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Background: Japan is one of the countries experiencing a "super-aged society." The government has looked to Southeast Asia for recruiting workers to fill the demand for long-term care (LTC) workers. However, migrant LTC workers have faced many job-related stressors. This study aimed to examine the factors associated with job satisfaction and subjective well-being among Filipino, Indonesian, and Vietnamese LTC workers in Japan and explore the specific factors behind what makes them satisfied in their jobs., Methods: A convergent mixed methods study was conducted. The workers were recruited through snowball and convenience sampling and completed a self-administered questionnaire for the quantitative part. The association of the work environment with the workers' job satisfaction and subjective well-being were analyzed using multiple linear regression analysis. An interpretive phenomenological approach was used to conduct in-depth interviews of the workers, which were analyzed using a deductive and inductive approach for the qualitative part. Quantitative and qualitative results were integrated and interpreted to expand on the findings with new insights., Results: In the final analysis, 122 workers were included (20 Filipino, 43 Indonesian, and 59 Vietnamese). In the quantitative part, having the necessary tools/equipment (Unstandardized Coefficient [B] = 16.1, 95% Confidence Interval [CI] = 6.8, 25.3) and support from work (B = 18.1, 95% CI = 8.6, 27.6) were associated with a higher level of job satisfaction. Having experienced harassment on the job was associated with a lower level of job satisfaction (B = -18.2, p = 0.007, 95% CI = -28.5, -7.8). There is no strong evidence for the association with subjective well-being. In the qualitative part, prominent themes emerged related to cultural sensitivity and an inadequate knowledge of caring for older adults living with dementia. The integrated findings suggested inadequate and unequal Japanese language training across the facilities. Moreover, the importance of human relations in the workplace emerged, with some workers desiring a deeper connection with their Japanese coworkers., Conclusions: A supportive and culturally sensitive work environment may bring about more motivated employees and increase employee retention from migrant LTC workers. Government and facilities should consider policies supporting a culturally sensitive work environment and more equitable Japanese language training across all facilities., (© 2024. The Author(s).)

Health-related stigma plays a significant role in the burden of various health conditions such as neglected tropical diseases and mental illnesses, and undermines successful health outcomes. Stigmatised individuals can face lifelong socioeconomic consequences because of their condition. It is broadly recognised that culturally salient factors interact with the way stigma is expressed in different local contexts. This study aimed to capture cultural capabilities that shape health-related stigma in Indonesia, using the 'what matters most' (WMM) stigma framework. In this qualitative research, 15 in-depth interviews with experts in the field of Indonesian culture and health studies were conducted, followed by a group discussion. Data were collected between April and September 2021, and analysed using thematic content analysis. The analysis shows that cultural values such as communal participation in local networks and the 'shame culture' shapes experiences of stigma in Indonesia. Moreover, the participants explained that achieving full standing in the Indonesian context meant contributing to the collective interest and maintaining the family reputation. Personhood is also related to socially defined gender roles. For example, community participation was often influenced by patriarchal values, which lead to differences in access to life opportunities, while recognition in the family was often connected to complying with gender roles. This study contributes to research on the cultural shaping of health-related stigma involving the WMM framework in the Indonesian context. Future research should focus on the perspectives of those who are affected by stigmatised conditions and on integrating these insights in the assessment and reduction of health-related stigma., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study aimed to investigate perceptions of what it means to "age well" and to explore similarities and differences between a Western and non-Western culture (Britain and Java)., Methods: Qualitative interviews explored how Javanese and British older adults defined aging well, establishing the similarities and differences between cultures. Javanese (n = 14) and British (n = 15) adults aged 61-80 (mean age = 68) participated. The data were analyzed using reflexive thematic analysis and organized with NVivo., Results: Four themes were identified that captured what it means to age well across cultures: (a) good health is a springboard for aging well; (b) holding a positive outlook is a decisive factor in aging well; (c) "having enough" and "feeling safe" provide peace of mind; and (d) spirituality and religiosity provide tranquility. Although both cultures mentioned similar factors, there were variations in the interpretations and emphasis within themes. For example, Javanese participants emphasized the importance of the social environment whereas British participants highlighted the physical environment., Discussion: Differences between cultures are important for understanding how best to support people as they age. For example, in Java, aging well may be best supported by providing a vibrant social environment. For people in Britain, having a safe and secure physical environment may be more important., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

While researchers have highlighted the emotional distress of migrant domestic workers who experience abuse by employers, less is known about long-term effects of the psychological abuse that they experience. Drawing from a broader ethnographic study of Filipino and Indonesian migration to Chile, we analyze three Filipina domestic workers' migration narratives to examine how they narrate and manage the long-term effects of psychological abuse in the domestic workplace that they experienced more than ten years earlier. Building on insights from medical anthropology and using narrative analysis, we contribute to discussions on migrants' mental health and psychosocial wellbeing by showing how these migrants seek to make meaningful sense of their previous experiences to deal with the enduring effects. We show that they construct alternative narratives that foreground their experiences as linked to structural factors and suggest that their psychosocial wellbeing is linked to their ability to subvert or derive meaning from earlier experiences of structural violence., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Tissue at risk, as estimated by CT perfusion utilizing Tmax+6, correlates with final infarct volume (FIV) in acute ischaemic stroke (AIS) without reperfusion. Tmax thresholds are derived from Western ethnic populations but not from ethnic Asian populations. We aimed to investigate the influence of ethnicity on Tmax thresholds., Methods: From a clinical-imaging registry of Australian and Indonesian stroke patients, we selected a participant subgroup with the following inclusion criteria: AIS under 24 h and absence of reperfusion therapy. Clinical data included demographics, time metrics, stroke severity, pre-morbid, and 3-month Modified Rankin Score. Baseline computed tomography perfusion and MRI <72 h were performed. Volumes of Tmax utilizing different thresholds and FIVs were calculated. Spearman correlation was used to evaluate relationship involving ordinal variables and calculate the optimal Tmax threshold against FIV in both populations., Results: Two hundred patients were included in the study sample, 100 in Jakarta and 100 in Geelong. The median National Institutes of Health Stroke Scale (IQR) were 6 (3-11) and 3 (1-5), respectively. The median Tmax+6 (IQR) was 0 (0-46.5) in Jakarta group and 0 (0-7.5) in Geelong group. The median FIV (IQR) was 0 (0-30.5) and 0 (0-5.5). Tmax+8 s in Jakarta population against FIV showed Spearman's coefficient ρ = 0.72, representing the optimal Tmax threshold. Tmax+6 s showed Spearman's coefficient ρ = 0.51 against FIV in the Geelong population., Conclusion: Tmax thresholds approximating FIV were possibly different in the Asian when compared with the non-Asian populations. Future studies are required to extend and confirm the validity of our findings., (© 2023 S. Karger AG, Basel.)

