Attitudes toward active aging and their association with social determinants and views on older adults in Japan: a cross-sectional study.

BACKGROUND: Globally, the population of older adults has greatly increased, and active aging-whereby older adults can live healthy and fulfilling lives-is considered crucial for a sustainable society. However, the concept and practice of active aging are highly debated because it is unclear how people perceive active aging. This study explored Japanese people's attitudes toward active aging (ATAA) and examined the associations between ATAA scores and sociodemographic variables, views on older adults, and self-rated life and health. METHODS: This study used data obtained from an online survey that originally targeted adults of all generations in Taiwan, South Korea, and Japan. In this study, we used only data from Japanese participants to elaborate on factors associated with ATAA in Japan. We conducted a one-way analysis of variance test and multiple linear regression analysis to evaluate the associations between the ATAA scores of 506 Japanese individuals and sociodemographic variables, views on older adults, and self-rated life and health. RESULTS: The sample comprised 171 females and 335 males. The mean (± SD) ATAA score of the 506 respondents was 138.8 (± 20.80). Females had a significantly higher ATAA score than males (144.02 versus 136.13, F = 26.29, p < 0.001). The respondents with higher education attainment, religious beliefs, better views on older adults, and better self-rated health were more likely to have a positive ATAA score (B: 3.83, 95% CI: 0.11, 7.56; B: 4.31, 95% CI: 0.93, 7.69; B: 2.07, 95% CI: 1.61, 2.53; B: 2.87, 95% CI: 0.92, 4.82, respectively). Being male, single (i.e., never married, divorced, or widowed) and other non-married marital statuses, and satisfied with one's financial condition were negatively associated with ATAA (B: -8.73, 95% CI: -12.49, -4.96; B: -5.47, 95% CI: -9.07, -1.86; B: -2.04, 95% CI: -3.99, -0.09, respectively). CONCLUSIONS: This study identified that females have more positive ATAA than males. Better views on older adults are a possible contributing factor that promotes ATAA among Japanese people. Our findings provide useful evidence that an approach towards those who are male, single, and economically satisfied is needed so that they have a positive attitude toward aging in Japan. It is necessary to address ageism and develop an environment in which individuals can expect to age actively.

Association between Internet use and depressive symptoms among older adults in two regions of Myanmar: a cross-sectional study.

BACKGROUND: Internet use has both positive and negative effects on mental health. However, few studies have examined the association between internet use and mental health among older adults in developing countries. This study aimed to investigate the association between Internet use and depressive symptoms among older adults in two regions of Myanmar. METHODS: Data based on a visit to 1,200 older adults in urban and rural Myanmar were obtained through stratified random sampling using the cross-sectional baseline survey of the longitudinal study titled "Healthy and Active Aging in Myanmar." Our analysis included 1,186 participants. The dependent variable was depressive symptoms, and the 15-item version of the Geriatric Depression Scale (GDS) was used as a continuous variable; the higher the score, the more likely a person was to be depressed. Internet use (one of the questions about household property ownership) was used as an independent variable. After confirming the absence of multicollinearity, we adjusted for age, gender, educational background, activities of daily living, residential area, and frequency of meeting friends, and stratified by subjective economic status (above or below average). We also examined the interaction between internet use and subjective economic status. A linear regression analysis was performed. RESULTS: Among the 1,186 participants included in the analysis (women: 59.5%; median age: 68 years old), 202 (17.0%) were Internet users (95% Confidential Interval [CI]: 0.15, 0.19), and they had significantly lower GDS scores than the participants who did not use the Internet (B: -1.59, 95% CI: -2.04, -1.13).GDS showed a negative association with Internet use even in the multivariate analysis (B: -0.95, 95% CI: -1.41, -0.50). However, the interaction term for GDS between Internet use and subjective economic status was not significantly associated (B: 0.43, 95% CI: -1.11, 1.98). CONCLUSIONS: Internet use and depressive symptoms were associated especially among the older adults. However, there were no significant interaction between Internet use and subjective economic status for GDS.

Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study.

