Posyandu Lansia Research Articles

Integrated Service Pos Program Outcomes for Elderly in Kebonsari Village

Background: The elderly population has unique health needs requiring specialized services. Specific Background: This study investigates the implementation of the Posyandu Lansia Wijaya Kusuma program, focusing on operational procedures and challenges in a rural context. Knowledge Gap: There is a lack of understanding regarding specific obstacles faced in implementing such health programs in similar communities. Aims: This research aims to evaluate program operations and identify hindering factors. Results: Data from interviews and participatory observations indicate a structured Standard Operating Procedure (SOP) for the Posyandu Lansia, facilitating essential health services. While the program follows a clear framework, operational barriers impact service delivery. Novelty: This study highlights the importance of adhering to SOPs to enhance healthcare outcomes for the elderly, offering insights distinct from previous research emphasizing SOP improvements. Implications: Findings emphasize the need to optimize health services for the elderly, informing policy decisions to improve healthcare systems in rural areas and advocating for ongoing evaluation of health programs to address evolving elderly needs. Highlights : Structured SOP: The program follows a clear Standard Operating Procedure for service delivery. Operational Barriers: Identified challenges impact the effectiveness of health services for the elderly. Policy Implications: Findings inform improvements in rural healthcare systems and program evaluation. Keywords: elderly care, health services, Posyandu Lansia, implementation, rural health

The Relationship Between Tooth Brushing Methods and Gum Bleeding Among the Elderly at Posyandu Lansia in Surabaya

The elderly experience a decline in immune function, making them susceptible to dental and oral diseases, one of which is gum bleeding. Improper tooth brushing techniques can cause gum bleeding because brushing in the wrong direction can make the gums bleed easily and leave food residues uncleaned. Problem: The high percentage of gum bleeding during tooth brushing in the elderly at the Posyandu Lansia Kampung Mustika Baru Ngagel Surabaya in 2024. On average, the elderly have poor tooth brushing techniques. Objective: To analyze the relationship between tooth brushing methods and gum bleeding in the elderly at the Posyandu Lansia Kampung Mustika Baru Ngagel Surabaya in 2024. Research Method: This research is an analytical cross-sectional study. Sampling was done using purposive sampling with a sample of 36 elderly individuals. The data collection instruments used were observation sheets to measure tooth brushing methods and examination sheets to identify gum bleeding. The analysis technique used was the Chi-square test. Research Results: On average, the elderly's tooth brushing methods, after observation, were categorized as poor. There is a significant relationship between tooth brushing methods and gum bleeding in the elderly at the Posyandu Lansia Kampung Mustika Baru Ngagel Surabaya, with an asymp.sig (α) value of 0.000 (p < 0.05). Conclusion: The better the elderly brush their teeth, the less likely they are to experience gum bleeding, thereby reducing the risk of gum bleeding

The Relationship between Dental and Oral Health Maintenance in Elders with the Occurance of Periodontitis (Case Study at the Posyandu Lansia RW 07 Gunung Anyar Tambak Village, Surabaya

Periodontitis is one of the most common periodontal diseases with an incidence of approximately 10% of adults worldwide. Periodontitis can lead to tooth loss, which has negative impact on chewing function, aesthetics and can affect the quality of life of the sufferer. High percentage of elderly with periodontitis in Posyandu Lansia RW 07 Gunung Anyar Tambak Village, Surabaya. The aim of the research was to determine the relationship between oral health maintenance of the elderly and the incidence of periodontitis in the Posyandu Lansia RW 07 Gunung Anyar Tambak Village, Surabaya. The type of research conducted was analytical research with a cross sectional method, with a sample of 35 elderly people at the RW 07 Posyandu Lansia, Gunung Anyar Tambak Village, Surabaya. The data collection instrument used is a questionnaire used to measure oral health maintenance and an examination sheet to identify periodontitis. The data analysis techniques using Spearman's rho. Conclusion : The average maintenance of oral health of the elderly in answering the research questionnaire was categorized as sufficient at 70.8%. Elderly people who experience periodontitis are 65.72%. There is a strong relationship between oral health maintenance and periodontitis.

