Spatial Clusters of High Prevalences of Overweight and Obesity Among Children in Indonesia.

Objective Childhood obesity has emerged as a pressing health concern in both high-income and lower-middle-income countries, including Indonesia. The prevalence of overweight and obesity among school children aged 5-12 years has been increasing in Indonesia, with 20% of Indonesian children identified as obese or overweight in 2018. Therefore, addressing this problem will be challenging. This study aims to identify district- and city-level clusters with high prevalences of overweight and obese children aged 5-12 years in Indonesia. Methodology This is an ecological study that utilizes secondary data from the 2018 Basic Health Research report conducted by the Indonesian Ministry of Health. We included 514 districts and cities to detect district- and city-level clusters. Spatial cluster analysis was performed using restricted flexible scan statistics to identify clusters with high prevalences of childhood overweight and obesity in Indonesian districts and cities. Results The findings reveal that childhood overweight and obesity are not randomly distributed. The study detected 20 clusters with high prevalences of childhood overweight and 36 clusters of obesity, with a particular concentration in Western Indonesia. A primary cluster of childhood overweight occurred in Sijunjung, Tanah Datar, Agam, Pasaman, South Solok, Dharmasraya, West Pasaman, Sawah Lunto City, Padang Panjang City, and Kampar. A primary cluster of obesity occurred in Mandailing Natal, South Tapanuli, Central Tapanuli, North Tapanuli, Labuhan Batu, North Padang Lawas, Padang Lawas, North Labuhan Batu, West Pasaman, and Rokan Hilir. Conclusions This study found 20 clusters with high prevalences of childhood overweight and 36 clusters of obesity in Indonesia. Implementing health promotion programs in the identified cluster regions will be crucial to effectively addressing the growing problem of childhood obesity in Indonesia.

Experiences with smoking habits and the need for cessation among habitual smokers in Japan: a qualitative study based on semi-structured interviews.

BACKGROUND: Although more than half of the habitual smokers recognize that they want to quit smoking cigarettes, approximately half have failed to quit and experienced distress relapse; therefore, there is an urgent need to focus on these populations. When chronic behavior occurs, it is necessary to view the behavior in the context of the entire life of the person involved, considering the history of the person. In this study, we aimed to describe experiences with smoking from the onset to the present and the need for smoking cessation among habitual smokers in Japan and to explore efforts to address them. METHODS: Semi-structured interviews that lasted for 55-90 min were conducted with the cooperation of 16 habitual smokers who smoked cigarettes daily. The content of the interviews included demographic characteristics, experiences with smoking from the onset to the present, whether they have attempted to quit and related experiences, and their thoughts on smoking. Interviews were transcribed verbatim and analyzed qualitatively. The Medical Research Ethics Review Committee of Jikei University approved this study (approval number: 33-384(11008)). RESULTS: The participants were aged 26-59 years (mean ± SD: 40.8 ± 8.9 years) and included 10 men and 6 women. The participants started smoking between age 13 and 24 years. The highest number of cigarettes smoked in the participants' lives ranged from 10 to 80 daily, and 12 participants had attempted to quit smoking so far without success. Regarding experiences with smoking from the onset to the present, four themes of "expand one's world," "unconscious attachment," "attempts and failures," and "losing oneself" were extracted. Regarding the need for smoking cessation, four themes of "empowerment from experts," "peer interaction," "social commitment," and "recovery of confidence" were extracted. CONCLUSION: To support smoking cessation from the perspective of habitual smokers, in addition to improvements through the existing approaches, it is important to recover their confidence using ongoing activities in peer groups according to the target background and support from experts incorporating visual assessments of lung function, along with multiple short-term goals. It is also necessary to raise awareness in communities through activities.

Types and frequency of social participation and comprehensive frailty among community-dwelling older people in Japan.

Although research has established social participation as important for preventing frailty in older people, the association between the type and frequency of social participation and comprehensive frailty remains unclear. This study aimed to reveal the associations between types and frequency of social participation and comprehensive frailty among community-dwelling older people. This was a cross-sectional study conducted in four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) of Mie Prefecture, Japan, among adults who were: (i) aged ≥65 years and (ii) not certified as needing long-term care. We measured comprehensive frailty using the participants' total scores on the Kihon Checklist, developed by Ministry of Health, Labour and Welfare of Japan, which divides frailty status into three categories: robust (0-3 points), prefrail (4-7), and frail (8-25). Types and frequency of social participation were explanatory variables, and ordered logistic regression analysis adjusted for potential confounding factors identified the associations. The frailty status of the 296 participants (age 65-74 years: 44.3 %; female: 74.0 %) was as follows: frail, 21.3 %; prefrail, 40.2 %; and robust, 38.5 %. Lower level of frailty was associated with interaction using smartphones 2-3 times per month, participating in sports ≥4 times per week, participating in local improvement activities several times per year, and engaging in activities for children 2-4 times per month. Social participation among older adults at appropriate frequencies were associated with the lower level of comprehensive frailty. However, future longitudinal studies are needed using populations from more diverse countries or regions and from different cultures.

