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Background Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulty increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) instrumental ADL (IADL) limitations (LEWL). Methods Data came from the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) in the US from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models, for hearing and vision difficulty separately as well as for combined vision and hearing difficulties, by sex and age. Results 13% of men in England and the US had ADL/IADL-limitations, whereas for women was 16% and 19% in England and the US. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL-limitations than vision difficulty. In contrast, in the US, vision difficulty led to fewer years lived without ADL/IADL-limitations than hearing difficulty. Conclusions The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL-limitations.

Background Vitamin D (VD) plays a role in reducing the risk of diseases related to the immune system, including autoimmune diseases, by inhibiting proinflammatory cytokines such as IFN-γ. Children with Down syndrome (DS) are known to have interferonopathy due to trisomy 21 and have lower VD levels. This study aimed to evaluate the VD profile in Indonesian children with DS and its correlation with IFN-γ.Methods This study was conducted from March 2020 to June 2021 at Dr. Soetomo General Hospital, Surabaya. Data on sociodemographic status, milk, fish, and meat consumption, and sun exposure were obtained using a self-report questionnaire. VD and IFN-γ levels were measured using an ELISA kit. The chi-square test, t-test, Mann–Whitney test, and linear and logistic regression analysis were performed, with a significance threshold of p Results Of the 122 participants, 80 children had DS and 42 did not. The median VD levels in the DS and non-DS groups were 31.98 ng/mL and 56.19 ng/mL, respectively. The IFN-γ level was higher in the DS group, but this difference was not statistically significant (122.978 ± 123.420 vs. 100.715 ± 97.137 ng/mL, p = 0.548). Children with DS had lower daily milk consumption (300 cc/day vs. 380 cc/day; p = 0.027), sun exposure (17.5 vs. 150 hours/week; p = 0.000), and weekly meat and fish consumption (1 vs. 4 slices/week; p = 0.000). Daily milk consumption was a significant contributing factor for VD adequacy in the DS group (p = 0.000 [OR = 1.008]). VD levels had a significant role in decreasing IFN-γ levels in the DS group (p = 0.039; R2 = 5.8%).Conclusions VD levels in children with DS are lower than in children without DS. Adequate milk consumption can reduce the risk of autoimmunity through the role of VD in reducing IFN-γ levels in children with DS.

Purpose This paper aims to understand how the global supply chain in the medical device industry embraces resilience by adopting agility approach following COVID-19. Design/methodology/approach This study adopts an interpretative approach to examine the qualitative data drawn from interviews and observation under dynamic capability theory. The data collection concerned multiple stakeholders involved in purchasing and supply management in the medical device market: manufacturing suppliers, channel partners, hospital management and end-users. The coding analysis uses an application that helps the researchers categorise the nodes and extend the existing literature. Findings The findings show that global supply chain leaders leverage the dynamic capability by centralising the business process decision to respond to the shifting demand from the local governments to the national health ministry, shaping the partnership style from the area- to the funnel-based agreement, even though it exposes a risk of product acceptability from the end-users, encouraging the distributor to convert just-in-time approach into holding safety stock to avoid penalty from missing the procurement target even and restructuring the local partners’ debts to manage long-term performance. Originality/value This study extends the emerging literature in international business by underpinning dynamic capability theory.

PurposeThis paper aims to examine how multinational corporations respond to environmental turbulence by adopting a flexible supply chain (SC).Design/methodology/approachThis study adopts a case study in the medical industry to identify effective strategic approaches by taking advantage of new business opportunities and navigating complex business partnerships. This study focuses on medical diagnostic equipment, including computed tomography, magnetic resonance imaging and X-ray, that involves the suppliers, channel partners and medical users.Findings(1) The market turbulence brought the SC leaders to adopt multiple partnership approaches, i.e. funnel-based and area-based partnerships. (2) Adopting a funnel-based partnership allows the SC to seize new market opportunities. Still, it brought a risk element of SC failure from the flawed selection process and professional misconduct. (3) SC leaders adopted flexible partnerships to help address the risk of professional misconduct and select partners for long-term collaboration.Originality/valueThis paper contributes to emergent literature on social exchange theory by exposing the global SC when the SC leaders set up agility approaches. This paper also extends the discussion on the industrial marketing and purchasing theory, which seeks to promote an active buyer–seller relationship.

ObjectivesExposures in utero and during infancy may impact the development of diseases later in life. They may be linked with development of frailty, although the mechanism is unclear. This study aims to determine the associations between early life risk factors and development of frailty among middle-aged and older adults as well as potential pathways via education, for any observed association.DesignA cross-sectional study.SettingsThis study used data from UK Biobank, a large population-based cohort.Participants502 489 individuals aged 37–73 years were included in the analysis.Primary and secondary outcome measuresEarly life factors in this study included being breast fed as a baby, maternal smoking, birth weight, the presence of perinatal diseases, birth month and birth place (in or outside the UK). We developed a frailty index comprising 49 deficits. We used generalised structural equation modelling to examine the associations between early life factors and development of frailty and whether any observed association was mediated via educational attainment.ResultsA history of breast feeding and normal birth weight were associated with a lower frailty index while maternal smoking, the occurrence of perinatal diseases and birth month with a longer day length were associated with a higher frailty index. Educational level mediated the relationship between these early life factors and frailty index.ConclusionsThis study highlights that biological and social risk occurring at different stages of life are related to the variations in frailty index in later life and suggests opportunities for prevention across the life course.

Background frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. Objective to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. Design population-based cohort study. Setting communities in England. Subjects in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. Methods multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. Results the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0–34.6%] and 11.7 (11.1–12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2–1.3) and 2.2 (95% CI = 2.1–2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. Conclusions in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

This study aimed to analyze the influence of audit committee competence and audit firm-size on audit delay. This research was conducted using quantitative approaches and utilized data from 43 mining sector companies listed on the Indonesia Stock Exchange during 2017-2019. The result of the study concluded that audit committee competence and audit firm size partially have a negative effect on audit delay. Audit committee competence and audit firm size simultaneously negatively and significantly affect audit delay. Keywords: Audit Delay, Audit Committee Competence, Audit Firm Size.

