Adoption of policies to improve respectful maternity care in Timor-Leste

INTRODUCTION

There are now well-established global standards for supporting improvement in women's experience of maternity services, including frameworks for the prevention of mistreatment during childbirth. To support initiatives to improve the quality of care in maternal health services in Timor-Leste, we examine the adoption of global respectful maternity care standards in the national intrapartum care policy and in three urban birth facilities in Dili.

METHODS

From May to July 2022, we conducted a desk review of the Timor-Leste National Intrapartum Care Standards and Clinical Protocols for Referral Facilities and Community Health Centres. This was followed by a health-facility audit of policies, guidelines and procedures in three main maternity facilities in the capital, Dili to examine the extent to which the WHO (2016) standards for women's experiences of care have been adopted.

RESULTS

Despite the availability of global guidelines, key standards to improve women's experience of care have not been included in the National Intrapartum Care guidelines in Timor-Leste. There was no mention of avoiding mistreatment of women, needing informed consent for procedures, or strengthening women's own capability and confidence. In the policy wording, women tended to be distanced from the care 'procedures' and the protocols could be improved by taking a more woman-centred approach. The results of the health facility assessment showed extremely low use of standards that improve women's experiences of care. Health Facility 1 and 2 met two of the 21 quality measures, while Health Facility 3 met none of them.

CONCLUSION

The discourse communicated through policy fundamentally affects how health care issues are framed and how policies are enacted. Given the findings of this study, combined with previously documented issues around quality of care and low satisfaction with maternal health services, there is a need for a fundamental shift in the culture of care for women. This will require an immediate focus on leadership, training and policy-frameworks to increase respectful care for women in health facilities. It will also require longer-term effort to address the power imbalances that drive mistreatment of women within and across social systems, and to support models of care that inherently foster understanding and compassion.

Prediction of Toddlers Acute Respiratory Infection (ARI) to Become Pneumonia in Martapura Catchment Area, Banjar District, Indonesia

Introduction. The pneumonia pattern in young children may vary across different catchment areas. Therefore, this study aims to analyze the predictive factors for toddlers with an Acute Respiratory Infection (ARI) developing into pneumonia in the catchment area of Banjar Regency, Indonesia. Methods. A case-control design, with 300 respondents, consisting of 106 cases and 194 controls. A questionnaire of interviews with mothers/caregivers of toddlers. Forty-one indicators data were analyzed using multiple logistic regression with backward stepwise regression to arrive at the final model. Results. The predictive factors for toddlers with pneumonia were the child's age (P-value .070), child development (P-value .007), breastfeeding (P-value .051), family income (P-value .026), and location of houses along the river (P-value .025). Conclusion. A prediction index for toddler pneumonia has been compiled, which can be applied to improve the health of lower middle-class toddlers requiring more government attention.

Combination adipose-derived mesenchymal stem cells-demineralized dentin matrix increase bone marker expression in periodontitis rats

Background

Periodontal disease is common in both developed and developing countries and affects around 20-50% of the global population, especially in adolescents, adults and the elderly is a public health problem. ADMSCs have the advantage of regenerating damaged tissue with high quality. DDM in the form of slices can improve healing in the mandibular sockets of molar teeth. The combination of ADMSC-DDM is expected to accelerate bone regeneration.

Objectives

To analyze the combination of ADMSCs-DDM at increasing bone marker expression in periodontitis rats.

Methods

This research is experimental with a randomized control group post-test-only design. A total of 50 male Wistar rats were divided into four groups: 1) normal group (K); 2) CP model (K + ); 3) CP model and treated with DDM scaffold therapy (K(s)); 4) CP model and treated with ADMSCs-DDM combination therapy (K(sc)). Making a CP model with injected LPS P. gingivalis into interproximal gingiva of the right first and second lower molars. The in vivo research stage was the implantation of the DDM scaffold and the ADMSCs-DDM combination in the rat periodontal pocket. Rats were euthanized on days 7, 14, and 28, and immunohistochemistry of STRO-1, RUNX-2, OSX, COL-I, and OCN was performed. DDM scaffolds are made in 10%, 50% and 100% concentrations for MTT testing. Statistical results were analyzed with Kruskal-Wallis and Mann-Whitney tests.

Results

The results of the MTT scaffold DDM were significant in the 10%, 50%, and 100% dilution groups (p < 0.05). The results showed there was a substantial difference in the expression of STRO-1 between the study groups (p < 0.05). The (K(sc)) was significantly higher than the (K) in RUNX-2 expression (p < 0.05). OSX expression showed significant results between study groups (p < 0.05). The expression of OCN and COL-I showed a significant difference in all study groups on day 28, where the (K(sc)) was higher than the (K) (p < 0.05).

Conclusions

Administration of the ADMSCs-DDM combination can accelerate alveolar bone regeneration on day 28. There is a mechanism of alveolar bone regeneration through the STRO-1, RUNX-2, OSX, and the COL-I pathway in periodontitis models.

Immune system and tumor microenvironment in early-stage breast cancer: different mechanisms for early recurrence after mastectomy and chemotherapy on ductal and lobular types

Background: The most common type of breast cancer is the ductal type (IDC), followed by lobular type (ILC). Surgery is the main therapy for early-stage breast cancer. Adjuvant chemotherapy might be given to those at high risk of recurrence. Recurrence is still possible after mastectomy and chemotherapy and most often occurs in the first two years. We aimed to determine the mechanisms in early local recurrence in both types. Methods: We used an observational method with a cross-sectional study design. The samples were patients with early-stage IDC and ILC, who underwent modified radical mastectomy (MRM) and got adjuvant chemotherapy with taxan and anthracycline base, and experienced recurrence in the first two years after surgery. The materials in this study were paraffin blocks from surgical specimens; we examined vimentin, α-SMA and MMP1, PDGF and CD95 by immunohistochemistry (IHC). Data analysis was done using OpenEpi 3.0.1 and EZR. We used pathway analysis with linear regression. Results: There were 25 samples with local recurrence and 25 samples without recurrence in the ductal type group. The lobular type group consisted of six subjects without recurrence and seven with recurrence. There were significant differences in the expression of vimentin (p=0.000 and 0.021, respectively), PDGF (p=0.000 and 0.002) and CD95 (p=0.000 and 0.045) in ductal and lobular cancer types, respectively. MMP1 (p=0.000) and α-SMA (p=0.000) only showed a significant difference in the ductal type. The pathway analysis showed that in the ductal type, the mechanism of recurrence was enabled by two factors: α-SMA and CD95. Meanwhile, for the lobular type, the recurrence mechanism was through the CD95 pathway. Conclusions: Local recurrence in early-stage IDC and ILC had different mechanisms.  These findings are expected to make cancer treatment in both types more focused and efficient.

