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Aims: This study investigated the synergistic and independent effects of adherence to antiretroviral therapy (ART) and viral load on quality of life (QoL) among people with HIV/AIDS. Methods: This was a cross-sectional study of 129 patients with HIV/AIDS. The WHOQOL-BREF and the Morisky Medication Adherence Scale were used to measure QoL and adherence respectively. Information on viral load and CD4 cell count was obtained from patients' records and verified by a physician. An additive interaction method was used to estimate the synergistic effect of the linear regression. Findings: Patients who were adhering to ART and had an undetectable viral load had significantly higher scores on four domains of QoL − environment, physical health, social relationships and psychological − than those who were non-adherent. Moreover, ART adherence and undetectable viral load had a positive synergistic effect on QoL after controlling for covariate variables. Conclusion: Participants were more likely to have a good QoL if they had both undetectable viral loads and good ART adherence.

Arifin H, Chou KR, Ibrahim K, et al. J Multidiscip Healthc. 2022;15:2203–2221. Page 2203, Abstract, Results, line three, the text “passive smoking (aOR: 0.910; 95% CI: 0.878–0.942)” should read “passive smoking (aOR: 1.185; 95% CI: 1.136–1.236)”. Page 2210, Physiological Risk Factors, paragraph four, line four, the text “compared with smokers (p < 0.001; aOR: 0.910; 95% CI: 0.878–0.942)” should read “compared with smokers (p < 0.001; aOR: 1.185; 95% CI: 1.136–1.236)”. The authors apologize for these errors.

To explore the effects of disability, depressive, anxiety and stress symptoms on patients' and their partners' quality of life (QoL) using the actor-partner interdependence model (APIM).A cross-sectional study using actor-partner interdependence model.We recruited 183 dyads of stroke survivors and their family caregivers in Indonesia. The World Health Organization Disability Assessment (WHODAS 2.0), Depression, Anxiety and Stress (DASS-42) and Rand Short Form Health Survey (SF-36) were used to measure disability, depressive, anxiety and stress symptoms and QoL of stroke survivors and family caregivers. The actor-partner interdependence model was tested using multilevel modelling. The actor-partner interdependence mediation model (APIMeM) was applied to estimate the direct and indirect effect.Disability had actor effects on stroke survivor's overall QoL and partner effect on family caregiver's overall QoL. More severe disability of stroke survivors was associated with a lower overall QoL of their own and that of family caregiver's overall QoL. Depressive symptoms of stroke survivors had actor effects on stroke survivors' overall QoL and partner effects on family caregivers' overall QoL. Actor and partner effects also exist on family caregiver's depression symptoms to their own overall QoL and stroke survivor's overall QoL. Moreover, higher anxiety symptoms were associated with lower levels of their own and partner's overall QoL in both stroke survivors and family caregivers. Stroke survivor's stress symptoms also negatively associated with their own and family caregiver's overall QoL. However, a family caregiver's stress without a partner effects on stroke survivor's overall QoL. The APIMeM analysis showed that disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, disability mediated by stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS).The findings suggest that stroke survivors and family caregivers may influence each other during the caregiving process and social life. The disability of stroke survivors, and the depression, anxiety and stress symptoms of stroke survivors and family caregivers affect their own QoL and their partners' QoL. Disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, it indirectly via stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS).Dyadic actor-partner interdependence models have shown promising potential to predict the QoL among patients and family caregivers. The dyadic effects of disability, depression, anxiety and stress symptoms on the QoL of stroke survivors and family caregivers can be applied to guide the future development of nursing intervention addressed decreasing depression, anxiety and stress symptoms to optimize health outcomes among stroke survivors and their family caregivers.