ObjectiveThis study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory.MethodsData were drawn from 5 waves (2008–2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors.ResultsFive trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (−1.260, P ConclusionsEither stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

IntroductionVaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia.MethodsData come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined.Results and discussionThe results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195–1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026–1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027–1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998–1.040), need for chaos (OR = 1.044, 95% CI = 1.022–1.067), and populist views (OR = 1.028, 95% CI = 1.00–1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle “infodemics” are needed to address hesitancy during a new vaccine introduction program.

Lower-middle income Indonesia, the world’s fourth most populous country, has struggled to contain costs in its mandatory, single-payer public health insurance system since the system’s inception in 2014. Public procurement policies radically reduced prices of most medicines in public facilities and the wider market. However, professional associations and the press have questioned the quality of these low-cost, unbranded generic medicines.We collected 204 samples of 4 cardiovascular and 1 antidiabetic medicine from health facilities and retail outlets in East Java. We collected amlodipine, captopril, furosemide, simvastatin and glibenclamide, sampling to reflect patients’ likelihood of exposure to specific brands and outlets. We recorded sales prices and maximum retail prices, and tested medicines for dissolution and percent of labelled content, using high-performance liquid chromatography. We conducted in-depth interviews with supply chain actors.All samples, including those provided free in public facilities, met quality specifications.Most manufacturers make both branded and unbranded medicines. Retail prices varied widely. The median ratio of price to the lowest price for an equivalent product was 5.1, and a few brands sold for over 100 times the minimum price. Prices also varied between outlets for identical products, as retail pharmacies set prices to maximize profit. Since very low-cost medicines were universally available and of good quality, we believe richer patients who chose to buy branded products effectively protected medicine quality for poorer patients in Indonesia, because manufacturers cross-subsidize between branded and unbranded versions of the same medicine.

BackgroundThe World Health Organization (WHO) has warned that substandard and falsified medicines threaten health, especially in low- and middle-income countries (LMIC). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine quality recorded that 15.4 % of cardiovascular and 6.8% of diabetes samples failed at least one quality test. Review authors warn that study quality was mixed. Because they did not record medicine volume, no study reflected the risk posed to patients.Methods and FindingsWe investigated the quality of five medicines for cardiovascular disease and diabetes in Malang district, East Java, Indonesia. Our sample frame, based on dispensing volumes by outlet and price category, included sampling from public and private providers and pharmacies, and reflected the potential risk posed to patients. The content of active ingredient was determined by High Performance Liquid Chromatography, and compared with the labelled content. Dissolution testing was also performed.We collected a total of 204 samples: amlodipine (88); captopril (22); furosemide (21); glibenclamide (21); and simvastatin (52), comprising 83 different brands/products. All were manufactured in Indonesia, and all samples met specifications for both assay and dissolution. None was suspected of being falsified.ConclusionsWhile we cannot conclude that the prevalence of poor-quality medicines in Malang district is zero, our sampling method, which reflects likely exposure to specific brands and outlets, suggests that the risk to patients is very low; certainly nothing like the rates found in recent reviews of surveys in LMICs. Our study demonstrates the feasibility of sampling medicines based on likely exposure to specific products, and underlines the dangers of extrapolating results across countries.What is already known on this topicThe World Health Organisation suggests that as many as one in 10 medicines in low- and middle-income countries are of poor quality, but studies of the prevalence of substandard and falsified rarely take into account patient exposure.Medicines for non-communicable diseases and studies from large middle-income countries are under-represented in existing studies.What this study addsWe showed that it is feasible to sample medicines based on patient exposure. Our exposure-based study of cardiovascular and diabetes medicines in Indonesia, a lower-middle income country that is the world’s fourth most populous, found that all met quality standards.How this study might affect research, practice or policyAdopting exposure-based methods for sampling and/or calculating the prevalence of substandard and falsified medicines would improve our understanding of the potential public health impact of poor-quality products globally.

BackgroundPrevention of hearing loss via addressing potentially modifiable risk factors may offer means of reducing the global burden of hearing loss. Prior studies reported associations between individual markers of inflammation and risk of hearing impairment. Allostatic load is an index of cumulative physiological stressors, including inflammation, to multiple biological systems. Our aims were to investigate associations between allostatic load and both audiometric and self-reported hearing impairment and examine whether associations are stronger over time due to prolonged high allostatic load.MethodsData were taken from the English Longitudinal Study of Ageing (ELSA), a nationally representative study of people aged 50+ living in England over 3 time points between 2008 and 2014. Allostatic load score was comprised of thirteen different measures available at baseline and 4 years post-baseline (high-density lipoprotein/total cholesterol, triglyceride, fibrinogen, haemoglobin A1c, C-reactive protein, insulin-like growth factor 1 (IGF-1), systolic and diastolic blood pressure, mean arterial pressure, resting pulse rate, peak expiratory flow, BMI and waist circumference), measured using clinical cut-off points for normal biomarker parameters. Hearing acuity was measured with a simple handheld tone-producing device at follow-up 7 years post-baseline, while self-reported hearing impairment was measured at time point.ResultsWe included samples of 4373 and 4430 for the cross-sectional and longitudinal analysis, respectively. In the cross-sectional model high allostatic load was associated both self-reported (OR = 1.08, 95% CI 1.0,1.1; p < 0.01) and objective hearing loss (OR = 1.10, 95% CI 1.1,1.2; p < 0.001) adjusting for age and sex. Cross-sectional associations between allostatic load and hearing were not significant after further adjustment for covariates (qualification, physical activity and smoking).In longitudinal modelling, high allostatic load was associated with both audiometric (Z score OR = 1.11, 95% CI 1.1,1.2; p < 0.001) and self-reported hearing impairment (OR = 1.08, 95% CI 1.0,1.1; p < 0.001) adjusting for age and sex. Allostatic load was no longer associated with self-reported hearing loss but the association with audiometric hearing impairment (OR = 1.08, 95% CI 1.03,1.13; p < 0.001) remained following additional adjustment for baseline self-reported hearing, education, physical activity, and smoking.ConclusionsProlonged high allostatic load was associated with risk of hearing impairment. Reducing allostatic load via healthy lifestyle changes including non-smoking, healthy diet and exercise may offer an opportunity to reduce the risk of hearing impairment in later life.

