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Background: Spending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country. Methods: We adopted a mixed-method approach to gather information from all relevant stakeholders from December 2022 to June 2023. For the qualitative approach, we conducted (a) in-depth interviews (IDIs) and (b) focus group discussions (FGDs) with government officials at national and district levels, academics, professional organizations, healthcare workers in primary healthcare centres (PHCs), community health volunteers, non governmental organizations and private companies. For the quantitative approach, we applied a national online survey to healthcare workers involved in health promotion in PHCs. IDIs and FGDs were conducted with purposefully selected resource persons at the national level, five selected districts across Indonesia, and within 15 primary health offices and their communities. All qualitative data were recorded, transcribed, coded, interpreted, and then triangulated with national survey findings to develop the financing framework. Results: We identified gaps between the theory and practice of health promotion and disease prevention. These included the limited scope of health promotion initiatives, lack of direction and coordination between ministries, agencies and government levels, limited availability and capacity of health promoters, various yet uncoordinated funding resources and inflexibility in using the funds. To bridge the gap, the framework we developed suggests strengthening the legal and regulatory basis, strategically prioritizing financing arrangements, promoting evidence-based health promotion activities, developing the capacity of health promoters, enhancing the health financing information system and improving monitoring and evaluation. Conclusions: Identified gaps and challenges in health promotion and disease prevention initiatives inform the development of our framework for future health promotion financing. This framework assists the national government in organizing national health promotion financing strategies and potentially serves as a valuable model for other LMICs. [ABSTRACT FROM AUTHOR]

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Introduction: Spinopelvic parameter may result in the development of degenerative spondylolisthesis. However, previous studies show conflicting results; some found a significant relationship of some of these parameters with degenerative spondylolisthesis, while others did not. Previously, there was no meta-analysis regarding the association between spinopelvic alignment and degenerative spondylolisthesis. This meta-analysis aims to determine the association between spinopelvic alignment and degenerative spondylolisthesis. Methods: Systematic reviews and meta-analyses are based on the selected item reporting method for systematic review and meta-analysis (PRISMA). A literature search was performed using PubMed, EMBASE, ScienceDirect, Cochrane, and Google Scholar. Methodological quality is based on the cross-sectional checklist of the Agency for Healthcare Research and Quality (AHRQ) quality check methodology and the Newcastle–Ottawa scale (NOS) for cohort studies. Statistical analysis was performed using Rev-Man 5.3. Subgroup analyses were performed based on ethnicity and study design to ascertain racial relations and heterogeneity. Results: A total of 3236 articles were obtained. Of these, we found that pelvic incidence (mean difference [MD] = 11.94 [1.81–22.08], P = 0.02), pelvic tilt (MD = 4.47 [0.81–8.14]), P = 0.02), and age (MD = 11.94 [1.81–22.08], P = 0.02) were associated with the development of degenerative spondylolisthesis. Conclusion: This meta-analysis proves that pelvic incidence, pelvic tilt, and age are associated with degenerative spondylolisthesis. [ABSTRACT FROM AUTHOR]