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

The effect of preconditioning hypoxia in schwann-like-cells-derived adipose mesenchymal stem cells and rat sciatic nerve-derived stem cells: experimental research

The preconditioning hypoxia for stem cells is a strategy to achieve effective conditions for cell therapy, indicate increased expression of regenerative genes in stem cell therapy, and enhance the secretion of bioactive factors and therapeutic potential of their cultured secretome.

Objectives

This study aims to explore the response of Schwann-like cells derived from adipose-derived mesenchymal stem cells (SLCs) and Schwann cells rat sciatic nerve-derived stem cells (SCs) with their secretomes under normoxic and hypoxic conditions in vitro.

Material and methods

SLCs and SCs were isolated from the adipose tissue and the sciatic nerve of the adult white male rat strain Wistar. Cells were incubated in 21% O₂ (normoxic group) and 1%, 3%, and 5% O₂ (hypoxic group) conditions. Concentration values of transforming growth factor-β (TGF-β), basic Fibroblast Growth factor (bFGF), brain-derived neurotrophic factor, glial-derived neurotrophic factor, vascular endothelial growth factor, and nerve growth factor were detected and calculated utilizing an enzyme-linked immunosorbent assay, and the growth curve was described.

Results

SLCs and SCs indicated positive expression for mesenchymal markers and negative expression for hematopoietic markers. Normoxic conditions SLCs and SCs showed elongated and flattened morphology. Under hypoxic conditions, SLCs and SCs showed a classic fibroblast-like morphology. Hypoxia 1% gave the highest concentration in TGF-β and bFGF from the SLCs group and TGF-β, bFGF, brain-derived neurotrophic factor, and vascular endothelial growth factor from the SCs group. No significant differences in concentration of growth factors between the SLCs group compared to SCs group in all oxygen groups.

Conclusions

Preconditioning hypoxia has an effect on the composing of SLCs, SCs, and their secretomes in vitro; no significant differences in concentration of growth factors between the SLCs group compared with the SCs group in all oxygen groups.

The Implementation of Comprehensive Health Education to Improve Household Contacts' Participation in Early Detection of Tuberculosis

Lack of participation of household contacts is the main problem of early detection of tuberculosis (TB) in Indonesia. A comprehensive health education (CHE) program has been developed to encourage the participation of household contacts. This study aimed to assess the implementation of the CHE to improve participation of household contacts in early detection of TB. This was a quasi-experimental study conducted between November 2018 and June 2019 in Badung District, Bali, Indonesia. Twelve public health centers (PHCs) were randomly allocated to six PHCs implementing the CHE and six PHCs implementing standard health education (SHE). The CHE was developed through a pilot study using the health belief model supplemented with perceived stigma and social support to identify the factors that influence participation. The participation was measured using a TB register with a cross-check to the health care officer until 2 months after health education was provided. Four hundred and twenty-eight household contacts enrolled in this study-216 in the CHE group and 212 in the SHE group. The CHE group's participation was 28.2%, with 10 new TB cases found; in the SHE group, the participation was 15.6%, with 3 new TB cases found. The CHE increased the household contact participation by 1.83-fold (95% confidence interval [1.19, 2.81]) and case findings by 3.13-fold (95% confidence interval [0.85, 11.56]). The CHE implementation should be scaled up to other areas with a high level of TB transmission. The content and technique of the CHE could also be incorporated in contact investigation guidelines and materials for the TB campaign.

The role of social support and interpersonal trust to improve compliance of iron supplementation amongst adolescent girls: A qualitative approach

Context

Adolescence is a crucial phase in preventing and controlling anaemia. One of the efforts made by the Indonesian government to overcome adolescent girl's anaemia is the iron and folic acid (IFA) supplementation programme. This programme is one of the most effective interventions that various countries have used to overcome anaemia. The key to the success of the supplementation of IFA is the compliance of adolescent girls.

Aims

This study investigates the compliance and its contributing factors of IFA supplementation and the role of social support and interpersonal trust as a source of information and reminder amongst adolescent girls in Sidoarjo, Indonesia.

Methods

This research was a qualitative study using the in-depth interview to collect data. Thirteen adolescent girls from three high schools in Sidoarjo, Indonesia, were recruited using a snowball sampling technique.

Results

Most of the girls did not comply with IFA supplementation. Contributing factors were the influence of peers, influence of teachers, parental influence, risk and benefit of taking IFA tablet and also failure to remember to take IFA tablet. The social environment that provided information and reminder came from teacher, parent, peer and also health worker. Interpersonal trust was needed to have positive perceived social support.

Conclusions

Compliance with the consumption of IFA supplements requires the cooperation of various parties (teachers, parents, peers and health workers) and also interpersonal trust between adolescent girls to their social environment so the programme could be run optimally.

Platelet-rich fibrin (PRF) graft and amniotic membrane graft on transforming growth factor-β (TGF-β) and type 1 collagen post conjunctival excision

Background: Conjunctiva, when injured, can heal spontaneously. However, in extensive wounds, wound healing is often accompanied by scarring and wound contraction. Currently, for cases of disease and trauma to the surface of the eyeball, it can be reconstructed using the amniotic membrane, but there are still weaknesses in the use of amnion. Platelet-rich fibrin (PRF) is currently being developed for the reconstruction of ocular surface wounds. Methods: A total of 20 male New Zealand rabbits (20 eyes) were divided into two groups. In the first group, conjunctival excision and PRF membrane graft suturing were performed on the right eye conjunctival defect, while the second group had an amniotic membrane sutured on the right eye conjunctival defect. On the 14th day, enucleation was carried out and continued with histopathological examination using immunohistochemistry using TGF antibodies and type 1 collagen to evaluate the levels of TGF and type 1 collagen in the conjunctiva. Results: The results after 14 days of treatment showed that there was a very significant difference in TGF Beta expression between the AMT group and the PRF group (p = 0.007*; <0.05). However, in the expression of type 1 collagen, there was no significant difference in the expression of type 1 collagen between the AMT group and the PRF group (p = 0.791; >0.05). Conclusion: There were differences in the expression of TGF-β and type 1 collagen in the administration of the PRF membrane compared to the administration of the amniotic membrane after conjunctival excision of experimental male New Zealand rabbits on day 14.

