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IntroductionPsychiatric comorbidity is frequent in bariatric surgery candidates. This study aimed to classify bariatric surgery patients according to patterns of preoperative measures of the severity of the eating disorder (ED), depression, and personality traits.MethodsIn the present cross-sectional study, 115 adult candidates for bariatric surgery (75 females, 65.22% of sample; mean age 37) were considered for analysis. Patients’ sociodemographic and psychopathological variables were collected. K-Means clustering analysis was adopted to classify bariatric surgery candidates according to their preoperative Eating Disorder Inventory-2 (EDI-2) scores. In addition, we assessed depression and personality traits using the Beck Depression Inventory-2 (BDI-2) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).ResultsCluster analysis based on EDI-2 revealed two preoperative patterns: higher severity (n = 39), and low severity (n = 76). The more severe EDI-2 group had higher scores on the BDI-2 and presented higher scores on several MMPI-2 dimensions, particularly those related to anxiety (Psychasthenia, Anxiety, Fears, Obsessiveness), depression (Depression, including both content and clinical MMPI-2 subscales), externalizing symptoms (Anger, Cynicism, Type A Behavior), and social functioning (Social Introversion, Family Problems, Work Interference).DiscussionEating disorders symptoms in candidates for bariatric surgery are closely related to depression and different psychological conditions assessed with MMPI-2. These psychological variables should be evaluated preoperatively and targeted with more specific psychological interventions.

This research was performed to assess the possibility of substituting fishmeal (FM) with wheat gluten meal (WGM) at different levels. WGM in the total diet (%) are as follows; W0 (0%), W10 (10.21%), W12 (12.42%), W14 (14.65%), W16 (16.87%), and W19 (19.1%) as well as its effects on growth, and immunity in juvenile pearl gentian groupers (Epinephelus fuscoguttatus ♀ × Epinephelus lanceolatus ♂). A sum of 540 healthy fish (average initial body weight 11.04 ± 0.02 g) was selected randomly and put in eighteen fibreglass tanks (0.3 m3) (six groups with three replicate) at a density of 30 fish per tank and fed with experimental diets twice daily at 08:00 and 16:00 to apparent satiation for eight weeks. WGM102 had a significantly higher weight gain rate (498.82±22.50%) than the control group (345.57±24.93%) (P

Latar Belakang: Kejadian stunting pada anak anak usia di bawah 5 tahun masih merupakan masalah gizi di Indonesia. Tren stunting meningkat dalam lima tahun terakhir dari 25.7% menjadi 30.8% antara tahun 2013 dan 2018. Dampak negatif yang ditimbulkan karena stunting adalah rendahnya potensi akademik, tingginya risiko penyakit tidak menular, mahalnya biaya pelayanan kesehatan dan rendahnya produktivitas. Salah satu faktor terjadinya stunting pada balita adalah literasi ibu tentang gizi seperti pengaruh pola asuh ibu dan pola makan di dalam keluarga. Literasi pengetahuan gizi ibu harus diperkuat untuk menurunkan masalah stunting. Peneliti ingin melihat hubungan antara literasi gizi dan pengetahuan ibu terkait gizi terhadap kejadian stunting. Tujuan: Tujuan penelitian ini adalah untuk menganalisis hubungan antara literasi gizi dan pengetahuan ibu terkait gizi terhadap kejadian stunting pada anak usia 0-59 bulan. Ulasan: Scoping review ini berpedoman pada protokol PRISMA dan PICOS. Pencarian literatur dilakukan pada database Pubmed, Scopus dan ScienceDirect. Terdapat 13 artikel yang sesuai kriteria dari 630 artikel yang didapatkan. Literasi gizi dan pengetahuan gizi ibu memiliki hubungan yang signifikan terhadap kejadian stunting. Diperlukan peningkatan akses informasi gizi terutama bagi ibu yang memiliki anak usia 0-2 tahun terutama di daerah pedesaan. Topik gizi yang bisa diberikan adalah tentang pemberian makanan bayi dan anak, pemilihan dan persiapan produk makanan sehat bergizi, tumbuh kembang anak, pencegahan stunting, pencarian layanan kesehatan, ketahanan pangan, dan pengetahuan gizi pada makanan tradisional. Kesimpulan: Scoping review ini dapat menjadi acuan untuk penelitian selanjutnya serta dimanfaatkan oleh pembuat kebijakan dalam pembuatan program edukasi gizi untuk meningkatkan literasi gizi pada ibu sehingga mendukung upaya pencegahan dan penurunan kejadian stunting di Indonesia.

