The most common extra-articular manifestation of rheumatoid arthritis (RA) is interstitial lung disease (ILD). RA related ILD (RA-ILD) is associated with significant morbidity and mortality. The main objective of this study was to determine the correlation between the rheumatoid factor (RF) serotypes and the severity of RA-ILD based on computed tomography (CT) findings. We recruited a total of 100 RA patients who were tested for IgA RF, IgG RF and IgM RF and had high resolution CT chest performed. Seventy-two patients had ILD changes on HRCT of the chest and were included in this study. We found that the the CT scores for ground glass showed significant positive correlation with disease duration and IgA RF levels whereas the fibrosis scores had significant relationship with multiple clinical covariates i.e age, disease duration, IgA RF levels, IgG RF levels and anti-CCP levels. On multivariate analysis, only IgA levels remained significantly (p<0.05, standardized beta coefficient = 0.604) associated with the ground glass scores. Regarding the fibrosis scores, IgA RF levels and age were independent predictors based on multivariate analysis after adjusting for confounders, with p scores of <0.05 and 0.02, respectively. In conclusion, the IgA RF was the only serotype which was independently associated with the severity of RA-ILD.

PURPOSE: This study aimed to evaluate a pilot project of the Nursing Feeding Center “Posyandu Plus” (NFCPP) through local food-based complementary feeding (LFCF) program designed to improve the nutritional status of children aged 6–36 months at community health centers in Indonesia. METHODS: A quasi-experimental design was used to obtain data regarding the nutritional status of 109 children who participated in the project from 6 rural areas. The NFCPP was conducted for 9 weeks, comprising 2 weeks of preintervention, 6 weeks of intervention, and one week of postintervention. The LFCF intervention consisted of 12 sets of recipes to be made by mothers and given to their children 4 times daily over 6 weeks. The weight-for-age z score (WAZ), height-for-age z score (HAZ), weight-for-height z score (WHZ), and body mass index-for-age z score (BAZ) were calculated using World Health Organization Anthro Plus version 1.0.3. RESULTS: LFCF intervention significantly increased WHZ, WAZ, and BAZ scores but decreased HAZ scores (P<0.001). Average scores of WHZ (0.96±0.97) and WAZ (0.45±0.72) increased; BAZ increased (1.12±0.93) after 6 weeks of LFCF. WAZ scores postintervention were 50.5% of normal, and WHZ scores were 77.1% of normal. However, the HAZ score decreased by 0.53±0.52, which indicated 57.8% had short stature. CONCLUSION: The NFCPP program with LFCF intervention can improve the nutritional status of children in rural areas. It should be implemented as a sustained program for better provision of complementary feeding during the period of lactation using local food made available at community health centers.
Child* ; Community Health Centers ; Female ; Humans ; Indonesia* ; Infant ; Infant Nutritional Physiological Phenomena* ; Lactation ; Mothers ; Nursing ; Nutritional Status* ; Pilot Projects ; World Health Organization

OBJECTIVES: Complex and diverse factors are related to reproductive health (RH) behavior among adolescents according to the social and cultural context of each countries. This study examined the prevalence of active RH and factors related to active RH behavior among Indonesian adolescents. METHODS: A cross-sectional study was conducted among 1,040 of students who were selected through a multi-stage random sampling technique. A self-administered questionnaire was developed, including the World Health Organization Illustrative Questionnaire for Interview-Surveys with Young People, pubertal development scale, and sexual activity scale, modified in accordance to the Indonesian context. The data were analyzed using descriptive and comparative statistics, as well as logistic regression analyses. RESULTS: The prevalence of active RH behavior were more higher in boys (56.6%; 95% confidence interval [CI], 50.6% to 62.6%) than in girls (43.7%; 95% CI, 37.6% to 49.8%). Negative attitudes towards RH were a factor related to active RH behavior in both boys and girls. Smoking and kind relationship envisioned before marriage (pacaran [courtship] and nikah siri [non-registered marriage]) were factors related to active RH behavior in boys; whereas the absence of access to information on substance abuse was an additional factor in girls. Moreover, an interaction was found between access to information on development and smoking (boys) and attitudes on RH (girls) as independent variables associated with active RH behavior. CONCLUSIONS: Sex education for adolescents in Indonesia, particularly in the context of a health promotion program, should be developed based on prevalent social, cultural, and religious values to prevent active RH behavior. Such programs should focus on the kind of relationship envisioned before marriage and smoking for boys and access to information on subtance abuse for girls.
Access to Information ; Adolescent Behavior ; Adolescent* ; Cross-Sectional Studies* ; Female ; Health Promotion ; Humans ; Indonesia ; Logistic Models ; Marriage ; Prevalence* ; Reproductive Health* ; Sex Education ; Sexual Behavior ; Smoke ; Smoking ; Substance-Related Disorders ; World Health Organization

