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Purpose: This paper explores the reasons why Indonesia must have legal regulations to provide protection and guarantees for health workers in carrying out the profession in overcoming corona virus disease (COVID-19). This paper also explains the legal regulations as the foundation for today's medical workers' protection. This paper also aims at providing an ideal legal construction that safeguards the rights and obligations of health workers in overcoming COVID-19. Design/methodology/approach: In this paper, the author used qualitative research methods with a socio-legal approach. The data were obtained through literature study and analysis of laws and regulations through the socio-legal method. Findings: Various challenges and professional risks taken by health workers in dealing with COVID-19 derive from several factors, such as shortage of personal protective equipment, ineffective implementation of informed consent from the patients and the negative stigma spreading in the community. Moreover, the current legal regulation has not particularly modulated the protection of health workers, relying only on available articles that are actually irrelevant to be applied in the COVID-19 pandemic. Research limitations/implications: This research is focused on problems faced by health workers in combating COVID-19 and law concessions to ensure their protection. Practical implications: The final results of this research will be useful for The House of Representatives (DPR), the Ministry of Health of the Republic of Indonesia (Kemenkes RI) and the Indonesian Medical Association (IDI) in establishing legal and regulatory construction for the protection of health workers in tackling COVID-19. Social implications: This research aims at strengthening legal protections for the health workers so that their rights and obligations are well guaranteed. Originality/value: This paper proposes an ideal legal construction for the protection of health workers during the COVID-19 pandemic, which is currently still not specifically and rigidly regulated, to realize a guaranteed and sustainable life for health workers. [ABSTRACT FROM AUTHOR]

Background: An increasing number of evaluations of social accountability (SA) interventions have been published in the past decade, however, reporting gaps make it difficult to summarize findings. We developed the Social Accountability Reporting for Research (SAR4Research) checklist to support researchers to improve the documentation of SA processes, context, study designs, and outcomes in the peer reviewed literature and to enhance application of findings. Methods: We used a multi-step process, starting with an umbrella review of reviews on SA to identify reporting gaps. Next, we reviewed existing guidelines for reporting on behavioral interventions to determine whether one could be used in its current or adapted form. We received feedback from practitioners and researchers and tested the checklist through three worked examples using outcome papers from three SA projects. Results: Our umbrella review of SA studies identified reporting gaps in all areas, including gaps in reporting on the context, intervention components, and study methods. Because no existing guidelines called for details on context and the complex processes in SA interventions, we used CONSORT-SPI as the basis for the SAR4Research checklist, and adapted it using other existing checklists to fill gaps. Feedback from practitioners, researchers and the worked examples suggested the need to eliminate redundancies, add explanations for items, and clarify reporting for quantitative and qualitative study components. Conclusions: Results of SA evaluations in the peer-reviewed literature will be more useful, facilitating learning and application of findings, when study designs, interventions and their context are described fully in one or a set of papers. This checklist will help authors report better in peer-reviewed journal articles. With sufficient information, readers will better understand whether the results can inform accountability strategies in their own contexts. As a field, we will be better able to identify emerging findings and gaps in our understanding of SA. [ABSTRACT FROM AUTHOR]

Midwifery students still take notes the old-fashioned way, on paper, which has become very inconvenient. Students struggle to create accurate and complete care documentation due to the risk of losing important data, transferring data, and scribbling. Mobile Case Midwifery Notes (CMNotes) is an Android-based documentation system designed to develop learning methods and interactive consultations between students and lecturers. CMNotes facilitates digital and comprehensive recording of patient data starting from assessment, diagnosis, and plan of care to implementation and evaluation by applying Varney's management principles and Subjective Objective Analysis Planning (SOAP) documentation. This study is research and development (R&D) to produce a documentation system for midwifery care emphasising postpartum and breastfeeding care. The researchers recruited 185 midwifery students from Aceh Health Polytechnics to be involved in a needs analysis. Out of the total number of students, 39 students took part in the implementation stage where their experience using the application was assessed. The needs analysis revealed that postpartum care and breastfeeding are important subjects, and their documentation is the most important aspect. The implementation results show that the CMNotes provide convenience and satisfaction for students when documenting childbirth and postpartum care. Since CMNotes could provide the reference range of data, the system allows students to identify and focus on the issue experienced by the patients. Due to user feedback on the system's usability, it is necessary to create an Android-based CMNotes application to fill in patient data more easily and effectively without the need for internet access. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop and psychometrically test a competence‐based human resource management scale to improve managerial competence of first‐line nurse managers in public hospitals. Background: To ensure the high competence of the first‐line nurse managers, the competence‐based human resource management should be evaluated using the best‐fit instrument. However, no instrument has been identified in the hospital setting. Methods: This methodological study consists of three main steps: (1) generating scale items based on literature review and expert interviews, (2) pilot testing of face and content validity and (3) evaluating psychometric properties with 300 first‐line nurse managers from 16 public hospitals in Indonesia selected using a multistage sampling. Data were collected from May to December 2017. Principal component analysis and Cronbach's α were used for construct validity and internal consistency reliability. Results: The final scale consists of 30 items in five dimensions, which explained 65.48% of the total variance. The dimensions include 'training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system'. Cronbach's α for the scale was.89, with a range of.85 to.88. Conclusion: The competence‐based human resource management scale is reliable and valid to use in public hospital settings. Summary statement: What is already known about this topic? The concept of competence‐based human resource management has been applied worldwide in every organization, and it is applicable to use for developing managerial competence of first‐line nurse managers. Therefore, the effectiveness of this management system should be assessed via a valid and reliable instrument.Several instruments to measure competence‐based human resource management have been developed, but no instrument has been identified to measure competence‐based human resource management specifically in hospital settings. What this paper adds? This study developed a scale designed to measure competence‐based human resource management to support improvement of first‐line nurse managers' managerial competence in public hospitals.The scale demonstrated sound psychometric properties with acceptable internal consistency reliability, content validity and construct validity.The scale consists of 30 items in five dimensions: training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system. The implications of this paper: This study expands the basic knowledge of competence‐based human resource management as a concept with five dimensions that can be used in nursing organizations, and it can be used in quality assurance systems in public hospitals settings in Indonesia.The scale can be used as a feedback for first‐line nurse managers to see the impact of competence‐based human resource management framework on their competence and helps to identify which dimension of human resource management needs further improvement.With further research, the scale may be of use in other countries and settings. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to test the validity and reliability of a four‐item patient health questionnaire as a psychological distress screening tool for patients with type 2 diabetes in Indonesia. Methods: This cross‐cultural adaptation study was applied in five public health‐care centres in Indonesia in August–October 2018 using a four‐item patient health questionnaire. The content, convergent and factorial validity were assessed, and Cronbach's alpha coefficient was the reliability indicator. Results: A total of 147 participants were involved. Content validity resulted in acceptable outcomes (item and scale content validity indexes were 0.95 and 0.75, respectively). Anxiety and depression were associated with total score and psychological distress status (P < 0.001), supporting the convergent validity outcomes. Principal component analysis using varimax rotation revealed two factors, explaining 76.14% of variance (P < 0.001). Cronbach's alpha coefficients for anxiety, depression and total score were 0.780, 0.500 and 0.713, respectively. Conclusions: The study demonstrated adequate validity and reliability for the Indonesian version of a four‐item patient health questionnaire among patients with type 2 diabetes. Therefore, it is applicable as a screening tool for psychological distress in this population. Summary statement: What is already known about this topic? Anxiety and depression are common forms of psychological distress among patients with type 2 diabetes.Early identification of potential problems in diabetes benefits patients for prevention and treatment.A four‐item patient health questionnaire (PHQ4) is a valid tool for screening psychological distress. What this paper adds? The paper presents a psychometric evaluation of PHQ4 to assess psychological distress among patients with type 2 diabetes.Incidence of anxiety, depression and psychological distress for patients with diabetes in Indonesia was identified. The implications of this paper: Diabetes nurse specialists or nurse managers could consider using the Indonesian version of PHQ4 in their units.The availability of this screening tool in Indonesia makes identification of psychological distress possible.Further research and education related to psychological distress among patients with diabetes may use the valid PHQ4. [ABSTRACT FROM AUTHOR]