Gender differences and type 2 diabetes mellitus (T2DM)-associated inflammatory biomarkers are correlated with high levels of anxiety. However, no study has investigated gender differences and high level of white blood cells (WBC) on anxiety among participants with T2DM in Indonesia. We examined the roles of gender and WBCs on anxiety symptoms in T2DM. A cross-sectional study was performed on 294 patients with T2DM recruited from five community clinics with multistage cluster sampling. Depression, anxiety and Stress-21 (DASS-21) a standardized questionnaire was used to measure anxiety and WBCs was determined using an XP-100 automated haematology analyzer. The adjusted coefficients beta (coefficient Beta) and 95% confidence interval (CI) were performed using a multiple linear regression model. Statistical analyses were calculated using SPSS version 25.0, with a p-value of less than 0.05 set as statistically significant. Females exhibited significantly higher levels of anxiety (Beta=0.26 , 95% CI=0.07 – 0.94 ) than male respondents . Notably, respondents with WBCs of ³ 7.576 had significantly higher anxiety (Beta =2.04, 95% CI=1.12 – 3.71) than patients with WBCs of less than 7.576. There was high prevalence of axienty symptoms in this Indonesian sample of respondents. Female and high level of WBCs exist on increasing susceptibility to anxiety symptoms among individuals with T2DM. Abstrak: Perbedaan jenis kelamin dan biomarker inflamasi terkait diabetes mellitus tipe 2 ( T2DM ) berkorelasi dengan tingkat kecemasan yang tinggi. Namun, belum ada penelitian yang menyelidiki perbedaan jenis kelamin dan sel darah putih ( WBC ) pada kecemasan di antara penyandang T2DM di Indonesia. Kami memeriksa peran jenis kelamin dan WBCs pada gejala kecemasan untuk penyandang T2DM . Studi cross-sectional dilakukan pada 294 penyandang T2DM yang diperoleh dari lima klinik komunitas dengan multistage cluster sampling. Depresi on , Anxiety and Stress-21 (DASS-21) merupakan kusioner standar yang digunakan untuk mengukur kecemasan dan WBCs ditentukan dengan menggunakan penganalisis hematologi otomatis XP-100. Koefisien yang disesuaikan beta (koefisien ?) dan interval kepercayaan 95% (CI) dilakukan dengan menggunakan model regresi linier berganda. Analisis statistik dihitung menggunakan SPSS versi 25.0, dengan nilai p kurang dari 0.05 ditetapkan sebagai signifikan secara statistik. Wanita menunjukkan tingkat kecemasan yang jauh lebih tinggi (? = 0,26, 95% CI = 0,07-0,94) dibandingkan responden laki-laki. Khususnya, responden dengan nilai WBCs ³ 7.576 memiliki kecemasan yang lebih tinggi secara signifikan (? = 2.04, CI 95% = 1.12–3.71) dibandingkan responden dengan nilai WBCs kurang dari 7.576. Terdapat p revalensi gejala axienty yang tinggi pada sample dari responden sampel di Indonesia dalam penelitian ini. W anita dan nilai WBCs yang lebih tinngi memiliki peningkatan kerentanan terhadap gejala kecemasan di antara individu dengan T2DM.

Purpose: The purpose of the study was to explore the effect of synergistic interaction and the independence of physical activity and inflammatory markers, including platelet–lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), on sleep quality in persons with type 2 diabetes mellitus (T2DM). Methods: This descriptive cross-sectional study included 294 persons with T2DM in East Java, Indonesia. Fasting blood was analyzed for inflammation markers, including NLR and PLR. Physical activity and sleep quality were assessed using Metabolic Equivalent of Task and Pittsburgh Sleep Quality Index, respectively. Multivariate logistic regression, chi-square test, and independent t test were performed. Results: There was an independently significant relationship between physical activity, NLR, and PLR with sleep quality. Persons with both active physical activity and low PLRs were 12.52 times more likely to have high sleep quality scores than those with low physical activity and high PLRs. A positive additive interaction of active physical activity and low PLRs for high sleep quality scores was identified. Conclusion: Physical activity, NLR, and PLR revealed an independently significant relationship with sleep quality. Persons with both active physical activity levels and low PLR were the most substantial synergistic effect of high sleep quality. Further studies are necessary to examine the problems and solutions for sleep quality in this population.

Background: The benefits of breastfeeding in promoting child survival are well recognized. As one of the nutritional interventions for children, exclusive breastfeeding protects babies from various diseases that contribute to infant morbidity and mortality. However, no systematic review and meta-analysis has examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates in sub-Saharan Africa. Research Aim: We examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates at < 1 month, and at 1–5 months of breastfeeding in sub-Saharan countries including Ghana, Burkina Faso, Uganda, South Africa, Guinea-Bissau, Kenya, Tanzania, and the Democratic Republic of Congo. Methods: A systematic review and meta-analyses study of randomized controlled trials and quasi-experimental studies was conducted by searching in electronic databases and articles’ reference lists. Two investigators independently evaluated and extracted the data. A total of 131 studies were identified using five databases. Of the 10 studies meeting the inclusion criteria for systematic review, seven studies were included in the meta-analysis. We used a random-effects model to pool studies together and performed a subgroup analysis. Results: Breastfeeding promotion programs resulted in significantly higher exclusive breastfeeding rates at < 1 month ( OR = 1.60, 95% CI [1.36,1.86]). However, there was no significant effect observed for exclusive breastfeeding at 1–5 months. Combined interventions were more effective in improving exclusive breastfeeding rates than individual counseling or home-based counseling alone. Conclusion: Breastfeeding promotion programs in sub-Saharan Africa are effective in increasing exclusive breastfeeding rates at 6 months after birth.

