Journal of Preventive Medicine and Public Health

Original Articles

Predictors of Quality of Life among Older Residents in Rural and Urban Areas in Indonesia: An Approach Using the International Classification of Functioning, Disability, and Health: Dwi Rosella Komalasari, Chutima Jalayondeja, Wattana Jalayondeja, Yusuf Alam Romadhon; Received August 4, 2024 Accepted November 7, 2024 Published online November 29, 2024; DOI: https://doi.org/10.3961/jpmph.24.423 [Accepted]

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Abstract PDF: Objectives
The International Classification of Functioning, Disability, and Health (ICF) model provides a comprehensive framework for understanding health and quality of life (QoL) in older adults in both rural and urban settings, each presenting unique advantages and challenges. This study aimed to explore the relationship between factors based on the ICF model and QoL among older residents of these areas.
Methods
A cross-sectional study was conducted, involving 286 older adults aged 60 years or older from rural and urban areas of Surakarta, Central Java, Indonesia. The WHOQoL-BREF was utilized to assess QoL. The co-factors included personal factors, impairments, and activity limitations.
Results
Multiple linear regression analysis indicated that lower limb muscle strength was the most significant factor associated with QoL in older adults in rural areas (B=0.681, standard error [SE]=0.301, p=0.026), followed by static balance (B=0.085, SE=0.034, p=0.014). In urban areas, gender emerged as the most significant factor influencing QoL (B=-13.643, SE=2.499, p<0.001), followed by hemoglobin level (B=-1.847, SE=0.760, p=0.017), age (B=-0.935, SE=0.246, p<0.001), and cognitive function (B=0.493, SE=0.179, p=0.007).
Conclusions
Efforts to improve QoL for older adults in rural areas should focus on enhance physical performance through exercise. In urban areas, the maintenance of QoL is influenced by personal factors. It is crucial to address physical performance through exercise to enhance QoL in rural settings. Meanwhile, focusing on mental health, financial security, and social connections is recommended to improve QoL for older adults in urban areas.; Summary

The Impact of Student-led Community Health Screenings on Clients’ Health Knowledge and Outcomes: A Qualitative Study: Jia Rong Yap, Wendy Wenming Zhai, Cindy Seunghee Pak, Sharon Brownie; Received July 12, 2024 Accepted October 27, 2024 Published online November 28, 2024; DOI: https://doi.org/10.3961/jpmph.24.366 [Accepted]

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Abstract PDF: Objectives
This study investigated the impact of community health screenings (CHS) on the Asian community, focussing on the role of a student-led health and wellness centre in promoting and improving health outcomes. The CHS is a collaboration between Te Kotahi Oranga | Health and Wellness Centre and The Asian Network Incorporated, offering free health screenings to Asian migrants in the Waikato region, New Zealand.
Methods
Employing a qualitative approach, we interviewed clients who participated in the CHS to determine their perceptions regarding the effectiveness of the programme, its influence on their health knowledge and actions, and their overall satisfaction with the service. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study.
Results
Data analysis utilising reflexive thematic analysis yielded 5 themes: satisfaction and appreciation for the free health screening; strengthened commitment to better personal health; barriers and challenges in accessing public healthcare services; improved knowledge and awareness of health risks; and provision of more health screening tests and health seminars. The findings highlight the significance of culturally tailored health initiatives in addressing healthcare disparities, emphasising the need for innovative strategies to ensure continuity of care and support for underserved populations.
Conclusions
This research contributes to the understanding of how student-led health interventions can enhance public health efforts and improve health outcomes in Asian and migrant communities.; Summary

Health Effects of Heavy Metal Exposure Among E-waste Workers and Community-dwelling Adults in Thailand: A Cross-sectional Study: Chonyitree Sangwijit, Parichat Ong-artborirak, Warangkana Naksen, Kraiwuth Kallawicha, Pallop Siewchaisakul; Received July 31, 2024 Accepted October 18, 2024 Published online November 21, 2024; DOI: https://doi.org/10.3961/jpmph.24.415 [Accepted]