Aim: The study aims to examine the psychometric properties of the Pittsburgh Sleep Quality Index‐Indonesian version. Background: The Pittsburgh Sleep Quality Index has never been translated into Bahasa. Design This study employs a cross‐sectional and correlational study. Methods: Data were collected from 528 adolescents of junior high school age (13–16 years) during August to September 2014. All participants agreed on the Indonesian version of Pittsburgh Sleep Quality Index and Beck Depression Inventory‐II. Psychometric properties were examined including internal consistency, construct validity and known group validity, and the receiver operating characteristic curve was used to measure the cut‐off point. Results: The Cronbach's alpha for the Pittsburgh Sleep Quality Index‐Indonesian version was adequate. There were positive correlations between the total score and seven component scores. Construct validity revealed that the total score of the Pittsburgh Sleep Quality Index‐Indonesian version was correlated with the total score of the Indonesian version of the Beck Depression Inventory‐II. Known group validity indicated that adolescents without depression risk had better sleep quality. According to receiver operating characteristic curve analysis, the cut‐off point at a score of 6.5 indicated the best possible relationship of sensitivity and specificity. Conclusion: The Pittsburgh Sleep Quality Index‐Indonesian version has high reliability and validity for screening sleep quality among adolescents. SUMMARY STATEMENT: What is already known about this topic? The original Pittsburgh Sleep Quality Index has adequate internal consistency and favourable reliability.It is easy for patients and health‐care providers to use for interpreting sleep disturbances. What this paper adds? The results support the validity and reliability of the Pittsburgh Sleep Quality Index‐Indonesia in screening sleep quality among adolescents.The cutoff score for the Pittsburgh Sleep Quality Index‐Indonesian version for adolescents was 6.5. The implications of this paper: The cut‐off point could detect poor sleep quality among Indonesian adolescents.This simple tool is capable of quickly assessing sleep quality for health‐care providers. [ABSTRACT FROM AUTHOR]

Background: Service quality improvement efforts must focus on the utilisation of resources for continuous quality improvement. The importance-performance analysis (IPA) method is useful in finding service quality items that require corrective action. This study implemented the IPA method to obtain items that should be prioritised in improving the quality of a hospital's clinical forensic services. Methods: A cross-sectional study of 284 clinical forensic patients at Bhayangkara Hospital, Pekanbaru, Indonesia was conducted. Self-administered and paper-based questionnaires, specifically the modified service quality (SERVQUAL)-based questionnaire, were used as the study instruments. Twenty-two service quality items were used as indicators and they were divided into five dimensions of service quality: i) reliability, ii) responsiveness, iii) assurance, iv) empathy and v) tangibility. The data were analysed using the IPA method. Results: The results showed that only seven items had a gap and a level of conformity that met the expectations of clinical forensic patients. Improvements in service quality should prioritise four items: i) providing a more private examination room for clinical forensic patients, ii) improving healthcare workers' understanding of patient needs, iii) improving the readiness of healthcare workers to conduct examinations and iv) enhancing the clarity of information about examination procedures. Conclusion: The IPA method yielded several high-priority items that need to be improved; therefore, the hospital must focus on improving the quality of clinical forensic services. [ABSTRACT FROM AUTHOR]

INTRODUCTION Perception is an essential factor influencing smoking among adolescents. Thus, a valid tool for measuring perception is a requisite in smoking studies. This study further establishes the validity and reliability of a Malay language version of the Perception Towards Smoking Questionnaire (BMPTSQ) for assessing the perception of smoking among secondary school-going adolescents in Malaysia. METHODS We administered the BM-PTSQ to 669 secondary school students selected through multistage sampling; 60% of respondents were male (n=398), and 69.9% (n=463) were from rural areas. Respondents were aged 13--16 years, 36.4% (n=241) were 13 years, 40.0% (n=265) were 14 years, and 23.6% (n=156) were 16 years old. We used parallel and exploratory factor analysis (EFA) to determine the domains of the questionnaire. In addition, we also employed EFA, confirmatory factor analyses (CFA), and Cronbach's alpha to evaluate the construct validity and reliability of the BM-PTSQ. RESULTS EFA and parallel analysis identified two domains in the BM-PTSQ that accounted for 62.9% of the observed variance, and CFA confirmed the two-domain structure. The two domains' internal consistency scores ranged from 0.702 to 0.80, which suggested adequate reliability. CONCLUSIONS The BM-PTSQ has acceptable psychometric validity and is appropriate for assessing smoking perception and intention among Malaysian secondary school-aged youth. Researchers should further evaluate this tool's applicability in a more sociodemographically diverse population. [ABSTRACT FROM AUTHOR]