The current study aimed to explore sex-influenced risk factors for cognitive impairment among community-dwelling older adults in Taiwan. This cross-sectional study was a secondary analysis using a population-based design. We accessed and analyzed data from the Taiwan Longitudinal Study on Aging survey of 2011. Participants were older adults aged ≥55 years living in non-indigenous townships. A total of 3,392 community-dwelling older adults were included. Results showed that the prevalence of cognitive impairment in females and males was 15.3% and 5.7%, respectively. Having a low educational level and being single (i.e., single, widowed, or divorced) were risk factors for cognitive impairment in both sexes. Males who had more than two chronic diseases had a higher risk of cognitive impairment. Self-reported hearing loss and depression increased risk of cognitive impairment in older females. Older age, lower educational level, and single marital status were associated with cognitive impairment among community-dwelling older adults in Taiwan. The effects of self-reported hearing loss, depression, and chronic disease on cognitive impairment were influenced by sex. [ Journal of Gerontological Nursing, 48 (6), 19–25.]

Background: The determinants of intention to accept the COVID-19 vaccine and associated factors among nursing students during this pandemic need to be identified. Aims: The study assessed nursing students' attitudes to vaccination, health engagement and trust in government, as well as their intention to have a COVID-19 vaccination. Methods: A cross-sectional study was carried out among nursing students in three provinces of Java, Indonesia, from December 2020 to February 2021. Convenience sampling was used to gather primary data from 640 participants through a structured online survey. Multiple linear regression was used to analyse the results. Findings: All items of vaccine attitude and health engagement as well as trust in government were positive predictors of vaccine acceptance after adjusting for confounding factors. Conclusion: Nursing students were more likely to accept vaccination if they had a positive attitude to vaccination, high levels of health engagement and trust in the government regarding tackling the COVID-19 pandemic.

Background High-grade inflammation represents a critical contribution to the onset of depression and might be manageable by physical activity (PA). Nevertheless, no study has examined synergistic interactions of insufficient PA and high values of the systemic immune-inflammation index (SII) on psychological problems. Objective We investigated independent and synergistic interactions of insufficient PA and high SII levels on stress, anxiety, and depression in T2DM patients. Methods A cross-sectional research design with 294 T2DM patients was conducted. An XP-100 automated hematology analyzer was used to evaluate inflammatory biomarkers. Depression, Anxiety, and Stress Scale-21 items and a standardized questionnaire about PA were respectively used to measure psychological problems and metabolic equivalent of task (MET)-h/week. Results A multiple linear regression demonstrated that patients with insufficient PA were significantly more likely to have higher stress ( β = 1.84, 95% confidence interval (CI) = 1.03–2.65), anxiety ( β = 1.88, 95% CI = 1.81–2.96), and depression ( β = 2.53, 95% CI = 0.82–4.24) than those with active PA. A high SII level was a key predictor and was most strongly associated with stress ( β = 2.61, 95% CI = 2.02–3.20), anxiety ( β = 3.16, 95% CI = 2.37–3.94), and depression ( β = 3.72, 95% CI = 2.49–4.96) compared to those who had low SII levels. Notably, additive interaction results showed that combining insufficient PA and a high SII level had a significantly escalated 1.71-fold risk of stress, 1.82-fold risk of anxiety, and 2.69-fold risk of depression. Conclusions Active PA and a low SII had a positive synergistic effect of decreasing psychological problems.