Isolation of Native Plant-Derived Exosome-like Nanoparticles and Their Uptake by Human Cells

The exosome is a nano-sized vesicular particle commonly secreted from eukaryotic cells to extracellular space. Exosome functions in cellular communication, nutrients or bioactive compounds delivery, and cellular immunity. It is believed that plant-derived exosome-like particle (PDEN) potential to deliver nano-bioactive compounds to the human body. As Indonesia is one of the herbal centers of the world, we are encouraged to develop natural richness for human welfare. The study aimed to verify various methods to isolate exosomes from the fresh ginger rhizome and quina cells and examine the ginger PDENs' capacity to internalize in vitro human cells. The PDENs isolation was carried out by centrifugation and precipitation. The particles were observed through a transmission electron microscope, dynamic light scattering, and particle size analysis. Differential ultracentrifugation combined with PEG6000 provided a better size range of particles. Nanoparticles tracking analysis performed the concentration of particles within a specific size range. Ginger and quina PDENs size ranged from 40-650 nm, and the concentration was 3.6 × 107 and 2.8 × 106, respectively. The PKH67-labelled ginger PDENs were taken up by human dermal fibroblast and human Wharton's jelly mesenchymal stem cells after 30 minutes and 21 hours. DPPH assays revealed that ginger PDENs have antioxidant activity, indicating the presence of some nano-molecules in those particles. This study would be the baseline for developing ginger PDENs as a functional food with nano-ingredients, or as an effective vehicle of nano-drug, for human health.

Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review

Background

Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength.

Study Design

Systematic Review; Level of evidence V.

Data Sources

A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms ("stem cell") AND ("brachial plexus") as search keywords.

Methods

The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes.

Results

In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury.

Conclusion

This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.

Hypoxia Effects in Intervertebral Disc-Derived Stem Cells and Discus Secretomes: An in vitro Study

Background

This study aimed to investigate the effects of hypoxia and normoxia preconditioning in rabbit intervertebral disc-derived stem cells (IVDSCs) and discus-derived conditioned medium (DD-CM)/secretomes in vitro. Transforming growth factor (TGF)-β1, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) have a role in the proliferation, development, differentiation, and migration of MSCs.

Materials and Methods

Intervertebral discs were isolated from rabbit and incubated in normoxia and hypoxia 1%, 3%, and 5% (hypoxia groups) condition. Cell counting was performed after 24 hours of manipulation, then analyzed using one-way ANOVA. TGF-β1, PDGF, FGF, and VEGF were measured using the ELISA.

Results

The highest number of cells was in the hypoxia 3% preconditioning compared to the normoxia, hypoxia 1%, and hypoxia 5% groups. Hypoxia 3% also had the highest increase in PDGF protein production compared to normoxia, with hypoxia 1% and 5%. Among hypoxia groups, the highest secretions of VEGF and FGF proteins were in the hypoxia 3% group. Based on TGF-β1 protein measurement, the hypoxia 1% group was the highest increase in this protein compared to other groups.

Conclusion

Oxygen level in hypoxia preconditioning has a role in the preparation of IVDSCs and secretome preparation in vitro. The highest cell numbers were found in the treatment group with 3% hypoxia, and 3% hypoxia was significantly related to support IVDSCs preparation. Preconditioning with 3% hypoxia had higher PDGF and VEGF levels than other hypoxia groups.

COPING STRATEGIES, SELF-EFFICACY, AND PERCEPTION AMONG FAMILY CAREGIVERS FOR POST-STROKE SURVIVORS IN INDONESIA

Family caregivers experience stress and burden while caring for post-stroke survivors. Coping strategies are needed to deal with the stress, especially problem emotional-focused coping.  The stress adaptation model states that coping was influenced by self-efficacy. Meanwhile, ABC Hill model explained that perception also had effects on coping. The purpose of this study was to analyze factors that affected coping among family caregivers for post-stroke survivors, especially self-efficacy and caregiver perception. This study used cross-sectional design and also used self-report questionnaire. It was conducted from October 2020 – April 2021. Sample of this study was family members who take care the family member with post-stroke, and the post-stroke survivors already post hospitalized between 6 months to 3 years. Total sample was 200 family caregivers in 7 health care centers, Tomohon City, Indonesia. We used PLS to estimate the hypothesized fit with the data. T statistic was used to include or exclude the hypotheses (t-statistic >1.96). All path coefficients were significant. Self-efficacy had a positive effect on problem emotional-focused coping (β= 0.177; t-value= 0.030, R2=0.078). In addition, the caregiver perception had a positive effect on problem emotional-focused coping (β= 0.188, t-value = 2.248, R2=0.175).  Managing self-efficacy and perception among caregivers are needed to improve problem emotional-focused coping

Mitomycin C, curcumin, and fibrin glue inhibit the cell proliferation and expression of TGF-β in human pterygium fibroblast

Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery. Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody. Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p<0.05) suggesting their antifibrotic effect. Further analysis with immunofluorescence staining showed that mitomycin C, curcumin, and fibrin glue could significantly reduce the level of TGF-β as compared with control group (p<0.05). Conclusion: Mitomycin C was the most potent adjuvant agent to reduce the recurrence of pterygium, followed by curcumin and fibrin glue. Taken altogether, curcumin and fibrin glue have role as adjuvant therapy to prevent recurrence in pterygium surgery.

Multilevel Analysis of Lifestyle and Household Environment for Toddlers With Symptoms of Acute Respiratory Infection (ARI) in Indonesia in 2007, 2012, and 2017

Introduction. The morbidity and mortality rate of Acute Respiratory Tract Infection (ARI) in children under 5 is relatively high in Indonesia. Socio-demographic characteristic is considered one of the factors causing ARI in Indonesia. However, no study analyzed the prevalence of ARI among toddlers and the differences among the determinant factors in multiple periods. Thus, this study aimed to analyze the prevalence trends and determinant factors associated with ARI symptoms in children under 5 in Indonesia in 2007, 2012, and 2017. Methods. This study analyzed cross-sectional survey data from the Demographic and Health Survey (DHS) in Indonesia during 2007, 2012, and 2017. Bivariate and multivariate analysis with logistic regression was performed using Stata version 15. The final results were expressed in Adjusted Odds Ratio (AORs) and 95% Confidence Interval (CI). Results. The findings showed a progress in prevalence trends with a decrease in the percentage of children with ARI symptoms from 11.25% (2007), then 5.12% (2012) to 4.22% (2017). Risk factors for toddlers experiencing ARI symptoms were as follows: younger maternal age (OR: 1.13, 95% Cl 0.70-1.81 in 2007, OR: 1.72, 95% Cl 1.03-2.88 in 2012 and OR: 0.98, 95% Cl 0.48-1.97 in 2017), smoking habits of family members (OR: 1.12, 95% Cl 0.85-1.48 in 2012, OR: 1.23, 95% Cl in 2017), poor drinking water quality (OR: 1.12, 95% Cl 0.85-1.48 in 2012 and OR: 1.23, 95% Cl in 2017), unavailable toilet facilities (OR: 1.27, 95% Cl 1.04-1.56 in 2007, OR: 1.24, 95% Cl 0.95-1.63 in 2012 and OR: 1.28, 95% Cl 0.97-1.68 in 2017). Conclusion. There was a decrease in the prevalence of ARI symptoms among children in 2007, 2012, and 2017, with no prominent differences in other related factors. The lifestyle and household environmental factors such as the use of dirty fuel, the presence of smokers in the household, the poor quality of drinking water, unavailable toilet facilities in addition to the maternal age and child age were the determinant factors that must be prioritized and improved. Family self-awareness should also be enhanced for better prospects for toddler survival.