Individuals with an 'evening' chronotype tend to sleep and wake later than people described to be 'morning' type if given a free choice. Since early awakening times, due to school and occupation, may be more challenging for those with evening chronotype, they are expected to be at greater risk of adverse health, occupational and educational outcomes. Our objectives are to investigate associations between chronotype and occupational, educational and health outcomes in a longitudinal cohort. We use sleep, sociodemographic and health data from The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age, 1982 through 2010. The relationship between employment and longitudinal midsleep trajectories were estimated using linear mixed models. Associations between employment status and Cornell Medical Index, Beck Depression Inventory scores, cortisol concentrations at different times of the day stratified by chronotype were estimated using regression. The relationship between chronotype, occupational success, education, and cognition were also examined using regression methods. In older adults, compared to non-employed participants, employed participants get up 0.45 hours earlier. Evening-type employed individuals had earlier midsleep time compared to their non-employed counterparts and had abnormal longitudinal trajectories with an increasing trend as they aged. Employed individuals with evening chronotype had a higher risk of depression than employed morning-types. Moreover, employed individuals with evening chronotype had a higher cortisol concentration at 14:00 h than non-employed individuals. In addition, memory score was lower in individuals with morning chronotype, however processing speed was higher in individuals with morning chronotype compared to evening. Morning-types had a higher age when they finished full time education. Relative to evening-types, those with morning chronotype were 6.5% more likely to be in a job classed as professional or intermediate. Our findings suggest that evening-types are at a disadvantage with regards to occupational, educational and health outcomes in older adults due to their vulnerability to circadian and sleep disruption.

Introduction Ten percent of over 65 s and between a quarter and half of over 85 s are frail. Loneliness and social isolation are associated with increased falls, rates of hospitalisation and mortality. Lonely and socially isolated older adults may also be at risk of frailty. We examined the relationship between loneliness, social isolation and incident frailty among older adults in England longitudinally over 12 years. Methods The study sample are 9,171 older adults aged ≥50 years participating in a population representative longitudinal panel survey, the English Longitudinal Study of Ageing Waves 2–8. To define frailty across the biannual waves, we used the Frailty Index (FI), analysed continuously and into categories (FI ≤0.08 non-frail, 0.08–0.25 pre-frail and ≥ 0.25–1 frail). We used baseline (Wave 2): loneliness measure using the UCLA 3-item loneliness scale; social isolation measure using previously reported method (Banks et al. The Institute for Fiscal Studies. 2006.). Both were categorised into low/medium/high. To examine relationships, we used linear mixed methods modelling (for the continuous FI), and Cox proportional hazard model (for the categorical FI). Results Loneliness (β = 0.023; 95% CI = 0.022, 0.025) and social isolation (β = 0.007; 95% CI = 0.003, 0.010) were significantly associated with increased FI, after adjusting for cofounders (gender, age, marital status, smoking status and wealth). There was a 60% greater relative risk of belonging to the frail class with a medium loneliness score compared to low (HR = 1.570; 95% CI 1.492, 1.652) and a 160% greater relative risk with high loneliness score compared to low (HR = 2.621; 95% CI 2.488, 2.761). Although less pronounced, there was a 1% greater relative risk of developing frailty with a medium social isolation score compared to low (HR = 1.010, 95% CI 1.010, 1.197) and a 30% greater relative risk with high social isolation score compared to low (HR = 1.267; 95% CI 1.154, 1.390). Conclusions Our research indicates both loneliness and social isolation increase risk of developing frailty, expanding on previous evidence. This provides further support to the importance of understanding approaches to promote social inclusion of older adults.

Introduction In elderly populations, sleep quality deteriorates and sleep time shifts towards earlier times. These sleep characteristics have been associated with cardiovascular, metabolic and psychiatric disorders, cognitive decline and mortality. Our aims are to examine longitudinal changes of sleep in older adults and to investigate the relationship between sleep variations, general health and mortality. Methods The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort (6,375 participants, recruited in the North of England, between 1983 and 1993) was used. Mixed models were used to investigate individual sleep trajectories (5 waves in 30-year period). Sleep timing and efficiency trajectories were clustered using latent class analysis and analysed against daily habits, health and mortality. Results Older adults have decreased sleep efficiency (~20%) and early sleep time (~30 min) between 40 and 100 years of age. Those in the high sleep efficiency latent class had minimal decrease in their sleep efficiency as they aged. Belonging to the high sleep efficiency latent class was associated with having lower prevalence of hypertension, circulatory problems, arthritis, breathing problems and recurrent depression compared to the low efficiency latent class. Results showed a higher risk of hypertension and metabolic syndrome in the evening-type latent class compared to morning-type individuals. Evening class was associated with traits related to lower health such as reduced sport participation, increased risk of depression and psychoticism personality, late eating, increased smoking and alcohol usage. Survival analysis revealed that individuals in the evening class had 1.15-fold increased risk of all-cause mortality compared to those with morning preferences. Conclusion Ageing is associated with decreased sleep efficiency and early sleep timing. However, there are detectable subgroups of sleep traits that are related to prevalence of different diseases and longevity. Understating these subgroups may pave the way for new treatments for healthy sleeping habits in older population.