Much remains unknown about the population history of early modern humans in southeast Asia, where the archaeological record is sparse and the tropical climate is inimical to the preservation of ancient human DNA 1 . So far, only two low-coverage pre-Neolithic human genomes have been sequenced from this region. Both are from mainland Hòabìnhian hunter-gatherer sites: Pha Faen in Laos, dated to 7939-7751 calibrated years before present (yr cal BP; present taken as AD 1950), and Gua Cha in Malaysia (4.4-4.2 kyr cal BP) 1 . Here we report, to our knowledge, the first ancient human genome from Wallacea, the oceanic island zone between the Sunda Shelf (comprising mainland southeast Asia and the continental islands of western Indonesia) and Pleistocene Sahul (Australia-New Guinea). We extracted DNA from the petrous bone of a young female hunter-gatherer buried 7.3-7.2 kyr cal BP at the limestone cave of Leang Panninge 2 in South Sulawesi, Indonesia. Genetic analyses show that this pre-Neolithic forager, who is associated with the 'Toalean' technocomplex 3,4 , shares most genetic drift and morphological similarities with present-day Papuan and Indigenous Australian groups, yet represents a previously unknown divergent human lineage that branched off around the time of the split between these populations approximately 37,000 years ago 5 . We also describe Denisovan and deep Asian-related ancestries in the Leang Panninge genome, and infer their large-scale displacement from the region today., (© 2021. The Author(s).)

High graduation of nurses and limited job opportunities in Indonesia may lead to the emigration of nurses particularly through facilitated migration. This study aimed at identifying the prevalence of Indonesian nursing students with intention to work in Japan and predictors of their intention to migrate as well as having a definite plan to work in Japan. The study adopted cross-sectional design with a sample of 1,407 Indonesian nursing students. Factors associated with having migration intention, as well as a definite plan to work in Japan, were age, residence, and overseas experience. Other factors related to a definite plan to work abroad were family income, mastering a foreign language, knowledge about the nurse migration related to Indonesia-Japan cooperation, and their motivations to migrate to Japan. Sustainability of this international recruitment of nurses is possible by understanding the context of both source and destination countries. Maximizing benefits of migration of nurses for Indonesia and Japan requires structured policies targeting the educational sector and addressing the sustainability issues., (© 2020 John Wiley & Sons Australia, Ltd.)

We conducted an epidemiological study to identify the demographics and pre-operative characteristics of patients undergoing primary anterior cruciate ligament (ACL) reconstruction in a multi-ethnic Asian population. A retrospective study was performed on 696 patients who registered in our ACL reconstruction registry from January 2013 to August 2016. Important inter-ethnic differences were found. Indian patients were significantly older compared to Malay and Chinese patients. Malay and Indian patients were more likely to be male, overweight, and obese compared to Chinese patients. Soccer was the predominant sport involved, although ethnic predominance in specific sports exists. Novel findings from this study include increased prevalence of concomitant chondral injuries in the Chinese population compared to Malays and Indians, and significantly higher rates of concomitant intra-articular injuries in soccer and basketball compared to netball. Identification of these high-risk subgroups would serve useful in guiding the formulation of prevention strategies within our multi-ethnic community.

Within diverse global populations, validated tools are needed to assess common mental disorders. The Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used depression screeners. However, the PHQ-9 has not been structurally validated among female migrant domestic workers (MDWs). Female MDWs constitute a population numbering 11.5 million, and commonly report depression. This study aimed to structurally validate the PHQ-9 among Filipina and Indonesian female MDWs in Macao Special Administrative Region of China. Participants were recruited using respondent driven sampling. Participants were adult female MDWs from The Philippines (N=1375) or Indonesia (N=367) and legally working in Macao. We used confirmatory factor analysis (CFA) to test five structural models of depression using all PHQ-9 items with the Filipina and Indonesian samples. We applied multi-group CFA to test measurement invariance across samples. A two-factor (cognitive/affective, somatic) model yielded the best fit within both samples, and the multi-group CFA demonstrated invariance across samples. The two-factor model best represents the factor structure of the PHQ-9 among Filipina and Indonesian female MDWs., (Copyright © 2020. Published by Elsevier B.V.)

Background: Waist circumference (WC) measurement is practical to define central obesity. However, WC cut-off point might be differ based on different race or ethnicity. This study aims to analyze the optimal WC cut-off point to identify T2DM risk among Indonesian population., Method: We analyzed the secondary data of national based cross-sectional study of the Indonesian Basic National Health Research 2013, comprising 24,660 adults aged ≥ 18 years who were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). The new proposed cut-off point for WC was calculated using ROC curve analysis and Youden index. The odds ratio of having T2DM was calculated using logistic regression analysis., Results: Increased WC was associated with worsening dysglycemia status among men and women (p<0.001). The optimal cut-off point of WC for detecting T2DM from ROC analysis was 76 for men and 80 for women. Based on this WC cut-off point, the odds ratio for having T2DM was 1.64 [95% CI 1.45-1.86, p<0.01] for men and 1.90 [95% CI 1.71-2.11 p<0.01] for women., Conclusion: The newly proposed WC cut-off point of 76 for men and 80 women can be used to screen the risk of T2DM among Indonesian population., Competing Interests: The authors have declared that no competing interests exist.