INTRODUCTION Conventional (tobacco) and e-cigarette smoking prevalence is a growing concern in Indonesia. It has worsened as e-cigarettes complement conventional cigarettes, resulting in dual users, potentially causing an additional burden in terms of health. METHODS Our study is a secondary data analysis of the 2018 National Basic Health (Riskesdas) Survey. The sample is limited to respondents aged 15--64 years who either only used e-cigarettes (e-cigarette single users), only used conventional cigarettes (conventional cigarette single users) or used both e-cigarettes and conventional cigarettes (dual users) in the last month. The sample size of the data was 174917 individuals. Our analysis utilized the logit and negative binomial regression to test whether the type of smoking behavior was associated with reporting to have a non-communicable diseases (NCDs) and multimorbidity, respectively. RESULTS We found that: 1) dual users are positively associated to report having NCDs, such as liver failure (AOR=2.38; 95% CI: 2.32--2.44), diabetes (AOR=1.53; 95% CI: 1.50--1.57), hypertension (AOR=1.49; 95% CI: 1.48--1.51), and gum diseases (AOR=1.74; 95% CI: 1.73--1.74) compared to single users; and 2) e-cigarette single users are positively associated with reporting to have NCDs such as asthma (AOR=3.11; 95% CI: 3.01--3.22) and diabetes (AOR=16.01; 95% CI: 14.57--17.59), and dental problems such as broken teeth (AOR=1.04; 95% CI: 1.03--1.06), and they have disease multimorbidity compared to conventional cigarette single users. CONCLUSIONS Simultaneous control of the consumption of e-cigarettes and conventional cigarettes is essential. In addition, it is important to promote policies to increase the price of e-cigarettes and conventional cigarettes to reduce smoking prevalence and prevent dual users. Moreover, as there are negative health consequences for conventional and e-cigarette single users or dual users, the most effective alternative is to stop smoking, not switching products. [ABSTRACT FROM AUTHOR]

Drug use type and frequency may affect Anti-Retroviral Therapy (ART) uptake for HIV-infected people who inject drugs (PWID). This paper assesses the association between self-reported baseline drug use and ART among HIV-infected PWID in Indonesia, Ukraine and Vietnam. Data on self-reported baseline drug use and ART among HIV-infected PWID at the 26- and 52-week follow-ups were extracted from the HIV Prevention Trials Network (HPTN) 074, a randomized, controlled vanguard study to facilitate HIV treatment for PWID in Indonesia, Ukraine, and Vietnam. Multivariable logistic regression models were fit by study site and the whole HPTN 074 sample, using a 0.5 type I error rate. The response rate were 83.3% and 77.0% at 26th and 52th weeks. At 26-week, baseline use of over one non-opiate/non-stimulant drug was associated with lower odds of ART use among Indonesian participants (OR = 0.21, 95%CI: 0.05–0.82); and baseline injecting drugs for over 20 days in the previous month was associated with lower odds of ART use among all HPTN 074 sample (OR = 0.59, 95% CI: 0.36–0.97). The association of a specific drug use pattern with later ART uptake implies the importance of medication-assisted treatment to enhance ART uptake and adherence among participants. [ABSTRACT FROM AUTHOR]

Background: Psychotic symptoms are present in a wide range of both clinical and non-clinical populations. Psychotic symptoms in adolescents often take the form of psychotic-like experiences (PLEs), which are considered a risk factor for numerous serious mental illnesses. Socioeconomic disadvantages are across rural areas, and poverty is known as the third most important risk factor of PLEs. However, there have been limited studies on PLEs which focus on populations in rural areas. Objective: The aim of this study was to assess the prevalence of PLEs and investigate their predictors among early adolescents living in rural areas. Method: Data from 629 early adolescents from two rural areas in Indonesia were analysed using descriptive statistics to determine the prevalence of PLEs. Multiple logistic regression analysis was used to assess the predictors of PLEs. This was a school-based cross-sectional study, and data were collected using a paper questionnaire. Results: The results showed that the prevalence of PLEs among early adolescents in rural areas is 24.5%. Four significant predictors of PLEs were identified after controlling for sex: emotional problems, age, the number of caregivers in daily life, and psychological well-being. [ABSTRACT FROM AUTHOR]

Technology in libraries has played an essential role in serving today's communities. This study provides an overview of the integrated library systems/software (ILSs) used in libraries in South Sulawesi, Indonesia. It aims to highlight the strengths and possibilities of ILSs and briefly explain their advantages and disadvantages along with the cost of implementation. The data was gathered from questionnaires sent via an online survey and from direct interviews with certain academic libraries over the period of 2019 to 2020. Fifty-three of 67 libraries that fulfilled the study have implemented an ILS. To deeply understand the application, a direct interview with some libraries was conducted to learn the advantages and disadvantages. The result of the study showed that the most used ILSs are SLiMS and INLISlite and other programs like Apollo, Athenium Light, Simpus, Spektra, Jibas, KOHA, and Openlibrary. The budget spent is an average of300 USD. While the ILSs have helped these libraries improve services, IT expertise and adequate resources are needed, especially when the systems present problems. An easy-to-use system that costs less will potentially be used in this area of research. This study will be particularly helpful for any library in Indonesia. These findings may also be generalized to libraries in other countries facing economic and technological similarities. [ABSTRACT FROM AUTHOR]