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Abstract PDF: Objectives
Global concern is increasing about the health effects of electronic waste (e-waste). This study examines the health impacts of heavy metal (HM) exposure among e-waste workers (EWWs) and community-dwelling adults (CDAs) in Northeastern Thailand and identifies factors associated with adverse health outcomes.
Methods
A cross-sectional study was conducted of 164 EWWs and 164 CDAs. A survey was employed to collect data on participant characteristics, symptoms, anxiety, depression, and sleep quality. Urine samples were analyzed for lead (Pb) and cadmium (Cd) levels using atomic absorption spectrometry. Multiple logistic regression analysis was used to identify factors impacting health.
Results
Across all participants, urinary Pb and Cd levels ranged from 5.30 to 29.50 µg/g creatinine and from 0.60 to 4.00 µg/g creatinine, respectively. The most frequently reported health issues pertained to musculoskeletal disorders (MSDs) at 38.70%, central nervous system (CNS) issues at 36.60%, and skin disorders at 31.10%. Multivariable analysis indicated that the presence of MSDs was significantly associated with exposure to Pb and Cd. Poor sleep quality (PSQ) was significantly linked to CNS problems, while body mass index was significantly related to skin disorders. Factors including primary education level or below, smoking, cleaning the house more than 3 times weekly, and PSQ were significantly linked to depression. Anxiety was significantly associated with PSQ.
Conclusions
Environmental exposure to Pb and Cd can have adverse health impacts in the form of MSDs. Depression and anxiety are common conditions among CDAs. Public health officials should monitor HM exposure and mental health within the community.; Summary

Medication-related Burden and Experience With Medications in Indonesian Older Adults With Chronic Diseases: A Mixed-method Study: Yeni Farida, Anna Wahyuni Widayanti, Tri Murti Andayani, Probosuseno Probosuseno; Received July 16, 2024 Accepted November 7, 2024 Published online November 20, 2024; DOI: https://doi.org/10.3961/jpmph.24.374 [Accepted]

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This study explored the specific medication-related burdens experienced by older adults with chronic disease and the contributing factors.
Methods
An exploratory mixed-method study was conducted at a teaching hospital in Surakarta City, Central Java, Indonesia. Combining the Indonesian version of the Living with Medicine Questionnaire (LMQ) and semi-structured interviews allowed for a comprehensive understanding of the medication-related burden. Differences in LMQ scores related to patient characteristics were analyzed using the t-test, F-test, or other alternatives. Quantitative and qualitative data triangulation was used to derive trustworthy and dependable results.
Results
The overall LMQ mean score was 90.4 (n=129), indicating a moderate burden. The average LMQ scores varied significantly based on the number of medications, treatment duration, and the presence of cardiovascular disease (CVD), diabetes mellitus (DM) and stroke. The qualitative study found 3 themes in the chronic medication use of older adults: experiences, challenges, and motivation. Despite their limited understanding of a medication’s name and indication, some patients managed their medications based on the physical look and packaging of the medication. The study also found that patient motivation and familial support could effectively counteract the fatigue and dissatisfaction associated with taking medication.
Conclusions
Older adults with chronic diseases faced medication-related burdens associated with the presence of CVD, DM, stroke, a treatment duration >5 years, and the use of >10 medications. Effective communication with healthcare professionals is required to understand patients\' needs and concerns, thereby helping manage the challenges of medication-related burdens.; Summary

Church Leaders’ Health Behaviors and Program Implementation in the Faith, Activity, and Nutrition Program: Kelsey Day, Sara Wilcox, Lindsay Decker, John Bernhart, Meghan Baruth, Andrew Kaczynski, Christine Pellegrini; Received July 20, 2024 Accepted October 18, 2024 Published online November 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.384 [Accepted]

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Abstract PDF: Objectives
Church leaders are important to the success of faith-based health promotion interventions through the role modeling of health behaviors. However, clergy may be at a higher risk of chronic disease than their congregants and their health is understudied. This study examined church leaders’ health-related behaviors, differences in health behaviors by sociodemographic characteristics, and associations between health behaviors and church-level implementation of an ecological intervention.
Methods
Pastors (n=93) and church coordinators (n=92) reported body mass index (BMI), self-rated health, fruit and vegetable consumption (F&V), and physical activity (PA) at baseline and 12 months post-training in the intervention. Church coordinators reported program implementation for their church. Sociodemographic differences and associations between changes in health behaviors and program implementation were tested with regression models. Changes in health-related variables were examined using paired t-tests and McNemar’s test.
Results
Pastors (41% women, 42% Black/African American) had a mean BMI of 30 kg/m2; 45% met F&V guidelines and 24% met PA guidelines. Black/African American pastors were less likely to meet F&V guidelines and had lower self-rated health than their counterparts. Pastor PA improved over time, but pastor health behaviors were not associated with program implementation. Church coordinators’ (95% women, 39% Black/African American) mean BMI was 28 kg/m2; 27% met F&V guidelines and 63% met PA guidelines. Black/African American church coordinators had higher BMIs and lower self-rated health than their counterparts. Church coordinator F&V intake improved over time; self-rated health was positively associated with PA program implementation.
Conclusions
This study underscores the need for preventive interventions for church leaders.; Summary