In the era of scale up, global donor-driven HIV activities are transforming NGO work by demanding administrative, technical, and data-oriented activities. Drawing on interviews and participant observation in an NGO in the West Papuan city of Manokwari between 2011 and 2014, I attempt to understand why Indigenous Papuan NGO employees were steadily replaced by non-Indigenous migrant settlers, mainly of Javanese heritage, to deliver HIV services. I show that new rivalries, technical roles, performance targets and efficiency rhetoric intersected with existing racialization to produce a preference for Javanese employees, who were assumed to be more compliant and professional than their Papuan counterparts and to operate more easily within the technocratic regime imposed by donor expectations. I use the term technocratic racism to describe the way that global HIV rationalities intersect with ethnic stereotypes and gendered racial ideas to make possible certain HIV workers and not others. I contribute to anthropological literature on the delivery of HIV services by showing how a technocratic approach to HIV/AIDS intervention intersects with a settler-colonial context to gradually exclude Indigenous employees. Approaches that allow for relational, independent and flexible services would assist to decolonize HIV responses in West Papua.

Background: The profile of gastric mucosal microbiota has not yet been described in the Indonesian population where the prevalence of Helicobacter pylori is low., Methods: This is a cross-sectional study analyzing 16S rRNA of 137 gastric biopsy specimens. We analyzed the association between gastric microbiota, H. pylori infection, and gastric mucosal damage., Result: Among 137 analyzed samples, 27 were H. pylori-positive and 110 were H. pylori -negative based on culture, histology, and 16S rRNA gene analysis. Significantly lower α-diversity parameters, including Pielou's index, was observed in H. pylori-infected individuals compared with noninfected individuals (all P < .001). Among H. pylori-negative individuals, the permutational analysis of variance of Bray-Curtis dissimilarity distances showed a significant association with different ethnicities, suggesting some ethnic groups had specific microbiota profiles based on the presence of different operational taxonomic units. The linear discriminant analysis effect size (LEfSe) of the H. pylori-negative group showed significant associations between the presence of Micrococcus luteus and Sphingomonas yabuuchiae with Timor and Papuan ethnicities, respectively. The presence of Bulledia sp and Atopobium sp was associated with the Javanese ethnicity. We observed lower α-diversity scores in individuals with gastric mucosal damage and profiles with high abundances of Paludibacter sp and Dialister sp based on LEfSe analysis., Conclusion: Our findings suggest the presence of H. pylori is more correlated with a distinct microbiome profile than ethnic precedence., (© 2020 John Wiley & Sons Ltd.)

Rationale: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum., Patient Concerns: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss., Diagnoses and Interventions: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion., Outcome: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery., Lessons: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.

Empirical studies among small-scale societies show that participation in national development programs impact traditional norms of community cooperation. We explore the extent to which varying levels of village and individual involvement in development policies relate to voluntary cooperation within community settings. We used a field experiment conducted in seven villages (208 participants) from an indigenous society in Indonesia known for their strong traditional cooperative norms, the Punan Tubu. We framed the experiment in terms of an ongoing government house-building program. The results indicate that there were synergistic and antagonistic interactions between existing cooperative norms and government development policies. Participants' cooperation in the experimental setting was low, probably because the Punan Tubu are used to cooperating and sharing both under demand and in a context in which uncooperative behavior is largely unpunished. Variation in experimental behavior was related to both village- and individual-level variables, with participants living in resettlement villages and participants living in a house constructed under the government program displaying more cooperative behavior. The cooperation evident in resettled villages may indicate that people in these villages are more comfortable interacting in anonymous settings and less committed to the demand-sharing norms still prevalent in the upstream villages. The more cooperative behavior among villagers who have previously received a house might indicate that they recognize that they are now better off than others and feel more obliged to cooperate. Policies aiming to capitalize on existing cooperative behavior to stimulate community collective action should consider the specific conditions under which cooperation occurs in real settings since traditional norms that regulate cooperative behavior might not translate well to cooperation in government-led programs.

Background: Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan., Purpose: This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan., Methods: Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data., Results: Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry., Conclusions: Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.

Background: Since the National Malaria Elimination Action Plan was launched in China in 2010, local malaria transmission has decreased rapidly. Zero indigenous cases were reported since 2017. However, after 2010, the proportion of imported cases in China increased from 45.7% in 2010 to 99.9% in 2016, and almost all provinces of China have reported imported cases in recent years. Prevention of the reintroduction of malaria into China is crucial for the maintenance of its malaria-free status. Hence, it is of utmost importance to correctly identify the source of malaria infections within the country., Case Introduction and Response: In 2016 and 2017, three laboratory-confirmed cases of malaria caused by Plasmodium falciparum were identified in patients with no previous travel history to endemic areas were reported in Jiangsu Province, China, where malaria due to P. falciparum was eliminated about 30 years ago. These were diagnosed after 41, 31 and 39 days of seeking treatment, respectively, and all of them had received blood transfusions. Further investigations indicated that two of the cases had received blood from foreign students (from Indonesia and Ghana), and the other had received blood from an individual who had worked in Equatorial Guinea. All three blood donors were traced, and found to be carrying asymptomatic P. falciparum infections by microscopic examination and PCR. Furthermore, five polymorphic microsatellite markers (C1M4, C4M62, C13M13, C14M17, and C13M63) were typed and used to link parasites from the donors with those of the transfusion-receiving patients., Conclusions: Three transfusion-transmitted malaria cases were identified in China, all of which were due to the transfusion of blood donated by individuals who had contracted malaria outside the country. These cases can provide a reference for those faced with similar challenges in malaria case identification and classification in other regions. In addition, a stricter screening policy including the use of appropriate detection methods for malaria parasites should be developed and adopted for blood donation in regions undergoing malaria elimination.