Factors associated with overweight/obesity of children aged 6-12 years in Indonesia.

BACKGROUND: Globally, the prevalence of childhood obesity has increased considerably, including in Indonesia. Obesity results from multifactorial interactions at the personal, familial, and environmental levels. However, little is known about the factors associated with overweight/obesity among children in Indonesia. This study is intended to identify personal, familial, and environmental factors associated with overweight/obesity in children aged 6-12 years in Indonesia. METHODS: Study design was a secondary data analysis using the Indonesia Family Life Survey in 2014/2015, focusing on 6,090 children aged 6-12 years. The questions covered the child's body mass index and potential personal, familial, and environmental factors. Logistic regression analysis was performed to identify the personal, familial, and environmental factors. RESULTS: The mean age of participants was 8.9 years (SD = 2.0); 51.0% were boys; 9.4% were overweight; and 8.1% were obese. Overweight and obesity were associated with age [AOR 1.09 (95% CI 1.04-1.14)], having an overweight [AOR 1.93 (95% CI 1.58-2.36)] or obese [AOR 3.36 (95% CI 2.43-4.61)] father compared with a normal father, being of Chinese [AOR 9.51 (95% CI 1.43-79.43)] or Javanese [AOR 1.60 (95% CI 1.16-2.24)] ethnicity compared with Sundanese ethnicity, and residing in an urban area [AOR 1.36 (95% CI 1.10-1.70)]. A lower risk of child overweight/obesity was associated with the father's perception [AOR 0.56 (95% CI 0.38-0.80)] and mother's perception [AOR 0.66 (95% CI 0.43-0.98)] of the child's food consumption as being less than adequate compared with adequate. CONCLUSIONS: Risk factors in children for overweight/obesity were older age, having an overweight/obese father, membership of certain ethnic groups, and urban residence. The main protective factor was parents' perception that a child's food consumption was less than adequate. Health promotion programs focused on these factors could help control or prevent childhood obesity in Indonesia.

Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling.

Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants' frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (ß = 0.25), and by seeking health information (ß = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (ß = 0.34), receiving support from health professionals (ß = 0.23) and Islamic spiritual practice (ß = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (ß = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.

Protective and high-risk social activities associated with homebound status among older adults in rural Japan.

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65-74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends' houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64-17.64 and AOR 3.49, 95 % CI 1.07-11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01-0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03-0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90-441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

Association between the type of physical activity and metabolic syndrome in middle-aged and older adult residents of a semi-mountainous area in Japan.

BACKGROUND: Physical activity is reported to prevent metabolic syndrome. However, it is unclear whether exercise or daily physical activity is more beneficial for residents of semi-mountainous areas. This study aimed to identify whether daily physical activity is more beneficial than exercise for the prevention of metabolic syndrome among middle-aged and older residents in semi-mountainous areas. METHODS: We analyzed secondary data of 636 people who underwent a specific health checkup in a semi-mountainous area of Japan. Physical activity was classified into four types: inactivity (I-type; without exercise and without daily physical activity), only exercise (E-type; with exercise and without daily physical activity), only daily physical activity (D-type; without exercise and with daily physical activity), and full physical activity type (F-type; with exercise and with daily physical activity). We compared the means of risk factors for metabolic syndrome by these four types, followed by logistic regression analysis, to identify whether and to what extent the D-type was less likely to have metabolic syndrome than the E-type. RESULTS: The prevalence of metabolic syndrome was 28.5% (men 45.7%, women 15.8%). The proportions of men with exercise and daily physical activity were 38.7% and 52.8%, respectively. For women, the proportions were 33.0% and 47.1%, respectively. In women, the D-type had the significantly lowest BMI, smallest waist circumference, highest HDL-C, and lowest prevalence of metabolic syndrome of the four types; the same was not observed in men. Additionally, D-type activity was more strongly associated with a reduced risk of metabolic syndrome than E-type activity in women (adjusted odds ratio 0.24; 95% confidence interval 0.06-0.85, P = 0.028). CONCLUSIONS: Compared to middle-aged and older women residents with exercise in a semi-mountainous area of Japan, those with daily physical activity may effectively prevent metabolic syndrome.