Extracellular vesicles: a promising cell-free therapy for cartilage repair

Few effective therapies for cartilage repair have been found as cartilage has a low regenerative capacity. Extracellular vesicles (EVs), including exosomes, are produced by cells and contain bioactive components such as nucleic acids, proteins, lipids and other metabolites that have potential for treating cartilage injuries. Challenges like the difficulty in standardizing targeted therapy have prevented EVs from being used frequently as a treatment option. In this review we present current studies, mechanisms and delivery strategies of EVs. Additionally, we describe the challenges and future directions of EVs as therapeutic agents for cartilage repair.

Repairing cartilage damage is challenging due to the tissue’s low regenerative capacity. Extracellular vesicles (EVs) contain bioactive components that may be able to treat cartilage injuries. However, EV-based therapy is not widely used. This review summarizes the current state of knowledge regarding the use of EVs for cartilage repair, including the mechanisms, delivery strategies, challenges and future directions.

Quality of Life of Hemodialysis Patients during COVID-19 Pandemic in Gatoel Hospital, Mojokerto City

AIM: The purpose of this study was to analyze the quality of life of hemodialysis patients during the COVID-19 pandemic. METHODS: This study used a descriptive design. The sample in this study was hemodialysis patients at the Gatoel Hospital, Mojokerto City, as many as 122 respondents who were determined using simple random sampling technique. The sample criteria in this study were hemodialysis patients at Gatoel Hospital, Mojokerto City, undergoing hemodialysis therapy <2 years, and willing to participate in research activities. The research instrument used was adopted from the WHOQOL-BREF questionnaire. RESULTS: From the results of the study, it was found that more than half of the respondents had poor physical health dimensions as many as 62 respondents (50.8%), more than half of respondents had poor mental health dimensions as many as 68 respondents (55.7%), more than half of respondents had social health dimensions. Bad as many as 62 respondents (50.8%) and most respondents have poor functional health dimensions as many as 74 respondents (60.7%). CONCLUSION: It was found that more than half of the respondents in this study had poor quality of life. More than half of the respondents had physical health dimensions in the poor category, more than half of the respondents had mental health dimensions in the bad category, more than half of the respondents had social health dimensions in the bad category and most of the respondents had functional health dimensions in the bad.

Challenges and strategy in treatment with exosomes for cell-free-based tissue engineering in dentistry

In dentistry, problems of craniofacial, osteochondral, periodontal tissue, nerve, pulp or endodontics injuries, and osteoarthritis need regenerative therapy. The use of stem cells in dental tissue engineering pays a lot of increased attention, but there are challenges for its clinical applications. Therefore, cell-free-based tissue engineering using exosomes isolated from stem cells is regarded an alternative approach in regenerative dentistry. However, practical use of exosome is restricted by limited secretion capability of cells. For future regenerative treatment with exosomes, efficient strategies for large-scale clinical applications are being studied, including the use of ceramics-based scaffold to enhance exosome production and secretion which can resolve limited exosome secretory from the cells when compared with the existing methods available. Indeed, more research needs to be done on these strategies going forward.

Preconditioning of Hypoxic Culture Increases The Therapeutic Potential of Adipose Derived Mesenchymal Stem Cells

Various in vitro preconditioning strategies have been implemented to increase the regenerative capacity of MSCs. Among them are modulation of culture atmosphere (hypoxia or anoxia), three-dimensional culture (3D), addition of trophic factors (in the form of growth factors, cytokines or hormones), lipopolysaccharides, and pharmacological agents. Preconditioning mesenchymal stem cells by culturing them in a hypoxic environment, which resembles the natural oxygen environment of the tissues (1% –7%) and not with standard culture conditions (21%), increases the survival of these cells via Hypoxia Inducible Factor-1α (HIF-1a) and via Akt-dependent mechanisms. In addition, the hypoxic precondition stimulates the secretion of pro-angiogenic growth factors, increases the expression of chemokines SDF-1 (stromal cell-derived factor-1) and its receptor CXCR4 (chemokine receptor type 4) - CXCR7 (chemokine receptor type 7) and increases engraftment of stem cell. This review aims to provide an overview of the preconditioned hypoxic treatment to increase the therapeutic potential of adipose-derived mesenchymal stem cells.  

Plant-derived exosome-like nanoparticles: A concise review on its extraction methods, content, bioactivities, and potential as functional food ingredient

Plant-derived exosome-like nanoparticles (PDENs) are small vesicles released by multivesicular bodies mainly to communicate between cells and regulate immunity against pathogen attack. Current studies have reported that PDENs could modulate gene expression in a cross-kingdom fashion. Therefore, PDENs could be a potential future functional food ingredient as their cross-kingdom communication abilities were reported to exert multiple health benefits. Macrophage and other cells have been reported to absorb PDENs in a manner regulated by the membrane lipid and protein profile and the intactness of the PDENs lipid bilayer. PDENs could be extracted from plant materials by various techniques such as ultracentrifugation, immunoaffinity, size-based isolation, and precipitation, though each method has its pros and cons. PDENs mainly contain lipid, protein, and genetic materials, mainly micro RNAs, which could exert multiple health benefits and functionalities when consumed in sufficient amounts. However, most studies on the health functionalities of PDENs were conducted through in-vitro and in-vivo studies, and its potency to be used as a functional ingredient remains a question as PDENs are sensitive to storage and processing condition and requires costly extraction method. This concise review features various exosome extraction methods, contents of PDENs and their roles, the health functionalities of PDENs, and its potency as a functional food ingredient.

