Sarcopenia in a Multiethnic State: A Cross-Sectional Data Analysis of Multicentre Indonesia Longitudinal Aging Study.

BACKGROUND: Previous regional studies related to sarcopenia in multiethnic Indonesia suggested inconsistent findings. We aimed to find the prevalence of sarcopenia and its associated factors among Indonesian older adults. METHODS: In this cross-sectional analysis, we utilised the data of Indonesia Longitudinal Aging Study (INALAS) from community-dwelling outpatients in eight centres. Statistical analyses included descriptive, bivariate, and multivariate analyses. We categorised older adults into sarcopenia group based on the criteria of the SARC-F questionnaire, namely strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire. RESULTS: Among 386 older adults, 17.6% were in sarcopenia group. The prevalence of sarcopenia was found to be the lowest in Sundanese group (8.2%). Following appropriate statistical adjustment, sarcopenia was associated with female sex (OR 3.01, 95% CI 1.34-6.73), dependent functional capacity (OR 7.38, 95% CI 3.26-16.70), frailty (OR 11.82, 95% CI 5.41-25.80), and history of fall (OR 5.17 (95% CI 2.36-11.32). Sarcopenia was not significantly associated with age 70 years and older (OR 1.67, 95% CI 0.81-3.45), Sundanese group (OR 0.44, 95% CI 0.15-1.29), and being at high risk for malnutrition or malnourished (OR 2.98, 95% CI 0.68-13.15). All centenarians had no sarcopenia nor frailty, and 80% of them were Sundanese older adults. CONCLUSION: One in five Indonesian community-dwelling older adults had sarcopenia, associated with female sex, dependent functional capacity, frailty, and history of fall. Albeit statistically nonsignificant, there may still be link between Sundanese, age 70 years and older, as well as being at high risk for malnutrition, and sarcopenia.

Sedentary Lifestyle of Older Adults and Its Associated Factors: A Multicentre Cross-Sectional Study During COVID-19 Pandemic in Indonesia.

BACKGROUND: COVID-19 is here to stay, and humans ought to decide how to adapt. We aimed to describe lifestyle changes during COVID-19 pandemic, and to determine the prevalence and factors associated with sedentary lifestyle among older adults. METHODS: We obtained data from community-dwelling older adults aged ≥60 years. We presented the data descriptively and used multivariate analysis to assess the association between Physical Activity Scale for the Elderly (PASE) -based sedentary lifestyle and other variables in several tertiary geriatric centres. RESULTS: Among 601 participants, 21.1% had sedentary lifestyle. Ethnic groups with the highest prevalence of sedentary lifestyle were Minang, Balinese, and Sundanese. Changes related to food intake, body weight, and physical activity were seen in a small proportion of older adults. Sun exposure habit was described. Sedentary lifestyle was associated with less consumption of food (OR 2.59, 95% CI 1.07-6.30), weight loss (OR 3.00, 95% CI 1.64-5.48), and higher intensity of snacking (OR 0.45, 95% CI 0.20-0.99). CONCLUSION: During COVID-19 pandemic, one out of five older adults had sedentary lifestyle, which was positively associated with less consumption of food and weight loss, and negatively associated with higher intensity of snacking. The prevalence of sedentary lifestyle varied across ethnic groups. Adequate and appropriate food intake may be crucial to keep older adults active, preventing them from entering vicious cycle of malnutrition, sarcopenia, and frailty.

Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia.

OBJECTIVES: Up to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under-recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia. METHODS: A survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five-point scale to indicate agreement or YES/NO response to questions regarding sensory-cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done). RESULTS: Respondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training. CONCLUSIONS: There is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory-cognitive knowledge, attitudes and practice in professional care teams is called for.

The Effect of Physical Activity on Social Isolation in Elderly.

BACKGROUND: Elderly people who have poor social relationships have a higher risk of death than those who have strong social networks. Loneliness and social isolation are associated with an increased risk of coronary heart disease and stroke. Physical activity can reduce social isolation, diverting feelings of loneliness by socializing with other people and expanding social networks by participating in the community. This study aimed to determine the effect of physical activity on social isolation in the elderly. METHODS: A Cross-sectional study was conducted to 181 respondents. The data is collected through interviewing respondents with the International Physical Activity Questionnaire (IPAQ) and social isolation questionnaires. The data was then analyzed descriptively and calculated using Fisher's exact test. SETTING: Ardirejo and Panggungrejo villages, Kepanjen District, Malang Regency. RESULTS: Based on the Fisher's exact between  physical activity and social isolation results were obtained p-value 0.000 (PR = 23.407; 95% CI = 3,117-175,800). CONCLUSION: There is a significant relationship between physical activity and social isolation in the elderly in the community.

Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition.

