Category: Publikasi

Astuti Prodjohardjono, Amelia Nur Vidyanti, Noor Alia Susianti, Sudarmanta, Sri Sutarni, Ismail Setyopranoto

Background
Serum vascular endothelial growth factor (VEGF) and infarct volume detected by brain imaging have been associated with stroke outcome. However, the relationship of these two variables with post-stroke cognitive impairment (PSCI) remains unclear. We aimed to investigate the association between acute serum VEGF levels and infarct volume with PSCI in ischemic stroke patients.

Methods
Fifty-six first-ever ischemic stroke patients who were hospitalized in Dr. Sardjito General Hospital Yogyakarta, Indonesia were prospectively recruited. Serum VEGF level was taken on day 5 of stroke onset and measured by ELISA. Infarct volume was calculated manually from head CT scan by expert radiologist. PSCI was assessed after 3 months follow up by using Montreal Cognitive Assessment-Indonesian version (MoCA-INA). We performed a ROC curve analysis to determine the cut-off point of VEGF level and infarct volume. Multivariate logistic regression analysis was performed to measure the contribution of VEGF level and infarct volume to PSCI after controlling covariates (demographic and clinical data).

Results
The mean age of PSCI and non-PSCI patients was 61.63% ± 8.47 years and 58.67% ± 9.01 years, respectively (p = 0.221). No differences observed for vascular risk factors, infarct location, and NIHSS in both groups. Multivariate logistic regression showed that patients with higher VEGF level alone (≥519.8 pg/ml) were 4.99 times more likely to have PSCI than those with lower VEGF level (OR = 4.99, 95% CI = 1.01–24.7, p = 0.048). In addition, patients with larger infarct volume alone (≥0.054 ml) were also more frequently associated with PSCI (OR = 7.71, 95% CI = 1.39–42.91, p = 0.019).

Conclusions
Acute ischemic stroke patients with higher serum VEGF level (≥519.8 pg/ml) and larger infarct volume (≥0.054 ml) were more likely to have PSCI 3 months after stroke. These findings may contribute to predict PSCI earlier and thus better prevention strategy could be made.

Selengkapnya:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239370

Michael Andreas Leman, Mora Claramita, Gandes Retno Rahayu

Introduction: Producing healthy physicians who act as a “healthy role-model” in their environment must be one of the concerns of medical schools today in response to the global movement of “health-promoting university” by the WHO (1995). However, no publications explained the “healthy role-model” in medical school. This study aimed to fill this gap by exploring the definition and characteristics of a “healthy role-model” for medical teachers.

Methods: We used a grounded theory approach with in-depth interviews and e-mail communications to 48 medical teachers from various backgrounds of “health professions education,” “health education and behavior”/’health education and promoter,’ “general practitioners/family medicine,” “adolescent health,” “internal medicine,” and “cardiology-vascular medicine.” The medical teachers were from Indonesia, one other developing country (Bangladesh), and five developed countries (United States of America, Canada, Netherlands, Australia, and United Kingdom). We also invited 19 medical students from Indonesia for three focus group discussions.

Results: We identified four categories to define a “healthy role-model” for medical schools as persons who are seen: 1) “physically,” “socially,” “mentally”, and “spiritually” healthy; 2) internalized healthy behaviors; 3) willing to promote healthy lifestyles; and, 4) a life-long learner. In each category, there are several characteristics discussed.

Conclusion: Our study provides some insights to define a “healthy role-model” of medical teachers by using the characteristics of healthy people and adult learners. The first category describes the characteristics of healthy people, but cultural issues influence the perspectives of medical teachers to define a “healthy role-model” for medical schools.

Selengkapnya:
https://www.dovepress.com/defining-a-ldquohealthy-role-modelrdquo-for-medical-schools-learning-c-peer-reviewed-fulltext-article-JMDH

Suryani Yuliyanti, Adi Utarini & Laksono Trisnantoro

Background
Heart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases.

Methods
A participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software.

Discussion
This research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality.

Trial registration
Retrospectively registered in the ISRCTN registry with study ID ISRCTN82300061 on Feb 6, 2019.

Selengkapnya:
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05769-3

Evi Widowati, Wahyudi Istiono, Adi HeruHusodo.

Abstract

Educational institutions are obligated to protect children from multi-hazard disaster risks. The development of reliable and valid measuring instruments for school safety is an important component for reducing the impact of disasters on children’s future at schools. This study aimed to examine the appropriateness of measuring instrument models, constructs and indicators of the Disaster Preparedness and Safety School (SSSB) program to be used in the assessment of the multi-hazard-based child safety education system in schools. This study used an explanatory research design with a cross-sectional approach. The sampling technique used was multistage cluster sampling with 539 elementary schools as samples. The data were analyzed by Confirmatory Factor Analysis (CFA) using Lisrel 8.80 software. The CFA results showed that the SSSB constructs are considered valid and reliable. The modified model fulfilled the Goodness of Fit criteria so that the model is considered fit and suitable to be applied at schools, with school commitment as the strongest forming factor (R2 of 82%) for creating a successful SSSB program.