Latar Belakang: Pemerintah Indonesia memiliki program untuk mencegah dan mengatasi anemia dengan pemberian tablet tambah darah. Program ini dapat berhasil apabila didukung dengan pengetahuan masyarakat yang baik tentang anemia. YouTube sebagai media sosial, tidak lagi hanya digunakan untuk hiburan melainkan sumber pembelajaran. Berbagai video edukasi anemia di YouTube memiliki karakteristik berbeda-beda yang menarik untuk dianalisis. Tujuan: Studi ini bertujuan untuk mengidentifikasi ketersediaan video dan menggambarkan karakteristik video YouTube sebagai media edukasi anemia di Indonesia. Metode: Pencarian melalui google.com dan youtube.com untuk video dengan kata kunci “edukasi anemia di Indonesia.” Video diskrining berdasarkan kriteria inklusi. Data terkait karakteristik meliputi bentuk video, jenis pengunggah, durasi, dan jumlah penayangan, serta gambaran isi materi video diidentifikasi. Analisis deskriptif digunakan untuk menggambarkan karakteristik dan gambaran isi materi video edukasi. Hasil: Dari total 115 video yang didapatkan, 28 video dianalisis. Video edukasi dengan durasi lebih dari 3 menit lebih banyak ditemukan (55,17%), setengah dari total video dibuat dalam bentuk animasi (51,72%), dan sebagian besar video berasal dari kanal non pemerintah/swasta (41,38%). Rata-rata video memiliki 3 menit lebih (190,68 ± 145,50), jumlah penayangan beragam dari mulai 1.033 hingga 77.628, dan rata-rata setiap video dilihat sebanyak 24 kali dalam sehari. Video yang menampilkan presenter/tokoh, memiliki jumlah penayangan (29.557,7 ± 22.353,08) dan penayangan per hari (41 ± 36,4) paling tinggi dibandingkan jenis video animasi dan non animasi lainnya. Video dari kanal institusi non pemerintah atau swasta memiliki jumlah penayangan per hari lebih banyak dibandingkan dari kanal pemerintah dan perseorangan. Penayangan per hari video dengan durasi 3 hingga 6 menit lebih banyak (36,59 ± 34,39) dibandingkan video dengan durasi kurang dari 3 menit (8,04 ± 8,58). Lebih dari 60% video mencantumkan masing-masing informasi edukasi tentang anemia. Kesimpulan: Video edukasi tentang anemia banyak ditemukan di YouTube dengan karakteristik yang berbeda-beda. Penilaian kualitas video tidak cukup dilakukan hanya mengidentifikasi panjang durasi, jumlah penayangan per hari dan banyaknya poin informasi edukasi. Penelitian lebih lanjut dibutuhkan untuk melihat hubungan durasi dan bentuk video serta jenis pengunggah terhadap engagement pada video edukasi anemia.

Latar Belakang: Stunting menjadi masalah malnutrisi yang saat ini menjadi fokus untuk diselesaikan. Pulau Jawa merupakan pulau dengan jumlah penduduk paling banyak di Indonesia yang memiliki pengaruh pada kejadian stunting terlihat dari banyak wilayah yang menjadi lokasi fokus penanganan stunting. Tujuan: Untuk mengetahui prevalensi kejadian stunting pada anak usia 6-23 bulan di setiap provinsi di Pulau Jawa. Melakukan identifikasi faktor yang berhubungan dengan kejadian stunting di masing-masing provinsi di Pulau Jawa. Metode: Data Studi Status Gizi Indonesia (SSGI) tahun 2021 digunakan pada penelitian. Metode yang digunakan pada studi ini adalah cross-sectional dengan data sekunder. Uji logistik regresi dengan pembobotan digunakan pada penelitian untuk mengetahui hubungan antara setiap variabel dengan kejadian stunting. Hasil: Prevalensi stunting pada anak usia 6-23 bulan di 6 provinsi di Pulau Jawa, DKI Jakarta 11,9%; Jawa Barat 16,3%, Jawa Tengah 13,2%; DI Yogyakarta 12,1%, Jawa Timur 15,9%, dan Banten 14,6%. Faktor risiko dari kejadian stunting di DKI Jakarta adalah status ekonomi; di Jawa Barat adalah usia, konsumsi makanan ringan, tempat tinggal, pendidikan ibu, dan status ekonomi; di Jawa Tengah adalah status ekonomi; di DI Yogyakarta adalah usia; di Jawa Timur adalah usia, jenis kelamin, konsumsi makanan ringan, pendidikan ibu, dan status ekonomi; dan di Banten adalah usia, jenis kelamin, konsumsi makanan ringan, tempat tinggal, dan status ekonomi. Kesimpulan: Prevalensi kejadian stunting pada anak usia 6-23 bulan di provinsi-provinsi di Pulau Jawa masuk dalam kategori menengah. Intervensi yang dilakukan dapat ditargetkan pada peningkatan status ekonomi.

Background/Objectives: Iron deficiency anemia (IDA) and stunting are prevalent global health issues, particularly in developing countries, where previous studies have suggested a potential relationship between them. This systematic review aims to analyze the relationship between iron deficiency anemia and stunting in pediatric populations in developing countries. Methods: Literature searches were conducted on PubMed, EMBASE, Cochrane Library, and EBSCO Host. The primary outcome was the association between IDA and stunting. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and the Effective Public Health Practice Project (EPHPP) for other observational studies. Meta-analysis was performed with a random-effects model and heterogeneity assessment. A Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment was performed to determine the certainty and importance of the study. Results: Out of 19,095 articles, 15 studies were included in the systematic review, and 4 studies were included in the meta-analysis, encompassing 21,936 subjects aged 0 to 12 years. IDA prevalence ranged from 3.6 to 58.8%, while stunting prevalence varied from 6.6 to 44.5%. Nine articles supported a significant relationship between IDA and stunting, revealing that stunted children had a 1.31–6.785 times higher risk of developing IDA. The odds ratio of children with IDA to be stunted was 2.27 (95% CI = 1.30–3.95). All studies exhibited a moderate risk of bias. GRADE assessment suggested that the evidence’s certainty is low but important. Conclusions: The high IDA prevalence in developing countries, including Indonesia, is associated with stunting in children, suggesting a synergistic relationship.

Introduction: The school-based refractive error screening program is important in preventing visual impairment caused by uncorrected refractive errors and enhancing students' academic performance. This study aimed to identify key dimensions for establishing an effective school-based refractive error screening program from the perspective of elementary teachers. Methodology: The focus group discussion (FGD) using the qualitative-exploratory method among ten elementary teachers from one public school in Jakarta. The voice records of participants were transcribed verbatim, coded, and qualitatively analyzed to generate relevant dimensions. Several dimensions in the conceptual framework were concluded within the twelve categories. Results: Four key dimensions to establish an effective school-based refractive error screening program were identified ranging from resources, screening procedure, education and awareness, and spectacles. These dimensions emphasized the significance of having trained teachers as screeners, understanding the comprehensive screening and referral process, offering incentives and user-friendly tools, and ensuring accessible and affordable spectacles to enhance students' compliance. Conclusion: This study identified four dimensions for effective school-based refractive error screening programs, which are resources, screening procedures, education and awareness, and spectacles.