BACKGROUND: Information about frailty status and its transition is important to inform clinical decisions. Predicting frailty transition is beneficial for its prevention. While Indonesia is the 4th largest geriatric population in Asia, data about frailty transition is limited. This study aimed to obtain data on prevalence of frailty, its risk factors, frailty state transition and its prognostic factors, as well as to develop prognostic score for frailty state transition. METHODS: Multicenter study on subjects aged ≥60 years old was done to obtain the prevalence of frailty status and to identify risk factors of frailty. Prospective cohort over 12 months was done to obtain data on frailty state transition. Multiple logistic regression analysis was performed to identify its prognostic factors from several clinical data, which then were utilized to develop prognostic score for frailty state worsening. RESULTS: Cross-sectional data from 448 subjects showed that 25.2% of the subjects were frail based on Frailty index-40 items. Risk factors of frailty were age (OR 2.72; 95% CI 1.58-4.76), functional status (OR 2.89; 95% CI 1.79-4.67), and nutritional status (OR 3.75; 95% CI 2.29-6.13). Data from the 162 subjects who completed the cohort showed 27.2% of the cohort had frailty state worsening. Prognostic factors for frailty state worsening were being 70 years or older (OR 3.9; 95% CI 1.2-12.3, p < 0.05), negative QoL, i.e., fair and poor QoL (OR 2.5; 95% CI 1.1-5.9, p < 0.05), and slow gait speed (OR 2.8; 95% CI 1.3-6.4, p < 0.05). The internal validation of the prognostic score consisted of those three variables showed good performance. CONCLUSION: The prevalence of frailty in this study among Indonesian elderly in outpatient setting was 25.2%. The risk factors of frailty were age, functional status and nutritional status. The prognostic factors for frailty state worsening were being 70 years old or older, negative QoL (fair or poor quality of life), and slow gait speed. A prognostic score to predict frailty state worsening in 12 months had been developed.

Responses to combined abiotic and biotic stress in tomato are governed by stress intensity and resistance mechanism.

Stress conditions in agricultural ecosystems can occur at variable intensities. Different resistance mechanisms against abiotic stress and pathogens are deployed by plants. Thus, it is important to examine plant responses to stress combinations under different scenarios. Here, we evaluated the effect of different levels of salt stress ranging from mild to severe (50, 100, and 150mM NaCl) on powdery mildew resistance and overall performance of tomato introgression lines with contrasting levels of partial resistance, as well as near-isogenic lines (NILs) carrying the resistance gene Ol-1 (associated with a slow hypersensitivity response; HR), ol-2 (an mlo mutant associated with papilla formation), and Ol-4 (an R gene associated with a fast HR). Powdery mildew resistance was affected by salt stress in a genotype- and stress intensity-dependent manner. In susceptible and partial resistant lines, increased susceptibility was observed under mild salt stress (50mM) which was accompanied by accelerated cell death-like senescence. In contrast, severe salt stress (150mM) reduced disease symptoms. Na(+) and Cl(-) accumulation in the leaves was linearly related to the decreased pathogen symptoms under severe stress. In contrast, complete resistance mediated by ol-2 and Ol-4 was unaffected under all treatment combinations, and was associated with a decreased growth penalty. Increased susceptibility and senescence under combined stress in NIL-Ol-1 was associated with the induction of ethylene and jasmonic acid pathway genes and the cell wall invertase gene LIN6. These results highlight the significance of stress severity and resistance type on the plant's performance under the combination of abiotic and biotic stress.

Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: a multi-centre study.

AIM: to obtain profile of food and nutrient intake in Indonesian elderly population and factors associated with energy intake. METHODS: multi-center cross sectional study in 13 hospitals across Indonesia was conducted among 387 elderly who had attended geriatric clinics. Data collected including demographic characteristics, functional status, cognitive status, mental status, nutritional status, food intake, present activities, and data on chronic diseases. Chi square and logistic regression tests were performed to analyze the data. RESULTS: most of subjects (58.4%) were women and had educational background senior high school or higher degree (61.1%). The average of energy intake was 1266.74 (336.51) kilocalories. Calcium and protein intake were below the recommended of dietary allowance. female sex (OR 0.23; 95% CI 0.139-0.390) and osteoporotic subjects (OR 0.48; 95% CI 0.25-0.93) have lower risk for having <80% RDA daily energy intake, while lower educational level (OR 1.96; 95% CI 1.21-3.18) has higher risk for having <80% RDA daily energy intake. CONCLUSION: total energy intake were inadequate in the elderly. Female sex and osteoporotic subjects have lower risk for having <80% RDA daily energy intake, while lower educational level has higher risk for having <80% RDA daily energy intake.

Drought Stress Interacts With Powdery Mildew Infection in Tomato.