Empowerment of Posyandu Lansia cadres in overcoming depression and violence among elderly women after the Covid-19 pandemic in Dukuh Panggungan

Introduction: The COVID-19 pandemic has significantly impacted the mental health and safety of the elderly, particularly affecting elderly women. Research indicates a rise in anxiety and depression among older adults, with pre-existing elevated depressive symptoms exacerbating their resilience during this period. Increased isolation, financial strain, and restricted access to support services have led to a surge in elder abuse cases, disproportionately affecting women. Effective strategies, such as raising awareness and ensuring timely provision of resources, are crucial to safeguarding the mental well-being of the elderly. Indonesia's commitment to sustainable development and health equity, exemplified through initiatives like the Sustainable Development Goals, must address the specific challenges faced by elderly women in communities like Panggungan Village. The demographic shift towards an aging population, coupled with the pandemic's effects, further magnifies vulnerabilities. Empowering community-based resources can provide holistic support to elderly women, contributing to sustainable health development and social equity. Methods: The approach targets 15 Posyandu Lansia cadres and 20 elderly women in Panggungan Village through an offline community service program adhering to health protocols. Tools used in this study were the Mental Health Improvement Module, Geriatric Depression Scale questionnaire, and knowledge/skills assessment for Posyandu Lansia cadres. A combined quantitative and qualitative analysis was applied. Results: Results showed that 55% prevalence of verbal violence, 45% neglect, and 35% exploitation violence among elderly women. Post-training, these figures improved to 25% for verbal violence, 10% for exploitation violence, and 15% for neglect violence. Depression tendencies witnessed a 25% shift. Cadres’ knowledge increased from 58.2 to 82.1, and skills improved from 63.5 to 79.2. Conclusion: Elevated violence and depression tendencies that were quite high, negatively impact elderly women's mental health in Panggungan Village. Cadre’s training significantly enhances residents' well-being and mental health, offering a meaningful solution.

“Lansia Berdaya” Program Penguatan Posyandu Lansia Dusun 2 Desa Karangwuni Sebagai Upaya Peningkatan Pengetahuan dan Pencegahan Hipertensi

Hypertension, a non-communicable disease, exhibits significant death and suffering rates worldwide, including in Indonesia. Hypertension ranks as the third leading cause of mortality in Indonesia, following strokes and tuberculosis, primarily impacting the older population. Dusun 2 Karangwuni is a region that experiences a high mortality rate due to hypertension. The hypertension screening findings revealed that out of the 49 elderly visitors to Posyandu, 41 of them were found to have hypertension. The team's objective is to implement the dedication of Lansia Berdaya's activities in managing hypertension in Dusun Two village, Karangwuni, Weru district. The Lansia activities occur in Dukuh Ngampas, Dusun 2, Village KarangWuni, district Weru, Sukoharjo. Activities encompass kader upgrading training, hypertension assessment, rehabilitation, and elderly gymnastics. The sequence of events will occur in February 2023. The intended recipients are 17 healthcare professionals, whereas the intended recipients are 47 individuals. Activities are evaluated by examining the level of knowledge, which is determined using pre-test and post-test values. Heath cadre training was conducted with 17 audiences. Hypertension screening, senior gymnastics, and health education activities were conducted and attended by 47 seniors. The hypertension exercise video has been distributed to the health cadre. The video is anticipated to serve as a comprehensive manual for gymnastics exercises at Posyandu Lansia to establish a long-lasting and sustainable devotion program.

The Effectiveness of Rheumatic Gymnastics on Patella Joint Flexibility in Elderly with Rheumatoid Arthritis at the Elderly Integrated Service Post (Posyandu Lansia) in Mipiran Village, Purbalingga

Background: Based on data from the 2018 Riskesdas, 7.30% of the Indonesian population is estimated to suffer from rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic disease that causes joint pain, swelling, stiffness, and limited joint movement. As the most common autoimmune rheumatic disease, rheumatoid arthritis is a chronic inflammatory condition that permanently damages the joints, where the body's immune system, which generally protects the body from infections and diseases, attacks joint tissues for unknown reasons. Method: The research design used in this study was the Pre-Experimental one-group pre-test post-test method. The sample consisted of 31 individuals selected using a total sampling technique. The research instruments used were rheumatic gymnastics SOP and the Long-arm universal goniometer (UG) for measuring patella joint flexibility. Data were analyzed using the Wilcoxon statistical test. Results: There was an increase in the average value of right and left patella joint flexibility before and after the application of rheumatic gymnastics. The obtained P value was 0.005 for the right patella and 0.001 for the left patella. Both statistical analyses discovered that P-value was less than 0.05. Conclusion: Rheumatic gymnastics significantly affects patella joint flexibility in elderly patients with rheumatoid arthritis at the elderly integrated service post (Posyandu Lansia) in Mipiran Village, Purbalingga.

