disease. To address undernourishment among children under five, this study aimed to evaluate the prevalence of undernutrition in children from low-income households and provide appropriate handling. Pandeglang District was selected as the study area due to its high rate of province undernourished children. Information was gathered on the children’s anthropometry, general characteristics, household socioeconomics, and 24-hour recall of food consumption. The results revealed that among the 105 children assessed, 40% were stunted, 23.8% were underweight, and 4.8% were experiencing wasting, indicating a notably high level of undernutrition. These figures place Pandeglang as the district with the highest undernutrition rates in the region, exceeding both the provincial and national averages reported in 2018. According to WHO standards, the area falls under the medium category for underweight and high category for both stunting and wasting. Dietary intake analysis using the Calculator of Inadequate Micronutrient Intake (CIMI) showed that only 55.2% of the children met energy requirements, while 50.5% and 53.3% met the needs for iron and zinc respectively. Alarmingly, nearly all (98.1%) had insufficient intake of vitamin A. This indicates that micronutrient deficiencies are a significant issue. It may have an impact on kids’ development and health. To address this problem, better diets, supplementation, and nutrition education are required.
IMPACT OF THE INNOVATIVE CARE FOR CHRONIC CONDITIONS PROGRAM ON BLOOD SUGAR, BLOOD PRESSURE, LIPID LEVELS, MEDICATION COMPLIANCE AND MENTAL HEALTH AMONG ELDERLY CHINESE WITH HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Hypertension (HT) and type 2 diabetes mellitus (DM) affect the morbidity and mortality of elderly Chinese. In this study, we aimed to determine the efficacy of the Innovative Care for Chronic Conditions (ICCC) program for improving blood sugar levels, blood pressure levels, lipid levels, medication compliance and mental health among elderly Chinese with HT and DM in order to inform efforts to reduce morbidity and mortality caused by these conditions in the study population. The ICCC program, administered along with standard pharmacotherapy in the study population (valsartan and metformin), consists of a 6-month program of a supervised low-salt/fat diet, a regular exercise program, daily self-monitoring of blood pressure and blood sugar and psychological support. The minimum number of subjects calculated to be needed for the study was 322. Study subjects were recruited from patients with HT and DM admitted to Nanjing First Hospital, China during April 2021-January 2025. Inclusion criteria for study subjects were: 1) being aged ≥65 years, 2) having diagnoses of HT and DM, 3) living in the study area for at least 6 months, and 4) giving written informed consent to participate in the study. Exclusion criteria for study subjects were: 1) having severe cardiac, hepatic or renal disease, 2) having a malignant neoplasm, a mental health condition or an active peptic ulcer, 3) being allergic to or intolerant of valsartan and/or metformin, 4) having undergone major surgery in the previous 3 months or 5) having had a serious infection in the previous 3 months. All patients received standardized pharmacotherapy (valsartan 80-160 mg/day and metformin 1500 mg/day), which is standard pharmacological treatment in this study population. Subjects were randomly assigned to either the usual treatment (control) group (n = 161) or the ICCC group (n = 161). The following were conducted both prior to and after the intervention: blood tests consisting of a fasting blood glucose (FBG) level and lipid profile (consisting of a total cholesterol (TC) level, triglyceride (TG) level, a low density lipoprotein cholesterol (LDL-C) level and a high density lipoprotein cholesterol (HDL-C) level), a blood pressure (BP), a medication compliance assessment (using the Medication Adherence Report Scale (MARS-5) where good compliance was given a score of 5, moderate compliance a score of 3-4 and poor compliance a score of ≤2), a mental health assessment (using the Self-related Anxiety Scale (SAS) and the Self-related Depression Scale (SDS), where the higher