Summary: Background: It is estimated that about 10% of people aged 65 and older are frail. Loneliness and social isolation are linked to increased mortality and poorer functional capacity. We assessed trends in frailty status associated with loneliness and social isolation over 14 years in a representative sample of English older adults. Methods: In this longitudinal study, we used data from the English Longitudinal Study of Ageing (ELSA), which was designed to recruit a representative sample of adults aged 50 years and older living in private households in England. We analysed Waves 2–8 (covering June, 2004, to June, 2017). Frailty was defined using the frailty index, analysed continuously and as pre-specified categories, to categorise individuals as being non-frail (≤0·08), pre-frail (>0·08 to

ObjectivesThis study aims to examine sociodemographic characteristics and health access associated with COVID-19 infection and death in Malang District, Indonesia.DesignA non-random cross-sectional study.SettingPopulation in 390 villages in Malang District, East Java Province, Indonesia.ParticipantsWe used Malang District government COVID-19 contact tracing data from 14 264 individuals, spanning from 1 March 2020 to 29 July 2020.Primary outcome measuresThe outcome variables in this study are COVID-19 infections and COVID-19 deaths. The associations between sociodemographic characteristics and health access of COVID-19 infection and death were analysed using multilevel logistic regression.ResultsAmong the 14 264 samples, 551 individuals were confirmed as being infected with COVID-19; 62 individuals died of COVID-19. Women, individuals with direct contact with confirmed COVID-19 cases and individuals with hypertension constituted the groups most vulnerable to COVID-19 infection. Among respondents with confirmed COVID-19 cases, men, individuals aged 61 years and older, individuals with hypertension, and those diagnosed with pneumonia and respiratory failure were at higher risk of death. The number of community-based healthcare interventions was significantly associated with lower COVID-19 infection and COVID-19 mortality. Greater distance to a COVID-19 referral hospital increased risk of COVID-19 mortality.ConclusionsCOVID-19 infection and death were related not only to sociodemographic characteristics of individuals but also to the presence of community-based healthcare interventions and access to hospital care. Strategies in public health, including improving healthcare access, are required to reduce COVID-19 infections among the most susceptible groups in Indonesia.

BackgroundMobile health applications (mHealth apps) have been widely used for various purposes for mitigating the COVID-19 pandemic, such as self-assessment, contact tracing, disseminating information, minimizing exposure, and reducing face-to-face health consultation. The objective of this study is to systematically review COVID-19 related mHealth apps and highlight gaps to inform the development of future mHealth initiatives in Indonesia.MethodsA systematic search strategy using a PRISMA flowchart was used to identify mHealth apps available in Google Play and Apple Play stores. We searched mHealth apps using certain specific terms related to COVID-19 outbreaks. The inclusion criteria were apps-based smartphone users related to COVID-19 using local language, free of cost, available in the Google Play and Apple Play Stores, and supported by the Indonesian government. We excluded games, apps on infectious diseases unrelated to COVID-19 specifically, and apps with non-Bahasa Indonesia (Indonesian language). The selected mHealth apps were assessed based on two measures: (1) the WHO guidelines on digital health intervention and (2) the four dimensions of the mHealth technology fit framework. In addition, user feedback from experienced and non-experienced users was conducted to evaluate four dimensions of the apps.ResultsA total of 339 mHealth apps were generated from the initial search, remaining seven selected apps that met inclusion criteria. The results highlighted that mHealth apps reviewed had still not been widely used by the general public. The applications were purposed to disseminate information, conduct a self-risk assessment, provide an online community forum, and telemedicine or teleconsultation regarding COVID-19. Data services, including data storage, aggregation, and data exchange, are available in most apps. The rarest function found was contact tracing and assisting health management and health workers, such as the availability of testing facilities, reporting test results, and prescribing medication. The main issues reported were the lack of data security and data privacy protection, integration and infrastructures, usability, and usefulness.ConclusionOur study highlighted the necessity to improve mHealth apps' functions related to assisting health workers and the function of digital contact tracing. An effort to increase public awareness regarding the use of mHealth is also necessary to streamline the function of this innovation. Policymakers must consider usefulness, usability, integration, and infrastructure issues to improve their mHealth function.

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, especially in a country such as Indonesia with its scarcity of health resources for testing and tracing. Using the case of Malang District, this study set out to evaluate KAP regarding COVID-19 and its risk factors immediately after the Malang health authorities implemented various preventive measures. A population-based survey involving 3425 individuals was carried out between 1 May and 20 May 2020. Our findings revealed that less than half of the respondents demonstrated accurate knowledge (25.3%), positive attitudes (36.6%), or frequent best practices (48.8%) with regard to COVID-19 prevention. The results of logistic regression analyses showed that more accurate knowledge was associated with more positive attitudes and more frequent best practices (OR = 1.603, p-value < 0.001; OR = 1.585, p-value < 0.001, respectively). More positive attitudes were also associated with more frequent best practices (OR = 1.126, p-value < 0.001). The level of KAP varied according to sociodemographic characteristics, access to the services of community health workers, and mobile health technology for COVID-19 screening. Some global health proposals to improve health behaviors among the general public in the context of the scarcity of health resource settings are suggested based on the study findings.

BackgroundCommunity health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions.MethodsA discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses.ResultsFive attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (β=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income.ConclusionCHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.

This study examined the long-term influence of loneliness and social isolation on mental health outcomes in memory assessment service (MAS) attendees and their care partners, with a focus on interdependence and bidirectionality.Longitudinal data from 95 clinic attendees with cognitive impairment, and their care partners (dyads), from four MAS in the North of England were analyzed. We applied the actor-partner interdependence model, seeking associations within the dyad. At baseline and 12-month follow-up, clinic attendees and care partners completed measures of loneliness and social isolation, depression, and anxiety.Social isolation at baseline was more prevalent in care partners compared to MAS attendees. Social isolation in MAS attendees was associated with higher anxiety symptoms (β = 0.28, 95% confidence intervals [CIs] = 0.11 to 0.45) in themselves at 12 months. We found significant positive actor and partner effects of loneliness on depression (actor effect: β = 0.36, 95% CIs = 0.19 to 0.53; partner effect: β = 0.23, 95% CIs = 0.06 to 0.40) and anxiety (actor effect: β = 0.39, 95% CIs = 0.23 to 0.55; partner effect: β = 0.22, 95% CIs = 0.05 to 0.39) among MAS attendees 1 year later. Loneliness scores of the care partners have a significant and positive association with depressive (β = 0.36, 95% CIs = 0.19 to 0.53) and anxiety symptoms (β = 0.32, 95% CIs = 0.22 to 0.55) in themselves at 12 months.Loneliness and social isolation in MAS clinic attendees had a downstream effect on their own and their care partners' mental health. This highlights the importance of including care partners in assessments of mental health and social connectedness and expanding the remit of social prescribing in the MAS context.