This study conducted a systematic scoping review to collect definitions and explanations of esports and its related concepts in the existing literature. A thematic coding approach was used to screen possible disagreements and issues between the different characteristics of esports as presented in the existing definitions. Based on a critical discussion, the results of the coding were combined with the objective facts of the current esports industry and theories from similar fields to reconstruct the construction of an esports definition. In addition, the relationship between esports and its related concepts was discussed based on the proposed esports definition structure. The proposed esports criteria can help avoid misunderstandings and confusion in future studies regarding the research subjects related to esports and propose standardized usage of relevant terms in the field of esports research.

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Food security, food sustainability, and malnutrition represent critical global challenges. Th urgency of comprehensive action is evident in the need for research collaboration between the food industry, agriculture, public health, and nutrition. This article highlights the role of philanthropy, of a non-profit organization, in supporting research and development and filling financial gaps. The article also explores the interplay of nutrition, agriculture, and government and policy, positioning philanthropy as a catalyst for transformative change and advocating for collaborative efforts to comprehensively address global food challenges. In addition, the discussion also underscores the ethical complexities surrounding charitable food aid, especially in terms of the dignity and autonomy of its recipients. The paper concludes by proposing future directions and implications, advocating for diversified intervention portfolios and collaborative efforts involving governments, businesses, and local communities. Apart from that, the importance of answering and alleviating ethical dilemmas related to food charity assistance needs to be a concern for future studies related to philanthropy because of the significant challenges faced by the contemporary food system, which include food security, health, and nutritional sustainability.

This study aims to analyze the intersection between the Metaverse and sustainable consumption by examining and reviewing 21 journal articles and to identify future research directions for studies in this domain. The review identifies five domains of literature in the field, namely smart cities, social sustainability, tourism, education, and sustainable marketing. Our findings suggest that these areas offer valuable insights for sustainable consumption in the Metaverse. The authors highlight the need for a comprehensive understanding of the economic and environmental impacts of the Metaverse on sustainable consumption. Finally, the study identifies future research directions, including a better understanding of consumer behavior, policy considerations, motivations in the Metaverse and the role of technology in promoting sustainable consumption. This study contributes to the emerging field of Metaverse and sustainable consumption by providing an overview of the current domains of literature in the field.

With the advent of multimedia streaming services such as 4K/8K and extended reality, managing and optimizing multimedia service delivery to end-users remains a challenge for mobile network operators, Internet service providers, and over-the-top (OTT) providers. To solve the present concerns and challenges associated with multimedia traffic management and quality of experience (QoE) in next-generation networks, new network and service management approaches for multimedia services are required. Network softwarization and virtualization paradigms that leverage software defined networking (SDN) and network function virtualization (NFV) are considered as key technologies for network and service management in future softwarized networks. This paper adopts SDN control logic to implement a dynamic QoE-aware resource management approach in future softwarized and virtualized networks. We propose QoESoft, a QoE-aware network softwarization approach for multimedia streaming services that (a) performs a dynamic link and switch resources management, and (b) improves end-user’ QoE in softwarized systems. We introduce two important components, the QoE-sdnFlow monitor and QoE-sdnFlow manager as an extension to the SDN controller to monitor and manage the overall utilization of resources of mapped virtual links and nodes. We present a practical implementation of the QoESoft approach using a dash.js reference player where the bitrate decision adaptation logic and video segment download process are modified by introducing two components: the $BandwidthPredictor$ and the $Reporting$ functions. The $BandwidthPredictor$ component ensures that the video bitrate is selected based on the available resources on the client’s side in a dynamic manner. The $Reporting$ module provides the current streaming status of the dash.js player (e.g., stall duration, bitrate switching, startup delay, and video QoE). In addition, we present the initial evaluations of virtual network survivability and an economical analysis that maximizes the profit for OTTs/ISPs by providing better QoE to customers. The performance of the proposed approach is analyzed through extensive experiments using a Laboratory for Image and Video Engineering - Amazon Prime Video (LIVE-APV) Streaming Database running over the developed softwarized - DASH- based platform based on the Mininet and POX controller. Preliminary results indicate that QoESoft outperforms the baseline approach in terms of link resources utilization and switch resources utilization, low-live latency, startup delays, bitrate switching, stall duration and video QoE.

BackgroundRapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. ObjectiveThis systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. MethodsWe searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. ResultsA total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI −0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). ConclusionsOur review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. Trial RegistrationPROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104

The first 1000 days of life constitute a critical phase that will determine the optimum growth and development of a child. An important factor in this phase of life is the perinatal mental health of mothers and children. Mental health awareness is an important public health issue with significant impacts on mothers, spouses, and families, as well as the long-term emotional and cognitive development of children as well. However, the awareness and promotion of mental health within the realms of reproductive health, maternal health, and infant health, i.e., the first 1000 days of life, do not receive high prioritization in Indonesia. Nonetheless, Indonesia, with its existing primary healthcare system, has the potential to raise awareness of and promote the importance of perinatal mental health for its citizens. This experts’ consensus proposes several strategies to maximize the usefulness of primary healthcare facilities in Indonesia, including Community Health Centers and Integrated Healthcare Posts, to support perinatal mental health awareness and promotion during the first 1000 days of life. The success of this program, in return, will improve the health status of women and children in Indonesia.