Role of adipose mesenchymal stem cells and secretome in peripheral nerve regeneration

The use of stem cells is a breakthrough in medical biotechnology which brings regenerative therapy into a new era. Over the past several decades, stem cells had been widely used as regenerative therapy and Mesenchymal Stem Cells (MSCs) had emerged as a promising therapeutic option. Currently stem cells are effective therapeutic agents againts several diseases due to their tissue protective and repair mechanisms. This therapeutic effect is largely due to the biomolecular properties including secretomes. Injury to peripheral nerves has significant health and economic consequences, and no surgical procedure can completely restore sensory and motor function. Stem cell therapy in peripheral nerve injury is an important future intervention to achieve the best clinical outcome improvement. Adipose mesenchymal stem cells (AdMSCs) are multipotent mesenchymal stem cells which are similar to bone marrow-derived mesenchymal stem cells (BM-MSCs). The following review aims to provide an overview of the use of AdMSCs and their secretomes in regenerating peripheral nerves.

Acceptance Model of a Mandatory Health Information System in Indonesia

Objectives

The purpose of this study was to develop a model of acceptance of the Mother and Child Health Information System in the Ngawi Regency Health Office, Indonesia based on the technology acceptance model, by integrating organizational support and personal characteristics as external variables and enjoyment as an intervening variable.

Methods

The design of this study was cross-sectional. The subjects of this study were 217 village midwives who had operated the Maternal and Child Health Information System in the Ngawi Regency Health Office, Indonesia. The variables studied were perceived organizational support, personal characteristics, perceived ease of use, perceived usefulness, perceived enjoyment, behavioral intention, and actual system use. Data were collected through questionnaires, and then analyzed using structural equation modeling.

Results

In terms of the total effect, the most meaningful factor affecting actual system use was perceived organizational support (0.766), followed in descending order by behavioral intention to use (0.344), perceived enjoyment (0.238), personal characteristics (0.118), perceived usefulness (0.054), and perceived ease of use (0.048).

Conclusions

In the acceptance model of the Mother and Child Health Information System in Ngawi Regency, perceived organizational support was the main determinant of actual system use, while enjoyment was the main intermediate determinant of the indirect effects of perceived organizational support and personal characteristics on actual system use.

The Effect of Acute and Chronic Infection-Induced by AvrA Protein of Salmonella typhimurium on Radical Oxygen Species, Phosphatase and Tensin Homolog, and Cellular Homolog Expression During the Development of Colon Cancer

AIM. The aim of the study was to analyze Avra's effector in inducing cancer stem cells into colon cancer through increased radical oxygen species (ROS), PTEN expression and c-myC as markers of tumorigenesis in mice model of the colorectal cancer infected with S. typhimurium. METHODS. The study used balb c mice induced once a week by 10 mg / mL / day of AOM for 1-week and 12-week treatment period. Isolation of S. typhimurium specific protein had been carried out before being induced to mice in intraperitoneal manner in the amount of 40 mL / 50 mL. Propagation of S. typhimurium ATCC bacteria with MacConkey media and isolation of S. typhimurium protein were administered. The sample was divided into 4 groups, positive control group (group that was only exposed to azoxymethane (AOM), group exposed to both AOM and AvrA (AOM + AvrA), and group exposed to both AOM and S. typhimurium (AOM + S. typhimurium). Blood flow cytometry and soft tissue sampling for IHC and data analysis were then conducted. RESULTS. The results of the study showed that there was an increase in the expression of ROS, PTEN and c-Myc. Increased ROS expression was found in the 12-week treatment period group and it was known that such increase was due to AOM + S. typhimurium (45.78 ± 2.93) induction compared to AOM, AOM + AvrA and control (p <0.05). PTEN and C-myc expression increased at the 12th week compared to the negative control. CONCLUSION. Inflammation is the triggering factor for colorectal cancer, in which the expression of ROS, PTEN and c-Myc as the colorectal cancer markers increases in both the acute and chronic phases.

Factors affecting the ability to speak in children with autism spectrum disorders

BACKGROUND

Communication deficit is one of the characteristics of autism spectrum disorder. Some children with this condition cannot communicate verbally and some have very limited speech skills. This study aims to analyze the factors that affect speaking ability in children with autism, namely age, sex, emotions, attention, and memory.

DESIGN AND METHODS

This study used a correlational analytical design with a retrospective cohort design. Data were obtained using questionnaires and scales. Furthermore, emotional factors, attention, memory, and age were analyzed for their effects on speaking ability using the Pearson test, while sex was analyzed for their effects on speaking ability using the Eta test.

RESULTS

The results showed that there was a significant effect of attention and age on the speaking ability of children with autism spectrum disorders. Furthermore, it showed that there was a significant effect of emotion on attention.

CONCLUSIONS

It was concluded that attention and age affect the speaking ability of children with autism spectrum disorder. Meanwhile, attention in affecting speaking ability is influenced by emotions. Therefore, to improve speaking ability, good emotional management and increased attention is required.

Perbedaan Hemoglobin Terglikosilasi (Hba1c) terhadap Profil Lipid Pasien Rumah Sakit Islam Surabaya