Background: The medical student is a part of education that has a pivotal role in contributing to the teaching-learning process. Assessing the learning process by student perception can give valuable input to predict academic achievement. This study aims to identify the student’s perspective regarding teaching-learning behaviour and which factor most influences academic achievement. Methods: A total of 443 medical students of the preclinical phase were selected to participate in this study. Design of the study comprised three single-groups time sequences with the observational approach. This study is divided into three phases: item construction by conducting exploratory factor analysis (EFA), validation through confirmatory factor analysis (CFA), and true surveys. Sample size calculation employed formulation of subject to item ratio for EFA and CFA; true survey utilized the estimate proportion population. Using regression linear, we determine the most influential factor to academic performance. Results: Results were summarized following two factors that influencing academic performance, namely learning experience (p value=0.013, r=0.041) and exam effectiveness (p value=0.041, r=0.028). Our work highlights the lecturer capacity and integrated module have contributed the academic success (79.46% and 77.80%). Conclusions: Our finding has novelty in which contribute the knowledge regarding exam significance on medicine. Meanwhile, related to the learning experience domain is increasingly proving an essential factor to achieve academic performance. The major strength of this study is the systematic manner in which it was conducted.

Objective This study examines the relationships between hearing impairment and cognitive function among older adults, and whether that association is mediated by loneliness and social isolation. Methods Data were drawn from English Longitudinal Study of Ageing (ELSA) wave two (2004/2005) until wave seven (2014/2015). The study sample consisted of 8,199 individuals aged 50 years or older. Cognitive function was measured using episodic memory. We performed analysis using a generalized structural equation modeling (GSEM) technique. Results GSEM analysis shows that the direct effect of hearing impairment on episodic memory was negative and significant (β = −0.29, p

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs’ knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response.

Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.

Community-based Healthcare Interventions (CBHIs) are regarded as a critical component of healthcare task-sharing in LMICs and have the potential to address LMICs' health system weaknesses to improve NCDs prevention care. This study aims to investigate the relationship between participation in CBHIs and NCDs early detection at medical facilities among Indonesians.Data come from the fifth Indonesian Family Life Survey (2014-2015), a total of 27,692 individuals (14,820 female and 12,872 male individuals age 15 and older). Multiple ordered logistics and logistics regression was used to assess the association between individual participation in CBHI and early detection of NCDs at medical facilities.Participation in CBHIs are associated with higher odds of having regular blood pressure test (adjusted odds ratio [OR], 3.09; 95% confidence interval [CI], 2.67-3.58), cholesterol test (adjusted OR, 1.88; 95% CI, 1.60-2.22), blood glucose test (adjusted OR, 1.88; 95% CI, 1.58-2.23), electrocardiogram (adjusted OR, 1.37; 95% CI, 1.06-1.76) and basic dental examination (adjusted OR, 1.32; 95% CI, 1.09-1.60) at medical facilities. The odds of having pap smears (adjusted OR, 2.20; 95% CI, 1.62-2.98) and breast self-examination (adjusted OR, 1.73; 95% CI, 1.37-2.19) among females who participated in CBHIs are substantially larger than those who did not participate in CBHIs. No significant association is shown for the basic vision examination (adjusted OR, 1.14; 95% CI, 0.95-1.37), while the association of participation in CBHIs on prostate cancer checkup (adjusted OR, 0.18; 95% CI, 0.04-0.76) was negative and significant. The results were controlled with a wide range of predisposing, enabling and need factors for NCDs early detection.and recommendation: CBHIs may benefit NCDs early detection for the general population in Indonesia. Policymakers and health practitioners need to design CBHIs programs that are attractive to the population, especially men and younger people.

Purpose The purpose of this paper is to understand the impact of religiosity on civic engagement in the health sector through giving advocacy for people with AIDs, mental health, cancer and disability. Design/methodology/approach The authors achieve this aim by proposing a structural equation model, which was derived based on literature. The data collection involved an on-line purposive sampling survey, which targeted young people who intend to work in the health sector. The survey asked about the experience and perception of 610 respondents in Indonesia. Findings The results indicate that the respondents with high religiosity were identified to be more caring towards those who suffer from mental health, AIDs, cancer and disability. However, the highly religious were less motivated by empathy in conducting civic engagement in the health sector. In this study, the impact of religiosity on civic engagement was found to be stronger for those who identified with low materialism. Originality/value The study contributes to the discussion on altruistic theory by challenging the widespread assumption that feelings of empathy drive civic engagement. The results extend the discussion on how to promote civic engagement in the health sector for young people with high materialism attitude.

ObjectiveThe levels of health enjoyed by individuals vary according to socio-economic status, and inflammation has been proposed as one pathway through which socio-economic status influences health in high-income countries. However, little is known regarding the social determinants of inflammation in low- and middle-income countries. This study investigated the association between socio-economic status and C-reactive protein (CRP) in England and Indonesia.MethodsThis study used data from 4923 respondents aged 50+ in the English Longitudinal Study of Ageing and from 1812 respondents from the Indonesian Family Life Survey at baseline. The sources of information on individuals’ education attainment, wealth, CRP and other covariates were ELSA Waves 2, 4 and 6, and IFLS Waves 4 and 5. Linear mixed models were performed to identify the longitudinal relationships between socio-economic status and CRP, and joint models were used to deal with bias in longitudinal ageing surveys due to attrition.ResultsRespondents with high school education (β = −0.036, p

This final assignment was created with the aim of making multimedia content in the form of motion graphics. The content is expected to be an alternative content for Taman Impian Jaya Ancol which is published to its visitors, especially for increasing their brand value. The Production of Motion Graphics as an Information Media for Visitors at PT Pembangunan Jaya Ancol were using my own development method. The results of this final assignment were in the form of six video products in the form of motion graphics and two of them as information media for Taman Impian Jaya Ancol’s visitors. ABSTRAK Tugas Akhir dibuat dengan tujuan membuat konten multimedia dengan bentuk motion graphic. Konten ini diharapkan menjadi konten alternatif bagi pihak Taman Impian Jaya Ancol yang akan dipublikasikan kepada pengunjung. Di sisi lain pembuatan konten juga dapat meningkatkan brand value Taman Impian Jaya Ancol PT kepada audience. Pembuatan motion graphic sebagai media informasi bagi pengunjung di PT Pembangunan Jaya Ancol ini menggunakan metode pengembangan sendiri. Hasil dari kegiatan PKL berupa enam produk video berbentuk motion graphic dan dua diantaranya sebagai media informasi bagi pengunjung Taman Impian Jaya Ancol.