Abstract Aim The aim of this study was to examine the relationship between intake of vitamins B1, B6, B9 and B12 with emotional mental disorders among nurses in Indonesia. Design This cross‐sectional study included nurses who have worked at least six months at a private hospital in Indonesia from March to April 2021. Methods We used the Food Frequency Questionnaire, Self‐Reporting Questionnaire 20 and the Expanded Nursing Stress Scale questionnaire to assess the B‐vitamin intake, emotional mental disorders and work‐related stress. Results Of 80 interviewed nurses, 8.8% experienced severe work‐related stress, and 22.5% had emotional mental disorders. Most nurses had inadequate intake of vitamins B1 and B9 but had adequate intake of vitamins B6 (72.5%) and B12 (56.3%). Emotional mental disorders are more probably to occur in nurses with less intake of vitamins B6 and B12, with respective aOR of 20.06, 95% CI 4.14–97.09 (p

Adrenocortical carcinoma is a rare disease with poor prognosis whose clinical heterogeneity can at times present a challenge to accurate and timely diagnosis. We present the case of a patient who presented with extensive pulmonary lesions, mediastinal and hilar lymphadenopathy and an adrenal mass in whom the oncological diagnosis was initially uncertain. Through the use of immunohistochemistry, biochemistry and genomic testing, an accurate diagnosis of adrenocortical carcinoma was ultimately made which resulted in more directed treatment being administered. The use of multidisciplinary input and genomics to aid in diagnosis and prognosis of adrenocortical carcinoma is discussed.

ABSTRACT During the COVID-19 pandemic era, the government has implemented a new strategy of health protocol called Adaptation of New Habits to prevent COVID -19 virus spread. By implementing such protocol, it is expected that health and economic sectors can be handled well. The research aims to discover the implementation of health protocol in Indonesia’s food and beverage business, and to analyze factors that support and hamper its implementation. This research was cross-sectional research with direct observation and brief interviews with 16 food and beverage business places. Observations and interviews were guided using a checklist derived from government policies set by the ministry of health and commerce then the data will be analyzed descriptively. This research shows that the implementation health protocol remained far from expectations. Moreover, business activity, management system, and the awareness of employers, employees, as well as consumers, became a critical key in health protocol implementation. Comprehending the dangers of COVID-19 and committing to comply with health protocols are imperatives to succeed in the health protocol implementation. Keywords: Adaptation of New Habits, Health Protocol of COVID-19 Pandemic, evaluating health protocols implementation

ABSTRACT Background: Immature immune system in preterm infants is associated with gut dysbiosis and poses significant health risks to their growth and development. Current guidelines for managing preterm infants focuses solely on macro- and micronutrients, whereas preterm infants’ gastrointestinal system requires optimalization to support nutrient absorption. Studies on the positive impacts of prebiotics as supplements have been conducted, but has not been implemented in Indonesia. Indonesian pediatricians’ perspective on these findings needs to be assessed. Objectives: To describe the perspectives of Indonesian pediatricians on the role of gut microbiota balance in supporting immunity, growth, and development of preterm infants, and the role of breastmilk and prebiotic-supplemented formula in optimizing gut microbiota balance. Methods: A cross-sectional study was conducted on 114 Indonesian pediatricians using a previously-validated and previously-used questionnaire on the role of gut microbiota balance on preterm infants, as well as the role of breastmilk and prebiotic-supplemented formula in optimizing gut microbiota balance. Results: Most respondents agreed that gut microbiota balance supports immunity, growth, and development of preterm infants. Respondents also agreed that breastmilk contains nutrients that support gut microbiota balance and when breastmilk becomes unavailable, prebiotic-supplemented formula can be given as substitute. Conclusions: Indonesian pediatricians considered gut microbiota balance to be important for immunity, growth, and development of preterm infants, and breastmilk to be the most ideal source of nutrition for preterm infants in optimizing gut microbiota balance. When breastmilk is unavailable, prebiotic-supplemented formula can be considered as an alternative.

A plausible association is suspected among air pollution, respiratory allergic disorder, and infection. These three factors could cause uncontrollable chronic inflammation in the airway tract, creating a negative impact on the physiology of the respiratory system. This review aims to understand the underlying pathophysiology in explaining the association among air pollution, respiratory allergy, and infection in the pediatric population and to capture the public’s attention regarding the interaction among these three factors, as they synergistically reduce the health status of children living in polluted countries globally, including Indonesia.

Recently, the immune system has been identified as one of the possible main bridges which connect the gut–brain axis. This review aims to examine available evidence on the microbiota–immunity–cognitive relationship and its possible effects on human health early in life. This review was assembled by compiling and analyzing various literature and publications that document the gut microbiota–immune system–cognition interaction and its implications in the pediatric population. This review shows that the gut microbiota is a pivotal component of gut physiology, with its development being influenced by a variety of factors and, in return, supports the development of overall health. Findings from current research focus on the complex relationship between the central nervous system, gut (along with gut microbiota), and immune cells, highlighting the importance of maintaining a balanced interaction among these systems for preserving homeostasis, and demonstrating the influence of gut microbes on neurogenesis, myelin formation, the potential for dysbiosis, and alterations in immune and cognitive functions. While limited, evidence shows how gut microbiota affects innate and adaptive immunity as well as cognition (through HPA axis, metabolites, vagal nerve, neurotransmitter, and myelination).

Background: Including Indonesia, the elderly population worldwide is on the rise. This situation is closely related to the increase in the incidence and prevalence of non-communicable diseases. Eating behavior is related to the risk of non- communicable the risk of NCDs in the elderly. Therefore, nutrition intervention should be carried out from old age. Objectives: The purpose of this study is to review potential nutritional interventions to prepare for a healthy ageing process in an Indonesian context. Discusion: This review uses social cognition theory to emphasize the importance of nutrition education, the development of nutritional products with biologically active compounds, and practical guidelines that influence individual dietary behavior. Nutritional interventions should take into account Indonesia’s existing food-based balanced nutrition diet guidelines and the dietary patterns of adults and the elderly. Indonesia has a large population, ethnic and cultural diversity, which together affect people’s daily consumption of various foods. Conclusions: Customized nutrition education programs and the development of functional foods are appropriate interventions that can be implemented in Indonesia.