In February 2020, a Chinese cargo ship docked at the Port of Santos with reports of crew members with a feverish and respiratory condition. A team was gathered to verify the existence of suspected cases of COVID-19 inside the vessel and define its clearance. All 25 crew members were interviewed, and no suspected cases were found. The vessel was then cleared for port activities. The investigation resulted from the implementation of the contingency plan to face a public health emergency of international importance and several surveillance entities cooperated.

Background Many studies examine the use of medicines among pregnant women, however few studies report the pregnant women's belief for taking medication during pregnancy. Individual factors such as patients' beliefs about their medications have been known to influence medication adherence. Objective This study aimed to examine beliefs about medicines among pregnant women in Indonesia and how these varied across pregnancy trimesters. Setting We conducted a cross-sectional survey of pregnant women who had regular visits at 63 community health centres in Surabaya, Indonesia. Methods Participants were approached while they were in the waiting room and were asked to complete the questionnaire. The survey package contained information about the study, an informed consent form, and the Beliefs about Medicines Questionnaire (BMQ). Main outcome measure Beliefs about medicines were assessed using the BMQ, which comprises four subscales: general-overuse, general-harm, specific-necessity, and specific-concern. Differences in medication beliefs between pregnancy trimesters were assessed using suitable statistical tests according to data normality. Results A total of 492 pregnant women completed the survey. The majority were aged 21-30 years (57.1%), housemakers (68.7%), and educated to high-school level (51.4%); 92.9% did not have any chronic diseases, and more than 90% took vitamins and/or supplements. The difference between Specific-Concern and Specific-Necessity scores was calculated for each participant, and more than half of the participants (59.6%) were thus classified as having negative beliefs about medications. In the first trimester of pregnancy, women's beliefs about medication necessity were stronger than in the third trimester (p = 0.033). Conclusion Medication beliefs of pregnant women regarding their concerns and the necessity of medication taken in different trimesters of pregnancy were varied. The results of this study highlight the difference in medication beliefs during trimesters in pregnancy.

Background: Collaboration between community and healthcare professionals plays an essential role in ADHD care. Therefore, this study aims to identify the level of knowledge/understanding, perception and attitude among community members, primary school teachers, medical students, general practitioners, pediatricians and psychologists in Indonesia regarding ADHD and its association with several related factors., Methods: A cross-sectional study utilizing valid questionnaires to assess the level of knowledge/understanding, perception and attitude regarding ADHD among each respondent group was employed. 1,536 subjects participated in this study. Data was gathered and analyzed using the SPSS version 20.0 for Mac. A chi-square test was used to establish the associations. The value of p < 0.05 was considered statistically significant in this study., Results: Most of the participants showed poor to very poor levels of knowledge/understanding (community members = 56.8%, teachers = 58.9%, medical students = 60.4%, general practitioners = 54.9%, pediatricians = 65.6%, psychologists = 52.1%). The similar results were also found for perception and attitude levels. Several associations were found between practice experience and the level of knowledge/understanding, perception and attitude towards ADHD among general practitioners and psychologists (p < 0.05); educational level and level of attitude among community members and medical students (p < 0.05); practice experience and the knowledge/understanding level in the teachers group (p < 0.05); practice experience and the perception level among pediatricians (p < 0.05)., Conclusions: Further education regarding ADHD should be considered either through online media or formal education in order to achieve a better management of ADHD., Competing Interests: Declaration of Competing Interest We did not have any conflict of interest in this study., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Epilepsy stigma has been associated with poor quality of life among people with epilepsy (PWE). It is important to understand the variation and degree of epilepsy stigma in one of the most populous and culturally diverse nations in the world, Indonesia. Hence, this study aimed to test the validity and reliability of the Indonesian version of the Public Attitudes Toward Epilepsy (PATE) scale., Method: The translation was performed according to standard principles and tested in 200 native Indonesian speakers who were aged above 18-year-old for psychometric validation., Results: The items in each domain had similar means and standard deviations (equal item variance), means ranging from 2.17 to 2.86 in general domain and 2.75 to 3.56 in personal domain and, standard deviations ranging from 0.87 to 1.05 and 0.88 to 1.01 in general and personal domain, respectively. Item-domain correlations were more than 0.5 for all items, and they correlate higher within their own domain compare with the other domain (convergent and divergent validity). Multitrait analysis showed similar variance, floor, and ceiling patterns to a great extent compared with the initial study. The Indonesian PATE scale also showed mostly similar correlation with demographic characteristics except monthly income. Principle axis analysis revealed strong factor loading (>0.3) in their hypothesized domain, except item 14. The Cronbach's α values for general and personal domains were 0.836 and 0.765, which were within the accepted range of 0.7 to 0.9., Conclusion: The Indonesian PATE scale is a validated and reliable translation for measuring public attitudes toward epilepsy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The provision (or failure) of care reflects and produces vulnerability in old age. Reliable and appropriate care widely affects the imagination of "good care" of older Indonesians in North Sulawesi. Yet, their striving for better life goes with the growing chronification of conditions and processes with unpredictable endings. Three factors shape such uncertainty in elder care in North Sulawesi: (1) unsustainable, fragile care arrangements; (2) progressive-degenerative non-communicable diseases and aging impairments; and (3) structural insecurity in elder care and health-care institutions. Older persons mitigate the degree of chronifying care uncertainty by expanding social spaces, but often in normatively less accepted ways.