ABSTRAK Latar Belakang : Diabetes melitus merupakan penyakit metabolik dengan karakteristik hiperglikemia sebagai akibat kelainan sekresi insulin maupun kerja insulin. Diabetes sebagai salah satu penyebab dislipidemia sekunder, sehingga pengelolaan glukosa darah merupakan pencegahan primer timbulnya komplikasi penyakit kardiovaskular. Hasil Riskesdas tahun 2018, prevalensi diabetes melitus yang didiagnosis dokter pada penduduk di semua umur sebesar 3,4% di Kota Surabaya.Tujuan : Penelitian ini untuk mengetahui perbedaan profil lipid pada level HbA1C normal, prediabetes dan diabetes melitus.Metode : Penelitian cross sectional, teknik pengambilan sampel dengan simple random sampling dari data rekam medis pasien rawat jalan di Rumah Sakit Islam Surabaya  dari 1 Januari tahun 2018 sampai dengan 31 Desember 2019 berusia 35-80 tahun dan mendapat pemeriksaan HbA1c, kolesterol, trigliserida dan LDL-kolesterol pada waktu yang sama dan terdokumentasi lengkap pertama sekali sehingga diperoleh besar sampel 73 data pasien. Uji Anova one way digunakan untuk mengetahui perbedaan rata-rata kolesterol, trigliserida dan LDL-kolesterol berdasarkan HbA1C.Hasil : Hasil penelitian menunjukkantidakada perbedaan yang signifikan rata-rata kolesterol, dan LDL-kolesterol dengan tingkatan HbA1C (p>0,05), ada perbedaan yang signifikan rata-rata trigliserid dengan HbA1C normal, prediabetes, dan diabetes (p=0,01). Hasil multiple comparison dengan metode Tukey HSD menunjukkan perbedaan signifikan rata-rata trigliserid  pada HbA1C normal dengan diabetes (p=0,039) dan prediabetes dengan diabetes (p=0,044).Kesimpulan :Perbedaan rata-rata trigliserida signifikanpada HbA1Ckategorinormal dan prediabetes dengan diabetes, pentingnya mengendalikanglukosa darah untuk mencegahkomplikasi kardiovaskuler pada penderita diabetes melitus yang dapat dilakukan melalui pemantauan mandiri glukosa darah, pola hidup sehat, aktivitas fisik secara teratur, terapi nutrisi medis sesuai kebutuhan, menurunkan berat badan bagi yang mengalami obesitas, tidak merokokdan intervensi obat anti hiperglikemia jika dibutuhkan.Kata Kunci : diabetes, HbA1C, kolesterol, trigliserid, LDL-kolesterol. ABSTRACT  Background :Diabetes melitus is a metabolic disease characterized by hyperglicemia as a result of abnormal insulin secretion and insulin action. Diabetes is a cause of secondary dislipidemia, so that diabetes melitus monitoring is a primary deterrent to cardiovascular complication. Riskesdas 2018 said that the prevalence of doctors' diagnosed diabetes in the population at all age 3.4% in Surabaya.Objective : This study is to find out the difference in lipid profiles on normal HbA1Clevels, pre-diabetes and diabetes mellitusMethod: Cross-sectional study, the sampling technique used was simple random sampling fromoutpatient medical recordsthe Surabaya Islamic hospital's from 1st of January 2018 to 31st December 2019 aged 35-80 years and checked for HbA1C, cholesterol, triglyceride and LDL-cholesterol at the same and firsttime documented. Sample sizes of 73 data analized with One Way Anova test was used to identify differences in mean cholesterol, triglyceride and LDL-cholesterol based Hba1C.Results :The results showed that there was no significant difference mean cholesterol and mean LDL-cholesterol with HbA1C levels (p> 0.05), there were significant differences mean the triglyceride with normal HbA1C levels, pre-diabetes, and diabetes (p= 0.01). Multiple comparason results using Tukey HSD methods showed that there was significant differences mean the triglycerid on normal HbA1C levels with diabetes (p= 0.039) and the mean triglyceride ebetween hba1c prediabetesand diabetes (p= 0.044).Conclusions: The mean difference trigliseride signifnificant in normal HbA1C levels and pre-diabetes with diabetes.The importantce of controlling blood glucose to prevent cardiovasculer complication in people with diebetes mellitus can be done through education on independent monitoring of blood glucose, healthy lifestyle, reguler physical activity, medical nutrition therapy according to the needs, lost weight for those who are obese, do not smoke and  anti-hyperglicemia drug intervention if needed.

COMPARING SOCIO-ECONOMIC CONDITIONS OF MOTHER AND CHILDREN WITH LEPROSY IN ENDEMIC AND NON-ENDEMIC AREAS IN EAST JAVA, INDONESIA

Background

Leprosy is a disease that causes social, psychological, and economic issues. Failure to treat the causes of the immune system dysregulation in endemic areas of leprosy conditions makes the transmission of the bacteria easier. This paper aims to analyze the comparison of family income, occupation types of mothers and fathers, number of children, access to health facilities, and education of mothers, fathers, and children in mothers and children with leprosy in endemic and non-endemic areas.

Materials and Methods

A cross sectional study by survey was done in both an endemic and a non-endemic area of leprosy in Tuban Regency, East Java, Indonesia. Retrieval of research data was done using interview techniques. Respondents who participated in this study were 106 pairs of mother and child respondents who met the research restriction criteria. Subjects were divided into 5groups based on diagnosis of leprosy and area of living. Bivariate analysis was performed by comparing the independent variables in each group A, B, C, and D with group E.

Results

It was found that the variables that differed significantly between the endemic and non-endemic areas were the variable number of children with a p-value=0.004, family income with a p-value=0.049 and the variable mother's education with a p-value=0.016. Meanwhile, other variables do not have significant difference.

Conclusions

We found significant difference on the number of children, father's education, mother's education, and family income. These variables can be a risk factor for leprosy. To make efforts to prevent the transmission of leprosy, stakeholders should consider these factors.

Structural Model of Maternal Behavior in Community Setting to Prevent Low Birth Weight in East Nusa Tenggara, Indonesia

Low birth weight (LBW) is still a magnitude problem in Indonesia with a multifactorial causes. Studies revealed that one of cause of LBW-infants birth is mother's behavior in treating her pregnancy, including traditional pregnancy care practices. The purpose was to develop the structural model on community setting that might describe the LBW infants-birth. A case-control study on 50 post-partum mothers with LBW and 50 with normal birthweight infants was held in Kupang, East Nusa Tenggara, Indonesia, November 2016 - May 2017. Mother who have spontaneous birth, singleton, and received integrated ANC were inlcuded. Several data such as maternal characteristics, pregnancy knowledge, perceived behavioral control (PBC), maternal health status, obedience to traditional pregnancy care, were collected using questionnaire and medical records tracing. Statistical analysis was performed using path analysis from SmartPLS 3.2.7 and considered significant path when the coefficients were not zero with P value <0.05. Outer and inner model analysis showed two significant paths, both are come from maternal characteristic that influence the LBW infants-birth through pregnancy knowledge (0.489, P=0.000) and PBC (0,425, P=0,000). In the first path, PBC affect maternal health status (0.217, P=0.021) which in turn will cause LBW (0.201, P=0.001). The second path, PBC affect the obedience to traditional pregnancy care (0.474, P=0.000) and then influence to LBW (0.316, P=0.000). As conclusion, maternal characteristics, pregnancy knowledge, PBC, maternal health status, and obedience to traditional pregnancy care are key points that might be used as a significant variables in preventing LBW-infants birth.

Instrumental music therapy reduced depression levels in stroke patients

Background: Stroke is the fifth cause of death and disability, leading also to depression. However, depression in stroke patients is hardly handled optimally. The purpose of this study therefore is to determine the effectiveness of instrumental music therapy in reducing depressive symptoms in stroke patients.

Design and methods: It used a quasi-experiment pre-post design with a simple random sampling with 59 respondents. The respondents were divided into 3 groups as follows; group A (standard treatment), group B (instrumental music therapy), and group C (combined treatment).

Results: The results show that the combined treatment provided the most significant influence on reducing the level of depression (P=0.001) with a contribution of 68.6% compared to the group A which was given standard treatment (P=0.001) with a contribution of 61.7%. Instrumental music therapy had no effect (P=0.986), though it contributed most among the three interventions, specifically 82.6%.

Conclusions: The study recommended further improvement to include music as treatment options for reducing depression among stroke patients.