Background: Almost half of the population of stroke patient were aged 65 and older. Elderly patients who had a stroke were at risk of loneliness and isolation due to their frailty, inactivity, and difficulty moving. Objective: This study determined the daily physical functioning among post-stroke older people by sensor monitoring and matching data with the Functional Independence Measure (FIM). Methods: Sixteen home-dwelling post-stroke older people participated in this descriptive cross-sectional study. Daily functioning was measured using Physical Activity Monitor AM300 sensor devices and FIM. In addition, data on stroke history, fall history activities, blood pressure measurements, walking speed, leg muscle strength, grip strength, balance, pain, fall risk, fear of falling, selfefficacy, and nutritional intake were collected as demographic characteristics of the participants. Results: Most participants spent their time on at-home activities and very little time on sports activities. These findings were matched with FIM results where only one-fourth of participants had complete independence in locomotion walking, and no participants had complete independence in locomotion stairs. Conclusions Sensor monitoring and FIM could be combined to determine daily functioning and the type of rehabilitation needed by post-stroke patients.
Functional Status

Introduction: Fathers’ knowledge, attitude, and involvement in breastfeeding practices are crucial factors to determine the success of breastfeeding outcomes such as decision-making on breastfeeding, successfulness of exclusive breastfeeding, and continuation of breastfeeding practices. This study aimed to identify the determinants of fathers’ involvement in breastfeeding practices. Methods: This cross-sectional study involved 203 fathers attending Maternal and Child Health Clinics in Kuala Selangor. Self-administered questionnaires were used to obtain information regarding fathers’ sociodemography, breastfeeding knowledge, attitudes, and involvement towards breastfeeding practices. Results: Mean age of the fathers was 32.1±5.9 years, ranging between 21 to 50 years. Findings showed that majority of the fathers were involved in breastfeeding practices (52.7%; n=107, 57.0±6.2), had fair knowledge in breastfeeding (62.6%; n=127, 13.8±3.2), and showed low attitude towards breastfeeding (68.0%; n=138, 61.9±6.7). Multiple logistic regression analysis revealed factors with significant influence on fathers’ involvement towards breastfeeding practices were: (1) fathers’ breastfeeding knowledge, (2) fathers’ attitudes towards breastfeeding practices, and (3) mode of infant delivery. Conclusion: These significant predictors may help healthcare professionals to establish effective strategies by advocating the role of fathers in the breastfeeding process such as by offering continuous support, active involvement, and effective participation.

Introduction: Prevalence of Hepatitis B virus (HBV) infection among the non-indigenous people in Malaysia has been well established and range between 3% and 5%. However, data from the indigenous (Orang Asli) people is still lacking. The Negrito population is the most remotely located Orang Asli tribe with limited access to health care facilities. This study was undertaken to determine the epidemiology and seroprevalence of HBV infection among the Negrito. Methods: Surveys were conducted in five Negrito settlements in Kelantan and Perak states in Malaysia. A total of 150 participants were recruited. Clinical history was taken and physical examination was performed. Five millilitres of whole blood were collected and tested for hepatitis B surface antigen (HBsAg) using electrochemiluminescence immunoassay. Results: Participants were mainly from the Bateq (49.3%) and Mendriq (29.4%) sub-tribes. Overall, 13 subjects (8.7 %); nine males and four females were HBsAg positive. Nine of the HBsAg positive subjects were ≥35 years old. All of them had history of home deliver without evidence of antenatal record. Six (46%) of the HBsAg positive subjects had tattoo and body piercing in the past. Conclusion: The prevalence of HBV infection rate amongst the Negrito tribe is almost three-fold compared to the national rates. The reason for this finding remains unclear. Tattooing, body piercing and vertical transmission could be the main possible routes of transmission of HBV among the Negrito population in Malaysia.