IMPLEMENTATION OF ADA SCREENING TOOLS TO DETERMINE THE BLOOD SUGAR TEST FLOW IN POSYANDU LANSIA

Abstract Introduction: The high incidence of undiagnosed diabetes may increase the incidence of T2DM. Therefore, prediabetes screening activities are needed to detect prediabetes cases early to prevent them from developing into T2DM. Methods: A descriptive research analysis with a cross-sectional approach was conducted in Posyandu Lansia in the area of Sumbersari Health Centre, Jember. The population of this study was all people who visited the Sumbersari Health Centre aged 40 years and over. The number of samples obtained as many as 246 with the sampling technique is systematic random sampling. The Data processing was done descriptively and using the ROC (Receiver Operating Characteristic) test to see the results of the diagnostic test of the ADA Diabetes Risk Test instrument at the Sumbersari Health Centre with a random blood sugar test comparison. Results: From a total of 246 subjects, 159 had prediabetes. The sensitivity value at cut point 5 of 66% and specificity of 36% with a PPV value of 38% and NPV of 64%. While at the optimal cut-off point of 4, the sensitivity value is 90%, and the specificity value is 22%, with a PPV value of 40% and NPV of 77%. Moreover, the ROC curve has an AUC value that is statistically considered less effective, with a value of 56%. Conclusion: ADA Diabetes Risk Test shows promising results for prediabetes screening in the Sumbersari population with high sensitivity for determining disease. Keywords: ADA Diabetes Risk Test, Diabetes Mellitus Type 2, Prediabetes,

Pencegahan Risiko Jatuh Pada Lansia Dengan Penyakit Degeneratif

The risk of falling is an incident reported by the sufferer or family who saw the incident, which resulted in a person suddenly falling down, sitting on the floor or a lower place with or without loss of consciousness or injury. Based on an initial survey at the Posyandu Lansia Akbar (Elderly Center) in the working area of ​​the Puskesmas Jembatan Kecil (Community Health Center), it was found that some health problems which are still often experienced by the elderly are degenerative diseases such as hypertension, diabetes mellitus, and perceptual and sensory disorders that leads in decreasing balance, muscle strength and flexibility. These problems put elderly at high risk of falls. To reduce the risk of falls in the elderly, it is necessary to provide preventive, curative and collaborative health services in the form of health education and assistance with balance exercises. So the Community Service Team provides health education on preventing the risk of falls in the elderly.

Edukasi Dengan Pendekatan Fisioterapi Komunitas pada Komunitas Hipertensi Di Wilayah Puskesmas Gajahan Surakarta

Kauman is a village located in the Kliwon Market district of Surakarta. Hypertension is one of the most dangerous health problems in the world because it is a major risk factor that leads to cardiovascular diseases such as heart attack, heart failure, stroke and kidney disease. The goal of this program is to prevent, and control high blood pressure. The method used in this community service is health promotion related to hypertension targeted participants Posyandu Lansia Chasanah which is located in Kelurahan Kauman. The writer uses the lift to find out the level of understanding of the participants of Posyandu Chasanah. The results of the lift showed a pre-test average of 9.49, whereas the post-test averaged 9.84, which means an improvement of 0.35. The minimum pre-test score is 7 and the post test score is 9. The minimum score has an increase of 2.

Strategi Peningkatan Kapasitas Fungsional Pada Komunitas Osteoartitis Genu Dengan Latihan Fisik Di Wilayah Puskesmas Pajang Surakarta

Pajang is a locality in Kota Surakarta's Kecamatan Laweyan. Osteoarthritis is the most prevalent lansia disease in Kelurahan Pajang. Osteoarthritis lutut is a degenerative condition that affects the persendian that affects the kartilago, lapisan sendi, ligamen, and tulang such that it can cause nyeri and kekakuan in the sendi. The goals of a physical therapy program for osteoarthritis are to educate patients and demonstrate exercise therapy to improve nyeri and slow the progression of keluhan. This method employs teaching, demonstration, and penyuluhan (ceramah and tanya jawab) methods to discuss exercise regimens for osteoarthritis with Posyandu Lansia Mawar's consent. After providing education in physical therapy and demonstrating therapeutic techniques, the results included the discovery of any keluhan nyeri lutut on the lansia. We anticipate that the outcomes of this initiative to provide feedback to the public will serve as a benchmark for other professions in physical therapy or other fields of health care.