This study aims to examine whether maternal smoking, birth weight, birth month and breastfeeding are associated with COVID-19 infection and hospitalisation. Maternal smoking was positively associated with COVID-19 infection. Breastfeeding was negatively associated with COVID-19 infection. The odds of being hospitalised due to COVID-19 were higher among those who had lower birthweight and mothers who were smoking during pregnancy.

Introduction Frequent social contact benefits cognition in later life although evidence is lacking on the potential importance of the modes chosen by older adults for interacting with others in their social network. Method 11,513 participants in the English Longitudinal Study of Ageing (ELSA) provided baseline information on hearing status and social contact mode and frequency of use. Multilevel growth curve models compared episodic memory (immediate and delayed recall) at baseline and long-term in participants who interacted frequently (offline only or offline and online combined), compared to infrequently, with others in their social network. Results Frequent offline (β = 0.29; p Conclusion Supplementing conventional social interactions with online communication modes may help older adults, especially those living with hearing loss, sustain, and benefit cognitively from, personal relationships.

Objectives Frequent social contact benefits cognition in later life although evidence is lacking on the potential relevance of the modes chosen by older adults, including those living with hearing loss, for interacting with others in their social network. Method 11,418 participants in the English Longitudinal Study of Ageing provided baseline information on hearing status and social contact mode and frequency of use. Multilevel growth curve models compared episodic memory (immediate and delayed recall) at baseline and longitudinally in participants who interacted frequently (offline only or offline and online combined), compared to infrequently, with others in their social network. Results Frequent offline (B = 0.23; SE = 0.09) and combined offline and online (B = 0.71; SE = 0.09) social interactions predicted better episodic memory after adjustment for multiple confounders. We observed positive, longitudinal associations between combined offline and online interactions and episodic memory in participants without hearing loss (B = 0.50, SE = 0.11) but not with strictly offline interactions (B = 0.01, SE = 0.11). In those with hearing loss, episodic memory was positively related to both modes of engagement (offline only: B = 0.79, SE = 0.20; combined online and offline: B = 1.27, SE = 0.20). Sensitivity analyses confirmed the robustness of these findings. Discussion Supplementing conventional social interactions with online communication modes may help older adults, especially those living with hearing loss, sustain, and benefit cognitively from, personal relationships.

Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population; however, the economic impacts of implementing such an intervention are unknown. We conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period. A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event. Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention. The intervention had an incremental cost-effectiveness ratio of $4288 per DALY averted and $3681 per major CVD event avoided relative to usual care. One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels. Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population.

Objectives Up to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under‐recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia. Methods A survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five‐point scale to indicate agreement or YES/NO response to questions regarding sensory‐cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done). Results Respondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training. Conclusions There is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory‐cognitive knowledge, attitudes and practice in professional care teams is called for., Key points A survey of long term care (LTC) staff in six countries care revealed similar limitations in capacity to support residents with hearing/vision needsBetter capacity to support hearing/vision needs of people with dementia was associated with longer experience working in LTC and having received training in dementia awarenessPractice guidelines, training and fostering a long‐term professional work force could optimise support for hearing/vision needs for people living in LTC

Background Little attention has been paid to whether CBHIs improve awareness, treatment and control of hypertension in the contexts of low- and middle- income countries (LMICs). This study therefore aims to examine participation in CBHIs for non-communicable diseases (NCDs) and its association with awareness, treatment, and control of hypertension among Indonesians. Methods This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from 30,351 respondents aged 18 years and older. Participation in CBHIs was measured by respondents’ participation in CBHIs for NCDs (Posbindu PTM and Posbindu Lansia) during the 12 months prior to the survey. Logistic regressions were used to identify the relationships between participation in CBHIs for NCDs and awareness, treatment, and control of blood pressure among respondents with hypertension. Results The age-adjusted prevalence of hypertension was 31.2% and 29.2% in urban and rural areas, respectively. The overall age-adjusted prevalence was 30.2%. Approximately 41.8% of respondents with hypertension were aware of their condition, and only 6.6% of respondents were receiving treatment. Participation in CBHIs for NCDs was associated with 50% higher odds of being aware and 118% higher odds of receiving treatment among adults with hypertension. There was no significant association between participation in CBHIs for NCDs and controlled hypertension. Conclusion Our data emphasise the importance of CBHIs for NCDs to improve the awareness and treatment of hypertension in the Indonesian population.

Tobacco is well known as a risk factor for early morbidity and mortality worldwide. However, the relative risk of mortality and the effects of smoking vary among the countries. Indonesia, as one of the world’s largest market for smoking tobacco, is significantly affected by tobacco-related illness. Previous research has shown that smoking causes several diseases, including stroke, neoplasm and coronary heart disease. There has to date been no research on the hazard risk of smoking for all-cause mortality in Indonesia. This study aimed to identify the association between smoking and all-cause mortality rates in Indonesia. Information from a total of 3,353 respondents aged 40 years and older was collected in this study. The data were taken from the Indonesian Family Life Survey (IFLS) Wave 4 (2007) to collect personal information and determine smoking status and from Wave 5 (2015) to collect information about deaths. Current smokers make up 40.3% of Indonesia’s population. Current smokers were more likely to have a higher risk of all-cause death (hazard ratio = 1.48, 95% confidence interval = 1.11 to 1.98) than non-current smokers. The number of smokers in Indonesia remains high and is expected to increase gradually every year. A firm government policy is needed to reduce the number of smokers in Indonesia which would automatically reduce the health problem of smoking-related illness in the future.