Positive Deviance: Frequent Blood Pressure Monitoring Among Non-hypertensive Middle-aged Women in Rural Indonesia.

BACKGROUND: In Indonesia, as in many low and middle-income countries, hypertension is a significant health issue. Community health nurses need to identify those with early onset of hypertension by promoting frequent blood pressure (BP) checks, even among those with normal BP. Positive deviance approaches focus on identifying people who undertake uncommon preventive actions. Among middle-aged women in rural West Java, Indonesia, we aimed to identify covariates of the positive deviant practice of having one's BP checked at least once every three months even when having normal BP.  Methods: We conducted a cross-sectional survey recruiting participants at health centers. Our structured questionnaire measured socio-demographic characteristics, frequency of BP checks, BMI, beliefs and practices. We used binomial logistic regression to identify covariates. RESULTS: Among 520 participants, 265 had normal BP, and of those 156 had obtained frequent BP checks, making them positive deviants. For women with normal BP, significant covariates of obtaining frequent BP checks were: 1) having BMI ≥25.0 (adjusted odds ratio (AOR)  =2.57, 95% confidence interval (CI)=1.39-4.78), 2) greater tendency to seek health information (AOR=1.13, 95% CI=1.03-1.24), 3) receiving less support from family members (AOR=0.87, 95% CI=0.77-0.97), and 4) receiving greater support from health volunteers (AOR=1.12, 95% CI=1.01-1.23). CONCLUSION: Positive deviants were more likely to be proactive because of the convergence of their own individual-level tendencies to learn about  their health, family-level conditions that allowed for greater autonomy, and community-level capacity of health volunteers to provide them with support. Community health nurses should focus simultaneously on activating individual-level, family-level, and community-level capacity to prevent hypertension.

Homecare protective and risk factors for early childhood caries in Japan.

BACKGROUND: Early childhood caries (ECC) affects children across Japan and throughout the world. Thus, it is important to identify dietary and dental care habits that either promote oral health or cause ECC. The objective of this study was to identify protective and risk factors associated with ECC in Japan. METHODS: In a typical rural Japanese community, we selected children born between 2004 and 2008 who had received checkups at their community health center including oral examinations conducted by dentists. We obtained data from children's records and from a questionnaire filled out by parents. We enrolled only children who at their checkup for 18-month-olds had no caries, and we obtained data about them at their checkup for 3-year-olds. We classified children as either having caries (treated or untreated) or being caries-free. We conducted bivariate analyses using data on child/family demographic characteristics, child's dietary habits, and child/parental oral health habits. We also conducted logistic regression analysis to control for variables and identify predictors of the presence/absence of caries. RESULTS: Five hundred sixty six children (278 boys, 288 girls) were enrolled and followed. After 2 years, 173 children (30.6%) presented with caries. Logistic regression analysis predicting caries at follow-up identified the interaction term "bottlefed overnight and brushed irregularly" at 18 months of age as a highly significant predictor of developing caries-adjusted odds ratio (AOR) of 14.27, 95% confidence interval (CI) 1.02-199.71. Two variables measured at follow-up were also significant predictors: having low levels of dental plaque (AOR 2.41, 95% CI 1.34-4.35) and having a mother who had untreated caries (AOR 1.84, 95% CI 1.09-3.12). CONCLUSION: Public health efforts should encourage parents to eliminate bottle feeding overnight and promote brushing twice daily as children's teeth begin to erupt. Greater efforts should be made to teach parents and daytime caregivers how to brush effectively to remove all plaque. Health professionals should pay close attention to mothers' oral health status. Mothers with caries should receive prompt treatment and be assisted in developing better dietary and oral health habits that will benefit themselves and their children. Policies and programs should focus more on family oral health rather than just child oral health.

Model development of healthy-lifestyle behaviors for rural Muslim Indonesians with hypertension: A qualitative study.

Hypertension is a significant health issue in Indonesia. Health professionals in a rural district of West Java identified hypertension as a priority health issue. In this study, we describe healthy-lifestyle behaviors as perceived by the district's middle-aged Muslims with hypertension. A qualitative case-study design was used. Twelve married couples, directly or indirectly impacted by hypertension, and who visited community health centers, were purposively recruited. Semistructured interviews provided data that were systematically analyzed for categories and subcategories. Categories of healthy-lifestyle behaviors currently practiced were eating behavior, physical activity, resting, not smoking, managing stress, seeking health information, seeking health care, caring other people, and fulfilling an obligation to God. Categories of reasons for practicing healthy-lifestyle behaviors were behavioral beliefs, competence, religious support, prior experience, social support, and health system support. Categories for not practicing healthy-lifestyle behaviors were personal, social, and environmental barriers. To achieve healthy-lifestyle behavior changes, it is essential for rural middle-aged Muslim individuals to be supported by reinforcing their positive reasons and to address their negative reasons to practice healthy-lifestyle behaviors.