Global child feeding practices remain suboptimal. In this study, we assess the determinants of age-inappropriate breastfeeding, dietary diversity, and consumption of 3+ types of animal source foods (ASFs) using 11,687 observations from combined data from the Indonesian Demographic Health Survey of 2012 and 2017. We used linear and logistic regression after adjusting for the complex sampling design. Child's age and quality of antenatal care (ANC) were associated with all outcomes. Socio-economic status and labour force participation were positively associated with higher dietary diversity score, ASF consumption, and age-inappropriate breastfeeding. More ANC visits and having consultation at ANC were associated with more dietary diversity. Higher women's knowledge level was associated with more dietary diversity and consuming more ASF. Compared with western Indonesia, more children in eastern Indonesia were age-inappropriately breastfed and had lower dietary diversity. The Indonesian government needs to develop programmes to improve child feeding particularly in eastern Indonesia, focusing on improving dietary diversity and ASF consumption in poorer households and on prolonging breastfeeding in richer households. Women's labour force participation should be encouraged, but programmes for working mothers are also needed to support continued breastfeeding and to express breast milk. ANC and postnatal programmes need improved consultation sessions for child feeding., (© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

Mental health status may vary by nationality among expatriate workers; no conclusive data is available in Saudi Arabia. We invited expatriate nurses employed in governmental hospitals in Al-Qassim, Saudi Arabia to fill out an electronic survey that contained questions on demography (including nationality), lifestyle, job, depression, anxiety, and stress (assessed with DASS-21 scale). We categorized each outcome into normal, mild to moderate, and severe, and used adjusted multinomial logistic regressions for analyses. Nurses (n = 999) were from India (54.1%), the Philippines/Indonesia (37.0%), Pakistan (4.9%) and Arab countries (4.0%). Indian nurses were three times (OR = 2.93; 95% CI 1.84, 4.67), Pakistani nurses were 2.5 times (OR = 2.54; 95% CI 1.07, 6.00), and Arab nurses were five times (OR = 5.65; 95% CI 2.40-13.31) more likely to suffer from severe depression compared to Filipino/Indonesian nurses (reference group). Results were similar for stress. Depression and stress varied significantly by nationality among expatriate nurses.

Male homosexual preference (MHP) is an evolutionary enigma because it is partially heritable and imposes a fertility cost. In occidental societies, homosexual men are feminized at various levels and they have more older brothers than heterosexual men. To evaluate whether femininity and the fraternal birth order (FBO) effect are universal features of MHP or not, we collected original data from homosexual men, heterosexual men, and heterosexual women from Java (Indonesia). Facial photographs were used to test whether homosexual faces are feminized when compared with heterosexual ones. We found that faces manipulated to resemble the average face of homosexual men are perceived as facially feminized, suggesting that homosexual men are facially feminized compared to heterosexual men, although a higher facial femininity was not captured by morphological analyses. Then, family data were used to detect differences in siblings' composition between homosexuals and heterosexuals. Homosexual men displayed a higher number of older brothers than heterosexual men, even when sibship size was controlled for, suggesting that the FBO effect exists in Indonesian populations. Independent of sexual orientation, men with older brothers seem more feminized than those without older brothers, consistent with the immune origin of the FBO effect. In conclusion, MHP in Indonesia is partially feminized and they have more older brothers. Such features are also associated with MHP in other cultural contexts, suggesting a cross-cultural effect of men homosexual preference. An evolutionary explanation is available for the feminizing effect, although the FBO effect remains unexplained even if proximal mechanisms start to be identified.

Aims: Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar., Methods: A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia., Results: The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia., Conclusions: IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.

Objective: To test the hypothesis that cancer mortality rates among the Moluccan-Dutch, the oldest non-Western migrant group to arrive in the Netherlands after the Second World War, are similar to those in the general Dutch population., Design: Population-based retrospective study., Setting: Data from the national cause of death registry in the Netherlands and municipal registries., Participants: Using historic records containing family names of all Moluccan-Dutch who arrived in the Netherlands in 1951, we identified 81 591 Moluccan-Dutch persons in the national cause of death registry of the Netherlands. The reference group consisted of 15 866 538 persons of the general Dutch population., Outcome Measures: Mortality data were linked to demographic data from municipal registries. We calculated all-cancer and cancer-specific mortality and measured differences between the two groups using Poisson regression, adjusting for sex, age and area socioeconomic status. We conducted a sub-analysis for the first-generation and second-generation Moluccan-Dutch., Results: There was no difference in all-cancer mortality between Moluccan-Dutch and the general Dutch population. Mortality was higher among Moluccan-Dutch for liver, cervix and corpus uteri cancers, but lower for stomach, oesophagus, kidney and nervous system cancers. For most cancers, mortality risk as compared with the general Dutch population varied between different generations of Moluccan-Dutch., Conclusions: Several decades after migration, the Moluccan-Dutch show similar all-cancer mortality, but different cancer-specific mortality rates, when compared with the general Dutch population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

The "right to health" operates as a buzzword in Indonesia to frame health policies as beneficial to citizens. Right to health is equated with access to Western biomedical services. Within the policy on partnership between biomedical and traditional midwives, only the biomedical midwife can fulfill the right to health. The "traditional" midwife is reframed as her assistant. Right to health language hides underlying tensions in relationships between these two categories of midwives by presenting the policy as mutually beneficial. Right to health language is effective in the post-Suharto era as it aligns with other incontestable values, including democracy and modernity.