Purpose: This research aims to develop and test a model of digital health communication media (DHCM) use for healthy food information – DHCM usage – during the Covid-19 pandemic. More specifically, this research investigated the simultaneous effects of perceived threat of Covid-19, e-health literacy, attitude toward DHCM usage, knowledge toward DHCM usage, facilitating conditions and information quality on the DHCM usage. Design/methodology/approach: The empirical data were collected through a survey. The respondents of the survey are 192 DHCM users who lived in Tangerang Regency. Structural equation modelling (SEM) analysis was performed. Findings: The DHCM usage during the Covid-19 pandemic is significantly affected by the attitude towards the DHCM usage and the facilitating conditions. However, the DHCM usage during the Covid-19 pandemic is not significantly affected by the perceived threat of Covid-19, e-health literacy, information quality and knowledge of the DHCM usage. Research limitations/implications: This research was conducted only in Tangerang Regency and employed a purposive sampling technique. Future research should be conducted in other contexts to examine the stability of the research findings. Practical implications: In order to improve DHCM usage for healthy food information, it is important for building a positive attitude towards DHCM usage and ensuring the availability of the facilitating conditions. Originality/value: This paper is the first that develops and tests a model of DHCM usage for healthy food information during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Background Given the increased risk of malnutrition in children with cleft lip and/or palate (CLP), determining their nutritional status is critical for preventing adverse surgical risks. However, no such disaggregated, national-level data are available in Indonesia. We aimed to determine the nutritional status of patients with clefts in Indonesia and to identify problems and solutions for malnutrition cases within the population. Methods In this cross-sectional study, we considered records of individuals who underwent primary surgery for CLP in Smile Train-sponsored facilities in Indonesia between 1 January 2016 and 31 December 2021 (n = 18 480). We only included children under the age of five with an evaluation date prior to admission date and excluded subjects with invalid data values. We classified their nutritional status by z-scores according to the World Health Organization Child Growth Standard (2006). Malnutrition cases cover four indicators - stunting, wasting, underweight, and overweight. We compared the prevalence for malnutrition cases in children under the age of five using national health survey data. Results We included 1899 records following data validation. The national prevalence of stunting (24.4%), wasting (12.5%), and overweight cases (12.9%) was high, while underweight cases (6.8%) were comparatively low. Statistical analyses showed significant differences in nutritional status based on length/height-for-age between girls and boys aged 0-5 months (P = 0.008) and 48-60 months (P = 0.001), and based on body mass index-for-age (P = 0.000) between girls and boys aged 0-5 months. Girls in different age groups exhibited a statistically significant difference in nutritional status based on length/height-for-age (P = 0.002) and weight-for-age (P = 0.017). Concurrent stunting and overweight were the most common forms of concurrent malnutrition (8.7%). We found a significant difference in the prevalence of underweight (P = 0.001) and overweight (P = 0.000) cases between children with CLP and those without CLP. Conclusions Our findings highlight the importance of nutritional interventions for children with orofacial clefts in Indonesia, and the importance of age and gender in their design and implementation. Further investigation is necessary to explore the risks of overweight and concurrent malnutrition among this population. [ABSTRACT FROM AUTHOR]

Background Bacillus Calmette-Guérin (BCG) vaccination is recommended at birth or in the first week of life to achieve the most beneficial effects in protecting against the most severe type of tuberculosis (TB) disease in children. However, delayed vaccination is commonly reported, especially in outreach or rural areas. We assessed the cost-effectiveness of combining non-restrictive open vial and home visit vaccination strategies in order to increase timely BCG vaccination in a high-incidence outreach setting. Methods We applied a simplified Markov model for the Papua setting, which resembled a high-incidence outreach setting in Indonesia, to assess the cost-effectiveness of these strategies from a health care and a societal perspective. A moderate increase (75% wastage rate and 25% home vaccination) and a large increase (95% wastage rate and 75% home vaccination) scenario were assessed in the analysis. We calculated incremental cost-effectiveness ratios (ICER) based on the incremental costs and quality-adjusted life years (QALYs) gained by comparing the two strategies to the base case scenario (35% wastage rate and no home vaccination). Results The costs per vaccinated child were US$10.25 in the base case scenario, increasing slightly in the moderate (US$10.54) and large increase scenarios (US$12.38). The moderate increase scenario was predicted to prevent 5783 TB-related deaths and 790 TB cases while the large increase scenario predicted the prevention of 9865 TB-related deaths and 1348 TB cases for the entire lifespan of our cohort. From a health care perspective, the ICERs were predicted to be US$288/QALY and US$487/QALY, respectively, for the moderate and large increase scenarios. Using Indonesia's gross domestic product (GDP) per person as a threshold, both strategies were considered to be cost-effective. Conclusions We found that the allocation of resources for timely BCG vaccination based on combining home vaccination and a less restrictive open vial strategy could substantially reduce childhood TB cases and TB-related mortality. Although outreach activities are more expensive than vaccination at a health care facility only, these activities proved to be cost-effective. These strategies might also be beneficial in other high-incidence outreach settings. [ABSTRACT FROM AUTHOR]

Background Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR)=6.5; 95% confidence interval (CI)=3.4-12.5) and twice (OR=2.0; 95% CI=1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean=0.3 vs 3.6 days; P<0.001) and death came sooner (3.5 vs 5.3 days; P=0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median= 3.3 vs 1.3 hours; P=0.01). Conclusions Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres. Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. Study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions. Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. Results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. Conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. Implications for research, policy, and practice: A three-hour online training followed by a onemonth implementation period could be an effective and efficient approach to developing midwives' understanding and use of the gravimetric method of blood loss estimation postpartum. What is already known about the topic? * The gravimetric method estimates the blood loss volume by weighing sanitary materials used during the labour process (i.e., gauze, sheets, swabs, pads, etc.) before and after being contaminated by the blood. * In clinical practice, the weight difference (in grams) is considered as 'blood loss volume' for ease of measurement and reported in millilitres without any formal conversion of units of weight to volume. * The benefits of the gravimetric method have been reported previously. However, there is limited evidence on the evaluation of this method to train midwives regarding implementation of the gravimetric method in clinical practice. What this paper adds * An online training programme is effective in increasing midwives' knowledge and awareness of the gravimetric method for postpartum blood loss assessment. * The midwives found the gravimetric method simple to adopt in clinical practice, which increased their confidence in detecting postpartum haemorrhage. * The midwives encountered some barriers while implementing the gravimetric method and provided strategies to mitigate the issues raised. [ABSTRACT FROM AUTHOR]