Background: The rapid ageing population among older adults from 2020 to 2040 has led to an emerging focus as this group begins to experience ageing and has a higher risk of having chronic illness of non-communicable diseases. Therefore, it is important to provide General Practitioners (GPs) with adequate knowledge and attitude of healthy ageing to ensure the quality of health service among older adults. Objectives: To identify the perspective of general practitioners including the knowledge, attitude and practice towards adult health and nutrition to support healthy ageing in Indonesia. Methods: An online survey was conducted among 100 general practitioners registered at the Indonesian Medical Council (KKI) and domiciled in the Greater Jakarta area and outside the Jabodetabek area. The sample recruitment process was carried out using the Alomedika online application. All data were analyzed using SPSS software. Results: Almost all (92%) of respondents who took this survey had a supportive attitude in providing additional nutrition to adults to support healthy ageing. About 76% of the respondents did so by recommending milk. However, in terms of knowledge, around 67% of the respondents showed inadequate results, especially about physiological changes that occurred in adults. There is no statistically significant difference between respondents’ demographic characteristics and all perspectives measured in this study (i.e., knowledge, attitude and practice) Conclusions: The study indicates that it is important to educate general practitioners about the healthy aging process in order to maintain general practitioners' attitudes and behavior in health services to support the success of achieving healthy aging in Indonesia.

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Since its launch just over a decade ago by the cryptocurrency Bitcoin, the distributed ledger technology (DLT) blockchain has followed a breathtaking trajectory into manifold application spaces. This study aper analyses how key factors underpinning the success of this ground-breaking “Internet of value” technology, such as staking of collateral (“skin in the game”), competitive crowdsourcing, crowdfunding, and prediction markets, can be applied to substantially innovate the legacy organization of science, research, and technology development (RTD). Here, we elaborate a highly integrative, community-based strategy where a token-based crypto-economy supports finding best possible consensus, trust, and truth by adding unconventional elements known from reputation systems, betting, secondary markets, and social networking. These tokens support the holder’s formalized reputation and are used in liquid-democracy style governance and arbitration within projects or community-driven initiatives. This participatory research model serves as a solid basis for comprehensively leveraging collective intelligence by effectively incentivizing contributions from the crowd, such as intellectual property work, validation, assessment, infrastructure, education, assessment, governance, publication, and promotion of projects. On the analogy of its current blockbusters like peer-to-peer structured decentralized finance (“DeFi”), blockchain technology can seminally enhance the efficiency of science and RTD initiatives, even permitting to fully stage operations as a chiefless decentralized autonomous organization (DAOs).

Air pollution is an unseen threat to children’s health because it may increase the risk of respiratory infection, atopy, and asthma, and also alter gut microbiota compositions. The impact of air pollution on children’s health has not been firmly established. A literature review followed by a series of discussions among experts were performed to develop a theoretical framework on how air pollution could affect various bodily organs and functions in children. We invited experts from different backgrounds, such as paediatricians, nutritionists, environmental health experts, and occupational health experts, to provide their views on this matter. This report summarizes the discussion of multidisciplinary experts on the impact of air pollution on children’s health. The report begins with a review of air pollution’s impact on allergy and immunology, neurodevelopment, and cardiometabolic risks, and ends with the conceptualization of a theoretical framework. While the allergic and immunological pathway is one of the most significant pathways for air pollution affecting children’s health in which microbiotas also play a role, several pathways have been proposed regarding the ability to affect neurodevelopment and cardiometabolic risk. Further research is required to confirm the link between air pollution and the gut microbiota pathway.

We outline the concept of an open technology platform that builds upon a publicly accessible library of fluidic designs, manufacturing processes, and experimental characterization, as well as virtualization by a “digital twin” based on modeling, simulation, and cloud computing. Backed by the rapidly emerging Web3 technology “Blockchain,” we significantly extend traditional approaches to effectively incentivize broader participation by an interdisciplinary “value network” of diverse players. Ranging from skilled individuals (the “citizen scientist” and the “garage entrepreneur”) and more established research institutions to companies with their infrastructures, equipment, and services, the novel platform approach enables all stakeholders to jointly contribute to value creation along more decentralized supply chain designs including research and technology development (RTD). A blockchain-enabled token economy efficiently leverages the “Wisdom of the Crowds” and secures “trust” and transparency by reputation systems requiring “skin in the game” from contributors. Prediction markets are created for guiding decision making, planning, and allocation of funding; competitive parallelization of work and its validation from independent participants substantially enhances quality, credibility, and speed of project outcomes in the real world along the entire path from RTD, fabrication, and testing to eventual commercialization. This novel, Blockchain-backed, open platform concept can be led by a corporation, academic entity, a loosely organized group, or even “chieflessly” within a smart-contract encoded Decentralized Autonomous Organization (DAO). The proposed strategy is particularly attractive for highly interdisciplinary fields like microfluidic Lab-on-a-Chip systems in the context of manifold applications in the Life Sciences. As an exemplar, we outline the centrifugal “Lab-on-a-Disc” technology. Rather than engaging in all sub-disciplines themselves, many smaller, highly innovative actors can focus on strengthening the product component distinguishing their unique selling point (USP), e.g., a particular bioassay, detection scheme, or application scenario. In this effort, system integrators access underlying commons like fluidic design, manufacture, instrumentation, and software from a more resilient and diversified supply chain, e.g., based on a verified pool of community-endorsed or certified providers.