Optimizing apothecary through medicinal plant cultivation and education of elderly posyandu cadres in Tegalwaras

As people age, the prevalence of degenerative diseases increases. These diseases can reduce the quality of life and often cause fatal effects, and this happens a lot in Tegalwaras hamlet. Treatment with modern medicine sometimes causes problems such as relatively expensive prices and dangerous side effects so alternatives such as herbal medicines are needed. This community service aims to increase the knowledge of Posyandu Lansia cadres in Tegalwaras about herbs as a therapy for degenerative diseases through counseling and planting medicinal plants. The method of implementation is the preparation stage, counseling, planting medicinal plants, monitoring and evaluation. The results of the program showed an increase in knowledge of 50% after the counseling was carried out.

Implementasi Efektifitas Pelvic Floor Exercise Untuk Menurunkan Frekuensi Berkemih Pada Lansia

Pelvic floor exercise in the elderly plays a crucial role as a simple intervention that can be independently performed at home, aiming to address the issue of increased urinary frequency due to the decline in musculoskeletal and urinary physiological functions caused by the weakening of the sphincter muscles. In this effort, the activity aims to raise awareness about the importance of pelvic floor muscle exercises to reduce urinary frequency and the risk of urinary incontinence in the elderly. The implementation of this activity focuses on the area of the Healthy Elderly Integrated Service Post (Posyandu Lansia Sehat), with the goal of directly involving the elderly in maintaining their health quality. Community service projects employ a participatory approach through lectures, debates, demonstrations, and direct re-demonstrations to expand older people's understanding of pelvic floor exercises. One method for analyzing and assessing the degree of knowledge among older people is questionnaires. Conclusion community service activities carried out in the Jelidro community regarding pelvic floor exercise to reduce urinary frequency in older people can be understood by the percentage of 74% of questionnaire results. It can be done independently at home to maintain the physiological function of the pelvic muscle.

Injury Prevention and Treatment among Elderly Individuals in the Sukoharjo Village’s Posyandu Lansia Sehat Bugar

The household environment is vulnerable to domestic accidents, underscoring the necessity of possessing fundamental expertise in first aid as the primary approach to addressing such incidents before subsequent medical interventions. Insufficient attention to this primary measure can result in more severe injuries. Notably, a deficiency exists in targeted interventions that aim to enhance the elderly population's comprehension of strategies to prevent and treat domestic accidents. Two approaches have been implemented to tackle this issue and augment the elderly population's understanding. These methods encompass educational lectures and practical demonstrations tailored to seniors, specifically focusing on preventing and treating domestic accidents. As a result, there is observable enhancement in knowledge after the provision of information through community health education initiatives. Preceding the dissemination of insights into injury prevention and treatment among the elderly, knowledge distribution is categorized: 11% categorized as 'good,' reflecting a high level of knowledge; 33% as ‘moderate,' indicating a sufficient level; and 56% as 'poor,' representing a lower level of knowledge. A noticeable increase is observed upon sharing the information, with 61% rise in 'good' categories, a corresponding 39% increase of 'moderate' categories, while the 'poor' category remains unchanged. The findings indicate increased understanding among the elderly concerning injury prevention and treatment of domestic accidents.

Pemberdayaan Posyandu Lansia Melalui Pelatihan Pembuatan Kwetiau Labu Kuning Sebagai Alternatif Makanan Tambahan Bergizi

Lansia (elderly) is a group of people aged 60 years and over. In an effort to maintain the quality of life of the elderly, the government of the Republic of Indonesia formed an organization called Posyandu Lansia. Posyandu Lansia is a forum for the elderly that is useful for health services, both promotive and preventive efforts. One of the elderly posyandu in Bantul Regency, Yogyakarta Special Region which is active in its activities is Posyandu Lansia Wredho Utomo. There are 7 posyandu members. In the community service activities carried out, the program regarding healthy food is chosen as the main program. The healthy food program chosen was a training program for making independent food using processed kwetiau modified with pumpkin or pumpkin. Kwetiau is a food diversification based on processing from rice flour and tapioca flour. To increase the nutritional content, a pumpkin is added. Limited access due to the COVID-19 pandemic has resulted in this training being delivered in the form of a video which is then practiced independently by participants in their respective homes. According to the assessment of the participants, all participants stated that the videos they made were considered interesting and effective and most of them said the videos that were delivered made the participants enthusiastic.