BACKGROUND: Hypertension is a major cause of morbidity among older adults. We investigated older adults' access to health services in Myanmar by focusing on unmet needs in diagnosing hypertension. This study aims to identify factors associated with the unmet needs for hypertension diagnosis in the study areas of Myanmar. METHODS: This is a secondary data analysis of the survey which is a cross-sectional study conducted with older adults (aged ≥ 60 years) in the Yangon and Bago regions of Myanmar. Objective indicators of health were collected, including blood pressure, height and weight. The diagnosis of hypertension was considered an unmet need when a participant's blood pressure measurement met the diagnostic criteria for hypertension but the disease had not yet been diagnosed. Bivariate and multivariate analyses using logistic regression were performed to identify factors associated with the unmet need for hypertension diagnosis. Factors related to lifestyle habits and medical-seeking behaviour were selected and put into the multivariate model. RESULTS: Data from 1200 people, 600 from each of the two regions, were analysed. Altogether 483 (40.3%) participants were male, 530 (44.2%) were aged ≥ 70 years, and 857 were diagnosed with hypertension based on their measured blood pressure or diagnostic history, or both, which is a 71.4% prevalence of hypertension. Moreover, 240 (20.0%) participants had never been diagnosed with hypertension. In the multivariate analysis, these unmet needs for hypertension diagnosis were significantly associated with male sex (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.05), residence in the Bago region (OR 1.64, 95% CI 1.09-2.45) and better self-rated health (OR 1.70, 95% CI 1.24-2.33), but not with education, category on the wealth index or living arrangement. CONCLUSIONS: There are barriers to accessing health services for hypertension diagnosis, as evidenced by the regional disparities found in this study, and charitable clinics may decrease the financial barrier to this diagnosis.

Brief Exposure of Skin to Near-Infrared Laser Modulates Mast Cell Function and Augments the Immune Response.

The treatment of skin with a low-power continuous-wave (CW) near-infrared (NIR) laser prior to vaccination is an emerging strategy to augment the immune response to intradermal vaccine, potentially substituting for chemical adjuvant, which has been linked to adverse effects of vaccines. This approach proved to be low cost, simple, small, and readily translatable compared with the previously explored pulsed-wave medical lasers. However, little is known on the mode of laser-tissue interaction eliciting the adjuvant effect. In this study, we sought to identify the pathways leading to the immunological events by examining the alteration of responses resulting from genetic ablation of innate subsets including mast cells and specific dendritic cell populations in an established model of intradermal vaccination and analyzing functional changes of skin microcirculation upon the CW NIR laser treatment in mice. We found that a CW NIR laser transiently stimulates mast cells via generation of reactive oxygen species, establishes an immunostimulatory milieu in the exposed tissue, and provides migration cues for dermal CD103+ dendritic cells without inducing prolonged inflammation, ultimately augmenting the adaptive immune response. These results indicate that use of an NIR laser with distinct wavelength and power is a safe and effective tool to reproducibly modulate innate programs in skin. These mechanistic findings would accelerate the clinical translation of this technology and warrant further explorations into the broader application of NIR lasers to the treatment of immune-related skin diseases.

Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010.

BACKGROUND: Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce. METHODS: We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval. RESULTS: A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07-1.90) for women and 1.16 (95% CI, 0.90-1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population. CONCLUSIONS: Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.

Bathing Frequency and Onset of Functional Disability Among Japanese Older Adults: A Prospective 3-Year Cohort Study From the JAGES.

BACKGROUND: While bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan. METHODS: We used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 through January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into three groups: low frequency (0-2 times/week), moderate frequency (3-6 times/week), and high frequency (≥7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model. RESULTS: Functional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios of the moderate- and high-frequency groups were 0.91 (95% confidence interval [CI], 0.75-1.10) and 0.72 (95% CI, 0.60-0.85) for summer and 0.90 (95% CI, 0.76-1.07) and 0.71 (95% CI, 0.60-0.84) for winter. CONCLUSION: High tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people's health.

Re-evaluation of the Edinburgh Postnatal Depression Scale as screening for post-partum depression in Iwate Prefecture, Japan.

