Introduction: The nutritional status of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Down Syndrome (DS) is influenced by multiple food environment determinants. However, the precise relationship between food environment determinants and nutritional outcomes in these children remains unclear. This study aimed to understand the food environment determinants that are associated with the intake and nutritional status of these children in Malaysia, Lao PDR, and Indonesia. Methods: This cross-sectional study involved 7- to 18-year-old students with ADHD and DS in three Southeast Asian countries. Sociodemographic characteristics, dietary habits, and repeated 24-hour food recall data were collected through a structured questionnaire. Anthropometric data were obtained through direct measurements and analysed using the WHO AnthroPlus software. Further analyses were done using descriptive statistics and chi-square tests. Results: Total participants were 284 children, comprised of 37.7% with ADHD and 62.3% with DS; 62.3% of the children were boys and 37.7% were girls. Among the food environment determinants collected during the study, monthly household income and school food assistance status had significant associations (p<0.05) with BMI-for-age z-score category and total energy, protein, zinc, and calcium intakes. While the country, type of residence, and type of school had significant associations with total energy, protein, zinc, and calcium intakes. Conclusions: Food environment determinants, particularly household income and access to school food assistance, significantly influence the nutritional status and intake of children with ADHD and Down Syndrome. Thus, strengthening inclusive nutrition programmes may improve outcomes for this vulnerable group in Southeast Asia.

BACKGROUND : Diabetic retinopathy (DR) is a leading cause of preventable blindness. However, Indonesia lacks a comprehensive screening program. Artificial intelligence (AI)-assisted screening in primary health care (PHC) is a promising solution. Patient satisfaction is crucial for ensuring the participation and sustainability of such programs. This study aimed to adapt Indonesian version of evaluate client satisfaction questionnaire-18 (CSQ-18) and evaluate its acceptability. METHODS : This study was conducted from August 5–29, 2024 at 2 public PHCs in Jakarta. Patients with diabetes underwent DR screening, which included fundus photography and an AI-based grading system (RADR). Referable cases were graded secondarily by ophthalmologists. Satisfaction was assessed from November 10–20, 2024 using the Indonesian-translated CSQ-18, adapted through forward-backward translation, expert review, and pilot testing. Reliability was assessed using Cronbach’s alpha, validity was evaluated using Pearson’s correlation, and satisfaction scores were summarized as descriptive statistics. RESULTS : Of 300 selected participants, 216 completed telephone or in-person interviews. The Indonesian CSQ-18 demonstrated a strong internal consistency (Cronbach’s alpha = 0.886). All items showed acceptable item-total correlations. The mean (SD) satisfaction score was 60.19 (5.50) of 72, with a median of 59, indicating high patient satisfaction. Most participants expressed positive perceptions of screening duration, accessibility, and provider competence, although awareness-related items scored slightly lower. Potential interviewer bias and nonresponse may have affected the findings. CONCLUSIONS The Indonesian CSQ-18 is a reliable tool for assessing patient satisfaction with DR screening. These findings confirm the feasibility and acceptability of AI-assisted DR screening at the PHC level, supporting its potential for broader implementation in Indonesia.
artificial intelligence ; diabetic retinopathy ; patient satisfaction ; primary health care ; surveys and questionnaires