Improving Skills and Knowledge in Early Detection of Hyperuricemia in PKK and Posyandu Cadres, Banjarsari Turi Sleman

High uric acid levels will cause an increase in uric acid crystals that are shaped like needles, especially in the joints which will cause pain. Gout generally affects more men than women. In women, it will increase after menopause due to decreased function of the estrogen. The prevalence of hyperuricemia in Indonesia ranks second after osteoarthritis. Gout is not known with certainty and varies quite a bit from one region to another. Hamlet Banjarsari Wonokerto Turi Sleman is one of the hamlets with a high number of elderly people. The daily activities of most farmers are farming snake fruit and vegetables, and some have tilapia ponds. The independence of the elderly in this hamlet is very good so that the elderly is required to always stay healthy. The health check-ups activity is a routine monthly activity for the Elderly Integrated Service Post (Posyandu Lansia). Meanwhile, Posyandu lansia officers of Dusun Banjarsari play a role to summon participants and food providers. Not many PKK cadres and some Posyandu lansia workers have the skills to check blood uric acid. This service aims to increase the knowledge and skills of early detection of hyperuricemia for Family Welfare Movement (PKK) cadres and posyandu administrators in Banjarsari Turi village, Sleman. The results of this activity showed an increase in the participants' knowledge at 2.27%, Posyandu cadres made use of the grant items for routine inspection activities in Banjarsari community. The conclusion of this community service activities was it was welcomed by the participants. The counselling was able to increase participants' knowledge about hyperuricemia.

Relationship between Exercise with Blood Pressure Stability among Hypertension Elderly

Objective: This study aims to determine the relationship between elderly gymnastics and blood pressure stability in elderly hypertension in Porpri Posyandu Lansia Bunulrejo. Methods: This research is correlated with a cross-sectional approach. Samples were chosen by using the purposive sampling technique with inclusion and exclusion criteria, which got 25 people. The variables measured in this study were the elderly gymnastic relationship and blood pressure stability. The test statistic used was spearman rank correlation with a 95% confidence level. Results: The results of bivariate analysis showed that there was a significant correlation between daily gymnastics and stabilizing blood pressure (p = 0,000), with a correlation strength of 0,710. Conclusion: From the research results, it can be concluded that there is a relationship between elderly gymnastics and blood pressure stability in people with hypertension.

PUZZLE MODALITY THERAPY TO REDUCE DEMENTIA IN THE ELDERLY

The condition of the COVID-19 pandemic has changed all arrangements in society, including activities at the Posyandu Lansia. Posyandu Lansia which is held once a week is no longer held considering that the elderly are one of the vulnerable groups. Currently the condition is starting to improve, so it is necessary to do refresher for both cadres and members of the Posyandu Lansia. The purpose of this activity is to increase the knowledge and skills of Posyandu Lansia cadres in providing modality therapy, especially puzzle therapy to reduce the incidence of dementia. The method used in this community service activity is participatory educational approach that is providing health education and demonstrations about puzzle therapy. Furthermore, the Posyandu Lansia cadres apply to the Posyandu Lansia in their area. This activity was carried out for two months and was attended by ten elderly health cadres. Knowledge and skills of cadres in conducting health education about modality therapy was observed by questionnaire. As for the application of puzzle therapy, it was observed using the MMSE (Mini Mental State Examination) questionnaire. The results of community service show that the knowledge and skills of elderly health cadres in implement good health education. The results of puzzle therapy showed that there was a decrease in dementia scores.