Although 91% of 12&ndash, 23-month-old children in Indonesia received at least one immunization in 2013, only 76% completed DTP3 immunization. This percentage is below the UNICEF and WHO recommended standards. Thus, this study aims to investigate trends, spatial disparities, and social determinants related to low coverage of DTP3 immunization in Indonesia. Using a multilevel approach, we analyzed data from 305,090 12&ndash, 23-month-old children living across approximately 500 districts in Indonesia to study demand and supply factors determining DTP3 immunization status. We examined unique, nationally representative data from the National Socioeconomic Survey (Survei Sosial Ekonomi Nasional or Susenas) and Village Potential Census (Potensi Desa or Podes) from 2004 to 2016. The percentage of children receiving complete DTP3 immunization increased from 37.8% in 2004 to 75.9% in 2016. Primarily income, parity status, and education, showed influence on DTP3 coverage. Among individual-level factors, the presence of a professional birth attendant was the most influential factor. At the district level, the factors varied. Low progress in DTP3 immunization status in Indonesia is due to huge disparities across the country&rsquo, s islands, in the density of health services, and in household socioeconomic status.

Background: Hypertension is a leading global public health problem in both developed and developing countries including Indonesia, mainly due to its high frequency and risks of cardiovascular diseases. Prevalence of hypertension in the Indonesian population aged> 18 years in 2018 was 34.11%. Unmet need for healthcare generally has been explored, but limited empirical study explores it among people with hypertension. The objective of this study is to investigate the determinants of unmet need for healthcare among people with hypertension. Methods: The design of this study is cross-sectional, using the data from the Indonesia Family Life Survey wave 5 (IFLS-5). The sample of the survey was 6,302 adults age >40 years old, stratified by rural/urban status. Three-level multilevel analysis was performed to estimate the individual level, household level, and community-level determinants of unmet needs for hypertension care. Results: The data shows that 78.4% of respondents with hypertension reported an unmet need for healthcare. Age, female, single, income, having insurance, living in the urban area, and the number of health posts for elderly (Posyandu Lansia) are significantly associated with meet needs for health care utilization among hypertension, while education and employment status shows no association with them. Conclusion: Improving access to healthcare and reducing health inequality are required to address this problem.

Objective: This article aims to examine community long-term care (LTC) in Indonesia by drawing upon the five principles of human right provision: availability, accessibility, acceptability, quality, and universality. Method: We used a qualitative approach with exploratory multiple case studies in three different areas in East Java Province, Indonesia. This study gathered the initial evidence using a report card approach with self-report questionnaires. In-depth interviews and focus group discussions were carried out to understand factors that affect the efficacy of LTC services. Results: The Indonesia Government imposed a regulation that required each local community to make community health services available for the elderly. By managing the integrated post, the community provided LTC service for the elderly. Community leadership played a pivotal role to make LTC services available. Improving the services with religious activities was essential to improving the acceptability, but it also needed to take into consideration universality and nondiscrimination principles. Results show that LTC services are difficult to expand and quality standards are difficult to raise, due to challenges such as few community members volunteering their services, lack of support from religious leaders, limited resources, and inadequate volunteer training. Discussion: This study highlights the role of community engagement in LTC services and shows that it is difficult to succeed without adequate government support. Improving services with creative and culturally acceptable activities is necessary.

Objectives: To test whether hearing aid use alters cognitive trajectories in older adults. Design: US population-based longitudinal cohort study. Setting: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996–2014). Participants: Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040). Measurements: Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words. Results: Hearing aid use was positively associated with episodic memory scores (β=1.53, p

Highlights • We investigated the implications of heterogeneous cohort composition on depression trajectories of older adults in the United States and England, using the growth curve model to draw trajectories over a decade. The findings showed for the first time that the trajectories of depression in later life are radically different for different cohorts living at the same time in the early 21st century. • The trajectories of depression of older cohorts, particularly those of the prewar cohorts in both countries and the war cohort in England, followed a U-shape. Conversely, the trajectories of depression of the younger cohort, particularly those of the postwar cohorts in both countries and the war cohort in the United States, took an inverted U-shape., Objective This study aims to investigate the implications of the heterogeneous cohort composition on depression trajectories of older adults in the United States and England. Methods Using growth curve models to identify depressive symptom trajectories and data spanning six waves over 10 years (2002–2012) from the U.S. Health Retirement Study and the English Longitudinal Study of Ageing, community-dwelling Americans and Britons aged 50 years and older were studied. Depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression Scale. Results The sample included 11,919 respondents (7,095 women [59.53%]) in the United States and 10,606 respondents (5,802 women [54.7%]) in England aged 50 and older. Older cohorts were shown to have higher depressive symptoms than younger cohorts in the United States and England. The trajectories of depression of older cohorts, particularly those of the prewar cohorts in both countries and the war cohort in England, followed a U-shape. Conversely, the trajectories of depression of the younger cohort, particularly those of the postwar cohorts in both countries and the war cohort in the United States, took an inverted U-shape. Conclusion The trajectories of depression in later life between cohorts took different shapes. This finding may lead to the development of more cost-effective policies for treating depression in later life.

Introduction:Social and economic conditions in childhood have been found to predict cognitive ability in midlife and old age in high-income countries. This study examines the long-term effect of childhood conditions on cognition among a nationally representative sample of older adults in a low- and middle-income country.Materials and Methods:Data were obtained from the 2014 to 2015 Indonesia Family Life Survey Wave 5 (6676 respondents, aged 50 years and older). Cognitive function was assessed based on total score on a series of tests adapted from the Telephone Interview for Cognitive Status. Retrospective information was collected on childhood poverty, with questions including whether respondents ever experienced hunger before age 15, whether basic facilities were available, and the number of books in the childhood home. We used linear regression to examine the association between childhood conditions and cognitive function in later life.Results:The findings show that the numbers of facilities and books available in childhood homes are substantially associated with cognition in later life after taking adulthood characteristics into account. Childhood hunger has no significant association with cognitive ability in later life. Belonging to an older birth cohort and living in a rural area were shown to have negative associations with cognitive ability in Indonesia.Conclusions:Our findings suggest that childhood poverty, birth cohort, and living in a rural area may contribute to cognitive aging in Indonesia. Policies and interventions that target childhood poverty in developing countries may also recognize the rural–urban divide in access to educational and other socioeconomic resources.