Background and Objective: Hypertension is a major health issue worldwide, with primary schoolteachers possessing several lifestyle risks of the disease. There have not been any health promotion programs yet for primary schoolteachers in Indonesia, especially for blood pressure control. A school-based model of workplace wellness program for teachers was developed. It focused on using screening as feedback in controlling blood pressure by eating a healthy diet, doing physical activity, and having regular checks. This study aimed to assess its clinical and behavioral effects. Methods: This trial was a one group pre- and post-test study design without control. It was implemented purposively in three public primary school locations in Jakarta to 44 eligible teachers for approximately three months from January to March 2022. The workplace wellness program included on-site screening (blood pressure, body mass index/BMI, spot urine sodium-creatinine ratio), knowledge, motivation, and ongoing health behavior (physical activity and the dietary approach to stop hypertension/DASH), online education/training, consultation/counseling sessions with a family doctor, and self-monitoring. All screening measurements were repeated at the end of the program. A paired t-test or Wilcoxon analysis was performed using SPSS 20.0. Results: Both systolic and diastolic blood pressure decreased by 5.05 mmHg (p = 0.018) and 6.41 mmHg (p < 0.001), respectively. The spot urine sodium-creatinine ratio and BMI decreased slightly but not significant (p = 0.707; p = 0.761). Knowledge and motivation increased slightly but not significant (p = 0.529; p = 0.175). The DASH behavior significantly increased by 25% (p < 0.001). Though the overall physical activity did not change, the walking activity increased twofold significantly (p = 0.006). This study also showed that the outcome would be achieved when the participant followed the recommendations obediently. Conclusion This school-based workplace wellness program was found to have a potential effect on controlling blood pressure by changing health behaviors. A randomized controlled trial is recommended to provide stronger evidence on its effectiveness before doing a large-scale implementation in primary schools in Indonesia.
Health Promotion ; Hypertension ; Exercise ; DASH diet ; Dietary Approaches To Stop Hypertension

Objective: Ovarian tissue vitrification is widely utilized for fertility preservation in prepubertal and adolescent female patients with cancer. The current literature includes reports of successful pregnancy and live birth following autografting. However, the effects of the vitrification process on cumulus-mural granulosa cells (C-mGCs)—somatic cells in ovarian tissue crucial for oocyte maturation and early embryonic development—remain unclear. This study was conducted to explore the impact of vitrification on the cellular function of C-mGCs by quantifying the expression of growth differentiation factor 9 (GDF-9), bone morphogenetic protein 15 (BMP-15), follicle-stimulating hormone receptor (FSHR), luteinizing hormone receptor (LHR), connexin 37, survivin, and caspase 3. Methods: Mature and immature C-mGCs were obtained from 38 women with polycystic ovary syndrome who participated in an in vitro fertilization program. The C-mGCs were then divided into two groups: fresh and vitrified. The expression levels of target genes were assessed using real-time quantitative polymerase chain reaction. Results: After vitrification, GDF-9 expression was significantly decreased among both mature and immature C-mGCs, with 0.2- and 0.1-fold changes, respectively (p<0.01). Similarly, FSHR expression in the mature and immature groups was reduced by 0.1- and 0.02-fold, respectively, following vitrification (p<0.01). The expression levels of the other genes, including BMP-15, LHR, connexin 37, survivin, and caspase 3, remained similar across the examined groups (p>0.05). Conclusion Vitrification may compromise oocyte maturation through reduced GDF-9 and FSHR expression in C-mGCs after warming.

Objective: Ovarian tissue vitrification is widely utilized for fertility preservation in prepubertal and adolescent female patients with cancer. The current literature includes reports of successful pregnancy and live birth following autografting. However, the effects of the vitrification process on cumulus-mural granulosa cells (C-mGCs)—somatic cells in ovarian tissue crucial for oocyte maturation and early embryonic development—remain unclear. This study was conducted to explore the impact of vitrification on the cellular function of C-mGCs by quantifying the expression of growth differentiation factor 9 (GDF-9), bone morphogenetic protein 15 (BMP-15), follicle-stimulating hormone receptor (FSHR), luteinizing hormone receptor (LHR), connexin 37, survivin, and caspase 3. Methods: Mature and immature C-mGCs were obtained from 38 women with polycystic ovary syndrome who participated in an in vitro fertilization program. The C-mGCs were then divided into two groups: fresh and vitrified. The expression levels of target genes were assessed using real-time quantitative polymerase chain reaction. Results: After vitrification, GDF-9 expression was significantly decreased among both mature and immature C-mGCs, with 0.2- and 0.1-fold changes, respectively (p<0.01). Similarly, FSHR expression in the mature and immature groups was reduced by 0.1- and 0.02-fold, respectively, following vitrification (p<0.01). The expression levels of the other genes, including BMP-15, LHR, connexin 37, survivin, and caspase 3, remained similar across the examined groups (p>0.05). Conclusion Vitrification may compromise oocyte maturation through reduced GDF-9 and FSHR expression in C-mGCs after warming.