the SAS/SDS score the more severe the anxiety/depression) and being asked about treatment adverse reactions with each adverse reaction being counted separately when more than one was present). A total of 322 subjects were included in the study: 161 in the ICCC (n = 104, 64.6% males) and 161 in the control (n = 97, 60.2% males) group. The mean (±standard deviation (SD)) ages of study subjects in the ICCC and Control groups were 69 (±3) (range: 65-76) and 69 (±3) (range: 65-74) years, respectively. Among the ICCC and Control groups after the intervention, the mean (±SD) FPG results were 7.0 (±0.8) and 7.6 (±0.96) mmol/l (p<0.05), the mean (±SD) HbA1c results were 7.1 (±0.6%) and 7.5 (±0.9%) (p<0.05), the mean (±SD) TC levels were 4.6 (±0.6) and 5.0 (±0.7) mmol/l (p<0.05), the mean (±SD) TG levels were 1.5 (±0.4) and 1.6 (±0.3) mmol/l (p<0.05), the mean (±SD) LDL-C levels were 3.0 (±0.7) and 3.6 (±0.8) mmol/l (p<0.05), the mean (±SD) HDL-C levels were 1.3 (±0.2) and 1.1 (±0.2) mmol/l (p<0.05), the mean (±SD) SBP levels were 125.1 (±14.7) and 137.1 (±10.9) mmHg (p<0.001), the mean (±SD) DBP levels were 77 (±9) and 81 (±7) mmHg (p<0.001), the mean (±SD) SAS scores were 25.8 (±4.2) and 30.9 (±5.2) (p<0.001), the mean (±SD) SDS scores were 24.8 (±4.9) and 28.3 (±4.4) (p<0.001), the incidence of adverse reactions were 9.3% and 17.4% (p=0.033), the proportions of subjects with good blood pressure control were 78.9% and 50.3% (p<0.001) and the proportions of subjects with good treatment compliance were 88.2% and 79.5% (p<0.05), respectively. In summary, the ICCC program was significantly more effective than the usual treatment for lowering blood sugar, lowering blood lipids, lowering blood pressure, improving SAS and SDS scores, improving medication compliance and reducing adverse reactions. We conclude the ICCC program should be considered for use in the study population to improve outcomes. Further studies are needed to determine if the results of this study can be applied to other populations in China and if the financial benefits of the ICCC program outweigh the additional costs of the program.
LIFESTYLE, DIETARY HABITS AND PREVALENCE OF OBESITY AMONG FEMALE OFFICE EMPLOYEES AT QASSIM UNIVERSITY, SAUDI ARABIA
The prevalence of overweight and obesity in human societies is associated with many chronic syndromes, such as heart disease, high blood pressure and diabetes. The prevalence of obesity is 33.7% in the Kingdom of Saudi Arabia. A cross-sectional study was conducted on a cohort of randomly selected 132 female office employees at Qassim University, excluding pregnant women and breastfeeding mothers. The study aimed to identify dietary habits and lifestyle associated with obesity using a questionnaire and personal interviews. The majority of participants also attended a lecture on food educational program, and after one month, were assessed on the outcomes of their dietary habits, lifestyle and body physical parameters. The prevalence of overweight and obesity was 38 and 45% respectively. Lunch was the main meal, but nearly half of the participants neglected breakfast; the majority did not consume sugary juices; and ate while watching television or a mobile device, and also when upset or depressed. Slightly over half of the female office employees regularly conducted physical exercise, 1-2 times a week for two hours or less. Daily nutrient intake of energy, protein, carbohydrates, and vitamins was within the recommended allowances, but below the accepted range for fiber, unsaturated fat, vitamins B3, B6, C, and D, and the essential chemical elements, while that of sugar was higher. Attendance of the lecture resulted in only minor changes in the participants’ dietary habits and lifestyle: attention to reducing calorie intake and taking more exercise. On average, there is a significant decrease in waist circumference and total body water mass, an increase in the body percent fat mass, but no change in body mass index. In conclusion, the study highlights the need for more awareness of the high prevalence of overweight/obesity among Saudi female office employees and for a better knowledge of ways to maintain a healthy weight and avoid the overweight/obesity-related health risks.