The Development of an Assessment Instrument for Behavior Toward Hypoglycemia Risk Among Type 2 Diabetes Mellitus Outpatients in Jakarta, Indonesia: Putu Rika Veryanti, Rani Sauriasari, Ratu Ayu Dewi Sartika, Berna Elya, Muhammad Ikhsan Mokoagow; Received June 22, 2024 Accepted September 27, 2024 Published online November 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.313 [Accepted]

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Abstract PDF: Objectives
The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument.
Methods
The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling.
Results
The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times.
Conclusions
Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.; Summary

Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types: Seowoo Park, Haibin Bai, Jae-ryun Lee, Soomin Kim, Hyemin Jung, Jin Yong Lee; Received July 22, 2024 Accepted October 18, 2024 Published online November 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.388 [Accepted]

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Abstract PDF: Objectives
This study examined the potential of a new analytical framework for the Korea Community Health Survey (KCHS) with classification criteria for the sub-national governmental level, the degree of urbanization including an urban-rural multimodal category, and population size as a more effective tool to address local health problems and deduce practical implications.
Methods
Retrospective survey data from 2023 KCHS were obtained. Frequency analyses were performed for self-rated good health status, current smoking status, and unmet medical needs as proxies for health status, as well as healthcare utilization and health behavior, utilizing individual weights to represent national community residents.
Results
We established a new classification of local governments into 7 types to facilitate regional comparisons. These local government types are presumably composed of populations showing statistically significant differences in demographic characteristics. There were evident differences in health status, health behavior, and healthcare utilization in comparisons of groups categorized by local government types.
Conclusions
This study suggests that regional disparities can be analyzed using a new typology of local governments. This practically effective approach could be used in decision-making for community-centered health projects in terms of community health planning. Future research should conduct analyses of KCHS data that use these 7 local government types to comprehensively reflect regional characteristics.; Summary

Air Passengers’ Risk of SARS-CoV-2 Infection with a 14-day Quarantine and Accuracy Assessment of a Symptom-based Screening System at an Airport: Toonlaya Direkwutthikun, Chanapong Rojanaworarit, Isabella Andrade, Bhanasut Hunsajarupan, Nuttawoot Photisan, Pattarasuda Sookchom, Thawabhorn Jannok, Rome Buathong; Received September 9, 2024 Accepted October 2, 2024 Published online November 3, 2024; DOI: https://doi.org/10.3961/jpmph.24.517 [Accepted]

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Abstract PDF: Objectives
This study aimed to validate the risk of SARS-CoV-2 infection, identify infection risk factors among air passengers subject to a 14-day mandatory quarantine, and evaluate the accuracy of mass symptom-based screening criteria at an airport.
Methods
This retrospective cohort study analyzed data from 116,004 air passengers who entered Thailand through Suvarnabhumi Airport in Bangkok from April to September 2020. The incidence of SARS-CoV-2 infection, risk characteristics, and accuracy indices of symptom-based screening were calculated.
Results
The overall incidence of SARS-CoV-2 was 0.5%, or 540 infections per 100,000 air passengers. Identified risk factors included sex, nationality, continent of departure, on-arrival screening results, and month of travel. Positive screening results indicated a higher risk and positive likelihood ratio for SARS-CoV-2 infection. However, the on-arrival screening criteria demonstrated low sensitivity and area under the receiver operating characteristic curve.
Conclusions
The current study confirms previous findings that the risk of SARS-CoV-2 infection during air travel is low. However, this might result from strict pre-departure screening and the SARS-CoV-2 test requirement for arriving passengers. The symptom-based screening criteria used upon arrival showed a low probability of identifying positive cases, suggesting that incorporating additional criteria could help detect asymptomatic infections. The integrated screening and quarantine model proved effective in preventing the spread of the virus into local communities.; Summary

The Impact of COVID-19 on Admissions and In-hospital Mortality of Patients with Stroke in Korea: An Interrupted Time Series Analysis: Youngs Chang, Soo-Hee Hwang, Haibin Bai, Seowoo Park, Eunbyul Cho, Dohoung Kim, Hyejin Lee, Jin Yong Lee; Received August 8, 2024 Accepted October 2, 2024 Published online October 28, 2024; DOI: https://doi.org/10.3961/jpmph.24.432 [Accepted]

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Abstract PDF: Objectives
This study aimed to investigate the impact of COVID-19 on admission rates and in-hospital mortality among patients with ischemic and hemorrhagic stroke.
Methods
We constructed a dataset detailing the monthly hospitalizations and mortality rates of inpatients with stroke from January 2017 to December 2021. Employing an interrupted time series analysis, we explored the impact of COVID-19 on hospitalizations and 30-day in-hospital mortality among stroke patients.
Results
The number of ischemic stroke admissions decreased by 18.5%, from 5,335 to 4,348, immediately following the COVID-19 outbreak (p<0.001). The in-hospital mortality rate for ischemic stroke increased slightly from 3.3% to 3.4% immediately after the outbreak, although it showed a decreasing trend over time. The number of hemorrhagic stroke admissions fell by 7.5%, from 2,014 to 1,864, immediately following the COVID-19 outbreak. The 30-day in-hospital mortality rate for hemorrhagic stroke initially decreased from 12.9% to 12.7%, but subsequently showed an increasing trend.
Conclusions
We confirmed that COVID-19 impacted both the admission and death rates of stroke patients. The admission rate for both ischemic and hemorrhagic strokes decreased, while in-hospital mortality increased. Specifically, in-hospital mortality from ischemic stroke rose initially after the outbreak before stabilizing. Additionally, our findings indicate variable effects based on sex, age, and socioeconomic status, suggesting that certain groups may be more susceptible. This underscores the need to identify and support vulnerable populations to mitigate adverse health outcomes.; Summary

Development and Validation of an Instrument to Assess the Safe Use of Antidiabetic Medication to Prevent Hypoglycemia Requiring Hospitalization Among Ambulatory Patients with Type 2 Diabetes Mellitus: Made Krisna Adi Jaya, Fita Rahmawati, Nanang Munif Yasin, Zullies Ikawati; Received August 4, 2024 Accepted October 2, 2024 Published online October 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.424 [Accepted]

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Abstract PDF: Objectives
Ambulatory patients with type 2 diabetes mellitus (T2DM) require special attention when being discharged from the hospital with anti-diabetes medication. This necessity stems primarily from the risk of adverse drug reactions, particularly hypoglycemia. However, this risk is significantly influenced by the patients\' knowledge and behavior regarding their medication use. This study aimed to develop instrument to assess the risk of medication-related hypoglycemia in ambulatory T2DM patients by clinical pharmacists.
Methods
The study was conducted using an observational design that included multiple stages. These stages involved item development through focus group discussions (FGDs), content validation by clinical pharmacists, and criterion and construct validation by ambulatory T2DM patients using a cross-sectional approach.
Results
A total of 10 question items were developed for assessment by clinical pharmacists following FGDs and content validation. Criterion and construct validation identified 8 valid question items through multivariate analysis (p<0.05). The scoring system developed demonstrated a linear relationship between the score and the number of items at risk in the instrument (p<0.05, R²: 0.988). Additionally, the instrument was named \"Medication-related Hypoglycemia Risk Score Assessment Tools (HYPOGLYRISK).\"
Conclusions
The findings of this study suggest that HYPOGLYRISK may serve as a useful tool for clinical pharmacists to evaluate the risk of medication-related hypoglycemia in ambulatory T2DM patients. Additionally, this instrument could assist clinical pharmacists in identifying priority patients and tailoring educational services to meet their specific goals and needs.; Summary

Development of Machine Learning Models to Categorize Life Satisfaction in Older Adults Living Alone: Suyeong Bae, Mi Jung Lee, Ickpyo Hong; Received June 26, 2024 Accepted September 20, 2024 Published online October 23, 2024; DOI: https://doi.org/10.3961/jpmph.24.324 [Accepted]

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Abstract PDF: Objectives
This study aimed to identify factors associated with life satisfaction by developing machine learning (ML) models to predict life satisfaction in older adults living alone.
Methods
Data were extracted from 3,112 older adults participating in the 2020 Korea Senior Survey. We employed 5 ML models to classify the life satisfaction of older adults living alone: logistic Lasso regression, decision tree-based classification and regression tree (CART), C5.0, random forest, and extreme gradient boost (XGBoost). The variables used as predictors included demographics, health status, functional abilities, environmental factors, and activity participation. The performance of these ML models was evaluated based on accuracy, precision, recall, F1-score, and area under the curve (AUC). Additionally, we assessed the significance of variable importance as indicated by the final classification models.
Results
Out of the 1,411 older adults living alone, 45.34% expressed satisfaction with their lives. The XGBoost model surpassed the performance of other models, achieving an F1-score of .72 and an AUC of .75. According to the XGBoost model, the five most important variables influencing life satisfaction were overall community satisfaction, self-rated health, opportunities to interact with neighbors, proximity to a child, and satisfaction with residence.
Conclusions
Overall satisfaction with the community environment emerged as the most significant predictor of life satisfaction among older adults living alone. These findings indicate that enhancing the supportiveness of the community environment could improve life satisfaction for this demographic.; Summary

Institutional Delivery in the Philippines: Does a Minimum of 8 Antenatal Care Visits Matter?: Felly Philipus Senewe, Agung Dwi Laksono, Roy G.A Massie, Leny Latifah, Syarifah Nuraini, Rozana Ika Agustiya, Jane Kartika Propiona, Wahyu Pudji Nugraheni; Received May 15, 2024 Accepted September 20, 2024 Published online October 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.245 [Accepted]

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Abstract PDF: Objectives
This cross-sectional study investigated the association between the utilization of 8 antenatal care (ANC) visits and delivery in a healthcare institution in the Philippines, using data from the 2022 National Demographic and Health Survey.
Methods
A sample of women who had given birth within the past 3 years was selected for analysis (n=4452). The association between ANC utilization and institutional delivery was assessed using logistic regression models, covariates by relevant sociodemographic factors, and childbirth history.
Results
We found that 97.2% of respondents who completed antenatal care opted for institutional delivery. A higher proportion of rural residents did not undergo institutional delivery than urban residents (12.9% vs. 6.9%). The group aged 20-24 years had the highest coverage (92.8%), and the group aged 40-44 years had the lowest. Higher education levels, employment, and greater wealth were associated with higher institutional delivery rates. Divorced or widowed mothers (85.1%) and grand multiparous mothers had lower rates than other groups. Multivariable logistic regression analysis showed a significant positive association between ANC utilization and institutional deliveries after adjusting for covariates (adjusted odds ratio, 2.486; 95% CI, 2.485-2.487; p<0.001).
Conclusions
ANC visits were associated with deliveries in institutions in the Philippines. Policymakers should promote ANC by ensuring 8 WHO-recommended visits, strengthening programs, conducting community outreach, addressing access barriers, and integrating maternal health services to increase institutional births and improve maternal and infant health.; Summary

The Effects of Subjective Socioeconomic Status and Social Capital on Self-rated Health and Perceived Quality of Life: A Cross-sectional Survey-based Study in a Minority Group in Iran: Rashid Ahmadifar, Nader Rajabi, Shirzad Rostamizade, Nasroolah Nadimi, Parviz Sobhani, Aadel Irankhah; Received April 22, 2024 Accepted September 10, 2024 Published online October 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.210 [Accepted]

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Abstract PDF: Objectives
The purpose of this study is to examine the impact of subjective socioeconomic status and social capital on self-rated health and quality of life among a minority group in Iran.
Methods
This cross-sectional study involved 800 individuals from a minority group in Iran. The sampling method was clustering, and data collection was conducted using a questionnaire. Data analysis was performed using SPSS version and Stata version 8.
Results
The results of logistic regression analysis revealed that subjective socioeconomic status (odds ratio [OR], 1.47; 95% CI, 1.34-1.61), belonging and empathy (OR, 1.09; 95% CI, 1.03-1.15), and trust (OR, 1.06; 95% CI, 1.00-1.13) significantly impacted the quality of life. Additionally, the logistic regression analysis for factors influencing self–rated health demonstrated significant effects for the age group of 31-50 years (OR, 0.59; 95% CI, 0.38-0.91), gender (OR, 0.65; 95% CI, 0.46-0.92), academic education (OR, 2.00; 95% CI, 1.22-3.26), subjective socioeconomic status (OR, 1.27; 95% CI, 1.16-1.38), chronic disease (OR, 4.52; 95% CI, 2.49-8.19), belonging and empathy (OR, 1.06; 95% CI, 1.01-1.11), and participation (OR, 1.11; 95% CI, 1.00-1.24).
Conclusions
The findings indicate that bonding social capital significantly influences health levels and quality of life. Focusing on delegating local responsibilities to community members and striving to promote participation in health programs, along with increasing the socioeconomic status of minority groups, can effectively improve their health and quality of life.; Summary

Systematic Reviews

Use of Data Linkage Methods to Investigate Healthcare Interactions in Individuals Who Self-harm and Die by Suicide: A Scoping Review: Ferdi W. Djajadisastra; Received August 14, 2024 Accepted November 11, 2024 Published online November 20, 2024; DOI: https://doi.org/10.3961/jpmph.24.448 [Accepted]

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Abstract PDF: Objectives
In this review, the primary objective was to comprehensively summarize and evaluate the themes and findings of studies that used data linkage methods to examine the healthcare engagement of individuals with self-harming and suicidal tendencies. Additionally, the review sought to identify gaps in the existing literature and suggest directions for future research in this area.
Methods
This review utilized the PubMed, PsycINFO, and Scopus databases. Employing a scoping review methodology, 27 papers were analyzed.
Results
One particularly common data source is the routine information collected by government agencies. However, some studies augment this information with newly collected data. Compared to other research methods, data linkage has the advantage of incorporating participants from diverse backgrounds into the analysis. Most relevant studies employing data linkage methods have focused primarily on identifying sociodemographic correlates of self-harm, suicide deaths, and healthcare interactions. Additionally, cluster analysis has been used in certain studies to identify patterns of healthcare utilization within affected populations.
Conclusions
Data linkage offers a promising approach for researching self-harm and suicide. A notable challenge, however, is the focus of most studies on the associations between sociodemographic factors and the risks of self-harm and suicide. Integrating government datasets with data from recent studies, as well as fostering collaboration between researchers and government agencies to identify necessary data for routine administrative records, could help address these constraints. Despite its limitations, data linkage can reveal useful patterns in the interactions between individuals who self-harm or die by suicide and the healthcare system.; Summary

Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis: Yohanes Andy Rias, Renny Wulan Apriliyasari, Made Satya Nugraha Gautama, Faizul Hasan, Margareta Teli, Hsiao-Yen Chiu, Ratsiri Thato; Received July 6, 2024 Accepted September 10, 2024 Published online October 7, 2024; DOI: https://doi.org/10.3961/jpmph.24.354 [Accepted]

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Abstract PDF: Objectives
Physical and mind-body exercises represent distinct intervention strategies that may improve sleep quality by influencing physiological and psychological factors. Nevertheless, their effectiveness in individuals with diabetes is not well-established. This systematic review and meta-analysis aimed to examine the impacts of physical and mind-body exercise interventions on sleep quality in patients with diabetes mellitus.
Methods
Six randomized controlled trials (RCTs) that met the inclusion criteria were identified from PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane, and Ovid-Medline Library. The effect size for sleep quality was calculated using the standardized mean difference (SMD) with a 95% confidence interval (CI), employing a random-effects model. Heterogeneity and publication bias were also examined, and subgroup, meta-regression, and sensitivity analyses were performed.
Results
Physical and mind-body exercise interventions significantly improved sleep quality, with an SMD of −1.040 (95% CI, −1.686 to −0.394). Subgroup analysis revealed significant differences with respect to the type of intervention (p=0.047), or its duration (p=0.282). Meta-regression analysis indicated that mean hemoglobin A1c level was the only factor to be significantly related to the effect size for sleep quality, demonstrating a negative association (p=0.033). The assessment of publication bias and the sensitivity analysis suggested that the findings were reliable and robust.
Conclusions
Physical and mind-body exercises may serve as effective interventions for patients with diabetes mellitus who experience poor sleep quality. However, to substantiate these findings, additional rigorous RCTs with larger sample sizes, longer follow-up periods, and standardized interventions are required.; Summary

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