Introduction: Food security and dietary diversity are critical in ensuring the nutritional and dietary adequacy of mothers. However, since the COVID-19 outbreak, it has become more challenging for mothers to maintain a healthy and varied diet, as more households are reported to be food insecure. Thus, this study aimed to assess food insecurity and its determinants, as well as to determine how it relates to dietary diversity. Methods: A cross-sectional study comprising 200 of B40 mothers with children under the age of two who resided in metropolitan regions of Selangor was conducted. Household Food Insecurity Access Scale (HFIAS) and Minimum Dietary Diversity for Women (MDDW) questionnaires were used to measure food insecurity and dietary diversity, respectively. Results: About 67% of mothers experienced food insecurity and 29.5% experienced dietary monotony. Less than 12 years of education (AOR=4.89, 95% CI=1.87-12.83) and living in a family with six or more people (AOR=3.48, 95% CI=1.20-11.20) were significantly associated with food insecurity. Besides, mothers with a monotonous diet were eight times more likely to be food insecure (AOR=8.03, 95% CI=2.67-24.05). Higher odds of dietary monotony were associated with less than 12 years of education (AOR=2.46, 95% CI=1.13-5.35) and household income contributor of not more than one person (AOR=3.78, 95% CI=1.66-8.60). Conclusion: Food insecurity was associated with an increased chance of dietary monotony among low-socioeconomic women residing in urban community. Therefore, identifying and addressing issues related to poor dietary diversity may allow for preventive and proactive measures to improve their nutritional status and well-being.

Introduction: Hepatic diseases patients are especially prone to malnutrition, which is often underestimated. Screening tools were developed to detect the risk of malnutrition. However, screening tools for patients with liver disease were frequently underestimated. Fluid overload is the main issue to perform nutritional screening in liver disease patients. Therefore, this study aimed to validate the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) among patients and to evaluate association between RFH-NPT, Nutritional Risk Screening (NRS 2002) and Subjective Global Assessment (SGA). Methods: This cross sectional study was conducted in 3 phases; transcultural adaptation, criterion validity and reliability phases. Content validity was confirmed by interviewing eight liver disease professionals. Face validity was assessed by surveying forty nurses working in the liver disease ward. In addition, agreement between NRS 2002 and RFH-NPT assessment was assessed using the SGA tool. Results: Eighty patients with liver disease took part in this study. The SGA assessment found malnutrition in 75% of patients (95% CI, 60%–95%) while 80% (95% CI, 65%-80) were found as at risk of malnutrition using RFH- NPT. Moderate specificity and high sensitivity of RFHNPT were 97% and 74%, respectively, and 95% positive predictive value was measured. Conclusion: The RFH-NPT nutritional screening tool is the initial and most reliable in this population to assess the malnutrition risk. Thus, inclusion of the RFH-NPT with NRS 2002 demonstrated positive and a fair agreement between the SGA and RFH-NPT tool to be used as a routine nutrition screening protocol for identifying patients at risk of malnutrition.

Periosteum is a connective tissue that envelopes the outer surface of bones and is tightly bound to the underlying bone by Sharpey’s fibers. It is composed of two layers, the outer fibrous layer and the inner cambium layer. The periosteum is densely vascularised and contains an osteoprogenitor niche that serves as a repository for bone-forming cells, which makes it an essential bone-regenerating tissue and has immensely contributed to fracture healing. Due to the high vascularity of inner cambium layer of the periosteum, periosteal transplantation has been widely used in the management of bone defects and fracture by orthopedic surgeons. Nevertheless, the use of periosteal graft in the management of bone defect is limited due to its contracted nature after being harvested. This review summarizes the current state of knowledge about the structure of periosteum, and how periosteal transplantation have been used in clinical practices, with special reference on its expansion.