Female, Live in Urban, and the Existence of a Caregiver Increased Risk Overnutrition in Elderly: an Indonesian National Study 2010

Background: Over-nutrition could leads health problems in the elderly which requires control efforts. Knowing the risk factors of over-nutrition is necessary to overcome the over-nutrition related health problems.This study aimed to identify the determinant factors of over-nutrition in the elderly.Methods: The study used a cross-sectional study as a part of Basic Health Research (Riskesdas) 2010. The subjects consisted of 16 142 respondents aged 60 years or older with normal nutritional status and overnutritionthat derived from 26 6510 household members. Riskesdas data on sociodemographic was collected by questionnaire. Nutritional status was measured using body mass index (BMI). BMI was categorized intonormal (18.5-24.9) and over-nutrition (25 or over). Nutrition intake was obtained from 24 hour food recall. Over-nutritional risk factors identifi ed by relative risks.Results: This analysis noted 3 184 (19.7%) subjects were over-nutrition and 12 958 (80.3%) were normal. Female than male 56% more risk to be over-nutrition [adjusted relative risk (RRa) = 1.56; 95% confi dence interval (CI) = 1.44;1.69]. Living in urban than rural area 30% more risk to be over-nutrition(RRa = 1.30; 95% CI = 1.24;1.35). While the presence of caregiver 26% increased to be over-nutrition in elderly (RRa = 1.26; 95% CI = 1.16;1.40).Conclusion: The presence of a caregiver, woman, and living in urban area increased risk to be over-nutrition in elderly. Health education is needed for the elderly family and caregiver to enhance their knowledge on providing balanced nutrition to control over-nutrition. (Health Science Indones 2012;1:9-14

Work Stressors, Alcohol Consumption and Risk of Mental Emotional Problem

Background: Mental emotional problem in workers may reduce work productivity. It is therefore necessary to identify the risk factors for mental emotional problem in chemical industry workers. Methods: In this cross sectional study subjects were selected purposively among chemical industry workers in Banten (Indonesia) who performed medical check up (MCU) at the end of 2010. Data collected included demographics, habits (smoking, sport, alcohol consumption), work (work stressors, shift work), fasting blood sugar levels, and psycho-psychiatric examination.Results: Subjects with and without mental emotional problem seemed equally distributed in terms of gender, age, smoking habits, sport, work system, as well as fasting blood sugar levels. Subjects who consumed alcohol than who did not consume alcohol had 2.3 times risk to be having a mental emotional problem [adjusted relative risk (RRa) = 2.26; 95% confidence interval (CI) = 0.89 - 8.83, P = 0.114]. In addition, compared with workers who experienced light work stressors, workers who experienced moderate or severe work stressors had increased risk to be distress. Subjects who had moderate work stressors than mild work stressors had 67% higher risk to be mental emotional problem (RRa = 1.67; P = 0.022). Whereas subjects who had severe work stressors than mild had a 3.6-fold risk to be mental emotional problem (RRa = 3.56, P = 0.031). Compared with workers who had a normal body mass index (BMI), the obese 1 workers only who related to mental emotional problem which was 38% less to be mental emotional problem (RRa = 0.62; P = 0.031). Conclusion: Work stressors as well as heavy alcohol consumption increased the risk of mental emotional problem in chemical industry workers. (Health Science Indones 2013;1:17-21

Peran Indeks Massa Tubuh, Tanda Vital dan Sosiodemografi terhadap Kebugaran Peserta Klub Jantung Sehat, Jakarta Timur

Kebugaran jasmani adalah kemampuan tubuh untuk melakukan kegiatan sehari-hari tanpa menimbulkankelelahan yang berarti. Banyak faktor yang berperan terhadap tingkat kebugaran jasmani antara lainsosiodemografi dan status gizi. Penelitian ini dilakukan untuk mengetahui peran faktor-faktor tersebutterhadap tingkat kebugaran seseorang. Desain penelitian ini adalah potong lintang dengan respondenpeserta senam Klub Jantung Sehat Kecamatan Duren Sawit, Jakarta Timur. Data diambil padabulan Juli 2009; 41 orang responden dipilih dengan convenient sampling. Tingkat kebugaran dinilaidengan nilai prediksi VO menggunakan six minutes walk test dan kuesioner. Berdasarkan statusgizi dan tanda vital responden, didapatkan rerata frekuensi nadi 79,59x/menit (±7,8), sebanyak 15orang (36,6%) memiliki kategori IMT obesitas I, 25 orang (61,0%) memiliki tekanan darah pretesttidak normal, 27 orang (65,9%) memiliki tekanan darah posttest tidak normal. Disimpulkan mayoritaspeserta klub jantung sehat memiliki tingkat kebugaran rendah (70,7%), serta terdapat hubungan negatifantara VO2max2max responden dengan usia (r=-0,325; p=0,038) dan hubungan positif dengan frekuensi nadi(r=0,343; p=0,028). Variabel lain seperti jenis kelamin, jenis pekerjaan, tingkat pendidikan, dan IMTtidak berhubungan dengan nilai prediksi VO