Perceived workload and organizational justice are significantly correlated with nurses’ intention to leave. However, limited studies have used a large sample to investigate this association. Therefore, this study aims to identify the association between perceived workload and organizational justice on nurses’ intention to leave. A cross-sectional online survey was conducted among 278 nurses by the simplified snowball sampling technique method from five hospitals in Surabaya, East Java Province, Indonesia. Adjusted odds ratios (AORs) and multiple linear regression were employed for data analysis. Perceived workload had increased intention to leave by 0.251-fold (95% CI = 0.20 to 0.31; p =

The Brief Illness Perception Questionnaire (B-IPQ) has been recommended to validate illness perception. Nevertheless, this measurement has yet to be validated with an assessment of the construct and convergent validities and reliability in Indonesia. Our study aimed to psychometrically test the 8-item B-IPQ among Indonesians with type 2 diabetes mellitus (T2DM). Data included 294 patients with T2DM with stratified multistage clustering. The 36-item Short Form Survey, 21-item Depression Anxiety Stress Scale, and fasting blood glucose (FBG) were used to examine convergence and divergence. The validity analysis included the construct and convergent validities with significant person correlations. Cronbach’s alpha, composite reliability (CR), and average variance extracted (AVE) were used to assess reliability. Confirmatory and exploratory factor analyses indicated a multidimensional structure, including cognitive with a five-item structure and emotional illness representation with a three-item structure, with an acceptable goodness of model fit. The tool revealed good internal consistency for the cognitive, emotional, and overall domains and was positively moderately correlated with FBG, stress, anxiety, and depression but negatively correlated with the overall quality of life and mental and physical component scores. Findings provide empirical evidence that the Bahasa version of the B-IPQ showed adequate internal consistency, exploratory and confirmatory, and thus is valid and reliable for illness perception assessments among Indonesians with T2DM.

Background: Understanding the health practice of Indonesian residents and its related factors during the COVID-19 pandemic is crucial, but such association necessitates clarity. Objective: To examine the health practices of the Indonesian citizens and their correlations with knowledge and health belief model (perceived susceptibility, barriers, benefits, severity, and self-efficacy) during the COVID-19 pandemic. Methods: A community-based online cross-sectional design was employed. The study was conducted from 10 July to 30 August 2020 among 552 citizens selected using convenience sampling. Sociodemographic characteristics, knowledge, health belief model, and health practices, including wearing a mask, social distancing, and washing hands, were measured using validated questionnaires. Adjusted odds ratios (AORs) and logistic regression were employed for data analysis. Results: The adjusted AORs (95% CIs) of a good level of health practices—wearing the mask, social distancing, and washing hands—were 3.24 (1.52~6.89), 2.54 (1.47~4.39), and 2.11 (1.19~3.75), respectively, in citizens with the high level of knowledge. Interestingly, respondents with positively perceived susceptibility exhibited significantly good practice in wearing the mask (4.91; 2.34~10.31), social distancing (1.95; 1.08~3.52), and washing hands (3.99; 2.26~7.05) compared to those with negatively perceived susceptibility. In addition, perceived barriers, benefits, severity, and self-efficacy also exhibited a significantly good all variables of health practice regarding COVID-19 pandemic after adjusting for confounding variables. Conclusion: Citizens with high levels of knowledge and positive levels of the health belief model had good practice of wearing masks, social distancing, and washing hands. The outcomes of this survey could encourage health professionals, including nurses, through management practices of nursing intervention based on the health belief model during the pandemic. Funding: This study was funded by the University of Kadiri, Kediri, Indonesia (106/P.1/LP3M/XII/2020).

To analyze the association between smoking status (active smoking and exposure to Second-Hand Smoking (SHS)) and the synergistic effect of smoking status and BMI with gout risk, a community-based case-control design was undertaken among 385 participants, including 304 healthy controls and 81 gout patients from seven community health services. Adjusted Odd Ratios (AORs) and 95% Confidence Interval (CIs) of gout for active smoking and SHS were 3.26 (95% CI = 1.07~9.90) and 4.67 (95% CI = 2.18~10.00) compared to non-smokers. Time-dependent manner of active smoking and SHS significantly increased gout risk with AORs and 95% CIs of 5.95 (1.41~25.03) and 10.12 (3.51~29.14). Dose-dependency of active smokers and SHS showed AORs and 95% CIs of 5.15 (1.28~20.63) and 4.37 (1.33~14.28). Smoking 20 cigarettes (one pack) per day for one year is equivalent to one pack-year. Active smoking >20 pack-year and SHS > 26.5 pack-year increased gout risk with AORs and 95% CIs of 7.18 (1.53~33.67) and 9.95 (3.64~27.22). Participants who smoked (active smoking and SHS) and with Body Mass Index (BMI) of > 24.9 kg/m2 synergistically increased gout risk, with an AOR of 9.65 and 95% CI of 3.25~28.65, compared to BMI ≤ 24.9 kg/m2 and non-smoker. Smoking status (active smoking and SHS) and the synergistic effect of smoking status and BMI increased gout risk in Indonesia.