Health risks associated with high waist circumference: A systematic review

Obesity is a health disorder characterized by an increase in body weight, measured by waist circumference. High waist circumference is linked to potential development of non-communicable diseases. A systematic review study was used to explore health risks of high waist circumference through Google Scholar, Science Direct, Pubmed, and Proquest. Findings show that high waist circumference increased the risks of developing hypertension, type 2 diabetes mellitus, hypercholesterolemia, joint pain, low back pain, and hyperuricemia. It is recommended that government increase their role in raising public awareness to maintain healthy lifestyle.

Structural Model of Maternal Behavior in Community Setting to Prevent Low Birth Weight in East Nusa Tenggara, Indonesia

Low birth weight (LBW) is still a magnitude problem in Indonesia with a multifactorial causes. Studies revealed that one of cause of LBW-infants birth is mother's behavior in treating her pregnancy, including traditional pregnancy care practices. The purpose was to develop the structural model on community setting that might describe the LBW infants-birth. A case-control study on 50 post-partum mothers with LBW and 50 with normal birthweight infants was held in Kupang, East Nusa Tenggara, Indonesia, November 2016 – May 2017. Mother who have spontaneous birth, singleton, and received integrated ANC were inlcuded. Several data such as maternal characteristics, pregnancy knowledge, perceived behavioral control (PBC), maternal health status, obedience to traditional pregnancy care, were collected using questionnaire and medical records tracing. Statistical analysis was performed using  path analysis from SmartPLS 3.2.7 and considered significant path when the coefficients were not zero with P value <0.05. Outer and inner model analysis showed two significant paths, both are come from maternal characteristic that influence the LBW infants-birth through pregnancy knowledge (0.489, P=0.000) and PBC (0,425, P=0,000). In the first path, PBC affect maternal health status (0.217, P=0.021) which in turn will cause LBW (0.201, P=0.001). The second path, PBC affect the obedience to traditional pregnancy care (0.474, P=0.000) and then influence to LBW (0.316, P=0.000). As conclusion, maternal characteristics, pregnancy knowledge, PBC, maternal health status, and obedience to traditional pregnancy care are key points that might be used as a significant variables in preventing LBW-infants birth.

Indicators and Index of Elderly Well-Being to Support an Age–Friendly City

Introduction: Increasing the life expectancy of the elderly raises complex problems concerning the life aspects of the elderly, family, community, and government. A well-being indicator for the elderly is needed as a measurement tool to facilitate Indonesian elderly individuals to becoming more prosperous. The purpose of this study was to develop well-being indicators and to formulate the elderly well-being Index.Methods: This study used an explanatory research design with a quantitative approach. In total, 400 respondents were collected using multistage random sampling. The physical well-being variable used the Mini-Mental State Examination (MMSE) instrument, Barthel’s index, and the Disease Complaint questionnaire. In addition, a psychology and social well-being instrument, social well-being instrument, and spiritual instrument were employed. Confirmatory Factor Analysis was used to verify the factor structure of all of the observed variables.Results: The results showed that the indicators for elderly well-being are demographic with the following factor loading: (λ) 0.32, social environment (λ)=0.51, health services (λ)=0.55, physical well-being (λ=0.36 psychological well-being (λ)=0.46, social well-being (λ)=0.45 and spiritual well-being (λ)=0.50. The indicators and index can be used as an effort to drive the program, so then the elderly can become productive, prosperous, and meaningful.Conclusion: The elderly well-being index is expected to be a programmatic instrument that can measure and evaluate the welfare of the elderly. This will increase the elderly health program that is available to achieve more holistic well-being and an age-friendly city. 

VIABILITY STATUS OF DIABETES MELITUS PATIENTS WITH COMPLICATIONS OF HYPERGLYCEMIA, CETOASIDOSIS, AND GANGRENE

Background: Indonesia ranked the seventh position of the most diabetes patients among other countries. Several risk factors affected the viability of diabetes mellitus patients, such as sex, age, type of DM, obesity, diet program, and family history of DM. Purpose: This research aims to analyze the variables that affect the viability of diabetes mellitus patients with complications. Methods: This research used descriptive analytic research with cross-sectional research design. The population used in this research was diabetes mellitus patients with complications (hyperglycemia, ketoacidosis, and gangrene) who were hospitalized at X Hospital in Madiun, which recorded in January-December 2018. This research used a total sample with data obtainment techniques used medical records data sources of diabetes mellitus patients with complications (hyperglycemia, ketoacidosis, and gangrene) which recorded in January-December 2018 and observed until January 2019. The analysis technique used was survival analysis using Kaplan Meier, Breslow, and Cox regression. Results: The characteristics of respondents were the majority were 60 years old and over (53.70%) and were female respondents (63%). Based on the research results of several variables, only diet program variable which was significant among all independent variables (p = 0.01; HR = 3.74; 95% CI = 1.65 <OR <8.48), which suspected to affect the viability of diabetes mellitus patients with complications (hyperglycemia, ketoacidosis, and gangrene). Conclusion: The most influential risk factor is diet program.

The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding

The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.

Dengue Haemorrhagic Fever and House Conditions in Kupang City, East Nusa Tenggara Province

Kupang City has the highest Incidence of DHF in East Nusa Tenggara and also higher than the national figure. This study aims to analyze the relationship between housing conditions and the DHF incidence in the Kupang City. This observational study uses a case-control study in 25 villages with a total sample of 500 people. Data is analyzed using t test and chi square test. The house conditions were significantly related to the DHF incidence (p≤0.05), namely house lighting, water usage, wall construction, ventilation area and ownership of clean water facilities. People are advised to ventilate the house ≥10% of the floor area and often open the house ventilation as a place for air exchange and for entering the light into the house. Construction of the wall is expected to be repaired to be more permanent or close the open part so not as a mosquitoes path into the house. The government is advised to increase access to clean water for the community and promote to always clean water reservoirs and not hold water for a long time.