The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

__Background:__ Indonesia has not resolved tuberculosis burden since its prevalence and incidence has remained high. As the capital of Indonesia with a large population and a high number of tuberculosis cases, Jakarta has a distinctive condition of tuberculosis burden. This study aimed to obtain social determinants of knowledge and perception of pulmonary tuberculosis in an urban community. __Methods:__ This study used 2,323 samples taken by random sampling in Jakarta during February-May 2011. Questionnaires were delivered to assess respondents’ knowledge and perception about pulmonary tuberculosis. Levels of knowledge were categorized into ‘poor’ and ‘good’. Perceptions about tuberculosis were measured by whether respondents perceived tuberculosis as a humiliating disease and a shunned disease. __Results:__ Most respondents (88.7%) had good level of knowledge about tuberculosis, but misperception remained high (45.9%) in the community. Education level determined level of knowledge. The higher the education level the lower the risk of lack of knowledge. Tuberculosis perceptions were determined by family income and education level. Higher family income and education level were protective factors of misperception about tuberculosis as a humiliating disease and tendency to shun tuberculosis patie

Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia's implementation of universal health coverage

Background: As well as imposing an economic burden on affected households, the high costs related to tuberculosis (TB) can create access and adherence barriers. This highlights the particular urgency of achieving one of the End TB Strategy's targets: that no TB-affected households have to face catastrophic costs by 2020. In Indonesia, as elsewhere, there is also an emerging need to provide social protection by implementing universal health coverage (UHC). We therefore assessed the incidence of catastrophic total costs due to TB, and their determinants since the implementation of UHC. Methods: We interviewed adult TB and multidrug-resistant TB (MDR-TB) patients in urban, suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier. Following the WHO recommendation, we assessed the incidence of catastrophic total costs due to TB. We also analyzed the sensitivity of incidence relative to several thresholds, and measured differences between poor and non-poor households in the incidence of catastrophic costs. Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs. Results: We analyzed 282 TB and 64 MDR-TB patients. For TB-related services, the median (interquartile range) of total costs incurred by households was 133 USD (55-576); for MDR-TB-related services, it was 2804 USD (1008-4325). The incidence of catastrophic total costs in all TB-affected households was 36% (43% in poor households and 25% in non-poor households). For MDR-TB-affected households, the incidence was 83% (83% and 83%). In TB-affected households, the determinants of catastrophic total costs were poor households (adjusted odds ratio [aOR]=3.7, 95% confidence interval [CI]: 1.7-7.8); being a breadwinner (aOR=2.9, 95% CI: 1.3-6.6); job loss (aOR=21.2; 95% CI

The Role of CYP4502E1 Genetic Polymorphism on Benzene Metabolism

The carcinogenic effect of benzene is associated with metabolites produced in benzene metabolism such as phenol, catechol, quinones, muconic acid (tt-MA), and phenyl mercapturic acid (s-PMA). The role of CYP4502E1 enzyme in benzene metabolism is very important, which is determined by its genetic polymorphism. This cross-sectional study is aimed to obtain the distribution of frequency of s-PMA concentration in workers who had been low exposure of benzene based on CYP4502E1 genetic polymorphism. The study was conducted between September 2007 and April 2010. Data were collected by methods of interviews, physical examinations, laboratory examinations, and direct observation on the work place. The variables studied were CYP4502E1, benzene exposure at the work place, age, type of work, history of work, length of work, body mass index (BMI), antioxidants intake, behavior and management, and s-PMA concentration in the urine. The distribution of CYP4502E1 genetic polymorphism in workers is 87.8% wild type homozygote, 11.3% heterozygote and 0.9% mutant homozygote. There was no significant difference in the proportion of s-PMA concentration based on CYP4502E1 genetic polymorphism (p=0.595; ORraw=0.98; 95% CI=0.95-1.01). There were also no differences of age, type of work, length of work, BMI, antioxidants consumptions, behavior and management of subjects with s-PMA. Further study should be conducted on CYP4502E1 genetic polymorphism in various Indonesian races at different workplace with low-level benzene

Cost of seeking care for tuberculosis since the implementation of universal health coverage in Indonesia