AIM: Although the Edinburgh Postnatal Depression Scale (EPDS) is widely used for screening for post-partum depression (PPD), screening time point and cut-off value in the current medical environment are not sufficiently examined. In this study, we examined appropriate timing and cut-off value of EPDS for the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. METHODS: This study was a prospective cohort study of women who delivered at the Iwate Medical University Hospital from August 2016 to February 2019. The EPDS self-assessment was conducted at 4 days and at 1 month after delivery (4D-EPDS and 1M-EPDS), and the Center for Epidemiologic Studies-Depression scale (CES-D) self-assessment was conducted at 1 month after delivery (1M-CES-D) in eligible patients and the scores were tabulated. Participants were interviewed by a psychiatric specialist to identify PPD within 2 months after delivery. For each screening, a receiver operating characteristic analysis was performed to calculate the cut-off value for PPD. Sensitivity, specificity, positive predictive value, negative predictive value and correct diagnostic rate were evaluated. RESULTS: Of the 80 post-partum women, PPD was found in nine cases (11.3%). The cut-off values for PPD were ≥10 for 4D-EPDS, ≥13 for 1M-EPDS and ≥21 for 1M-CES-D. No significant difference was found in the sensitivity, positive predictive value or negative predictive value among the three screening methods. However, a significant difference was found in the specificity, and the correct diagnosis rate and these values were relatively higher in 1M-EPDS. CONCLUSION: Based on the result of this Japanese cohort, 1M-EPDS with a cut-off value of ≥13 might be appropriate for PPD screening although that of ≥9 is currently employed.

Does Type of Residential Housing Matter for Depressive Symptoms in the Aftermath of a Disaster? Insights From the Great East Japan Earthquake and Tsunami.

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents' mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

Living Alone or With Others and Depressive Symptoms, and Effect Modification by Residential Social Cohesion Among Older Adults in Japan: The JAGES Longitudinal Study.

BACKGROUND: There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan. METHODS: We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level. RESULTS: Among men (but not women), living alone (OR 1.43; 95% confidence intervals [CI], 1.18-1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09-1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion. CONCLUSIONS: Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.

Cervical Cancer Screening With Human Papillomavirus DNA and Cytology in Japan.

OBJECTIVE: The aim of this study was to determine the value of human papillomavirus (HPV) testing for primary cervical cancer screening in Japan. METHODS: In total, 5065 women who underwent primary screening with cytology and HPV between January 2005 and December 2006 were enrolled. In the baseline phase, these women were stratified by age, and the rates of HPV-positive and abnormal cytology were compared between women younger than and older than 30 years. In the follow-up phase, women aged 20 to 69 years and cytology negative for intraepithelial lesions or malignancy at baseline were followed up until December 2011 (n = 2383). Progression to grade 2/3 cervical intraepithelial neoplasia or worse (CIN2+/CIN3+) was compared between the HPV-positive and HPV-negative groups. RESULTS: In the baseline phase, HPV-positive rates were significantly higher in women younger than 30 years at 20.7% (95% confidence interval [CI], 18.4-22.9; 255/1234) compared with women 30 years or older at 7.2% (95% CI, 6.4%-8.0%; 275/3831; P < 0.001). However, there was no statistical difference for high-grade squamous intraepithelial lesion or worse rates between them, at 2.7% (95% CI, 1.8%-3.6%; 33/1234) and 2.4% (95% CI, 1.9%-2.9%; 91/3831), respectively, P = 0.55. In the follow-up phase, the rate of progression to CIN2+/CIN3+ was significantly higher in the HPV-positive group than in the HPV-negative group (P < 0.001). Moreover, relative risk of progression to CIN2+ was 15.9 times higher in the HPV-positive group, and that of progression to CIN3+ was 16.1 times higher in the HPV-positive group. CONCLUSIONS: Human papillomavirus testing is a useful test for predicting progression to CIN and is recommended as a primary screening tool. However, screening with cytology alone is still appropriate for younger women, younger than 30 years, because HPV testing yields more false-positive results in younger women.

Childhood Socioeconomic Status and Onset of Depression among Japanese Older Adults: The JAGES Prospective Cohort Study.