Individual and neighborhood socioeconomic status in the prediction of liver transplantation among patients with liver disease: A population-based cohort study in Taiwan

Given the fact that >80% of liver transplantations (LTs) were living donor liver transplantation (LDLT) in Taiwan, we conducted this study to assess whether patients with lower socioeconomic status are subject to a lower chance of receiving hepatic transplantation.This was a cohort study including 197,082 liver disease patients admitted in 1997 to 2013, who were at higher risk of LT. Personal monthly income and median family income of living areas were used to indicate individual and neighborhood socioeconomic status, respectively. Cox proportional hazard model that considered death as a competing risk event was used to estimate subdistribution hazard ratio (sHR) of LT in association with socioeconomic status.Totally 2204 patients received LT during follow-up, representing a cumulative incidence of 1.12% and an incidence rate of 20.54 per 10 person-years. After adjusting for potential confounders, including age, sex, co-morbidity, location/urbanization level of residential areas, we found that patients with < median monthly income experienced significantly lower incidence of LT (aHR = 0.802, 95% confidence interval (CI) = 0.717-0.898), but those with >- median monthly income had significantly elevated incidence of LT (aHR = 1.679, 95% CI = 1.482-1.903), as compared to those who were not actively employed. Additionally, compared to areas with the lowest quartile of median family income, the highest quartile of median family income was also associated with significantly higher incidence rate of LT (aHR = 1.248, 95% CI = 1.055-1.478).Higher individual and neighborhood socioeconomic status were significantly associated with higher incidence of LT among patients with higher risk of LT.

Clinical Outcome of Patients with Diffuse Axonal Injury Receiving Adrenocorticotropin Analogue at Dr. Soetomo Hospital

Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.

Exploring Midwives' Need and Intention to Adopt Electronic Integrated Antenatal Care

Documentation requirements for the Indonesian integrated antenatal care (ANC) program suggest the need for electronic systems to address gaps in existing paper documentation practices. Our goals were to quantify midwives' documentation completeness in a primary healthcare center, understand documentation challenges, develop a tool, and assess intention to use the tool. We analyzed existing ANC records in a primary healthcare center in Bangkalan, East Java, and conducted interviews with stakeholders to understand needs for an electronic system in support of ANC. Development of the web-based Electronic Integrated ANC (e-iANC) system used the System Development Life Cycle method. Training on the use of the system was held in the computer laboratory for 100 midwives chosen from four primary healthcare centers in each of five regions. The Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire was used to assess their intention to adopt e-iANC. The midwives' intention to adopt e-iANC was significantly influenced by performance expectancy, effort expectancy and facilitating conditions. Age, education level, and computer literacy did not significantly moderate the effects of performance expectancy and effort expectancy on adoption intention. The UTAUT results indicated that the factors that might influence intention to adopt e-iANC are potentially addressable. Results suggest that e-iANC might well be accepted by midwives.

THE ADAPTATION MODEL OF CARE GIVER IN TREATING FAMILY MEMBERS WITH SCHIZOPHRENIA IN KEDIRI EAST JAVA

Introduction: Schizophrenia is a severe mental disorder that is characterized by impaired reality (hallucinations and delusions), inability to communicate, affect unnatural or blunt, cognitive disorders (not capable of abstract thinking) and had difficulty doing daily activities. Normally, the family is most affected by the presence of people with schizophrenia in their families. The purpose of this study was to develop an adaptation model of the caregiver in caring for family members with schizophrenia in Kediri. Methods: This study used cross-sectional design with nature explanatory research. Data were collected using a questionnaire on 135 respondents in nine health centers in the city of Kediri region. The sampling technique used simple random sampling. For data analysis and test, the feasibility used a test model of SEM with AMOS program 19. Results: The results showed self esteem caregiver (-0.25 <0.05), community resources (0.24 <0.05), self-efficacy (0.22> 0.05) , caregiver coping effort (12:17 <0.05), and the perception of caregiver about the family situation at this time (0:19 <0.05), which means that adaptation of caregiver in treating patients with schizophrenia is influenced by the characteristics of the family, namely community resources, self-efficacy, caregiver coping effort, self-esteem and perception of family caregiver to the conditions experienced at this time. Perception of caregiver about the condition of today's families is affected by stress, which appears on a caregiver stress due to stressor for caring for people with schizophrenia, especially the aggressive behavior of schizophrenics. Discussion: Adaptation of caregiver was highly influential in the care of people with schizophrenia because in this case becomes one of the important points to be able to sustain the process of treatment and prevent relapse of schizophrenics.

Development of Predictive Index for Default Treatment At Multibacillary Leprosy in District Sampang

ABSTRACTDefault relating to the regularity of treatment in the patients taking the drugs. If the leprosy patients taking medication irregularly, then the leprosy bacteria can become resistant or immune to Multy Drug Therapy, so the symptoms persist and even worsen. The purpose of this study was to determine the indicators and develop a predictive index formula default incidence of leprosy treatment. This type of research was a case control design. The sample size in this study was 62 respondents. The sampling technique in this study used simple random sampling technique. Data collection techniques done with interviews with the questionnaire. The results showed that a candidate indicator variables (p <0.25) is income (p value = 0.013), access to health care (p value = 0.022), the role of health workers (p value = 0.032), knowledge (p value = 0.001), and family support (p value = 0.023), perception of the disease (p value = 0.098), leprosy reactions (p value = 0.198). Variables as indicators of default treatment of leprosy patients are the role of health workers, family support, knowledge, and income. The predictive index of default treatment at multibacillary leprosy patients are (-1666+ 1451 * Revenues (low) + 1989 * Role of Health Personnel (less instrumental) + 1.338 * Knowledge (less) + 1543 * Support Family (unfavorable). This index has a 79% accuracy rate. This index is expected to be used as a measuring tool in helping health workers to screen patients with leprosy who are undergoing treatment, so early can know where the potential patients defaulting treatment.Keywords: indicators, predictive index, default of treatment, leprosy, multibacillary

Development of Predictive Index for Default Treatment At Multibacillary Leprosy in District Sampang

Default relating to the regularity of treatment in the patients taking the drugs. If the leprosy patients taking medication irregularly, then the leprosy bacteria can become resistant or immune to Multy Drug Therapy, so the symptoms persist and even worsen. The purpose of this study was to determine the indicators and develop a predictive index formula default incidence of leprosy treatment. This type of research was a case control design. The sample size in this study was 62 respondents. The sampling technique in this study used simple random sampling technique. Data collection techniques done with interviews with the questionnaire. The results showed that a candidate indicator variables (p <0.25) is income (p value = 0.013), access to health care (p value = 0.022), the role of health workers (p value = 0.032), knowledge (p value = 0.001), and family support (p value = 0.023), perception of the disease (p value = 0.098), leprosy reactions (p value = 0.198). Variables as indicators of default treatment of leprosy patients are the role of health workers, family support, knowledge, and income. The predictive index of default treatment at multibacillary leprosy patients are (-1666+ 1451 * Revenues (low) + 1989 * Role of Health Personnel (less instrumental) + 1.338 * Knowledge (less) + 1543 * Support Family (unfavorable). This index has a 79% accuracy rate. This index is expected to be used as a measuring tool in helping health workers to screen patients with leprosy who are undergoing treatment, so early can know where the potential patients defaulting treatment.Keywords: indicators, predictive index, default of treatment, leprosy, multibacillary