An overwhelming majority of experts has been flagging for decades that “Saving the Planet” requires immediate, persistent and drastic action to curb a variety of catastrophic risks over the 21st century. However, despite compelling evidence and a range of suggested solutions, transnational coordination of effective measures to protect our biosphere continues to fall short. To remedy, we propose a novel platform for addressing the central issue of affording trust, transparency and truth while minimizing administrative overheads. This will empower an even loosely organized, global grass-roots community to coordinate a large-scale project on a shared goal (“Commons”) spanning the digital and real world. The Web3 concept is based on the swiftly emerging “Blockchain” and related cryptographic, distributed and permissionless technologies. “Wisdom of the crowds” mechanisms involving competitive parallelization and prediction markets are enabled by formalized reputation and staking to incentivize high-quality work, fair validation and best management practice. While these mechanisms have been (mostly separately) applied to science, business, governance, web, sensor, information and communication technologies (ICT), our integrative approach around Blockchain-enabled ‘operating principles and protocols’ sets the basis for designing novel forms of potentially crowdfunded Decentralized Autonomous Organizations (DAOs).

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

Abstract Background Working mothers have a higher risk to terminate breastfeeding earlier than stay-at-home mothers. Researchers reported that support from the workplace by creating lactation facilities and develop supportive programs are necessary to increase the success of exclusive breastfeeding. The aim was to achieve expert consensus on developing a workplace-based lactation promotion model. Methods A three-round online survey using Delphi approach was conducted to reach consensus on to the development of a lactation program at a workplace. Results Twenty-two experts from Indonesian health authority, community medicine, child health and obstetrics were invited to join the Delphi study; 15 (68.2%) enrolled in the first round. The response rate in the second and third round was 80.0% (12/15) and 86.7% (13/15), respectively. The first round categorized the workplace-based promotion model into seven dimensions, i.e. policy and regulation, facility, education material, target participants, promotion approach, human resources, and time. In the final round, “maternity leave of 3-6 months” (median (Q1;Q3):2 (1, 4)) and “employees have the right to breast-pumping every 3 hours” (median (Q1;Q3):3 (2, 4)) ranked as the two most important indicators regarding policy and regulation. A dedicated lactation room (median (Q1;Q3):1 (1)) is the highest ranked indicator regarding facility dimension. Regarding education materials, benefits of breast milk for babies ranked as the highest indicator while for the education and delivering methods dimensions, social media and interactive counseling were two highest ranked indicators. The top management in the company and lactation counselor are the two highest-ranked indicators in human resources dimension. Conclusion In the view of experts, involvement of a dedicated policy maker in the company, a workplace-based lactation counselor, regular promotion with interactive education and dedicated facilities are necessary to develop an effective workplace-based lactation promotion model.

Abstract To screen the complex central nervous system (CNS) injury responses, we created a quadruple-labelled ‘PrismPlus’ mouse line with a genetically encoded distinct fluorescent tag in oligodendrocytes, microglia, neurons, and astrocytes. Cx3cr1-gfp and Prism mice originally developed by Jung et al., 2000 and Dougherty et al., 2012, respectively, were cross-bred. First, we confirmed the presence of fluorophores in appropriate cell types in PrismPlus mice. PrismPlus mice were then used to examine the cellular responses to brain implanted micro-devices. We observed an increase in microglial response at earlier time points as compared to 4 weeks, a progressive astrocytic response, and fewer neurons at the vicinity of an implanted device. These results are similar to what has been described in literature using other rodent strains, previously attainable only through time-consuming and variable immunohistochemistry methods. Finally, we demonstrate the compatibility of PrismPlus brain tissue with CLARITY, an advanced tissue clearing technique, opening the door to future thick tissue imaging studies. This report confirms PrismPlus transgenic fluorescence and highlights the utility of these mice to study CNS injuries. The work herein seeks to establish a novel transgenic mouse line to improve experimental scope, consistency, and efficiency for CNS researchers.

Latar belakang. Kualitas tumbuh kembang balita ditentukan oleh nutrisi, kasih sayang, stimulasi, dan perlindungan terhadap penyakit. Ibu sebagai pengasuh utama anak berperan penting mengoptimalkan pertumbuhan dan perkembangan anak, sehingga harus memiliki sikap yang baik tentang pemantauan tumbuh kembang saat kunjungan ke tenaga kesehatan. Peningkatan pengetahuan Ibu dapat dilakukan dengan edukasi dan pelatihan. Tujuan. Menganalisis efektivitas seminar pada perubahan sikap ibu dalam pemberian dukungan nutrisi dan stimulasi selama pemantauan tumbuh kembang. Metode. Penelitian desain potong lintang dengan kuesioner pre dan post intervensi dilakukan pada ibu dengan balita. Perubahan sikap ibu dievaluasi dalam pemantauan tumbuh kembang anaknya. Intervensi berupa seminar mengenai kesehatan anak yang diadakan di 6 kota besar di Indonesia dengan purposive sampling peserta yang mengisi lengkap kuesioner. Analisis data digunakan metode paired T-test dalam software IBM SPSS statistics versi 22. Hasil. Terdapat 617 ibu yang mengisi lengkap kuesioner yang diberikan dalam seminar. Terjadi peningkatan yang bermakna (beda mean -0,15±0,26;95%CI -0,17sampai-0,13; p