Coronavirus disease 2019 (COVID-19) has become a pandemic. We examined the KAP’s relationship with factors associated with practice toward the COVID-19 pandemic in Indonesia. This cross-sectional survey study was conducted between March and April 2020 and included 1033 participants. Knowledge scores of COVID-19 were positively associated with wearing a mask when leaving home (odds ratio (OR): 1.22, p &lt, 0.05). Although men had a lower knowledge score, they were less likely to go to a crowded place compared with women (OR: 0.79, p &lt, 0.05). However, women (OR: 1.25, p &lt, 0.05) were more likely than men to wear a mask when leaving home. Furthermore, men (OR: 3.32, p &lt, 0.05) were more likely than women to have a positive attitude toward COVID-19. Indonesian residents had satisfactory knowledge, demonstrated a positive attitude, and followed appropriate practices toward the pandemic. More educated individuals had a more positive attitude. Men and women differed with respect to their knowledge-based practices. Men were less likely to go to crowded places, and women were more likely to wear a mask when leaving home. Furthermore, men were more likely to wear a mask when leaving home than women when men had the attitude that Indonesia can win against COVID-19.

Latar Belakang: Organisasi Kesehatan Dunia (WHO) menyatakan bahwa Penyakit Coronavirus 2019 dikategorikan sebagai pandemi global.Hingga tanggal 31 Maret 2020, jumlah positif Covid -19 di Indonesia sebanyak 1.528 kasus, pasien sembuh 81 orang , meninggal dunia sebanyak 136 orang. Tindakan penanggulangan COVID-19 masih tetap berlanjut sampai saat ini, dibutuhkan kepatuhan masyarakat terhadap langkah-langkah upaya yang dilakukan, yang sebagian besar dipengaruhi oleh pengetahuan, sikap, dan tindakan masyarakat terhadap COVID-19. Tujuan : Mengetahui gambaran distribusi frekuensi pengetahuan, sikap dan tindakan masyarakat Indonesia Bagian Barat selama Pandemi Covid 19. Metode : Metode kuantitatif dengan jumlah sampel adalah masyarakat Indonesia Bagian Barat sebanyak 817 orang. Teknik pengambilan sampel menggunakan random sampling . Hasil: Hasil analisa data univariat diperoleh sebagian besar pengetahuan masyarakat Indonesia Bagian Barat selama pandemi Covid 19 adalah berpengetahuan baik yaitu sejumlah 581 orang (71,1%), sebagian besar sikap masyarakat Indonesia Bagian Barat Selama Pandemic Copid 19 adalah sikap positif yaitu sejumlah 761 orang (93,1%), sebagian besar tindakan masyarakat Indonesia Bagian Barat Selama Pandemic Covid 19 adalah tindakan positif yaitu sejumlah 607 orang (74,3%). Kesimpulan : Sebagian besar masyarakat Indonesia Bagian Barat memiliki pengetahuan yang baik, sikap yang positif dan tindakan yang positif sebagai upaya untuk mencegah penularan COVID-19

Background: Herbal medicines are gaining a greater degree of popularity as complementary and alternative medicines during the COVID-19 pandemic. Nonetheless, there is a lack of data concerning the rationale for and factors influencing their use. Methods: A cross-sectional community-based online study involving 1,621 participants was conducted to explore the effects of magical health beliefs, holistic health beliefs, knowledge, and pro- complementary alternative medicine (CAM) attitudes on herbal medicine use in the Indonesian population. Results: Logistic regression findings showed that knowledge about herbal medicines was independently and positively associated with herbal medicine use to a greater extent than herbal medicine non-use (adjusted odds ratio; AOR = 1.20; 95% confidence interval; CI = 1.16 to 1.24). The participants who used herbal medicines had a greater magical health belief score than herbal medicine non-users, with AOR = 1.03 and 95% CI = 1.00 to 1.06. Moreover, holistic health beliefs and pro-CAM attitudes were also found to be independently associated with herbal medicine use. Conclusion: Magical health beliefs, holistic health belief, knowledge, and attitudes are key factor in determining the herbal medicine use. Our findings offer crucial implications for health policymakers to encourage the use of herbal medicine during the COVID-19 pandemic.