Under field conditions, plants are often exposed to more than one stress factor at the same time, and therefore need to adapt to different combinations of stresses. Crosstalk between responses to abiotic and biotic stresses is known to occur, and the interaction between stress responses can be positive or negative. We studied the interaction of drought stress and powdery mildew (PM) infection in tomatoes using near-isogenic tomato lines (NILs) carrying the Ol-1, ol-2, or Ol-4 gene that confers resistance to tomato PM caused by Oidium neolycopersici. Our study demonstrated that drought-induced growth reduction was not further reduced by powdery mildew infection. Drought stress, however, decreased fungal infection in the susceptible genotype Moneymaker (MM) with fungal biomass tending to decrease further as the drought severity increased. Drought stress did not affect PM resistance levels of resistant NIL carrying ol-2 (a mutant of the tomato susceptibility Mlo gene) and Ol-4 an NLR (nucleotide-binding site-LRR) R gene associated with a fast hypersensitivity response (HR) but tended to slightly decrease disease levels of NIL-Ol-1 (no gene characterized yet, associated with a slow HR following PM infection). At the molecular level, genes involved in abscisic acid (ABA), salicylic acid (SA), and ethylene pathways were highly induced under combined stress indicating the involvement of ABA, SA, and ethylene in the crosstalk between abiotic and biotic stress. Messenger RNA expression of the ABA-responsive dehydrin SlTAS14 was induced under drought and combined stress with the highest induction under combined stress, and resistant NIL lines showed higher expression levels than MM. The expression of SlNCED (involved in ABA synthesis) was also upregulated under drought and highly induced under combined stress. Expression levels of pathogen responsive gene SlPR1 (an indicator of the SA pathway) and SlACS (involved in ethylene synthesis) were highly induced under powdery mildew infection in MM and the Ol-1 and were induced the most under combined stress in these lines. Taken together, these findings indicate that drought stress can interact with and influence PM infection in tomatoes in a resistance type-dependent manner. The role of hormonal signaling pathways in the crosstalk between drought stress and PM infection is further discussed.

Artificial intelligence in healthcare: opportunities and risk for future.

OBJECTIVE: This study aimed to find out the opportunity of artificial intelligence (AI) and the risk in health service. METHOD: A comprehensive literature search was collected from three databases (Web of Science, Google Scholar, and EBSCOhost) to identify articles studied Implementing AI in improving in health services. Two reviewers independently assessed the quality of studies using the Joanna Briggs Institute. RESULTS: The application will improve diagnostics, prevention, and treatment of patients, increasing cost efficiency and equality and equality in health services. For the challenge, there is no AI adoption in public sector, patients' privacy, patient autonomy rights become problems in AI applications. CONCLUSIONS: Implementation of AI is needed in the efficiency of health service management as well as making medical decisions. The challenge is facilitating early adoption and ongoing implementation in the health care system, and we consider some of the ethical problem lists faced by AI clinical application.

Frailty and Its Associated Risk Factors: First Phase Analysis of Multicentre Indonesia Longitudinal Aging Study.

Background: National long-term care development requires updated epidemiological data related to frailty. We aimed to find the prevalence of frailty and its associated factors among Indonesian elderly. Methods: We conducted first-phase cross-sectional analysis of Indonesia Longitudinal Aging Study (INALAS) data collected from community-dwelling outpatients aged 60 years and older without acute illness in nine geriatric service care centres. Descriptive, bivariate and multivariate analyses were conducted. Results: Among 908 elderly in this study, 15.10% were robust, 66.20% were pre-frail, and 18.70% were frail. Functional dependence was associated with frailty among Indonesian elderly (OR 5.97, 95% CI 4.04-8.80). Being depressed and at risk for malnutrition were also associated with frailty with OR 2.54, 95% CI 1.56-4.12, and OR 2.56, 95% CI 1.68-3.90, respectively. Prior history of fall (OR 1.77, 95% CI 1.16-2.72) and hospitalization (OR 1.46, 95% CI 0.97-2.20) in the previous 12 months were associated with frailty. There is also significant association between poly pharmacy and frailty (OR 2.42, 95% CI 1.50-3.91). Conclusion: Approximately one in five Indonesian community-dwelling elderly was frail. Frailty is associated with functional dependence, being at risk for malnutrition or being malnourished, depression, history of fall, history of hospitalization, and poly pharmacy. There may be bidirectional relationships between the risk factors and frailty. The development of long-term care in Indonesia should be considered, without forcing the elderly who need it.

The Role of Tomato WRKY Genes in Plant Responses to Combined Abiotic and Biotic Stresses.

In the field, plants constantly face a plethora of abiotic and biotic stresses that can impart detrimental effects on plants. In response to multiple stresses, plants can rapidly reprogram their transcriptome through a tightly regulated and highly dynamic regulatory network where WRKY transcription factors can act as activators or repressors. WRKY transcription factors have diverse biological functions in plants, but most notably are key players in plant responses to biotic and abiotic stresses. In tomato there are 83 WRKY genes identified. Here we review recent progress on functions of these tomato WRKY genes and their homologs in other plant species, such as Arabidopsis and rice, with a special focus on their involvement in responses to abiotic and biotic stresses. In particular, we highlight WRKY genes that play a role in plant responses to a combination of abiotic and biotic stresses.