Background Play stimulates children’s growth and development. When mothers and their children play, a positive attitude from the mother and adequate interest from the child is required. Little is known about the play activities that effectively stimulate such positive maternal attitude and child interest. Objective To assess for associations between various play activities with maternal attitude and child interest before and after mother-child play sessions. Methods Pre-post intervention questionnaires were distributed to mothers before and after playing with their children. Children were aged 1-5 years, from two play sites (in Surabaya and Makassar), and included using purposive sampling. Eight types of toys/play activities were provided. The allocated time for answering the 17-question survey was 15 minutes. Average scores before and after the mother-child play sessions were analyzed using paired T-test. Results We collected 264 valid questionnaires, 235 in Surabaya and 29 in Makassar. Improvement of maternal attitude after the mother-child play session was found in 132 mothers [mean diff. 0.07 (SD 0.42); 95%CI -0.117 to -0.015; P=0.011]. Play activities with significant improvements in maternal attitude were jigsaw puzzle [mean diff. 0.09 (SD 0.66); 95% CI 0.007 to 0.167;P= 0.033), Lego blocks (mean diff.-0.10 (SD 0.69); 95%CI -0.186 to -0.018; P=0.017), mini-gardening (mean diff. -0.15 (SD 0.75); 95%CI -0.238 to -0.057; P=0.002), sandbox [mean diff.-0.24 (SD 0.83); 95%CI -0.339 to – 0.138; P < 0.001], fishing [mean diff. -0.17 (SD 0.68); 95%CI -0.253 to -0.088; P < 0.001], and animal figurines [mean diff. -0.21 (SD 0.75); 95%CI -0.3 to -0.117;P

The World Health Organization (WHO) has projected that the world should prepare for an aging society. As the fourth most populous country in the world, the elderly population in Indonesia is also continuously growing. In 2010, the proportion of the elderly group was merely 5%, and it is expected to increase to 11% in 2035. Understanding the current situation of the adult population in Indonesia would be crucial to prepare for the future aging population. This article analyzed the current socio-demographic status, nutrition status, nutrient intake, and health profile of the current Indonesian adult population through a literature review. The key issues to prepare for healthy aging in Indonesia are summarized. Acknowledging the profile of the adult and senior adult population in Indonesia will provide beneficial information for all stakeholders in preparing Indonesia for a better healthy aging population with improved quality of life.

Background: Proton-pump inhibitors (PPIs) and clopidogrel are frequently coprescribed, although the benefits and harms of their concurrent use are unclear.Objective: To examine the association between concurrent use of PPIs and clopidogrel and the risks for hospitalizations for gastroduodenal bleeding and serious cardiovascular disease.Design: Retrospective cohort study using automated data to identify patients who received clopidogrel between 1999 through 2005 after hospitalization for coronary heart disease.Setting: Tennessee Medicaid program.Patients: 20,596 patients (including 7593 concurrent users of clopidogrel and PPIs) hospitalized for myocardial infarction, coronary artery revascularization, or unstable angina pectoris.Measurements: Baseline and follow-up drug use was assessed from automated records of dispensed prescriptions. Primary outcomes were hospitalizations for gastroduodenal bleeding and serious cardiovascular disease (fatal or nonfatal myocardial infarction or sudden cardiac death, stroke, or other cardiovascular death).Results: Pantoprazole and omeprazole accounted for 62% and 9% of concurrent PPI use, respectively. Adjusted incidence of hospitalization for gastroduodenal bleeding in concurrent PPI users was 50% lower than that in nonusers (hazard ratio, 0.50 [95% CI, 0.39 to 0.65]). For patients at highest risk for bleeding, PPI use was associated with an absolute reduction of 28.5 (CI, 11.7 to 36.9) hospitalizations for gastroduodenal bleeding per 1000 person-years. The hazard ratio associated with concurrent PPI use for risk for serious cardiovascular disease was 0.99 (CI, 0.82 to 1.19) for the entire cohort and 1.01 (CI, 0.76 to 1.34) for the subgroup of patients who had percutaneous coronary interventions with stenting during the qualifying hospitalization.Limitations: Unmeasured confounding and misclassification of exposure (no information on adherence or over-the-counter use of drugs) and end points (not confirmed by medical record review) were possible. Because many patients entered the cohort from hospitals with relatively few cohort members, the analysis relied on the assumption that after adjustment for observed covariates, PPI users from one such hospital could be compared with nonusers from a different hospital.Conclusion: In patients with serious coronary heart disease treated with clopidogrel, concurrent PPI use was associated with reduced incidence of hospitalizations for gastroduodenal bleeding. The corresponding point estimate for serious cardiovascular disease was not increased; however, the 95% CI included a clinically important increased risk.Primary Funding Source: Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute. [ABSTRACT FROM AUTHOR]

Objective: African Americans have less use of antidepressants than whites, suggesting racial differences in the diagnosis and treatment of mood disorders. This study assessed whether this racial disparity is present among patients with a very high risk of severe mood disorders--that is, those with completed suicides.Methods: Completed suicides that occurred between 1986 and 2004 were identified by examining records of Tennessee Medicaid/TennCare enrollees aged 18 to 84 years who had no serious medical illness or chronic psychosis. Use of antidepressants in the 365 days before the suicide was ascertained from filled prescriptions. Unconditional logistic regression was used to adjust for racial differences in demographic characteristics and somatic comorbidity.Results: The study included 127 African Americans and 1,379 whites who completed suicide. African Americans had significantly reduced odds of receiving treatments for mood disorders in the year preceding the suicide: 29% of African Americans had filled an antidepressant prescription, compared with 51% of whites (adjusted odds ratio=.43, 95% confidence interval=.26-.71, p<.001). In contrast, there was no significant difference between the two racial groups in the proportions filling prescriptions for antipsychotic medications (13% of African Americans and 11% of whites). These findings persisted after the analysis controlled for other comorbidities linked with suicide, including alcohol or substance abuse, seizure disorders, borderline personality disorder, and serious neurological conditions.Conclusions: Although there are several other potential explanations, the study findings provide indirect evidence that there is underdiagnosis or undertreatment of African Americans with serious mood disorders. Further research on this question in African-American populations is essential. [ABSTRACT FROM AUTHOR]