The first 1000 days of life constitute a critical phase that will determine the optimum growth and development of a child. An important factor in this phase of life is the perinatal mental health of mothers and children. Mental health awareness is an important public health issue with significant impacts on mothers, spouses, and families, as well as the long-term emotional and cognitive development of children as well. However, the awareness and promotion of mental health within the realms of reproductive health, maternal health, and infant health, i.e., the first 1000 days of life, do not receive high prioritization in Indonesia. Nonetheless, Indonesia, with its existing primary healthcare system, has the potential to raise awareness of and promote the importance of perinatal mental health for its citizens. This experts' consensus proposes several strategies to maximize the usefulness of primary healthcare facilities in Indonesia, including Community Health Centers and Integrated Healthcare Posts, to support perinatal mental health awareness and promotion during the first 1000 days of life. The success of this program, in return, will improve the health status of women and children in Indonesia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-empowerment-based patient-centered services with a coaching approach are imperative in the management of students with obesity. This study evaluated the applicability and effectiveness of self-empowerment-based patient-centered coaching for the weight loss program model for obese students. MATERIALS AND METHODS: This randomized control trial recruited 60 obese students aged 17--22 years in Universitas Indonesia from August to December 2021. Intervention group subjects were coached by a health coach. Each health coach assisted four subjects with SMART model coaching in six meetings every 2 weeks through a zoom platform. Both groups had instructions on obesity, nutrition, and physical activity from specialist doctors online. Paired t-test or Mann-Whitney test, as appropriate, to compare the measurements of anthropometry, body composition (bioelectrical impedance analysis), food intake (food record form), physical activity (physical activity form), subjective well-being (subjective well-being questionnaire), and healthy behavior habits (satisfaction scale) between the two groups before and after the intervention. RESULTS: A total of 41 obese students completed the study, 23 from intervention group and 18 from the control group. The change in total body fat (-0.9 [-12.9, 0.70] vs. 0.0 [-6.9, 3.50], P = 0.02) and healthy behavior habit (13.5 ± 11.85 vs. 7.5 ± 8.08, P = 0.04) in the intervention group was significantly greater than in the control group. The change in satisfaction scale of hobby/passion (2 [-4.6] vs. 1 [-2.2], P = 0.02), movement exercise (2.3 ± 2.11 vs. 1.2 ± 1.93, P = 0.03), sleep rest (2 [-6.5] vs. 1 [-3.2], P = 0.01), and spiritual (1 [0.6] vs. 0 [-1.3], P = 0.00) was significantly higher in the coached group. CONCLUSION: A weight loss program for obese students was tested through self-empowerment-based patient-centered care with a coaching approach and has proven to effect changes in anthropometric indicators, body composition, self-empowerment, food intake, and physical activity. [ABSTRACT FROM AUTHOR]

Introduction: Noncommunicable diseases (NCDs) are still a major public health problem in Indonesia. Studies have shown that risk factors of NCDs are associated with coronavirus disease 2019 (COVID-19) severity and mortality. However, it is unclear whether NCD risk factors are also risks for new COVID-19 cases. This study aimed to obtain an NCD risk profile among university employees and its associations with contracting COVID-19. Methods: A cross-sectional study was conducted in October 2021. Participants were administrative employees of Universitas Indonesia (UI), Depok City, West Java. Assessment of NCD risk factors was based on the World Health Organization STEPwise approach to NCD risk factor surveillance (WHO STEPS). Demographic, working, and medical-history data were obtained electronically by using a Google Form. Physical and laboratory examinations were done in the Integrated Post for NCDs. Risks were expressed as adjusted odds ratio (ORadj) and 95% confidence interval (CI) in multivariate analyses. Results: A total of 613 employees were enrolled. Men were predominant (54.8%), and about 36% of them work in shift as security personnel. About 66.7% were overweight or obese and 77.8% had hypertension. There were 138 (22.8%) employees who had COVID-19. Nearly all (95.6%) had been fully vaccinated against COVID-19. At-risk waist circumference (ORadj 1.72, 95% CI 1.15–2.56, p = 0.008) and total cholesterol level of 200–239 mg/dL (ORadj 2.30, 95% CI 1.19–4.44, p = 0.013) were independent risk factors, but shift work (ORadj 0.52, 95% CI 0.34–0.80, p = 0.003) was protective against COVID-19. Conclusion: The prevalence of NCD risk factors among university administrative employees was high, increasing the risk of contracting COVID-19. A behavioral intervention program to manage NCD risk factors at the university level is urgently needed according to the Health Promoting University framework. [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity have increasingly been recognized as a significant global public health crisis, including in Asia. This study aimed to assess the obesogenic environment in primary schools in Jakarta, Indonesia. Methods: A qualitative, multi-site, case study design was used to capture different elements of the school environment and policies related to obesity, with a focus on nutrition and physical activity. An adaptation of the Primary School Environmental Assessment tool was used. Six primary schools in Jakarta were purposively selected based on their location, socioeconomic status, and type (public or private). In addition to direct observation at each school, interviews were conducted with the principal, physical education teacher, canteen staff, street food vendors, and students. Results: Among the six schools, two were private and four were public. The most popular foods consumed by students were unhealthy, such as deep-fried foods and sugar-sweetened beverages. Students had easy and constant access to unhealthy foods, whereas only limited variation of healthy foods were available in the school canteen. Some schools also allowed the student to have access to street food vendors. School policies related to healthy eating and physical activities had been implemented, mainly in the form of teaching these topics as part of the school curriculum. However, promotion of healthy eating and physical activities by the schools was still limited. Conclusions: This study showed the usefulness of the Primary School Environmental Assessment tool in identifying obesogenic factors in urban area of Indonesia. Effective implementation of guidelines to foster good nutritional practices and healthy lifestyles at school should be prioritized to improve the health and nutritional status of the students. [ABSTRACT FROM AUTHOR]