Objective: Ovarian tissue vitrification is widely utilized for fertility preservation in prepubertal and adolescent female patients with cancer. The current literature includes reports of successful pregnancy and live birth following autografting. However, the effects of the vitrification process on cumulus-mural granulosa cells (C-mGCs)—somatic cells in ovarian tissue crucial for oocyte maturation and early embryonic development—remain unclear. This study was conducted to explore the impact of vitrification on the cellular function of C-mGCs by quantifying the expression of growth differentiation factor 9 (GDF-9), bone morphogenetic protein 15 (BMP-15), follicle-stimulating hormone receptor (FSHR), luteinizing hormone receptor (LHR), connexin 37, survivin, and caspase 3. Methods: Mature and immature C-mGCs were obtained from 38 women with polycystic ovary syndrome who participated in an in vitro fertilization program. The C-mGCs were then divided into two groups: fresh and vitrified. The expression levels of target genes were assessed using real-time quantitative polymerase chain reaction. Results: After vitrification, GDF-9 expression was significantly decreased among both mature and immature C-mGCs, with 0.2- and 0.1-fold changes, respectively (p<0.01). Similarly, FSHR expression in the mature and immature groups was reduced by 0.1- and 0.02-fold, respectively, following vitrification (p<0.01). The expression levels of the other genes, including BMP-15, LHR, connexin 37, survivin, and caspase 3, remained similar across the examined groups (p>0.05). Conclusion Vitrification may compromise oocyte maturation through reduced GDF-9 and FSHR expression in C-mGCs after warming.

Objective: The objective of this study was to assess factors related to renal function in crane operators at a port container terminal in Indonesia. Methods: A cross-sectional study on crane operators in Medan Container Terminal, Indonesia, was conducted. Renal function was measured through Glomerular Filtration Rate (GFR). Individual characteristics such as age, nutritional status, fluid consumption, hydration status, and physical activity level were collected. Fluid consumption was obtained from a 24-h food recall questionnaire. Physical activity was measured based on the Bouchard questionnaire. Association was determined by calculating the odds ratio (OR) and its 95% confidence interval (CI). Results: A total of 87 subjects were involved. All were male with the median age of 30.1 ± 2.4 years old. The prevalence of decreased renal function was 49.4%. Inadequate fluid consumption (OR = 6.1, 95% CI 2.1 -17.7; p<0.001) significantly increase the risk of renal function decreased, while being overweight/obese (OR 3.3, 95% CI 0.7 -11.7;p<0.125) and dehydration (OR 2.3, 95% CI 0.8-26.9; p=0.111) also increase the risk although not significantly. Conclusion Inadequate fluid consumption increases the risk of decline in the renal function of crane operators in the container terminal. A company should regularly monitor and evaluate the kidney function of this group of workers through annual medical checkups and provide easier access to drinking water and convenient toilets to improve fluid consumption of the workers.
Dehydration

Objective: This study aimed to investigate the incidence and risk factors for musculoskeletal injuries among junior badminton athletes during a national championship. Methods: A retrospective cohort study was conducted among 128 junior badminton athletes who were members of one Indonesian badminton club and participated in the National Premier Circuit held in June 2019 in West Java, Indonesia. Data on demographic characteristics, history of previous and current injuries, physical examination, diagnosis (type, anatomical structure involved, and location), and treatment of injuries were collected along with data on the format of the game (single, double, or combination), and the number of matches for each respective athlete. Measures of injury frequency used were the incidence proportion and clinical incidence. Determinant factors for incidence were investigated. Results: Twenty-four injury events involving 23 athletes were recorded, with an incidence proportion of 23/128 athletes (18%) and a clinical incidence of 24/128 athletes or 18.8 per 100 athletes. Acute injuries were more frequent (13/24, 54.2%) than chronic/overuse injuries. More than half (14/24, 58.3%) of the injuries occurred in the lower extremities. Factors that increased the risk of injury were age ≥ 15 years (relative risk [RR] = 6.26, 95% confidence interval [CI] 1.96, 20.04, p < 0.001), and the number of matches ≥ 3 (RR = 3.79, 95% CI 1.61, 8.92, p = 0.001). Conclusion Musculoskeletal injuries occurred frequently among Indonesian junior badminton athletes during the national elite championship. An effective injury-prevention program specific to young athletes should be developed to maintain their future participation and performance in competition.
Racquet Sports ; Wounds and Injuries ; Epidemiology ; Athletes ; Adolescent