Background: For high-risk children with asthma enrolled in Medicaid, loss of Medicaid coverage is a potential threat to access to quality asthma care.Objective: We sought to quantify the effect of gaps in enrollment on emergency department visits and hospitalizations for children with asthma in TennCare, Tennessee's managed care program for Medicaid-eligible and uninsured children.Methods: Children with asthma were identified from a research database of files maintained by the state. Gaps in enrollment in the state insurance program were measured between 1998 and 2002. Children with gaps were compared with children without gaps with respect to emergency department visits and hospitalizations for asthma, respiratory illnesses, croup, and other diagnoses.Results: Among children who met study definitions of asthma, 2373 experienced a gap in enrollment during the study period (10.4%). The rate of hospitalizations and emergency department visits for children with gaps (7402/10,000 person years) was significantly lower than the rate of study events for children with no gaps (9230/10,000 person years) (adjusted incidence rate ratio 0.88; 95% confidence interval 0.81-0.96). The rate of hospitalizations for asthma and other respiratory conditions was not different between the 2 groups; however, there was a significantly lower rate of hospitalizations for other reasons for children with gaps (adjusted incidence rate ratio 0.59; 95% confidence interval 0.41-0.86).Conclusions: Children with asthma who had gaps in a Medicaid managed care insurance program had no increase in asthma related emergency department visits and hospitalizations. Children who had gaps did have fewer nonrespiratory emergency department visits and hospitalizations than their non-gap counterparts. Further study is needed to explore the reasons for this unexpected finding. [ABSTRACT FROM AUTHOR]

Context: Cisapride, a gastrointestinal tract promotility agent, can cause life-threatening cardiac arrhythmias in patients susceptible either because of concurrent use of medications that interfere with cisapride metabolism or prolong the QT interval or because of the presence of other diseases that predispose to such arrhythmias. In June 1998, the US Food and Drug Administration (FDA) determined that use of cisapride was contraindicated in such patients and informed practitioners through additions to the boxed warning in the label and a "Dear Health Care Professional" letter sent by the drug's manufacturer.Objective: To evaluate the impact of the FDA's 1998 regulatory action regarding contraindicated use of cisapride.Design and Setting: Analysis of data for the 1-year periods before (July 1997-June 1998) and after (July 1998-June 1999) the regulatory action from the population-based, pharmacoepidemiology research databases of 2 managed care organizations (sites A and B) and a state Medicaid program (site C).Participants: Patients with at least 180 days of prior enrollment in 1 of the 3 sites who were prescribed cisapride at least once in the period before (n = 24 840) or after (n = 22 459) regulatory action. Patients could be included in both cohorts.Main Outcome Measures: Proportion of cisapride users in each period for whom cisapride use was contraindicated by the product label, based on computerized patient medical encounter records.Results: In the year prior to regulatory action, cisapride use was contraindicated for 26%, 30%, and 60% of users in study sites A, B, and C, respectively. In the year after regulatory action, use was contraindicated for 24%, 28%, and 58% of users, a reduction in contraindicated use of approximately 2 per 100 cisapride users at each site. When the analysis was restricted to new users of cisapride after regulatory action, only minor reductions in contraindicated use were found.Conclusion: The FDA's 1998 regulatory action regarding cisapride use had no material effect on contraindicated cisapride use. More effective ways to communicate new information about drug safety are needed. [ABSTRACT FROM AUTHOR]

Context: Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.Objective: To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.Design: Randomized controlled trial.Setting and Participants: Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention.Intervention: Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety.Main Outcome Measures: The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention.Results: The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P=.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P=.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year.Conclusion: The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs. [ABSTRACT FROM AUTHOR]

Context: Beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors are effective antihypertensive agents for patients with diabetes mellitus. However, beta-blockers attenuate some components of the autonomic response to hypoglycemia and could increase the risk of hypoglycemia. ACE inhibitors may increase insulin sensitivity and predispose users to hypoglycemia.Objective: To determine whether use of cardioselective beta-blockers, nonselective beta-blockers, ACE inhibitors, thiazide diuretics, calcium channel blockers, or other antihypertensive drugs alters the risk of developing serious hypoglycemia among older persons prescribed insulin or sulfonylureas.Design: Retrospective cohort study.Setting: Tennessee Medicaid Program.Patients: A total of 13,559 elderly (mean age, 78+/-7 years) Medicaid enrollees, who were prescribed insulin (n=5171, 38%) or sulfonylureas (n=8368, 62%) from 1985 through 1989. These enrollees contributed a total of 33,107 person-years of insulin or sulfonylurea use for follow-up.Measurements: Hospitalization, emergency department admission, or death associated with hypoglycemic symptoms and a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL).Results: We identified 598 persons with an episode of serious hypoglycemia during the study period. The rate of serious hypoglycemia was 2.01 per 100 person-years among those who were not prescribed antihypertensives. Crude rates of serious hypoglycemia were highest among users of ACE inhibitors (2.47 per 100 person-years) and lowest among users of cardioselective beta-blockers (1.23 per 100 person-years). However, when we controlled for demographic characteristics and markers of comorbidity, there was no statistically significant increase or decrease in risk of serious hypoglycemia among users of any class of antihypertensive agents compared with nonusers of antihypertensive drugs. Using nonselective beta-blockers as the reference group, each of these agents was associated with a lower, but not statistically significant, risk of hypoglycemia.Conclusions: In this population, specific antihypertensive drug therapy had little impact on the risk of hypoglycemia in older diabetic patients. Therapy should be chosen based on other considerations of safety and effectiveness. [ABSTRACT FROM AUTHOR]