Introduction: The potential role of medical students in raising awareness during public health emergencies has been acknowledged. To further explore their potentials as public educators and role models for the communities during the coronavirus disease 2019 (COVID-19) pandemic, this study aims to assess the knowledge, attitude, and practice of these students toward COVID-19. Methods: An online cross-sectional survey was conducted among undergraduate medical students in Indonesia. Socio-demographics characteristics, social interaction history, information-seeking behavior, as well as knowledge, attitude, and practice toward COVID-19 were collected through a self-reported questionnaire. A p-value of <0.05 indicated statistical significance. Results: Out of 4870 respondents, 64.9% had positive attitude and 51.5% had positive practice toward COVID-19, while only 29.8% had adequate knowledge. Knowledge was slightly positively correlated with attitude and practice (ρ = 0.074 and ρ = 0.054, respectively; both p<0.001), while attitude was weakly correlated with practice (ρ = 0.234, p<0.001). Several factors including age, sex, place of residence, institution type, academic level, family income, history of chronic illness, prior volunteering experience, and perceptual awareness on COVID-19 were significantly associated with either knowledge, attitude, and/or practice toward COVID-19. Furthermore, health institution's and the government's press releases, as well as health expert opinions were deemed as the most reliable sources of COVID-19-related information–yet trivially none of these sources were associated with knowledge, attitude, and practice in the study population. Conclusion: Many undergraduate medical students in Indonesia had positive attitude and practice against COVID-19, yet only a few had adequate knowledge. This warrants further interventions to keep them updated with COVID-19 evidence to maximize their potentials in raising public awareness on COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: visuospatial is a type of high-level visual perception necessary for identification, information integration, analysing of visual and spatial forms, details, structures and spatial relation. These functions are required in order to successfully complete aviation-related tasks, such as analysing movement, distance perception, and spatial navigation. The aim of this study is to examine whether hypobaric hypoxia can significantly influence changes in visuospatial function, thus increasing the risk of accident or serious incident during flight operation. Methods: this study is a quasi-experiment of pre-post study including before and after hypobaric hypoxia simulated through an altitude chamber. In this study, 42 military aircrews were exposed to different altitude zones at ground level, 10,000 ft (ft) and 25,000 ft respectively, for five minutes. At each altitude zone, the participants were instructed to complete a clock drawing test as a measurement for visuospatial function. The results were analysed using the McNemar non-parametric test. Results: among the 42 subjects, six show impaired visuospatial function at 10,000 ft and 26 participants show it at 25,000 ft. There were significant increased on the proportion of impaired visuospatial function between the ground level to 10,000 ft (p=0.031), 10,000 to 25,000 ft (p=0.0001) and ground level to 25,000 ft (p=0.0001). Conclusion: hypobaric hypoxia may have a significant influence on visuospatial function, starting from as early as 10,000 ft to 25,000 ft. This decrease of visuospatial function could affect human cognitive performance when flying and increase the risk of aviation accidents. [ABSTRACT FROM AUTHOR]

Aim: To screen for ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods: A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 h after birth using the RetCam shuttle (Natus Medical Incorporated, USA). Retinal findings were documented and analyzed according to obstetric and neonatal risk factors. Results: Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common finding (88%) in which 2.67% involved the macula, followed by chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18–0.41, p < 0.001) was a protective factor against RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24–2.72, p = 0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19–0.44, p < 0.001), while other risk factors were not. Conclusions: Our study showed that universal eye screening in healthy neonates is beneficial in the early diagnosis, monitoring and treatment of ocular abnormalities such as retinal hemorrhage, chorioretinitis and retinoblastoma. Retinal hemorrhage is the most common ocular abnormality and is associated with the delivery method and the duration of labor. Universal eye screening is visual-saving and life-saving for neonates with chorioretinitis, retinoblastoma as well as other abnormalities and should be mandatory in newborn screening. [ABSTRACT FROM AUTHOR]

Background: The question to involve or restrict medical students' involvement in the coronavirus disease 2019 (COVID-19) pandemic response remains contentious. As their state of preparation and perceptions in volunteering during this pandemic have yet to be investigated, this study aims to evaluate Indonesian medical students' willingness to volunteer and readiness to practice during the COVID-19 pandemic. Methods: A web-based survey was conducted among undergraduate medical students throughout Indonesia. Socio-demographic and social interaction information, in addition to willingness to volunteer and readiness to practice, were obtained using a self-reported questionnaire. The significance level was set at 5%. Results: Among 4870 participants, 2374 (48.7%) expressed their willingness to volunteer, while only 906 (18.6%) had adequate readiness to practice. Male students, students with prior volunteering experience in health or non-health sectors, and students from public universities or living in Central Indonesia (vs Java) had higher scores of willingness and readiness to volunteer. Students from Sumatra also had better preparedness (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.15–2.12, p = 0.004), while the opposite occurred for students from Eastern Indonesia (OR 0.63, 95% CI: 0.44–0.89, p = 0.002)–when compared to students from Java. In addition, compared to students with high family income, students from lower-middle income families were less willing to volunteer (OR 0.76, 95% CI: 0.59–0.98, p = 0.034), though those with low family income had better readiness (OR 1.51, 95% CI: 1.10–2.08, p = 0.011). Shortage of medical personnel, sense of duty, and solicitation by stakeholders were the main reasons increasing the students' willingness to volunteer; whereas contrarily fear for own's health, absence of a cure, and fear of harming patients were the primary factors diminishing their willingness to volunteer. Conclusion: Our findings indicated that many Indonesian medical students are willing to volunteer, yet only few of them were ready to practice, indicating that further preparations are required to maximize their potentials and minimize their exposure to hazards. We suggest that their potentials as a firm support system during the pandemic should not be overlooked, and that the integration of relevant courses to the medical curricula are imperative to prepare for future public health emergencies. [ABSTRACT FROM AUTHOR]

Physical exercise plays an essential role as a non-pharmacological and cost-effective treatment, improves insulin sensitivity, a better quality of life (QoL), enhances diabetes treatment efficacy, thus lowering morbidity and mortality in people with T2D. Keywords: diabetes; primary care; treatment; quality of care; comprehensive management EN diabetes primary care treatment quality of care comprehensive management 1 3 3 03/23/22 20220317 NES 220317 Currently, 537 million adults aged 20-79 years have diabetes mellitus (DM) worldwide. [Extracted from the article]

Since 2010, Indonesian government has initiated a chronic disease management program, Prolanis (Program Pengendalian Penyakit Kronis) targeted for diabetes and hypertension. The program is continued at the commencement of universal health coverage (UHC) in 2014. "This study aimed to report the utilization and cost of the implementation of Prolanis in Indonesia from 2014 to 2016, or two years since the commencement of Indonesian universal health coverage." Secondary data analysis was performed using publicly available data and data obtained from the national health insurance agency (BPJS); while data on disease prevalence were collected from basic national health survey. There was an increase trend of Prolanis participants, from around 11,000 participants in 2014 to more than 250,000 in 2016. More than 70% of participants were adults living in Java, however, the acceptance rate was very low in other area. Across different activities in Prolanis, physical activity was the most participated ones. In comparison to other regions, regions in Java were the most active area. The total expenditure for Prolanis program in 2016 increased almost triple from the annual cost in 2014. However, the cost per person was actually decreased more than 50%. Within two years of UHC implementation, there were increase covered participants and total costs, but cost per individual was decreased and there was significant difference in of cost between Java and outside Java. Further study and routine monitoring-evaluation process by health authority is needed to assess whether the cost difference would affect the service quality. [ABSTRACT FROM AUTHOR]

