Expanding self-consciousness of health status for diabetes chronic complications among adults: a systematic review

OBJECTIVE

Self-consciousness is defined as a subject (I) then becomes the object (Me) associated with a present moment of self-experience in which one is aware of their experience without any reflexive judgment attached, a state commonly investigated in mindfulness studies. On the other hand, self-consciousness is viewed as a reflexive experience and, thus, as a synonym for self-reflection. Self-consciousness is an important determinant of behaviors. Expanding self-consciousness is important among adults with diabetes to optimize health prevention and compliance with diabetes self-management in the long term. The chronic complications of diabetes comprise heart disease, stroke, nephropathy, retinopathy, and neuropathy. This review aims to explain the relationship between self-consciousness and chronic diabetes complications.

MATERIALS AND METHODS

An electronic literature search was conducted in the English language in several databases. The Joanna-Briggs Institute was referenced for the quality assessment of case studies, cohort and cross-sectional studies, and qualitative studies, while systematic reviews were evaluated through PRISMA-S. Results were reported according to the PRISMA guidelines.

RESULTS

A total of 89 studies related to self-consciousness of diabetes chronic complications were not found. However, many findings related to chronic complications are based on a lack of knowledge of diabetes and long-term self-management. People with less education, multiple comorbidities, and cognitive dysfunction need lifestyle changes to prevent diabetes and chronic complications.

CONCLUSIONS

Future research should be oriented toward assessing the risk of chronic diabetes complications. Our findings suggest that research should expand self-consciousness and caring partnerships to improve self-consciousness and patients' obedience.

How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia

While Indonesia introduced a national health insurance scheme (JKN) in 2014 and coverage has grown to over 80% of the population, Indonesians still spend significant sums out-of-pocket (OOP) for their healthcare-over 30% of current health expenditure (CHE). This study aims to better understand how JKN is influencing OOP payments, especially among the poor and rural, at the range of health facilities. This study uses data from the National Socio-Economic Survey (SUSENAS) in 2018 and 2019, as these surveys started including a question on how much OOP spending a household incurs on health. The results show that households with JKN membership are far less likely than the uninsured to pay OOP for healthcare, and that if they do incur a cost, the magnitude of this cost is much lower among JKN households than uninsured ones. The results also show that JKN households in the two poorest quintiles have a higher probability to not incur any OOP (37% and 35%, respectively) compared to those in the wealthier quintiles 4 (32%) and 5 (30%). Poorer JKN households living in the eastern part of Indonesia-the less urbanized and developed regions-experienced the most cost-savings, though largely due to supply-side constraints. In fact, JKN members save more at public primary health care facilities vs. private ones (who often do not contract with JKN) and also save significantly more (over 50%) than uninsured households at both public and private hospitals. The study demonstrates the positive influence JKN has on OOP payments, especially among the poor and rural, but also highlights how the scheme needs to better engage with the growing private sector and invest in infrastructure in rural areas to help secure financial protection for its entire population.

A policy-making strategy to forecast outcomes of drug development in Indonesia

Purpose

The pharmaceutical industry in Indonesia appears hesitant to make the transition from inventor to innovator and instead continues with the process of formulation and packaging. Evidence-based policy has been advocated for Indonesia and, in general, this is more likely to hold. This study aims to establish a model for a policy-making process that is strategically able to predict strategies that would encourage drug development in Indonesia.

Design/methodology/approach

A quantitative approach with the survey method was designed to obtain appropriate data from a population of pharmaceutical industries in Indonesia and relevant government institutions to assess the relationship of various factors capable of triggering domestic drug development, including pharma capability, political feasibility and innovation incentives. The construct was validated using a set of techniques pertaining to the calculation of structural equation modeling.

Findings

The model demonstrates how it matters when applied to the policy-making process. It proves that pharma capability, political feasibility, and innovation incentives correlated to pharma capability are major catalysts in the promotion of drug development. These are largely explained by market opportunity, pull factors, government power, and position. Although all of the elements were moderately to strongly related to the promotion of drug development, this study has revealed the predictive impact on drug development in Indonesia to be only 46%.

Originality/value

This study adds values to policy-makers as it attempts to predict strategies that would encourage a successful policy when being implemented. Encompassing both pharma industries and government institutions, this study captures a real situation and provides an empirical contribution to the concept of the integrated research of drug development in developing countries.