• Reducing modifiable risk factors could prevent the onset of cognitive decline. • Physical multimorbidity–cognitive function association was mediated by depression. • Routine screening for depression in multimorbidity patient may delay dementia onset. This paper explores the role of depressive symptoms (mediator/moderator) in the association between physical multimorbidity (exposure) and cognitive function (outcome) among older adults in the three most populous middle-income countries. This study used cross-sectional data from China (2015 China Health and Retirement Longitudinal Study), India (2017/2018 Longitudinal Ageing Study in India), and Indonesia (2014/2015 Indonesian Family Life Survey), with a total sample of 73,199 respondents aged ≥ 45 years. Three domains of cognitive tests were harmonised across surveys, including time orientation, word recall, and numeracy. The four-way decomposition analysis assessed the mediation and interaction effects between exposure, mediator/moderator, and outcome, adjusted for covariates. The mean age of the respondents (in years) was slightly younger in Indonesia (56.0, SD = 8.8) than in China (59.5, SD = 9.3) and India (60.0, SD = 10.5). The proportion of male respondents was 49.3 % in China, 47.3 % in India, and 47.5 % in Indonesia. Respondents in China had the highest mean cognitive function z scores (54.7, SD = 19.9), followed by India (51.1, SD = 20.0) and Indonesia (51.0, SD = 18.4). Physical multimorbidity was associated with lower cognitive function in China and India (p < 0.0001), with 48.4 % and 40.0 % of the association explained by the mediating effect of depressive symptoms ('overall proportion due to mediation'). The association was not found in Indonesia. Cognitive functions were lower among individuals with physical multimorbidity, and depressive symptoms mainly explained the association. Addressing depressive symptoms among persons with physical multimorbidity is likely to have not only an impact on their mental health but could prevent cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Cymbopogon is a member of the family Poaceae and has been explored for its phytochemicals and bioactivities. Although the antimicrobial activities of Cymbopogon spp. extracts have been extensively studied, comprehensive analyses are required to identify promising compounds for the treatment of antimicrobial resistance. Therefore, this study investigated the antioxidant and antimicrobial properties of Cymbopogon spp. ethanolic extracts in every single organ. Methods: Ethanolic extracts were obtained from three Indonesian commercial species of Cymbopogon spp., namely Cymbopogon citratus (L.) Rendle, Cymbopogon nardus (DC.) Spatf., and Cymbopogon winterianus Jowitt. The leaf, stem, and root extracts were evaluated via metabolite profiling using gas chromatography-mass spectrometry (GC–MS). In silico and in vitro analyses were used to evaluate the antioxidant and antimicrobial properties of the Cymbopogon spp. ethanolic extracts. In addition, bioactivity was measured using cytotoxicity assays. Antioxidant assays were performed using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2-azino-bis [3-ethylbenzothiazoline-6-sulfonic acid (ABTS) to determine toxicity to Huh7it-1 cells using a tetrazolium bromide (MTT) assay. Finally, the antimicrobial activity of these extracts was evaluated against Candida albicans, Bacillus subtilis, Staphylococcus aureus, and Escherichia coli using a well diffusion assay. Results: GC–MS analysis revealed 53 metabolites. Of these, 2,5-bis(1,1-dimethylethyl)- phenol (27.87%), alpha-cadinol (26.76%), and 1,2-dimethoxy-4-(1-propenyl)-benzene (20.56%) were the predominant compounds. C. winterianus and C. nardus leaves exhibited the highest antioxidant activity against DPPH and ABTS, respectively. Contrastingly, the MTT assay showed low cytotoxicity. C. nardus leaf extract exhibited the highest antimicrobial activity against E. coli and S. aureus, whereas C. winterianus stem extract showed the highest activity against B. substilis. Furthermore, computational pathway analysis predicted that antimicrobial activity mechanisms were related to antioxidant activity. Conclusions: These findings demonstrate that the leaves had strong antioxidant activity, whereas both the leaves and stems showed great antimicrobial activity. Furthermore, all Cymbopogon spp. ethanolic extracts showed low toxicity. These findings provide a foundation for future studies that assess the clinical safety of Cymbopogon spp. as novel drug candidates. [ABSTRACT FROM AUTHOR]

Background/Aims: Cultural factors significantly impact maternal mortality during pregnancy and birth, and cultural norms can affect pregnancy, labour and care-seeking behavior. This study explored local cultural perspectives of birth preparedness in a rural area of Java, Indonesia. Methods: This descriptive qualitative study used individual semi-structured interviews with 16 purposively selected participants, including 10 pregnant women, two community midwives, two pregnant women's parents and two health cadres. Data were analysed thematically. Results: Three primary themes were found: the meaning of pregnancy in the sociocultural context, the meaning of childbirth and cultural values in pregnancy. Conclusions: Sociocultural factors have a significant impact on pregnancy and childbirth in rural Indonesian areas, and pregnant women may be unprepared for birth. It is essential to create a culturally appropriate intervention model for childbirth readiness that pregnant women and their families can easily understand. Innovation is vital to empower the community to promote childbirth preparation. [ABSTRACT FROM AUTHOR]

Background: As one of the world's biodiversity hotspots, Indonesia contains over 25,000 plant species, including unconventional food plants (UFPs). These plants are integral to the dietary practices of rural communities, providing essential nutrients often overlooked in modern diets. However, the use of UFP is declining, with both their dietary and cultural values being undermined. In rural West Java, this decline in UFP biodiversity coincides with public health challenges related to malnutrition. This study aims to document the diversity of UFPs used by local communities in rural West Java, assess their nutritional value, and explore their consumption practices. Methods: Data were collected using mixed methods, including interviews with 20 key informants and food frequency questionnaire administered to 107 women in three villages in the area. The nutritional compositions of documented UFPs were obtained from literature and analysis. Bivariate correlation was used to analyze the relationships between UFP consumption frequency and potential correlates. Results: The study documented 52 species of UFPs from 29 families, many of which are rich in nutritional value. About half of respondents (56%) consumed UFPs moderately (2–3 times a week). UFP consumption frequency had a strong correlation (r = 0.70) with associated knowledge (r = 0.70, p < 0.01) and a weak correlation with age (r = 0.240, p = 0.015), livestock possession (r = 0.260, p = 0.008), and family size (r = − 0.220, p = 0.02). Motivations for UFP consumption included availability as free food (33%), medicinal value (26%), nostalgic value (23%), and preferred taste (18%). Most respondents (92%) agreed that consumption has declined compared to the past, with perceived reduced availability and lack of knowledge cited as the primary reasons for the declining trend. Conclusions: UFP use is common in the study area, where local communities value these plants for their critical roles in diet, medicine, and culture. Given their significant potential to meet dietary needs, educating and raising awareness about UFPs can enhance their consumption and contribute to food and nutrition security. [ABSTRACT FROM AUTHOR]

This study aims to examine the complex relationship between household food insecurity and outpatient care utilization among Indonesian older adults. Individual-level data from the 2020 National Socioeconomic Survey (SUSENAS; n = 29 950 older adults aged 60 and over in poor self-rated health who are unable to do daily activities) and environmental-level data (n = 84 096 villages in a data aggregation across 514 municipalities) from the 2021 Village Potential Data Census Collection Survey (PODES) are used in a two-level binary logistic regression model. Older adults who live in severely food insecure households (odds ratio [OR] 1.963) and lack of health insurance (OR 1.654) are more likely of not utilizing outpatient care. The interclass correlation coefficient value is 0.162, indicating that primary health care services in every village improve outpatient care utilization. Food insecurity is the major determinant of reduced likelihood of outpatient care utilization, which can be explained by household resource constraints. [ABSTRACT FROM AUTHOR]

BACKGROUND The short version of the new brief job stress questionnaire (SV-NBJSQ) that is originally in Japanese could evaluate work-related stress in Indonesian office workers. However, it has not been validated in Indonesian. Thus, this study aimed to test the validity and reliability of the Indonesian version of the SV-NBJSQ. METHODS This study was conducted by linguistic and cultural adaptation of the original Japanese questionnaire into Indonesian and continued with exploratory factor analysis, internal consistency, and reliability test of Cronbach's alpha. Electronic and paper-based data were collected using total sampling from office workers at two companies in Jakarta from December 2017 to August 2018. RESULTS A total of 438 respondents filled the questionnaire. The final version of the questionnaire consisted of 63 items, screened based on a loading factor of >0.4 and 13 factors (dimensions). Each factor had a Cronbach's alpha of 0.628-0.887, while the entire 63 had 0.904 with a total documented cumulative variation of 64.97%. CONCLUSIONS The Indonesian version of the SV-NBJSQ is valid and reliable. Thus, we may use it as a more suitable, updated, and comprehensive tool to evaluate workrelated stress among office workers. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea often occurs in adolescent girls and disrupts their daily activities. Dysmenorrhea occurs 1-2 years after menarche, with an average age of 12.8 years. One way to reduce dysmenorrhea is to use plants, such as ginger and citronella oil. Purpose: This study aimed to determine the effectiveness of ginger and citronella oil on dysmenorrhea in adolescent girls. Methods: This research was quasi-experimental with a one-group pretest-posttest design approach. The sample consisted of 68 adolescent girls from SMPN 14 Tasikmalaya city who were experiencing dysmenorrhea with moderate pain intensity. Purposive sampling was used. The results of this study were obtained using the Numeric Rating Scale (NRS) and then analyzed using the Wilcoxon signed-rank test. Results: The research results showed that the average dysmenorrhea score before being administered ginger and citronella oil to adolescent girls was 4.6, and after the intervention, it was 3.69 out of ten. The statistical-test results showed that ginger and citronella oil were effective for dysmenorrhea in adolescent girls (p = 0.000). Conclusion: This study concluded that there is a difference in the average dysmenorrhea score before and after administering ginger and citronella oil to adolescent girls. Therefore, adolescent girls can use ginger and citronella oil to reduce dysmenorrhea. Implications for Nursing: Integrating complementary ginger and citronella oil therapy into nursing or midwifery services is necessary to reduce dysmenorrhea. This innovation can be a reference source to provide care and minimize chemical-drug use. [ABSTRACT FROM AUTHOR]

Purpose: Determine the impact of education-based treatment on sustaining quality of life during COVID-19 adaptation. Designs: A randomized, 2-group, structured, holistic education-based intervention within eight weeks in preserving total quality of life (QoL) for hypertension patients with conventional care. Methods: Utilizing randomized controlled trials, 380 patients with hypertension are separated into two groups and evaluated. The patients are separated into two groups totaling 190 individuals each group. The intervention group is treated with a holistic education-based intervention. After two months, the EQ-5D-5L is used to evaluate the quality of life. Findings: The QoL pretest for the intervention group revealed that 25 (13.2%) patients had good QoL (Score = 1), while the QoL posttest revealed that the number of patients with good QoL had grown to 48 (25.3%). Using Kolmogorov–Smirnov for data analysis yielded non-normally distributed data. The p -value for the Wilcoxon signed ranks test is.001. Conclusions: The intervention group is better equipped to deal with COVID-19 and has a higher quality of life. Education-based hypertension treatment can sustain a high quality of life. [ABSTRACT FROM AUTHOR]

Background: Breast cancer affects patients' quality of life, which is influenced by the body's functional abilities and the patients' spiritual well-being. Currently, there is no research on the spiritual determinants that affect quality of life in the Indonesian context. Purpose : This research analyzes the determinants of spiritual well-being in terms of breast cancer patients' quality of life using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp). Methods: A cross-sectional study was conducted with 112 participants who were selected using purposive sampling. Women with breast cancer who had a Palliative Performance Scale version 2 score of 60 and who were able to read and write were included. The instruments used included the RAND SF-36 Quality of Life Questionnaire, which was modified to the Indonesian context and was used to survey breast cancer patients (Cronbach coefficient of >0.90), in addition to the FACIT-Sp (Cronbach coefficient of 0.768). The multivariate data were analyzed using logistic regression. Results: The determinants of spiritual well-being for the participants' quality of life included meaning (odds ratio of 0.436) and peace (odds ratio of 0.303). Conclusion: The meaning and peace domains of spiritual well-being significantly affect breast cancer patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Health education programs can enhance self-efficacy and disaster preparedness. However, research incorporating the Health Belief Model (HBM) in education for infectious disasters is lacking. Aims: Examine the effectiveness of an HBM-based education program on self-reported self-efficacy and self-reported preparedness for infectious disasters in rural populations. Methods: In total, 109 eligible participants were allocated to two groups: participants who received HBM-based education (n = 55) or regular education (n = 54), presented at in-person meetings, with individual follow-up conducted on WhatsApp. Self-reported self-efficacy and preparedness for infectious disasters in both groups were measured at 4 and 8 weeks. Findings: Participants showed a significant interaction between groups and in time to increase in self-reported self-efficacy and self-reported preparedness to deal with infectious disasters. After 4 and 8 weeks, the groups had statistically significant differences (p ≤.001) in all outcome measures. Conclusion: HBM-based education was associated with increased self-reported self-efficacy and self-reported infectious disaster preparedness among the rural population. Follow-up by nurses is essential to implementing continuing health belief education programs to enhance rural populations' self-efficacy and infectious disaster preparedness. [ABSTRACT FROM AUTHOR]