Improvement of Cadres' Skills and Knowledge to Provide Comprehensive Health Services for the Elderly

Highlights: Due to the increasing elderly population in Indonesia, this study must address the knowledge and skill gaps among health cadres in a number of Integrated Health Posts for the Elderly (Pos Layanan Terpadu Lanjut Usia/ Posyandu Lansia). Through this study, the health cadres increased their knowledge and skills, enabling them to provide comprehensive health services for the elderly. Abstract Numerous issues have arisen as a result of the large size and rapid growth of the elderly population, attesting to the need for serious efforts from all sectors to enhance their welfare. However, the health cadres at the Integrated Health Post for the Elderly (Pos Layanan Terpadu Lanjut Usia/ Posyandu Lansia) lacked the training that would have equipped them with the necessary knowledge and skills to carry out their duties. This study aimed to evaluate the significance of training for enhancing the cadres' knowledge and skills in providing comprehensive health services for the elderly. This study was quasi-experimental research with a pre-test and post-test design. The data analysis was performed using the Shapiro-Wilk test (p>0.05) and the Wilcoxon test (p<0.05). A total of 30 health cadres at Songgon Community Health Center were measured for their levels of knowledge and skills before and after the training. The training included filling out health evaluation charts, providing leaflets containing health counseling materials for the elderly, practicing exercise for the elderly, and singing an elderly marching song. Before filling out the health evaluation chart, the cadres had to measure the elderly's degree of independence as well as their mental, emotional, and nutritional status. The cadres also had to measure the weight, height, and blood pressure of the elderly. Prior to training, the cadres' knowledge of hospitalization referrals, independence, and physical exercise for the elderly was limited. The cadres' skills in filling out health evaluation charts, assessing mental, emotional, and nutritional status, measuring blood pressure, and instructing physical exercise were also inadequate. There was a significant difference in the knowledge and skills of the health cadres before and after training (p<0.05). In conclusion, there was an improvement in the health cadres' knowledge and skills regarding comprehensive health services for the elderly at the Posyandu Lansia.

PEMANFAATAN MEDIA LEAFLET TERHADAP TINGKAT PENGETAHUAN PASIEN HIPERTENSI LANSIA DI POSYANDU LANSIA MELATI

South Kalimantan Province has the highest prevalence rate in Indonesia, which is 44.13%. Data from the Banjarmasin Indah Health Center Report for 2021 shows that there are 1,161 cases of hypertension and have an elderly Posyandu with the highest disease of hypertension. Efforts to improve the health status of the elderly by increasing the knowledge of the elderly through the provision of drug information, one of which is through the media of leaflets. This study aims to determine the effectiveness of providing information on hypertension drugs using leaflets for elderly patients at the Posyandu Lansia Melati. The study used a quasi-experimental design with the one group pre and post test method. Data collection prospectively in March-April 2022 using a total sampling technique. Data analysis using the Wilcoxon test to see the effectiveness of providing drug information. The results showed the level of knowledge before being given drug information was in the good category at 23.22% and after being given drug information through leaflets there was a significant change with the good category at 100% (p <0.05). The conclusion of the study showed providing information on hypertension drugs using leaflets was effective in increasing the level of knowledge of hypertensive patients.

Upaya Deteksi Dini Kanker Prostat Melalui Pemberdayaan Tenaga Kesehatan Posyandu Lansia Dinkes Kota Banjarmasin

Prostate cancer is one of the malignancies in men, the second most common cancer, and the sixth leading cause of death in men worldwide. The life expectancy of men in Banjarmasin City is increasing every year. As the elderly increase, the risk of prostate cancer also increases. Prostate Cancer Early Detection training is needed for health workers at Posyandu Lansia (Integrated Health Care Center for the Elderly) under the work area of Banjarmasin Health Office. The implementation of community service activities in the form of training on early detection of prostate cancer for health workers and cadres of Posyandu for the elderly in the Banjarmasin Health Office work area consists of 2 days of implementation, on 2 and 3 August 2022, at the Roditha Hotel Banjarmasin. Participants in this activity were 88 health workers and Posyandu cadres in the Banjarmasin City Health Office work area. Activities are carried out offline by implementing health protocols. This training activity includes a pretest, a presentation of training material by two speakers from FK ULM, a demonstration of the digital rectal examination technique (rectal toucher), discussion, response, and post-test. The success of this activity can be seen from the increase in knowledge (pretest average score of 35.88 and post-test of 76.18) and skills of health workers and Posyandu cadres in the Banjarmasin City Health Office work area regarding early detection and prevention of prostate cancer.