Kondisi Kesehatan Masyarakat yang Bermukim di Daerah Tertinggal : Kasus dari Bengkulu, Sulawesi Selatan, dan Nusa Tenggara Timur

Abstract  The condition of public health in disadvantaged areas has become a public highlight lately such as the high prevalence of child malnutrition and infectious diseases. This can be related to the lack of utilization of health services and the health behavior of the community itself. This study aims to provide a more comprehensive picture of clean and healthy living behaviors, health conditions, and the use of health services in disadvantages areas. Inference is made based on primary data collected at the household-level and public primary health centre in areas  classified as disadvantaged, border and outer islands (DTPK) based on Presidential Decree Number 131 year 2015, and areas with the need for health workers, some of which are locations for the Nusantara Sehat (NS) program placement This study uses quantitative methods and analysis used in the form of descriptive analysis. The results show that most households have adopted some of the clean healthy behaviors that were implemented by the Ministry of Health. Almost all households know the location of the public health centre for treatment, but 47% of patients did not find a doctor when visiting the public health centre.It was also found that 36% of households choose to seek selt-medication when sick. For maternal and child health, it is known that already 66% of deliveries are assisted by midwives, and most of children under five years have received basic immunisation. What still needs to be improved is the knowledge of health and housing infrastucture that supports clean and healthy living. Suggestion for  policymakers to equalize the distribution of health workers and to innovate health promotion programs in advantaged areas. Abstrak Kondisi kesehatan masyarakat di daerah tertinggal menjadi soroton publik belakangan ini seperti tingginya prevalensi gizi buruk pada balita maupun penyakit infeksi. Hal tersebut bisa dikaitkan dengan kurangnya pemanfaatan pelayanan kesehatan maupun perilaku kesehatan masyarakat itu sendiri. Kajian ini bertujuan untuk memberikan gambaran yang lebih komprehensif tentang perilaku hidup bersih dan sehat, kondisi kesehatan, serta penggunaan pelayanan kesehatan di daerah tertinggal. Inferensi dibuat berdasarkan data primer yang dikoleksi di tingkat rumah tangga dan puskesmas di daerah yang tergolong daerah tertinggal, perbatasan, dan kepulauan terluar (DTPK) berdasarkan Peraturan Presiden (Perpres) No. 131 tahun 2015 dan daerah berkebutuhan tenaga kesehatan yang beberapa diantaranya menjadi lokasi penempatan program Nusantara Sehat. Metode penelitian ini menggunakan metode kuantitatif dan analisis yang digunakan berupa analisis deskriptif. Hasil kajian menunjukkan bahwa sebagian besar rumah tangga telah mengadopsi sebagian perilaku hidup bersih dan sehat seperti yang dicanangkan Kementrian Kesehatan RI. Hampir semua rumah tangga mengetahui lokasi Puskesmas untuk berobat, tetapi 47% pasien tidak menemukan dokter saat berkunjung ke puskesmas. Ditemukan juga bahwa 36% rumah tangga memilih untuk berobat sendiri ketika sakit. Untuk kesehatan ibu dan anak, diketahui bahwa sudah 66% persalinan dibantu oleh bidan dan sebagian besar balita telah menerima imunisasi dasar. Hal yang masih perlu ditingkatkan adalah pengetahuan tentang kesehatan dan prasarana rumah yang menunjang perilaku hidup bersih sehat. Saran bagi pembuat kebijakan untuk melakukan pemerataan distribusi tenaga kesehatan maupun menginovasikan program promotif kesehatan di daerah tertinggal.

The Diabcare-Asia 1998 study--outcomes on control and complications in type 1 and type 2 diabetic patients

The aim of this study was to describe the glycaemic and metabolic control and diabetes-related complications in type 1 and type 2 Asian patients.

METHODS

Data of diabetes patients from 230 diabetes centres in 12 Asian regions were collected on a retrospective-prospective basis through review of medical records, interview and laboratory assessments. Analysis of glycated haemoglobin (HbA1c) was carried out in central laboratories appointed by Bio-Rad. The data collection case record forms were scanned electronically.

RESULTS

22177 patients with valid data made up the analysis population. Among patents with type 1 and type 2 diabetes, there was a higher proportion of women than men (53% vs. 47% for type 1 patients and 56% vs. 44% for type 2 diabetes). Hypertension (61%) and overweight (40% with BMI > or = 25 kg/m2 were common in type 2 patients. Dyslipidaemia was also present in at least half of both types of patients. Control of glycaemia (mean HbA,1c and fasting blood glucose [FBG]) was poor in type 1 (9.9 +/- 2.5%; 10.2 +/- 5.2 mmol/l) and type 2 patients (8.5 +/- 2.0%; 8.9 +/- 3.4 mmol/l). Glycaemia in the majority of both types of patients fell short of those stipulated by various guidelines. In type 2 patients, glycaemia deteriorated (HbA1c > 7.5%, FBG > or = 7.0 mmol/l) with duration of diabetes > 7 years. Both types of diabetes appear to share a similar high prevalence of complications of cataract, retinopathy and neuropathy, although the prevalence of cataract (27%) and neuropathy (35%) was higher in type 2 diabetes. Screening for microalbuminuria was not common.

CONCLUSIONS

The Inadequate metabolic and hypertension control, especially in type 2 patients, needs to be addressed.