Background: Although tuberculosis (TB) patients often incur high costs to access TB-related services, it was unclear beforehand whether the implementation of universal health coverage (UHC) in Indonesia in 2014 would reduce direct costs and change the pattern of care-seeking behaviour. After its introduction, we therefore assessed TB patients' care-seeking behaviour and the costs they incurred for diagnosis, and the determinants of both. Methods: In this cross sectional study, we interviewed adult TB patients in urban, suburban, and rural districts of Indonesia in July-September 2016. We selected consecutively patients who had been treated for TB in primary health centers for at least 1 month until we reached at least 90 patients in each district. After establishing which direct and indirect costs they had incurred during the pre-diagnostic phase, we calculated the total costs (in US Dollars). To identify the determinants of these costs, we applied a general linear mixed model to adjust for our cluster-sampling design. Results: Ninety-three patients of the 282 included in our analysis (33%) first sought care at a private clinic. The preference for such clinics was higher among those living in the rural district (aOR 1.88, 95% CI 0.85-4.15, P = 0.119) and among those with a low educational level (aOR 1.69, 95% CI 0.92-3.10, P = 0.090). Visiting a private clinic as the first contact also led to more visits (β 0.90, 95% CI 0.57-1.24, P < 0.001) and higher costs than first visiting a Primary Health Centre, both in terms of direct costs (β = 16.87, 95%CI 10.54-23.20, P < 0.001) and total costs (β = 18.41, 95%CI 10.35-26.47, P < 0.001). Conclusion: Despite UHC, high costs of TB seeking care remain, with direct medical costs contributing most to the total costs. First seeking care from private providers tends to lead to more pre-diagnostic visits and higher costs. To reduce diagnostic delays and minimize patients' costs, it is essential to strengthen the public-private mix and reduce the fragmented system between the national health insurance scheme and the National TB Programme

Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia

BACKGROUND: While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there is little evidence about their impact on TB treatment outcomes and adherence. We assessed their effect on treatment outcomes and adherence in Indonesia. METHODS: We interviewed 282 adult TB patients who underwent TB treatment in urban, suburban and rural districts of Indonesia. One year after the interview, we followed up treatment adherence and outcomes. We applied multivariable analysis using generalized linear mixed models. RESULTS: Follow-up was complete for 252/282 patients. Eighteen (7%) patients had unsuccessful treatment and 40 (16%) had poor adherence. At a threshold of 30% of annual household income, catastrophic costs negatively impacted treatment outcomes (adjusted odds ratio [aOR] 4.15 [95% confidence interval {CI} 1.15 to 15.01]). At other thresholds, the associations showed a similar pattern but were not statistically significant. The association between catastrophic costs and treatment adherence is complex because of reverse causation. After adjustment, catastrophic costs negatively affected treatment adherence at the 10% and 15% thresholds (aOR 2.11 [95% CI 0.97 to 4.59], p = 0.059 and aOR 2.06 [95% CI 0.95 to 4.46], p = 0.07). There was no evidence of such an effect at other thresholds. CONCLUSIONS: Catastrophic costs negatively affect TB treatment outcomes and treatment adherence. To eliminate TB, it is essential to mitigate catastrophic costs

Adaptation of the Tool to Estimate Patient Costs Questionnaire into Indonesian Context for Tuberculosis-affected Households

BACKGROUND: Indonesia is the second-highest country for tuberculosis (TB) incidence worldwide. Hence, it urgently requires improvements and innovations beyond the strategies that are currently being implemented throughout the country. One fundamental step in monitoring its progress is by preparing a validated tool to measure total patient costs and catastrophic total costs. The World Health Organization (WHO) recommends using a version of the generic questionnaire that has been adapted to the local cultural context in order to interpret findings correctly. This study is aimed to adapt the Tool to Estimate Patient Costs questionnaire into the Indonesian context, which measures total costs and catastrophic total costs for tuberculosis-affected households. METHODS: the tool was adapted using best-practice guidelines. On the basis of a pre-test performed in a previous study (referred to as Phase 1 Study), we refined the adaptation process by comparing it with the generic tool introduced by the WHO. We also held an expert committee review and performed pre-testing by interviewing 30 TB patients. After pre-testing, the tool was provided with complete explanation sheets for finalization. RESULTS: seventy-two major changes were made during the adaptation process including changing the answer choices to match the Indonesian context, refining the flow of questions, deleting questions, changing some words and restoring original questions that had been changed in Phase 1 Study. Participants indicated that most questions were clear and easy to understand. To address recall difficulties by the participants, we made some adaptations to obtain data that might be missing, such as tracking data to medical records, developing a proxy of costs an

Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia

Background: The World Health Organization’s End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. Methods: From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. Results: We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients’ primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). Conclusions: Indonesia’s current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TBaffected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding