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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus diseases 2019 (COVID-19) pandemic, continues to spread rapidly worldwide and is associated with high rates of mortality among older adults, those with comorbidities, and those in poor physiological states. This paper aimed to systematically identify the impact of frailty on overall mortality among older adults with COVID-19. We conducted a systematic review of the literature indexed in 4 databases. A random-effects model with inverse variance-weighted meta-analysis using the odds ratio was used to study the association of frailty levels with clinical outcomes among older adults with COVID-19. Heterogeneity was measured using the I 2 statistic and Egger's test. We identified 22 studies that met our inclusion criteria, including 924,520 total patients. Overall, frailty among older adults was associated with high rates of COVID-19-related mortality compared with non-frail older adults (OR [odds ratio]:5.76; 95% confidence interval [95% CI]: 3.85–8.61, I 2 : 40.5%). Our results show that physical limitations, such as those associated with frailty among older adults, are associated with higher rates of COVID-19-related mortality.

Aims and objectives:The purpose of this study was to explore the self-management of patients with early-stage chronic kidney disease (CKD) and its influencing factors. Methods: A convenient sample of 226 patients with early-stage CKD was recruited from 63 Public Health Centers in Indonesia, from June to September 2020. Demographic characteristics, health literacy, illness perception, self-efficacy and self-management were assessed using self-reported questionnaires. Stepwise multiple linear regression analysis was performed to identify the factors influencing selfmanagement. This study adhered to the EQUATOR checklist, STROBE. Results: The mean estimated glomerular filtration rate was 63.45 ml/min/1.73 m 2 (standard deviation [SD] = 15.34). The average scores for health literacy, illness perception, self-efficacy and self-management were 32.11 (SD = 4.46), 4.57 (SD = 1.46), 183.64 (SD = 38.23) and 76.92 (SD = 9.45), respectively. The influencing factors were education level, monthly income, family history of comorbidity, health literacy and self-efficacy, which accounted for 45% of total self-management score.Conclusions: Indonesian patients with early-stage CKD showed low level of health literacy, but positive illness perception and self-efficacy; these factors significantly affected CKD self-management. Health literacy was found to influence all dimensions of self-management: self-integration, problem-solving, seeking social support and adherence to the recommended regimen.Relevance to clinical practice: Adherence to the recommended regimen is the most challenging dimension of CKD self-management. Health literacy was found to be a major determinant of self-management. Improving health literacy and motivation of patients with early-stage CKD may help sustain positive illness perception and selfefficacy, and improve self-management.

Adolescents are a transition to adulthood with changes in growth and development, adolescents are at risk of reproductive health especially during menstruation. Personal hygiene during menstruation is the issue of determinants of adolescent health that affect the life of old age. Management of disorders at the time of menstruation is to familiarize themselves hygienic behavior. The aim of this research is to know factors related to Personal hygiene during menstruation. Such as knowledge, peer communication, menarche age and belief in mythology at siswi in MI Miftahul Ulum Pamekasan. Quantitative research type with cross sectional approach. Respondents in the study were MI Miftahul Ulum Pamekasan as many as 117 student. The measuring tool used is questionnaire and tested using Chi Square Sampling is done by purposive sampling method. The results showed that 76.1% of respondents have enough Personal hygiene categories and as many as 23.9% of respondents into the category of Personal hygiene is less. The Chi Square test shows that there is a relationship between knowledge (p = 0.001), peer communication (p = 0.002), and mythic belief (p= 0.001) with Personal hygiene during menstruation, and menarche age (p= 0.473) Personal hygiene during menstruation. Teenagers are expected to increase Personal hygiene during menstruation by providing knowledge gained from mass media, parents, health workers and books. Schools apply health education methods to improve Personal hygiene during menstruation like SGD (Small Group Discussion).