Selengkapnya:
https://www.sciencedirect.com/science/article/pii/S2212420920315065?via%3Dihub

Nicholas E. Handoyo, Gandes R. Rahayu, Mora Claramita, Julie Ash, Lambert W.T. Schuwirth.

Introduction: Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of wellbeing and is associated with better satisfaction with life. Building personal resilience has the benefits of lowering vulnerability to work-related adversity. This study examined the association between rural doctors’ personal resilience and the duration of rural practice.

Methods: This cross-sectional study was set in a rural province in Indonesia. A total sampling procedure was implemented. A total of 528 participants responded to an online survey. The survey tool measured six dimensions of a resilience profile (determination, endurance, adaptability, recuperability, comfort zone and life calling) and collected personal data such as date of birth, practice location and duration of rural practice experience. These participants were classified into four groups: intern, general (GP) with <5 years experience, GP with 5–10 years experience, and GP with >10 years experience. The data were analysed quantitatively using Oneway analysis of variance (ANOVA).

Results: Doctors with longer durations of rural experience showed higher resilience levels in four of the dimensions of personal resilience: endurance, adaptability, recuperabilit­y and comfort zone. Among those four dimensions, endurance and comfort zone showed significant differences between groups with >10 years of difference in rural experience (p<0.05). The other two dimensions, determination and life calling, showed fluctuations across groups with different rural durations.

Conclusion: This study provides a preliminary result for understanding the relationship between personal resilience and rural doctor retention. It suggests that resilience is partly associated with rural doctor retention. Further studies are needed to examine the causal relationship between resilience and retention.

Selengkapnya:
https://www.rrh.org.au/journal/article/6097

Tunjung Wibowo, Neti Nurani, Janatin Hastuti, Alifah Anggraini, Rina Susilowati, Mohammad Hakimi, Madarina Julia and Mirjam Van Weissenbruch

Background: Interactions between the genome and intrauterine environment can affect bone mineralization in newborns and even in adult life. Several studies show that intrauterine fetal bone mineralization or early postnatal bone condition influences the risk of osteoporosis in later life.

Objectives: To determine whole body bone mineral content (WB BMC) and factors that influence neonatal WB BMC in Indonesian term newborns.

Subjects/Methods: A cross-sectional study was conducted in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 45 term, appropriate for gestational age (AGA) newborns were included in this study. BMC was assessed by dual-energy x-ray absorptiometry (DXA) in the first week of life. Weight (g), length (cm) and head circumference (cm) were measured at birth. Data on maternal characteristics were obtained from the maternal health records or reported by the mothers.

Results: WB BMC measured in the present study (mean ± SD: 33.2 ± 9.3 g) was lower than WB BMC of similar populations in developed countries. Multiple linear regression showed that birth weight, birth length, and gestational age had a positive association with WB BMC (p = 0.048, 0.017, and <0.001, respectively), while maternal cigarette exposure had a negative association with WB BMC (p = 0.012). Male infants had significantly higher of WB BMC than female (p = 0.025). These determinants contribute to 55% variability of WB BMC.

Conclusions: WB BMC in Indonesian term newborns is lower than populations in developed countries. Birth weight, length, gestational age, sex, and maternal cigarette exposure during pregnancy are significantly associated with WB BMC observed in Indonesian newborns.

Selengkapnya:
https://www.frontiersin.org/articles/10.3389/fped.2021.680869/full

Ajib Diptyanusa, Elisabeth Siti Herini, Soedarmanto Indarjulianto, Tri Baskoro Tunggul Satoto.

Abstract

The West Kalimantan province in Borneo island, Indonesia belongs to endemic area of Japanese encephalitis (JE) that accounts for approximately 30% of total cases yearly. As the presence of pig holdings is uncommon in West Kalimantan, another reservoir host might have played a role in the local transmission of JE virus in this area. Current study aimed to identify the potential role of bats in the local transmission of JE by performing molecular detection of JE virus in bats and mosquitoes using RT-PCR. Sample collection was performed in 3 districts in West Kalimantan, covering 3 different ecosystems: forest, coastal, and residential areas. Bat collection was performed using mist net and harp net, while mosquito collection was carried out using animal-baited trap and human landing collection. A total of 373 blood samples from bats were tested for JE virus, among which 21 samples (5.6%) showed positive results, mainly from Cynopterus brachyotis (lesser short-nosed fruit bat) found in residential areas. Out of 53 mosquito pools, 3 JE-positive pools of Culex tritaeniorhynchus and Cx. vishnui were collected at the same location as JE-positive bats. Current study showed the first evidence of JE virus detection in several species of Megachiropteran bats in Indonesia, demonstrated the potential role of frugivorous bats in local transmission of JE in West Kalimantan. More aggressive measures are required in JE risk mitigation, particularly in initiating JE vaccination campaign and in avoiding disruption of bats’ natural habitats through changes in land-use.

Selengkapnya:
https://www.sciencedirect.com/science/article/pii/S2213224421000419?via%3Dihub