INFLUENCE OF MUROTTAL QS AL FATIHAH THERAPY ON STRESS AMONG OLDER PEOPLE IN UPT PSTW KHUSNUL KHOTIMAH, RIAU, INDONESIA
Stress is a problem that is often experienced by the older people. QS Al-Fatihah murottal therapy is an effective complementary therapy to overcome the psychosocial problems. This study aimed to determine the effect of QS Al-Fatihah murottal therapy on the stress of the older people at UPT PSTW Khusnul Khotimah, Riau, Indonesia. The study design was quasi-experimental with a pre- and post-test and a control group. QS Al-Fatihah murottal therapy intervention was provided twice a week for two weeks with 30-45 minutes for each session to a group of participants. Participants were recruited by the consecutive sampling technique, and a total number 36 older people participated. The instrument used for identifying respondent characteristic data was a characteristics questionnaire and that for evaluating the stress conditions of respondents was the DASS 42. Data analysis used were the dependent and independent t-tests. The results showed that most of the respondents were 60-74 years of age (63.9%), being female (55.5%), of Malay ethnicity (38.8%), had completed primary school (63.8%), were unemployed (100%), and had non-communicable disease (100%). The effects of QS Al-Fatihah murottal therapy were positive on reducing stress (p-value <0.001). This study recommends QS Al-Fatihah murottal therapy as a complementary therapy that nurses do for the older people with a psychoreligious approach.
ASSESSMENT OF THE PREVALENCE AND MANAGEMENT OF ELDERLY PATIENTS WITH TYPE 2 DIABETES MELLITUS AND MULTIMORBIDITIES AT PRIMARY LEVEL CARE INSTITUTIONS IN THAILAND
It is important to correctly manage elderly patient with type 2 diabetes mellitus (T2DM) with multimorbidity to prevent an increase in morbidity and mortality. This study had two parts. In Part 1 we aimed to determine the prevalence of multimorbidity among elderly T2DM patients in Thailand and in Part 2 we aimed to assess the management of elderly T2DM patients in Thailand at primary level care (PLC) institutions in order to inform strategies to reduce morbidity and mortality in the study population. Inclusion criteria for subjects in both study parts were being aged ≥60 years and having T2DM. Subjects in both study parts having incomplete or inaccurate medical records or having only one visit for T2DM were excluded from the study. The data used for Part 1 of this study were population health data obtained from the Ministry of Public Health, Health Data Center (HDC) for the year 2019. The data used for Part 2 of this study were obtained from the medical records of the study subjects at 4 purposively selected PLC district hospitals. The care given at these 4 hospitals was compared with the Thailand’s 2017 Clinical Practice Guidelines for Diabetes. 529,277 subjects were included in Part 1 of the study, 348,376 (65.82%) females. The mean (±standard deviation (SD)) age of study subjects was 70.0 (±8.8) years. 377,630 subjects (71.35%) had multimorbidity. Of the subjects in Part 1, among patients who received care at all PLC institutions, 157,951 (71.72%) had ≥1 comorbid condition in addition to their T2DM. 6,460 subjects were included in Part 2 of the study, 4,171 (64.57%) females. The mean (±SD) age of subjects was 70.0 (±7.6) years. Of the subjects in Part 2, 6,112 (94.61%) had ≥1 comorbid condition. The most common comorbid conditions were hypertension (n = 5,045, 78.10%), dyslipidemia (n = 3,125, 48.37% and renal insufficiency (n = 2,684, 41.55%). Among subjects with multimorbidity at the 4 study institutions, from 648 of 1,090 (59.45%) to 867 of 1,054 (82.26%) subjects had yearly HbA1c testing following the recommendations in the 2017 Clinical Practice Guidelines for Diabetes and from 97 of 1,090 (14.97%) to 256 of 1,126 (27.71%) subjects achieved the HbA1c target of ≤7.0% following the recommendations in the 2017 Clinical Practice Guidelines for Diabetes. In summary, in our study population, the proportion of subjects with multimorbidity was relatively high and much of the care at the PLC study institutions did not meet recommended guidelines. We conclude there is a need to improve the care of elderly patients with T2DM at the study institutions. Further studies are needed to determine what factors caused the failure to reach care guidelines in the study population at the study PLC institutions and how to improve compliance rates with those guidelines, in order to reduce morbidity and mortality in the study population at the studied PLC institutions.