"Bumiputra" or "son of the soil" is a term used to represent the Malays and other indigenous populations of Malaysia. The Malays are Austronesian speaking population and originated from different parts of the Indo-Malay Archipelago. The migration of Malay population from different parts of Indo-Malay Archipelago were mainly due to trading purposes which shaped the current Malay sub-ethnic groups with unique culture and with distinctive dialects. In this study, HLA typing was carried out using Sequence-based Typing (SBT) method on 109 individuals comprising of four Malay sub-ethnic groups namely Kelantan (n = 28), Champa (n = 29), Patani (n = 25) and Mandailing (n = 27) Malays. The HLA data is available in the Allele Frequencies Net Database (AFND)., (Copyright © 2019 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Background: Mortality variations have been reported for ethnic minority groups compared with their host populations. It is uncertain how this mortality variations change over time as younger generations become older and mix with the host population. This study aimed to examine all-cause mortality among three generations of Moluccans in the Netherlands, and to compare Moluccans with a mixed and non-mixed ethnic background., Methods: We used data from the death and municipality registry for the years 2000 through 2013, including all registered Dutch inhabitants. A list of Moluccan surnames was used to select the Moluccan population. Mortality differences were calculated by Poisson regression, controlling for sex, age and district socio-economic status., Results: High all-cause mortality rates were observed in all generations of Moluccans although the extent of the differences between Moluccans and the Dutch were smaller in second (1.15, 1.07-1.23) and third generation (1.14, 1.00-1.29) compared with the first generation (1.55, 1.49-1.60). Higher all-cause mortality is also reflected in the higher mortality from most causes of death except neoplasms and external causes. Both mixed and non-mixed Moluccans showed high all-cause mortality among the first (child) and second generation compared with the Dutch., Conclusion: Our findings show a higher all-cause mortality in three generations of Moluccans compared with the Dutch. The results show that mortality inequalities may persist, though in an attenuated form, over generations among ethnic minorities., (© The Author 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Objectives: We report the testing and refinement of the Adaptive Stress Index (ASI), a psychosocial assessment tool designed to measure the longer terms stressors of adapting to the psychosocial disruptions experienced by refugees., Methods: The ASI is based on a theoretical model, the Adaptation and Development After Persecution and Trauma (ADAPT), which postulates that five psychosocial domains are disrupted by conflict and displacement, namely, safety and security, attachment, access to justice, roles and identities, and existential meaning. We used confirmatory factor analysis (CFA) and item response theory (IRT) to shorten and refine the measure based on data obtained from 487 refugees participating in a household survey in Papua New Guinea (response rate: 85.8%)., Results: CFA allowed the exclusion of low loading items (<0.5) and locally dependent items. A good fit was found for single models representing each of the five ASI domains. A graded response IRT model identified items with the highest discrimination and information content in each of the five derived scales., Conclusions: The analysis produced a shortened and refined ASI for use amongst refugee populations. The study offers a guide to adapting measures of stress for application to diverse populations exposed to mass conflict and refugee displacement., (© 2019 John Wiley & Sons, Ltd.)

The Hajj is an annual pilgrimage that 1-2 million Muslims undertake in the Kingdom of Saudi Arabia (KSA), which is the largest mass gathering event in the world, as the world's most populous Muslim nation, Indonesia holds the largest visa quota for the Hajj. All Hajj pilgrims under the quota system are registered in the Indonesian government's Hajj surveillance database to ensure adherence to the KSA authorities' health requirements. Performance of the Hajj and its rites are physically demanding, which may present health risks. This report provides a descriptive overview of mortality in Indonesian pilgrims from 2004 to 2011. The mortality rate from 2004 to 2011 ranged from 149 to 337 per 100,000 Hajj pilgrims, equivalent to the actual number of deaths ranging between 501 and 531 cases. The top two mortality causes were attributable to diseases of the circulatory and respiratory systems. Older pilgrims or pilgrims with comorbidities should be encouraged to take a less physically demanding route in the Hajj. All pilgrims should be educated on health risks and seek early health advice from the mobile medical teams provided., Competing Interests: The authors have no conflicts of interest to declare., (© Atlantis Press International B.V.)

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

Genetic variations in the glutathione S-transferase genes GSTT1 and GSTM1 have been widely studied, and homozygous deletions or null genotypes have been reported in different populations. Previous studies suggest that individuals who are homozygous-null at the GSTM1 or GSTT1 locus may have an increased risk of environmentally related cancers and drug-induced hepatotoxicity. The aim of the present study was to determine the GSTM1 and GSTT1 polymorphisms in 154 healthy, unrelated individuals from the Javanese-Sundanese and Malay ethnic populations of Indonesia to provide a resource for improving the prognosis of possible susceptibilities in specific populations. The subjects were genotyped for the presence of GSTM1 and GSTT1 using the multiplex polymerase chain reaction technique. The GSTM1-null genotype was more frequent among Javanese-Sundanese ethnics (99%) than among the Indonesian Malay (67.2%). Similarly, Javanese-Sundanese ethnics showed a higher frequency of the GSTT1-null genotype (66.7%) than the Indonesian Malay (36.2%). Analysis of the combined distribution of the GSTM1 and GSTT1 genes revealed that 66.7% of the individuals from the Javanese-Sundanese population lack both the genes, whereas only 21.1% of the Indonesian Malay is GSTM1-null and GSTT1-null. This study contributes significant information on the variability of GSTT1 and GSTM1 gene polymorphisms worldwide, which can provide new knowledge about the relationship between ethnicity and the prevalence of certain diseases., (Copyright © 2018. Published by Elsevier B.V.)

Objective: Few European studies examined frailty among older persons from diverse ethnic backgrounds. We aimed to examine the association of ethnic background with frailty. In addition, we explored the association of ethnic background with distinct components that are considered to be relevant for frailty., Design and Setting: This was a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS) in the Netherlands., Participants: Community-dwelling persons aged 55 years and older with a Dutch, Indonesian, Surinamese, Moroccan or Turkish ethnic background were included (n=23 371)., Measurements: Frailty was assessed with the validated TOPICS-Frailty Index that consisted of 45 items. The TOPICS-Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL, health-related quality of life, psychosocial health and self-rated health. To examine the associations of ethnic background with frailty and with distinct frailty components, we estimated multilevel random-intercept models adjusted for confounders., Results: TOPICS-Frailty Index scores varied from 0.19 (SD=0.12) among persons with a Dutch background to 0.29 (SD=0.15) in persons with a Turkish background. After adjustment for age, sex, living arrangement and education level, persons with a Turkish, Moroccan or Surinamese background were frailer compared with persons with a Dutch background (p<0.001). There were no significant differences in frailty between persons with an Indonesian compared with a Dutch background. The IADL component scores were higher among all groups with a non-Dutch background compared with persons with a Dutch background (p<0.05 or lower for all groups)., Conclusions: Compared with older persons with a Dutch background, persons with a Surinamese, Moroccan or Turkish ethnic background were frailer. Targeted intervention strategies should be developed for the prevention and reduction of frailty among these older immigrants., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The intention to include a category of Complex Posttraumatic Stress Disorder (CPTSD) in ICD-11 has renewed interest in this construct. Although growing evidence from high income countries supports the construct validity of CPTSD, little parallel research has been undertaken across cultures. We tested theoretically supported CPTSD structures (a one-factor, six-factor, one-factor higher-order, and two-factor higher order structure) in a community sample of West Papuan refugees living in a remote town, Kiunga, in Papua New Guinea (PNG)., Procedures: A community-wide survey was conducted (2016-2017; response rate 85.5%) amongst 486 West Papuans. Culturally adapted measures were applied to assess cumulative traumatic exposure, postmigration living difficulties (PMLDs), CPTSD symptoms, and functional impairment., Findings: A six factor structure for CPTSD provided the best fit to the data, consistent with our past study amongst West Papuans., Conclusions: The cross-cultural validity of our findings is supported by the isolation of West Papuan participants from services treating traumatic stress. To further support the universal applicability of CPTSD, our findings need to be confirmed amongst other refugee groups from diverse cultural backgrounds., (Copyright © 2018. Published by Elsevier Inc.)