OBJECTIVE: Previous investigations on the impact of childhood socioeconomic status (SES) on depression have focused on middle-aged adults in Western countries. It is unknown whether childhood SES has a long-latency effect on the onset of depression among older adults. DESIGN: Prospective cohort study. SETTING: Data were from the Japan Gerontological Evaluation Study. PARTICIPANTS: We analyzed 10,458 individuals aged 65 years and older without depression (Geriatric Depression Scale <5) at baseline in 2010. MEASUREMENTS: Participants rated their childhood SES at the age of 15 years according to standards at that time. We used binomial regression analyses with log link and with adjustment for known and potential risk factors to evaluate the risk of depression onset by 2013. RESULTS: Overall, 13.9% of participants newly reported depression in 2013. After adjusting for age and sex, low childhood SES was positively associated with depression onset (adjusted risk ratio [ARR]: 1.44, 95% confidence interval [CI]: 1.23-1.69). The association decreased after adjustment for education (ARR: 1.33; 95% CI: 1.13-1.57). Even after adjustments for adult SES, current disease status, health behaviors, and social relationships, the association remained significant (ARR: 1.27; 95% CI: 1.08-1.50). The link was stronger among the younger old (65-74 years) than the oldest old (≥75 years). CONCLUSIONS: Low childhood SES, perhaps due to poverty in post-World War II, has a long-latency effect on the onset of depression among older Japanese adults. The impact of childhood SES on depression was weaker among the oldest old, suggesting survival effects for healthy older Japanese people.

Eating alone and depression in older men and women by cohabitation status: The JAGES longitudinal survey.

BACKGROUND: Eating by oneself may be a risk factor for mental illness among older adults, but may be influenced by cohabitation status. We examined the association between eating alone and depression in the context of cohabitation status in older adults in Japan. DESIGN: A longitudinal, population-based study. SETTING: Data from the Japan Gerontological Evaluation Study. SUBJECTS: We analysed 17,612 men and 19,581 women aged ≥65 without depression (Geriatric Depression Scale <5) at baseline in 2010. METHODS: Eating status was classified into two categories: eating with others and eating alone. The risk of depression onset by 2013 was estimated using Poisson regression. RESULTS: After adjusting for socioeconomic status, physical health, nutritional status, social support, social participation, frequency of meet friends, employment status and marital status, the adjusted rate ratio (ARR) for depression onset in men who ate alone compared with those who ate with others was 2.36 (95% confidence intervals [CI]: 1.18-4.71) for those living alone and 1.03 (95% CI: 0.81-1.32) for those living with others. Among women, the ARR for depression for those who ate alone compared with those who ate with others was 1.31 (95% CI: 1.00-1.72) for those living alone and 1.21 (95% CI: 1.01-1.44) for those living with others. CONCLUSIONS: Eating alone may be a risk factor for depression. Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.

Family planning practice and predictors of risk of inconsistent condom use among HIV-positive women on anti-retroviral therapy in Cambodia.

BACKGROUND: In Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high. These facts raise concern on possible exposure of many HIV-positive women on ART to the potential risk of unintended pregnancy. This study aimed to clarify family planning practices in Cambodia and determine predictors of risk of inconsistent condom use among women on ART. METHODS: A cross-sectional survey with a structured questionnaire was conducted at five government-run health centers in Phnom Penh, Cambodia, from June to September, 2012. Multiple logistic regression analysis was used to identify predictors of risk of inconsistent condom use among regular users of contraceptive methods. RESULTS: Of 408 respondents, 40, 17 and 10 used the pill, IUD, and injection, respectively, while 193 used condoms. 374 were not planning to have a child. Among 238 sexually active women who were not planning to have a baby, 59 were exposed to the risk of unintended pregnancy. Multivariate logistic regression analysis that did not include variables related to partners identified "seeking family planning information" (adjusted odds ratio (AOR): 2.6, 95% confidence intervals (95% CI): 1.1-6.2), awareness of mother-to-child transmission (MTCT) (AOR: 4.7, 95% CI: 1.9-11.6) and "having a son" (AOR: 2.0, 95% CI: 1.1-3.9) were significant predictors of inconsistent condom use. Another model that included all variables identified "able to ask a partner to use condom at every sexual intercourse" was the only predictor (AOR: 23.7, 95% CI: 5.8-97.6). CONCLUSIONS: About one-quarter of women on ART are at risk to unintended pregnancy although most do not plan to get pregnant. Furthermore, women on ART could be more empowered through improvement of communication and negotiation skills with partners to demand the use of condom during sexual intercourse. The use of other contraceptive methods that do not need partner involvement should be promoted.

Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study.

OBJECTIVES: This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference. DESIGN: Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region. SETTING: An urban and a rural area in Myanmar. PARTICIPANTS: A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256). OUTCOME: Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables. RESULTS: We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37-7.58; monastic: 3.42, 1.16-5.07; primary school: 2.41, 1.18-4.95), but wealth and income did not show similar associations. CONCLUSIONS: SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.

Duodenal Diverticular Perforation Treated Conservatively: Reassessing Indications for Treatment.

A 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white blood cell count of 5,300 cells/µL and C-reactive protein level of 0.07 mg/dL. Inflammation and anemia (hemoglobin 12.4 g/dL) were denied. Contrast-enhanced computed tomography (CT) revealed multiple duodenal diverticula and air surrounding a descending duodenal diverticulum. Based on these findings, duodenal diverticular perforation (DDP) was suspected. Oral food intake was stopped, and nasogastric tube feeding and conservative treatment with cefmetazole, lansoprazole, and ulinastatin were begun. On day 8 of hospitalization, follow-up CT revealed the disappearance of the air surrounding the duodenum, and the patient was discharged on day 19 after the resumption of oral feeding.

Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients.

BACKGROUND: Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. METHODS: This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence. RESULTS: Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%). CONCLUSIONS: The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.

Leisure activities and instrumental activities of daily living: A 3-year cohort study from the Japan Gerontological Evaluation Study.

AIM: We prospectively examined the association between leisure activities and changes in instrumental activities of daily living (IADL) among participants of the Japan Gerontological Evaluation Study (JAGES). METHODS: We analyzed data collected from 49 732 JAGES participants (23 359 men and 26 373 women), aged ≥65 years, from 24 municipalities in Japan. MEASUREMENTS: Baseline data were obtained for 25 types of leisure activities in which the cohort members participated. Baseline (2010) and follow-up (2013) data on IADL were collected - the outcome indicated changes in IADL scores from 2010 to 2013. We regressed changes in IADL scores from the 2010 to 2013 to the number of leisure activities. RESULTS: Older adults who engaged in more leisure activities had higher changes in IADL scores than those who engaged in fewer leisure activities: the ß values (95% confidence interval [CI]) of the IADL scores were 0.001 [-0.04-0.04], 0.04 [0.01-0.08], 0.09 [0.05-0.13], 0.09 [0.05-0.14], 0.08 [0.02-0.13], and 0.13 [0.07-0.18] for having one, two, three, four, five, and more than six types of leisure activities (P for trend <0.001), respectively. Similar associations were found for different types of leisure activities, including predominantly physical and cultural activities. Statistically significant linear trends were obtained among the group, solitary, and other leisure activity subgroups (P for trend <0.05). CONCLUSIONS: Encouraging engagement in leisure activities may promote maintenance of IADL among older populations. Different types of leisure activities appear to have similar positive impacts on IADL. Geriatr Gerontol Int 2022; 22: 152-159.

Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions.

Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking "Which of the following best describes your current financial situation in light of general economic conditions?" Responses ranged from "very difficult" to "very comfortable". Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.

Willingness to undergo HIV testing among factory workers in Surabaya, Indonesia.

The objective of this study is to investigate workers' perceptions of HIV testing in the workplace in Indonesia. In a cross-sectional study, we used a self-administered questionnaire in Surabaya, Indonesia. A convenient sample of 536 workers was chosen from two factories with similar sample characteristics from March through June 2008. Of these workers, 433 (response rate: 80.8%) answered questions about their willingness to undergo HIV testing. More than 40% of workers were willing to undergo HIV testing. Not knowing where to get tested (adjusted odds ratio [AOR] = 0.40, confidence interval [CI] = 0.18-0.89) and not feeling the need to be tested for HIV (AOR = 0.02, CI = 0.01-0.04) were negatively associated with willingness to undergo HIV testing. HIV prevention in the workplace needs to reach out to individuals who are not willing to undergo HIV testing - workers unaware of where to get tested for HIV and not feeling the need to get tested - through education, information, and communication in the workplace in light of the stigma and discrimination associated with HIV. High-impact voluntary counseling and testing (VCT) strategies need to be quickly developed to improve HIV prevention and access to care in the workplace.