COST-EFFECTIVENESS ANALYSIS OF USING METFORMIN AND GLIMEPIRIDE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN YOGYAKARTA, INDONESIA
Cost-effectiveness analysis (CEA) is a pharmacoeconomic method that assists in decision-making about the selection of benefit-effective and cost-effective therapies. The average cost-effectiveness ratio (ACER) is expressed as the dollar amount generated for each specific clinical outcome, regardless of comparison. The incremental cost-effectiveness ratio (ICER) reveals the costs to obtain one outcome unit relative to its comparison. Metformin is an oral antidiabetic for people with type 2 diabetes mellitus. Glimepiride can effectively improve glucose control in people with type 2 diabetes mellitus who possess a good health profile. This research aimed to determine the effectiveness of therapy, average cost, and cost-effectiveness of using metformin and glimepiride in people with type 2 diabetes mellitus. This research employed an observational study. Data collection was carried out retrospectively using total sampling at the community health centers in Yogyakarta. Data were analyzed using ACER or ICER to determine a more cost-effective therapy for lowering blood glucose levels. The cost-effectiveness analysis involving a total of 192 patients, 133 patients receiving metformin and 59 patients receiving glimepiride, disclosed that glimepiride was more cost-effective than metformin. The clinical results also unveiled the higher effectiveness of glimepiride therapy over metformin in reducing blood glucose levels. The average cost of glimepiride was IDR 6,101, exhibiting an effectiveness of 77.96% and an ACER value of IDR 78. The ICER calculation was omitted due to the low average cost, high effectiveness, and low ACER value of glimepiride in comparison to metformin. Therefore, glimepiride demonstrated more cost-effectiveness than metformin in people with type 2 diabetes mellitus at the community health centers in Yogyakarta.
MAGNESIUM INTAKE AS A POTENTIAL THEURAPEUTIC APPROACH FOR OBESITY AND METABOLIC SYNDROME: A LITERATURE REVIEW
Magnesium plays a crucial role in metabolic processes, influencing various aspects of health, including glucose regulation, insulin sensitivity, and lipid metabolism. This literature review aims to summarize current evidence on the potential role of dietary magnesium intake as a therapeutic strategy for managing obesity and metabolic syndrome. A selection of relevant articles published from 2019 to 2024 was reviewed based on defined inclusion and exclusion criteria. The articles were sourced from PubMed, ScienceDirect, and Google Scholar databases. This review was conducted following the PRISMA guidelines to ensure a systematic and transparent approach. Out of 8,662 articles initially retrieved, 14 met the eligibility criteria and were proceeded to the review. Of the selected articles, 4 employed RCTs including different dosage of magnesium supplement 250-300 mg/day, with duration 12-24 weeks were entered to this study. Furthermore, 1 RCT recommends an RDA of magnesium intake for children and adolescents of 360-410 mg/day. Five articles utilized cross-sectional designs while there were 3 cohort studies and 1 case-control study. An inverse association has been consistently reported between magnesium intake, whether from diet or supplementation, and the risk of metabolic disorders. This review highlights various studies that examine the effects of magnesium supplementation on health outcomes, alongside those focusing on the benefits of consuming magnesium-rich foods. By exploring both dietary and supplemental magnesium intake, this review provides a balanced perspective on how magnesium affects health, considering different sources and forms of intake.
MOLECULAR DETECTION OF ENTAMOEBA DISPAR FROM SURFACE WATER SAMPLES IN THAILAND
Accurate identification of Entamoeba species is crucial for a better understanding of the nature of these protozoan parasites and obtaining precise epidemiological data. Humans typically become infected with Entamoeba through the fecal-oral route, particularly from contaminated water in areas with poor sanitation. Therefore, it becomes important to determine the prevalence of human Entamoeba in surface water samples. We extracted DNA from surface 140 water samples collected along locations along canals, Pathum Thani Province, Thailand, for analysis of the presence of Entamoeba dispar, E. histolytica and E. moshkovskii using quantitative PCR, and of Entamoeba coli using nested PCR. Samples (14%) were positive for E. dispar and negative for the other three species. Although infection with E. dispar is generally non-pathogenic, intestinal symptoms in E. dispar infected patients have beebn reported in various regions. Routine surveillance of Entamoeba spp in surface water samples should help reduce the prevalence of amebiasis in Thailand.