Background: Currently, the determinants of anxiety and its related factors in the general population affected by COVID-19 are poorly understood. We examined the effects of spirituality, knowledge, attitudes, and practices (KAP) on anxiety regarding COVID-19. Methods: Online cross-sectional data (n = 1082) covered 17 provinces. The assessment included the Daily Spiritual Experiences Scale, the Depression, Anxiety, and Stress Scale, and the KAP-COVID-19 questionnaire. Results: Multiple linear regression revealed that individuals who had low levels of spirituality had increased anxiety compared to those with higher levels of spirituality. Individuals had correct knowledge of early symptoms and supportive treatment (K3), and that individuals with chronic diseases and those who were obese or elderly were more likely to be severe cases (K4). However, participants who chose incorrect concerns about there being no need for children and young adults to take measures to prevent COVID-19 (K9) had significantly lower anxiety compared to those who responded with the correct choice. Participants who disagreed about whether society would win the battle against COVID-19 (A1) and successfully control it (A2) were associated with higher anxiety. Those with the practice of attending crowded places (P1) had significantly higher anxiety. Conclusions: Spirituality, knowledge, attitudes, and practice were significantly correlated with anxiety regarding COVID-19 in the general population.

Alkaline electrolyzed water (AEW) and walking are strongly recommended for ameliorating oxidative stress and inflammation. Nevertheless, there is a lack of information on the combination of both on alleviating inflammation, oxidative stress, and improving the quality of life (QoL). We investigated the synergistic effects of drinking AEW and walking on advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), malondialdehyde (MDA), white blood cells (WBCs), neutrophil-lymphocyte ratio (NLR) and QoL. In total, 81 eligible patients with type 2 diabetes (T2DM) were randomly allocated via single blind to four groups: consumed 2 L/day of AEW (n = 20), instructed to walk for 150 min/week (n = 20), received a combination of AEW and walking (n = 20), and continue their habitual diet and activity (n = 21). Data were collected and analyzed before and after 8 weeks of intervention. Our results showed a significant interaction between the group and time, with both AEW and walking independently and synergistically ameliorating AGEs, AOPPs, MDA, NLR and WBCs levels. Moreover, the AEW group had a higher physical and total QoL score. The walking group and the combined group had higher scores in physical, mental and total QoL compared to the control group. The synergistic effect of AEW and regular walking are an advisable treatment for patients with T2DM.

Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM&ndash, associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil&ndash, lymphocyte ratio (NLR) and white blood cells (WBCs). A case&ndash, control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.

Background: Physical inactivity and Type 2 diabetes mellitus (T2DM)–associated inflammatory biomarkers are correlated with poor quality of life (QoL). However, no study has investigated the synergistic effect of physical activity (PA) and lower neutrophil–lymphocyte ratio (NLR) on QoL. Objective: We examined the independent and synergistic effects of PA and inflammatory biomarkers on three domains of QoL in T2DM. Methods: This cross-sectional study included 294 patients with T2DM from community clinics in Indonesia. The 36-item Short Form Survey and a questionnaire about PA engagement were used to measure QoL and metabolic equivalent of task (MET)-hr/week, respectively. Inflammatory biomarkers were measured in fasting blood. Adjusted coefficients β and 95% confidence interval (CI) were estimated using multiple linear regression. The synergistic effect was analyzed using additive interaction for linear regression. Results: Patients with PA ≥ 7.5 MET-hr/week exhibited significantly higher total QoL (β = 8.41, 95% CI = [6.04, 10.78]) and physical component score (PCS; β = 13.90, 95% CI = [10.52, 17.29]) than those with PA < 7.5 MET-hr/week. Patients with NLR < 1.940 had significantly higher total QoL (β = 4.76, 95% CI = [3.41, 6.11]), mental component score (MCS; β = 2.62, 95% CI = [0.75, 4.49]), and PCS (β = 6.89, 95% CI = [4.97, 8.82]) than patients with NLR ≥ 1.940. PA ≥ 7.5 MET-hr/week and NLR < 1.940 exhibited a synergistic effect on total QoL, MCS, and PCS. Conclusions: High PA level and low NLR had a positive synergistic effect on QoL among patients with T2DM.