Background A hospital-based cancer registry can be used as Background Autoimmune thyroiditis may manifest as overt hypothyroidism, subclinical hypothyroidism, euthyroidism, or hyperthyroidism in children. Although there is no consensus on treating euthyroidism and autoimmune thyroiditis in children, some studies have demonstrated the efficacy of levothyroxine in reducing thyroid volume, improving thyroid function, and stabilizing the immunological process. Objective To determine the effect of levothyroxine on thyroid gland volume changes, thyroid function, and thyroid antibodies in euthyroid children with autoimmune thyroiditis. Methods We performed a literature search of electronic databases (the Cochrane Library, MEDLINE, EBSCO, ProQuest, clinicaltrials. gov, and other sources, as well as a non-electronic search (searching journals and conference proceedings by hand) to identify studies of euthyroid children with autoimmune thyroiditis published by August 2018. Only English-language articles were included in the search (electronic and non-electronic). Randomized controlled trials that compared levothyroxine with a control (placebo or no treatment) in euthyroid children with autoimmune thyroiditis were selected. The outcome measures were thyroid volume changes, thyroid function, and thyroid antibody levels in euthyroid children with autoimmune thyroiditis. Two authors independently extracted the data, assessed the risk of bias, and analyzed the pooled data from the included studies using a random effects model. The same authors performed a sensitivity analysis. Results We identified 57 studies. Of these, three studies, involving 97 subjects (51 subjects in an intervention group and 46 subjects in the control group) were selected for inclusion in a systematic review/ meta-analysis. The meta-analysis revealed a significant difference in mean thyroid volume changes between the two groups (-1.10 SDs; 95%CI -1.56 to -0.64; I2=6%; P<0.0001). The mean difference in the thyroid-stimulating hormone (TSH) change of the two groups was -1.82 mU/L (95%CI -3.52 to -0.11; I2=87%; P=0.04). The standardized mean difference in free thyroxine (fT4) change of the two groups was 0.82 pmol/L (95%CI -1.14 to 2.78; I2=89%; P=0.41). Conclusion In euthyroid children with autoimmune thyroiditis, levothyroxine treatment reduces the thyroid volume better. The TSH level change in the intervention group is better than those in the control group. Levothyroxine treatment did not significantly improve free T4. [ABSTRACT FROM AUTHOR]

Objectives: The study sought to evaluate near-peer tutors' teaching of critical appraisal skills to medical students as an aspect of Evidence-based Medicine. Methods: In a randomized crossover trial, 241 students completing a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module in the Faculty of Medicine Universitas Indonesia (FMUI) were randomly assigned to intervention or control groups. During tutorial sessions, intervention group participants were assigned to near-peer tutors, who were newly graduated doctors, and those in the control groups were assigned to staff tutors. After two tutorial sessions, intervention and control groups exchanged tutors for the next two sessions. Outcomes were measured using written knowledge and skills multiple choice questions (MCQ) test, the Evidence-based Practice Confidence Scale (EPIC) and a student attitude questionnaire, along with student evaluation of tutors to evaluate the process. Results: On completion of the module, the written test scores of intervention group students were similar to those of the control group (t(239) = 1.553, p=0.122), as well as overall Evidence-based Practice Confidence Scale scores (Fo/170) = 0.179, p = 0.673) and attitude scores (t(219) =-0.676, p = 0.085). In the tutor evaluations, the students rated their near-peer tutored sessions as better than those tutored by staff in most respects. Conclusions: Near-peer tutors were as effective as and more readily accepted than staff tutors in teaching critical appraisal skills. These findings support the broader implementation of peer-teaching in other areas of medical education. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. Methods The 'Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011' is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. Results Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on 'rigor of development' and 'applicability' and the lowest score in the 'scope and purpose' domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. Conclusion Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to. [ABSTRACT FROM AUTHOR]