When a patient falls within a hospital setting, there is a significant increase in the risk of severe injury or health complications. Recognizing factors associated with such falls is crucial to mitigate their impact on patient safety. This review seeks to analyze the factors contributing to patient falls in hospitals. The main goal is to enhance our understanding of the reasons behind these falls, enabling hospitals to devise more effective prevention strategies. This study reviewed literature published from 2013 to 2022, using the Arksey and O’Malley methodology for a scoping review. The research literature was searched from seven databases, namely, PubMed, ScienceDirect, Wiley Library, Garuda, Global Index Medicus, Emerald Insight, and Google Scholar. The inclusion criteria comprised both qualitative and quantitative primary and secondary data studies centered on hospitalized patients. Out of the 893 studies analyzed, 23 met the criteria and were included in this review. Although there is not an abundance of relevant literature, this review identified several factors associated with falls in hospitals. These encompass environmental, patient, staff, and medical factors. This study offers valuable insights for hospitals and medical personnel aiming to enhance fall prevention practices. Effective prevention efforts should prioritize early identification of patient risk factors, enhancement of the care environment, thorough training for care staff, and vigilant supervision of high‑risk patients. By comprehending the factors that contribute to patient falls, hospitals can bolster patient safety and mitigate the adverse effects of falls within the health‑care setting. [ABSTRACT FROM AUTHOR]

Background: The Dementia Severity Rating Scale (DSRS) is an informant report, dementia staging tool that is quick to administer and has previous been shown to differentiate between people with dementia and healthy controls. However, it is not clear how accurate the tool is screening against diagnostic criteria in middle-income settings. Methods: Embedded within the STRiDE programme, older adults (aged ≥65 years) and their informants were randomly recruited from four sites across Indonesia and South Africa. All informants were asked to complete DSRS. We report the tool's psychometric properties and accuracy against the 10/66 short diagnostic algorithm. Results: Between September and December 2021, data was collected from 2110 older adults in Indonesia and 408 in South Africa. Overall, the DSRS scores significantly differed between those with and without dementia, as identified on the 10/66 short algorithm (p <.05). The difference between groups remained significant after controlling for key factors related to older adult and informant demographics. A score >2 on the DSRS had the greatest agreement with the 10/66 short algorithm and had excellent discriminative properties in both Indonesia (Area Under Curve (AUC) =.75, 95% CIs =.72–.77) and South Africa (AUC =.82, 95% CIs =.76–.88). Conclusions: The DSRS has potential as a screening tool for dementia in middle-income countries, with high sensitivity and specificity against a standardized diagnostic algorithm. [ABSTRACT FROM AUTHOR]

Indonesian children suffer from stunting because of a chronic lack of energy and protein intake. Maternal caregiving capabilities are skills and attributes of the mother which determine their ability to use resources for positive nutrition to support their children's health. This study aimed to analyse the association between maternal caregiving capabilities and energy-protein adequacy among children with stunting. This study used a cross-sectional correlation design. The data was collected using a maternal caregiving capabilities questionnaire and 24-hour food recall in 130 mothers of children aged 2 to 5 years with stunted growth, registered at Puskesmas. The study found a significant association between maternal caregiving capabilities and a child's energy and protein adequacy. As mothers' maternal caregiving capabilities increased, their capacity to provide adequate energy and protein for their children increased. We believe that community health nurses can promote health and empower mothers to increase their capability to meet the nutritional needs of children. [ABSTRACT FROM AUTHOR]

INTRODUCTION Illicit cigarettes because of their affordability could increase smoking prevalence, especially among young people. They also cause a large revenue loss for the government. This study aims to estimate illicit cigarette consumption and government revenue loss in Indonesia, a country with a very high smoking prevalence, especially among males. METHODS We estimated illicit cigarette trade in terms of volume and revenue loss. Illicit trade was estimated as the discrepancy between legal cigarette sales and domestic consumption recorded by national representative surveys. Data sources included Basic Health Research Survey, Global Adult Tobacco Survey, National Socioeconomic Survey, and data from Ministry of Finance. RESULTS We found that illicit cigarette consumption fluctuated from 19 billion sticks in 2007 to 14 billion sticks in 2013, and sharply increased to 59 billion sticks in 2018. Relative to cigarette consumption, illicit cigarettes were the lowest at 5% in 2013 and highest at 19% of consumption in 2018 (assuming 0% underreporting). The estimated government revenue loss ranged from IDR 24.2 to 42.0 trillion (US$ 1668 to 2897 million), which corresponds to 15.8% to 27.5% of cigarette excise revenue in 2018. CONCLUSIONS In Indonesia, illicit cigarette consumption was found to be high and increasing, which contributed to a large government revenue loss (almost onethird of tobacco excise tax revenue). To reduce illegal cigarette production and smuggling, the government should increase resources to enforce the regulation on the excise tax system including stronger penalties, especially related to illicit cigarette production. [ABSTRACT FROM AUTHOR]

Background and Objectives: The proactive activities of professional organizations have significantly contributed to improving nurses' knowledge related-specialty in order to improve health care services quality offered by nurses. Since the palliative care improvement and development in Indonesia remain still in their infancy, and the organization of palliative care for Indonesian nurses has not been established yet, it is imperative to investigate the Indonesian nurses' viewpoints concerning the importance of establishing a palliative nursing organization in fostering palliative care services in Indonesia. This study aimed to identify what kind of palliative care related activities are carried out by Indonesian nurses and what are the perspectives of nurses regarding the importance of establishing palliative nursing organizations in Indonesia. Materials and Methods: A national study was conducted using an embedded mixed-methods design, for which the quantitative and qualitative data were collected and analyzed in the same time period from October - December 2020. Results: There were a total of 552 (92%) respondents who participated through WhatsApp, and Telegram platforms, and completed our online survey. There were four themes and nine sub themes found in this study: namely, services improvement (quality improvement, and literacy improvement sub themes), human resource development (knowledge development, individual nurse development, and professional development sub-themes), boarding and information source (boarding, and information source sub themes), and policy and legality (policy, and legality sub themes). Conclusion: While barriers exist, respondents confirmed the importance of establishing an Indonesian palliative nursing organization. Establishing a palliative nursing organization could be an important step in developing palliative care in Indonesia. [ABSTRACT FROM AUTHOR]