INTRODUCTION: Offshore and onshore workers have a higher risk of psychological stress related to their job. Stress reactions vary depending on the type of stressor, the duration or severity of the stressor, their genetics, their coping styles, and their nutrition. Tryptophan is an essential amino acid precursor of serotonin and melatonin, which have an antidepressant effect and roles in stress perception and management. This study assessed the correlation of daily tryptophan intake and occupational factors with stress outcome scores based on the Indonesian Short Version New Brief Job Stress Questionnaire (SV-NBJSQ) among offshore and onshore workers. METHODS: A cross-sectional study was conducted on 14 offshore workers and 20 onshore workers. Interviews and questionnaires were conducted to obtain demographic data, dietary intake, occupational factors, and stress outcome scores. Tryptophan daily intake was measured through a single 24-hour dietary recall and a one-day-weighted food record. Data of average daily intake for two days were analyzed using the NutriSurvey software based on the food composition table from The United States Department of Agriculture National Nutrient Database for calculating tryptophan intake. RESULTS: The median (min-max) tryptophan daily intake of offshore workers was 5.5 (1.9–9.9) mg/kg, and 4.5 (1.4–7.5) mg/kg among onshore workers. There was no difference in tryptophan daily intake between offshore and onshore workers (p = 0.064). There was no significant difference between occupational factors except for the shorter tenure of offshore workers (12.5 vs 3, p < 0.001). There was no significant correlation between tryptophan daily intake and each of the stress outcome scores. There was a significant correlation between occupational factors and stress outcome scores among offshore and onshore workers, specifically between workload and fatigue (r = 0.35, p =0.04), workload and depression (r = 0.4, p = 0.02), interpersonal conflict and anxiety (r = 0.47, p = 0.005), role conflict and anxiety (r = 0.47, p = 0.005), as well as between tenure and physical reaction stress (r = -0.42, p = 0.02). CONCLUSION Adequate tryptophan daily intake and high stress outcome scores among offshore and onshore oil and gas workers are observed in this study, and no correlation was found between the two. Similar food sources, homogeneous occupational stressors, the selection bias of the “healthy worker effect” or other factors that were not studied may influence the findings. There is a correlation between occupational factors and stress outcome scores, namely workload and fatigue, workload and depression, interpersonal conflict and anxiety, role conflict and anxiety, and tenure and stress physical reactions.

INTRODUCTION: Lack of physical activity is a risk factor for dyslipidemia. Office work is a job associated with low physical activity. Wellness programmes in the workplace might increase physical activity and cardiorespiratory fitness. OBJECTIVE: This study aimed to determine the effect of a wellness programme on aerobic physical exercise adherence and blood lipid profile changes among government employees. METHODS: This study used a randomized controlled trial design, with the intervention (wellness programme) conducted for six weeks. Thirty participants who were office workers in a government institution were allocated into two groups. The intervention group (n = 15) received health education, aerobic physical exercise (30 minutes on a treadmill, three times/week for six weeks), reminders, and a logbook. The control group (n = 15) received education only. The outcomes were adherence to the exercise programme and lipid profile levels. RESULT: The intervention group showed more adherence to aerobic exercise than the control group (OR 42.2, 95% CI 5.1, 346.9). The mean (SD) total cholesterol level in the intervention group was decreased by 9.9 (21.1) mg/dl, while in the control group, it was increased by −16.0 (14.5) mg/dl at the end of the study (p = 0.010). The mean (SD) of low-density lipoprotein (LDL) cholesterol in the intervention group was also decreased by 0.9 (17.2) mg/dl while in the control group, it was increased by -14.8 (11.6) mg/dl (p = 0.007). No significant mean differences were observed for high-density lipoprotein (HDL) cholesterol and triglyceride. CONCLUSION A workplace wellness programmes can enhance employees’ adherence to physical exercise and decrease their total blood cholesterol and LDL level.