Malaysian construction sector is regarded as critical in the field of health because of the high rates of accidents and fatalities. This research aimed to determine the prevalence, sources and severity of injuries and its association with commitment to safety among foreign construction workers. A cross-sectional study was conducted among 323 foreign construction workers from six construction projects of a large organization in Malaysia, using a simple random sampling method. Data was collected using a structured questionnaire to assess work-related injuries and safety commitment. The collected data was analysed by SPSS 22.0 using descriptive statistics and χ 2 test. The prevalence of work-related injuries in a one year period was 22.6%, where most of the injuries were of moderate severity (39.7%) and falls from heights represented the main source (31.5%). The majority of the foreign construction workers had perceived between moderate and high safety commitment, which was significantly associated with work-related injuries. The results also showed a significant association of work-related injuries with the company's interest in Safety and Health, Safety and Health training, and safety equipment. Thus, the implementation of new procedures and providing relevant trainings and safety equipment; will lead to a decrease in injury rates in construction sites.

Depression may manifest differently across cultural settings, suggesting the value of an assessment tool that is sensitive enough to capture these variations. The study reported in this article aimed to develop a depression screening tool for Indonesians derived from ethnographic interviews with 20 people who had been diagnosed as having depression by clinical psychologists at primary health centers. The tool, which we have termed the Indonesian Depression Checklist (IDC), consists of 40 items. The tool was administered to 125 people assessed to have depression by 40 clinical psychologists in primary health centers. The data were analyzed with Confirmatory Factor Analysis (CFA) (IBM SPSS AMOS Software). CFA identified a five-factor hierarchical model ( χ 2  = 168.157, p = .091; CFI = .963; TLI = .957; RMSEA = .036). A 19-item inventory of the IDC, with five factors - Physical Symptoms, Affect, Cognition, Social Engagement and Religiosity - was identified. There was a strong correlation between the total score of the IDC and total score of the Center for Epidemiological Studies-Depression scale (revised version CES-D), a standard tool for assessing symptoms of depression. The IDC accommodates culturally distinctive aspects of depression among Indonesians that are not included in the CES-D.

Understanding the physiology and genetics of human hypoxia tolerance has important medical implications, but this phenomenon has thus far only been investigated in high-altitude human populations. Another system, yet to be explored, is humans who engage in breath-hold diving. The indigenous Bajau people ("Sea Nomads") of Southeast Asia live a subsistence lifestyle based on breath-hold diving and are renowned for their extraordinary breath-holding abilities. However, it is unknown whether this has a genetic basis. Using a comparative genomic study, we show that natural selection on genetic variants in the PDE10A gene have increased spleen size in the Bajau, providing them with a larger reservoir of oxygenated red blood cells. We also find evidence of strong selection specific to the Bajau on BDKRB2, a gene affecting the human diving reflex. Thus, the Bajau, and possibly other diving populations, provide a new opportunity to study human adaptation to hypoxia tolerance. VIDEO ABSTRACT., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Most studies of shame have focused on stigma as a form of social response and a socio-psychological consequence of mental illness. This study aims at exploring more complex Javanese meanings of shame in relation to psychotic illness., Method: Six psychotic patients and their family members participated in this research. Ethnographic fieldwork was conducted in Yogyakarta, Indonesia., Result: Thematic analysis of the data showed that participants used shame in three different ways. First, as a cultural index of illness and recovery. Family members identified their member as being ill when they had lost their sense of shame. If a patient exhibited behavior that indicated the reemergence of shame, the family saw this as an indication of recovery. Second, as an indication of relapse. Third, as a barrier toward recovery., Conclusions: Shame is used as a cultural index of illness and recovery because it associated with the moral-behavioral control. Shame may also be regarded as a form of consciousness associated with the emergence of insight. Further study with a larger group of sample is needed to explore shame as a 'socio-cultural marker' for psychotic illness in Java., (Copyright © 2018 Elsevier B.V. All rights reserved.)

When combined, primary and secondary infertility affects up to 21 percent of Indonesian couples. Based on ethnographic fieldwork with married heterosexual couples, I explore how intra-family adoption represents a culturally and religiously acceptable pathway to family formation for couples without access to assisted reproductive technologies. I examine how kinship is central to the negotiation of adoption, and to maintaining ethnic and religious continuity within adoptive families. I reveal how adoption can enable infertile women and birth mothers to achieve or escape the dominant expectations of heteronormativity, and discuss intra-family adoption by infertile couples in relation to reproductive stratification and leveling.