Background and Objectives: The COVID-19 pandemic raises a concern about the urgent issue of low levels of digital health literacy (DHL). Adequate DHL may mitigate the negative impacts of proliferating misinformation. This study as digital health information sources among high school students in East Java, Indonesia. The differences in DHL levels across sociodemographic factors, medical history, and social media preferences were also analyzed. Materials and Methods: This was a cross-sectional study, conducted in 2021, and enrolled high school students aged 15-18. The subjects were selected for convenience, with a minimum sample size of 384. An online questionnaire was shared through a survey platform. The sociodemographic variables and medical history were collected. The DHL measuring items were adapted from the validated DHL instrument developed in the COVID-19 context. Data were analyzed with SPSS 17.0. Results: We collected 432 responses. More than half of respondents (56.5%) have adequate DHL. Although 81.7 percent of respondents reported that searching for online information was easy, only 53.5 percent reported ease in appraising the reliability aspect. Fathers' education varied by DHL. Students whose fathers hold post-graduate degrees showed a significantly higher level of DHL than those of lower educational backgrounds. Students experiencing COVID-19 infection of their own or close relatives showed higher total DHL and information search scores. Instagram and TikTok were the most frequently chosen social media as digital health information sources, but no significant difference in DHL across the preference for social media. Conclusion: Even though the information can be obtained easily, there are still difficulties in evaluating its reliability. Considering the proportion of respondents with inadequate DHL, stakeholders in the health and education sectors need to develop DHL-promoting strategies for adolescents. Improvement in evaluating reliability should be the target of focus. [ABSTRACT FROM AUTHOR]

Background: Anxiety is a problem that most often occurs in the pre-operative coronary artery bypass graft surgery stage. The combination of prayer therapy with education is expected to be able to overcome anxiety. The combination of prayer and education therapy have been researched as a potential holistic intervention for reducing anxiety in coronary artery bypass graft surgery. Purpose: This study compares the effect of combination therapy with the golden standard of therapy in hospitals. Methods: A true-experimental design was used. Fifty participants were randomly assigned to two groups. Data were collected using a State-Trait Anxiety Inventory questionnaire from Spielberger. Findings: Most respondents were elderly, male, high school graduates in the treatment group, and bachelor graduates in the control group. Prayer therapy and education have an effect of 63.8% on reducing anxiety. An increase of 1 constant in the provision of prayer therapy and education can reduce anxiety by 0.772. Conclusions: The combination of prayer therapy and education becomes the holistic nursing modality that can reduce anxiety in pre-operative coronary artery bypass graft patients. [ABSTRACT FROM AUTHOR]

Objective: Intravesical electrical stimulation (IVES) remains a controversial therapy for detrusor underactivity (DUA). The purpose of this study is to determine the efficacy of IVES in patients with DUA using pre- and post-IVES urodynamic parameters. Methods: Intravesical electrical stimulation procedure is performed using a specific catheter equipped with an internal electrical electrode (cathode). The anode is subsequently affixed to the lower abdomen (suprapubic). Afterward, this specialized catheter is connected to a stimulator. Patients undergo a series of 12 IVES procedures in 1 month with the following predetermined parameters: 20 mA amplitude, 20 Hz frequency, 200 µs pulse width, and 60 minutes stimulation time. Patients underwent a follow-up urodynamic examination 1 month after the IVES series is completed. Results: After IVES, several notable changes were observed, including an increase in Qmax from 7.28 ± 5.24 to 7.29 ± 4.09 (P = .030), a decrease in post-void residual (PVR) from 73.03 ± 43.91 to 62.07 ± 39.10 (P = .005), and an increase in PDet@tQmax from 17.10 ± 12.35 to 18.87 ± 12.47 (P = .009). The aetiologies of DUA were categorized into 3 groups: chronic obstruction (CO), idiopathic (Idio), and neurological disorder (ND). The CO group exhibited significant changes in urodynamic parameters, specifically Qmax (P = .001), PVR (P = .001), and PDet@Qmax (P = .035). Similarly, the idiopathic group also demonstrated improvements in Qmax (P = .008), PVR (P = .037), and PDet@ Qmax (P = .033). Conclusion: Intravesical electrical stimulation has been shown to have a positive effect on patients diagnosed with DUA, particularly those whose DUA is idiopathic or due to chronic obstruction. [ABSTRACT FROM AUTHOR]

Background Expression of breast milk is a strategy to ensures continuous breastfeeding during temporary separation of infant from the mother. Handling and storage of expressed breast milk (EBM) should be based on established recommendations because these practices can affect milk quality and safety. Objective To describe perceptions and practices of EBM handling and storage, compare with commonly used recommendations and associated factors influencing these practices among mothers in Jakarta, Indonesia, Methods Mothers who practiced expressed breastfeeding (EBF) to their 6-12 weeks-old infants completed questionnaires about their peceptions and practices on how they handle and storage EBM. The differences in perceptions and practices about expressed breastfeeding management were analyzed using the Chi-square or Fisher's exact test. Results Among 30 mothers, 14/30 gave EBF exclusively, 19/30 used breast pump, and 26/30 expressed = 6 times/day. Infants in this study received expressed milk 5-10 times per day. Maternal age and resource of information were factors significantly associated with mother's perceptions, while maternal age, education, and parity were significantly associated with the practices of EBM handling and storage. Conclusion This study reveals inconsistent perceptions and practices on expressed milk handling and storage by the mothers. They have good knowledge about the theoretical aspects of expressed breastfeeding, but some other techniques are poor, which can be detrimental to the health of the infants. Further study is needed to find more efficient and optimal methods of expressed milk handling and storage, necessitating thoughtful consideration of better practices and recommendations. [ABSTRACT FROM AUTHOR]