Background In Indonesia, Family Medicine as a discipline is being developed through short courses since 12 years ago. A conversion program to become Family Physicians has been introduced recently. Among the 70,000 primary care physicians there are variety of practitioners, from new interns who start general practice to senior general practitioners. This study aims to describe the current Indonesian Primary Care Physicians (PCPs) profile which includes services provided and facilities as well as comparing the profile according to participation in the conversion program and practice hours. Methods A survey was carried out by using pre-tested, semi-structured and self-administered questionnaire among Indonesian primary care physicians (PCPs) who attended ASEAN Regional Primary Care Conference in Jakarta, November 2011. The survey elicited information regarding their practice environment, services provided, equipment, investigations provided, procedures, facilities and continuing medical education (CME) activities. Results Out of 240 PCPs participated, 65.4% (157/240) of them were family physicians and 67.1% (161/240) of them were full time practitioners (practice > 30 hours per week). Services like body mass index (BMI) measurement, substance abuse program, respiratory function test, mental health assessment, and cardiovascular assessment were provided by less than 50% of the PCPs as well as some investigations like electrocardiograph (ECG), proctoscopy, ultrasound, visual examination and funduscopy. Family Physicians significantly provided more house call services (77% vs 63%; p = 0.01), than those who are not. No other significant difference was found in the practice of the family physicians compare to nonfamily physicians. Conclusions The Indonesian PCPs were lacking in the provision of some particular medical procedures, management and follows up of acute and chronic conditions, and preventive medicine and health education. Improvement of primary health care has been seen globally as necessary effort in health systems reform and this information could provide guidance toward the efforts to improve the quality of primary care physicians in Indonesia. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the quality of reporting of the risk of bias of the Indonesian medical research. Methods Publications from PubMed and non-PubMed indexed Indonesian medical journals between January 2008 to December 2010 were assessed for risk of bias based on criterion combination from Hedges-criteria and the Oxford Center for Evidence-Based Medicine. We assessed whether the publications addressed the risk of bias adequately (quality of reporting) and whether the risk of bias criterion was fulfilled (quality of methods). The quality (both of reporting and of methods) of a study was classified as 'high' if, for at least two-thirds of the criteria were adequately reported and fulfilled. It was classified as 'low' when only one-third of the criteria were reported and or fulfilled. Results Of the 1753 publications, 29% ( n = 507) were original medical research. For 21% (109/507) the quality of reporting was high; for 15% (77/507) the quality of methods was high. The proportion of high quality was significantly higher among PubMed than non-PubMed, with difference between proportions: (95%CI of difference: 3 to 23). Conclusion A small proportion of Indonesian studies have high quality of reporting or methods. When international reporting guidelines are endorsed and followed, the quality of future studies may improve. [ABSTRACT FROM AUTHOR]

Background To assess the degree of awareness, agreement, adoption and adherence of physicians in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders. Methods Questionnaire survey among General Practitioners (GPs) attending the Indonesian Association of Family Practitioners annual conference in November 2012. The proportion of GPs who were aware of, agreed with, adopted and adhered to the seven recommendations in the guidelines (screening for diabetes, diagnosis, lifestyle modification, use of sulfonylurea, target blood glucose, target blood pressure and use of statin) were calculated in the total number of responders. Results Of the 399 GPs participating, 383 (89%) were aware of the existence of Indonesian type 2 diabetes guidelines. Awareness for each recommendation varied from 66 to 91%. The recommendation to use a random blood glucose test for diagnosing patients with classic diabetes symptoms had the least awareness (265/399, 66%) and least agreement (163/399, 41%). The recommendation on statin use was the least adopted (192/399, 48%), while the least adherence (7/399, 2%) was found for the recommendation on screening for diabetes for patients with risk factors. Years of practice experience and proportion of diabetes patients seen in their practice were independently related with adherence to statin prescription. Conclusions High awareness of the Indonesian type 2 diabetes guideline does not necessary lead to adoption or adherence to recommendations important for outcomes and quality of care. The awareness-to-adherence model helps in identifying barriers for the use of guidelines. [ABSTRACT FROM AUTHOR]

Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach’s α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach’s a for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in premodule scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum. [ABSTRACT FROM AUTHOR]

An abstract of the study "Pediatrician Level of Knowledge on Management of Type 1 Diabetes Mellitus and Diabetic Ketoacidosis" by Ratna Dewi Artari et al is presented.