Sabah is a Malaysian state situated in the northern part of Borneo, and it is endemic for malaria. The incidence of malaria is the lowest (0.05/1,000 population) in Penampang districts of Sabah. In June 26, 2012, two Plasmodium falciparum malaria cases were notified to public health department from a village in Penampang. Immediate investigation was initiated to identify the risk factors and to institute control measures. We performed active case finding by asking household members of all houses in the village regarding malaria symptoms and by examining blood smears. Environmental investigation was performed by collecting samples to detect mosquito breeding sites and to identify malaria transmitting vector mosquitoes. A case-control study with a ratio of 1:4 (11 cases and 44 controls) was conducted using self-administered questionnaire. The microscopic examination of blood smear for malarial parasite and entomology sampling was carried out. The malarial attack rate was 2.3%, 6/11 smears have gametocyte, and the case fatality rate was 9.1%. One case was a migrant rubber tapper from Indonesia which happened to be the first case with gametocyte positive. Overall, the incidence of malaria was higher (6/11) among rubber tappers. The odds of cases for those living nearby stagnant water were 7.3 [95% confidence interval: 1.2-43.5] times higher. In conclusion, an outbreak of P. falciparum malaria was introduced into a malaria-free village by a migrant rubber tapper, by whom the imported parasite was introduced to the community via vector Anopheles balabacensis . Living near stagnant water bodies was the risk factor in this outbreak.

Researchers have claimed that the absence of a biological father accelerates the daughter's menarche. This claim was assessed by employing a large and nationally representative sample of Indonesian women. We analyzed 11,138 ever-married women aged 15+ in the Indonesian Family Life Survey 2015. We regressed age at menarche on the interaction of father absence (vs. presence) and mother absence (vs. presence) at age 12 with or without childhood covariates. For robustness checks, we performed a power analysis, re-ran the same specification for various subgroups, and varied the independent variable of interest. All results produced a null relation between father absence and age at menarche. The power analysis suggests that a false negative was unlikely. Our review of the literature indicates that the claim of the relation between father absence and earlier menarche was based on weak statistical foundations. Other studies with higher-quality datasets tended to find no relation, and our results replicated this tendency. Therefore, the influence of father absence does not appear to be universal.

Indonesia, an island nation as large as continental Europe, hosts a sizeable proportion of global human diversity, yet remains surprisingly undercharacterized genetically. Here, we substantially expand on existing studies by reporting genome-scale data for nearly 500 individuals from 25 populations in Island Southeast Asia, New Guinea, and Oceania, notably including previously unsampled islands across the Indonesian archipelago. We use high-resolution analyses of haplotype diversity to reveal fine detail of regional admixture patterns, with a particular focus on the Holocene. We find that recent population history within Indonesia is complex, and that populations from the Philippines made important genetic contributions in the early phases of the Austronesian expansion. Different, but interrelated processes, acted in the east and west. The Austronesian migration took several centuries to spread across the eastern part of the archipelago, where genetic admixture postdates the archeological signal. As with the Neolithic expansion further east in Oceania and in Europe, genetic mixing with local inhabitants in eastern Indonesia lagged behind the arrival of farming populations. In contrast, western Indonesia has a more complicated admixture history shaped by interactions with mainland Asian and Austronesian newcomers, which for some populations occurred more than once. Another layer of complexity in the west was introduced by genetic contact with South Asia and strong demographic events in isolated local groups., (© The Author 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.)

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country's adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country's own participation in a bilateral trade and investment agreement, known as the Indonesia-Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia-Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia-Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia-Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.

The present research examines the influence of intuitive cognitive domain and religion on the God concepts of children growing up in religious traditions that present God in ways varying from abstract to concrete. In Study 1, we compared children from a Latter-Day Saints (LDS) background with those from mainstream Christian (MC) backgrounds in the United States. In contrast to MC theology that holds that God is all-knowing, all-powerful, and disembodied, LDS theology depicts God as embodied. In Study 1, 3- to 7-year-olds from LDS and MC backgrounds were asked about supernatural mental and immaterial attributes of God, a ghost, a dad, and a bug. In Study 2, children ages 3-7 from Muslim and Catholic backgrounds in Indonesia were presented with a variant of Study 1. Taken together, the two studies examine the God concepts of children raised in three different religious traditions with God concepts that range from highly abstract to concrete. Overall, we find that the youngest children, regardless of religion, distinguish God from humans and hold similar ideas of God, attributing more supernatural psychological than physical properties. Older children's conceptions of God are more in line with the theological notions of their traditions. The results suggest that children are not simply anthropomorphic in their God concepts, but early on understand supernatural agents as having special mental properties and they continue to learn about differences between agents, influenced by their religious traditions. Statement of contribution What is already known on this subject Research on children's God concepts has established that children begin to distinguish the mind of God from that of humans by around age 4-5. The main debate in the field is whether children start out thinking about God in anthropomorphic terms or whether they start out with an undifferentiated idea of agents' minds as all having access to knowledge. Research on children's understanding of immortality has demonstrated that around the same age that children begin differentiating God's mind from human minds, they also differentiate between the two in terms of life-cycle attributes, attributing immortality to God, but not to humans. What does this study add? The present research contributes to the field by examining the God concepts of children from different religious backgrounds. These religious backgrounds have theologies with God concepts that range from physically concrete (Latter-Day Saints or Mormonism) to highly abstract (Islam). We also include Christian samples for comparison. The present research examines children's attributions to different supernatural agents including God, but also a ghost and an angel. The present studies look at children's attribution of not only supernatural mental attributions, but also the supernatural physical attributions of immateriality and omnipresence that have been understudied., (© 2017 The British Psychological Society.)

In this article I demonstrate what can be learned from the indigenous healing knowledge and practices of traditional Sasak midwives on Lombok island in eastern Indonesia. I focus on the treatment of infertility, contrasting the differential experiences of Sasak women when they consult traditional midwives and biomedical doctors. Women's and midwives' perspectives provide critical insight into how cultural safety is both constituted and compromised in the context of reproductive health care. Core components of cultural safety embedded in the practices of traditional midwives include the treatment of women as embodied subjects rather than objectified bodies, and privileging physical contact as a healing modality. Cultural safety also encompasses respect for women's privacy and bodily dignity, as well as two-way and narrative communication styles. Local understandings of cultural safety have great potential to improve the routine practices of doctors, particularly in relation to doctor-patient communication and protocols for conducting pelvic exams.