Discovery and stereoselective synthesis of the novel isochroman neurokinin-1 receptor antagonist 'CJ-17,493'.

A novel central nervous system (CNS) selective neurokinin-1 (NK(1)) receptor antagonist, (2S,3S)-3-[(1R)-6-methoxy-1-methyl-1-trifluoromethylisochroman-7-yl]-methylamino-2-phenylpiperidine 'CJ-17,493' (compound (+)-1), was synthesized stereoselectively using a kinetic resolution by lipase-PS as a key step. Compound (+)-1 displayed high and selective affinity (K(i)=0.2 nM) for the human NK(1) receptor in IM-9 cells, potent activity in the [Sar(9), Met(O(2))(11)]SP-induced gerbil tapping model (ED(50)=0.04 mg/kg, s.c.) and in the ferret cisplatin (10mg/kg, i.p.)-induced anti-emetic activity model (vomiting: ED(90)=0.07 mg/kg, s.c.), all levels of activity comparable with those of CP-122,721. In addition, compound (+)-1 exhibited linear pharmacokinetics rather than the super dose-proportionality of CP-122,721 and this result provides a potential solution for the clinical issue observed with CP-122,721.

Structure-activity relationship study of novel NR2B-selective antagonists with arylamides to avoid reactive metabolites formation.

A novel potent NMDA-NR2B selective antagonist without the reactive metabolites formation issue was identified. Through this study, a close correlation between reactive metabolites formation and calculated HOMO energies of parent compounds was found.

Discovery of (-)-6-[2-[4-(3-fluorophenyl)-4-hydroxy-1-piperidinyl]-1-hydroxyethyl]-3,4-dihydro-2(1H)-quinolinone--a potent NR2B-selective N-methyl D-aspartate (NMDA) antagonist for the treatment of pain.

(-)-6-[2-[4-(3-Fluorophenyl)-4-hydroxy-1-piperidinyl]-1-hydroxyethyl]-3,4-dihydro-2(1H)-quinolinone was identified as an orally active NR2B-subunit selective N-methyl-d-aspartate (NMDA) receptor antagonist. It has very high selectivity for NR2B subunits containing NMDA receptors versus the HERG-channel inhibition (therapeutic index=4200 vs NR2B binding IC(50)). This compound has improved pharmacokinetic properties compared to the prototype CP-101,606.

Anti-emetic activity of the novel nonpeptide tachykinin NK1 receptor antagonist ezlopitant (CJ-11,974) against acute and delayed cisplatin-induced emesis in the ferret.

The anti-emetic effects of a novel tachykinin NK(1) receptor antagonist, ezlopitant ((2S,3S-cis)-2-diphenylmethyl)- N-[(2-methoxy, 5-isopropylphenyl)methyl]-1-azabicyclo- [2.2.2]octan-3-amine), were investigated in ferrets. Ezlopitant inhibited [(3)H]substance P ([(3)H]SP) binding to the human, guinea pig, ferret and gerbil NK(1) receptors (K(i) = 0.2, 0.9. 0.6 and 0.5 nmol/l, respectively), but had no affinity to NK(2) and NK(3) receptors up to 1 micromol/l. Ezlopitant also inhibited SP-induced contraction of guinea pig trachea with a pA(2) value of 7.8, but had no effects on the baseline tension and maximum contractile response. In ferrets, ezlopitant, either orally (0.03-3 mg/kg) or subcutaneously (0.3-3 mg/kg), prevented acute retching and vomiting responses induced by intraperitoneal injection of cisplatin (10 mg/kg). In addition, repeated subcutaneous injection of ezlopitant significantly inhibited delayed retching and vomiting responses that occurred in ferrets treated with the lower dose of cisplatin (5 mg/kg, i.p.). Ezlopitant (0.1-1 mg/kg, s.c.) also produced a dose-dependent inhibition of hindpaw tapping induced by intracerebroventricular injection of [Sar(9),Met(O(2))(11)]SP in gerbils, which is known to be mediated by NK(1) receptors in the brain. These findings indicate that ezlopitant is a potent and selective NK(1) receptor antagonist, and that it inhibits both acute and delayed emetic reactions induced by cisplatin in ferrets via acting on NK(1) receptors in the central nervous system.