Importance Cardiovascular diseases (CVDs) are the leading cause of disease burden in Indonesia. Implementation of effective interventions for CVD prevention is limited. Objective To evaluate whether a mobile technology–supported primary health care intervention, compared with usual care, would improve the use of preventive drug treatment among people in rural Indonesia with a high risk of CVD. Design, Setting, and Participants A quasi-experimental study involving 6579 high-risk individuals in 4 intervention and 4 control villages in Malang district, Indonesia, was conducted between August 16, 2016, and March 31, 2018. Median duration of follow-up was 12.2 months. Residents 40 years or older were invited to participate. Those with high estimated 10-year risk of CVD risk (previously diagnosed CVD, systolic blood pressure [BP] >160 mm Hg or diastolic BP >100 mm Hg, 10-year estimated CVD risk of 30% or more, or 10-year estimated CVD risk of 20%-29% and a systolic BP >140 mm Hg) were followed up. Interventions A multifaceted mobile technology–supported intervention facilitating community-based CVD risk screening with referral, tailored clinical decision support for drug prescription, and patient follow-up. Main Outcomes and Measures The primary outcome was the proportion of individuals taking appropriate preventive CVD medications, defined as at least 1 BP-lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD. Secondary outcomes included mean change in BP from baseline. Results Among 22 635 adults, 3494 of 11 647 in the intervention villages (30.0%; 2166 women and 1328 men; mean [SD] age, 58.3 [10.9] years) and 3085 of 10 988 in the control villages (28.1%; 1838 women and 1247 men; mean [SD] age, 59.0 [11.5] years) had high estimated risk of CVD. Of these, follow-up was completed in 2632 individuals (75.3%) from intervention villages and 2429 individuals (78.7%) from control villages. At follow-up, 409 high-risk individuals in intervention villages (15.5%) were taking appropriate preventive CVD medications, compared with 25 (1.0%) in control villages (adjusted risk difference, 14.1%; 95% CI, 12.7%-15.6%). This difference was driven by higher use of BP-lowering medication in those in the intervention villages (1495 [56.8%] vs 382 [15.7%]; adjusted risk difference, 39.4%; 95% CI, 37.0%-41.7%). The adjusted mean difference in change in systolic BP from baseline was −8.3 mm Hg (95% CI, −10.1 to −6.6 mm Hg). Conclusions and Relevance This study found that a multifaceted mobile technology–supported primary health care intervention was associated with greater use of preventive CVD medication and lower BP levels among high-risk individuals in a rural Indonesian population.

BackgroundThe brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia.MethodsWe conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016-2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension's region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour.ResultsAmong 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7-32.5%) than in semi-urban (28.7%, CI 27.3-30.1%) and rural areas (26.2%, CI 25.2-27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively.ConclusionsHigh cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.

Supplementary_files_revision_2 for Childhood Socioeconomic Status and Cognitive Function Later in Life: Evidence From a National Survey in Indonesia by Asri Maharani in Journal of Geriatric Psychiatry and Neurology

The relationships between older age and sleep efficiency have traditionally been assessed using cross-sectional studies that ignore changes within individuals as they age. This research examines the determinants of sleep efficiency, the heterogeneity in an individual's sleep efficiency trajectory across a period of up to 27 years in later life and its associations with health. The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort (n = 6,375; age 42-94 years) was used in this study. Depression and health data were collected using self-report validated instruments (Cornell Medical Index, Beck Depression Inventory and Geriatric Depression Scale). Longitudinal sleep and sociodemographic data were collected using a study-specific self-report questionnaire. A mixed-effect model was performed for sleep efficiency with adjustments for time-invariant and time-variant predictors. Latent class analysis was used to demonstrate subgroups of sleep efficiency trajectories and associations between sleep efficiency clusters and health history of the participants were investigated. Older adults have decreased sleep efficiency over time, with 18.6% decline between 40 and 100 years of age. Three sleep efficiency trajectory clusters were identified: high (32%), medium (50%) and low sleep efficiency (18%). Belonging to the high sleep efficiency cluster was associated with having lower prevalence of hypertension, circulatory problems, general arthritis, breathing problems and recurrent episodes of depression compared to the low efficiency cluster. Overall, ageing decreases sleep efficiency. However, there are detectable subgroups of sleep efficiency that are related to prevalence of different diseases.

Evening-oriented sleep timing preferences have been associated with risk of diabetes, cardiovascular diseases, obesity, psychiatric disorders, and increased mortality. This research aims to explore the relationship between diurnal preferences (chronotype), daily habits, metabolic health, and mortality, using longitudinal data from The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age (6375 participants at inception, recruited in the North of England) with a long follow-up period (up to 35.5 years). Mixed models were used to investigate the influence of aging, socio-demographic, and seasonal factors on sleep timing. Results show that sleep timing shifted towards earlier time with aging. Test seasons influence chronotype of older adults but working schedules challenge seasonality of sleep timing. Moreover, the season of birth may set chronotype in adulthood. Individual chronotype trajectories were clustered using latent class analysis and analyzed against metabolic health and mortality. We observed a higher risk of hypertension in the evening-type cluster compared to morning-type individuals (Odds ratio = 1.88, 95%CI = 1.02/3.47, p = .04). Evening-type cluster was also associated with traits related to lower health such as reduced sport participation, increased risk of depression and psychoticism personality, late eating, and increased smoking and alcohol usage. Finally, Cox regression of proportional hazards was used to study the effects of chronotype on longevity after adjusting for sleep duration, age, gender, smoking, alcohol usage, general health, and social class. The survival analysis (82.6% censored by death) revealed that evening-type chronotype increased the likelihood of mortality (Hazard ratio = 1.15, 95%CI = 1.04/1.26, p = .005). Taken together, chronotype is influenced by aging and seasonal effects. Evening-type preference may have detrimental outcomes for human well-being and longevity.