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BACKGROUND: Diabetes, which causes various complications, involves pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), nuclear factor kappa B p65 (NF-κB p65), interleukin-6 (IL-6), cluster of differentiation 4 (CD4), and matrix metalloproteinase-9 (MMP-9). Magnesium has demonstrated anti-diabetic properties, but its anti-inflammatory effects in preventing cardiovascular complications remain unclear. This study aimed to evaluate the anti-inflammatory effects of magnesium citrate, alone and in combination with metformin, by measuring TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression in diabetic model rats. METHODS: Thirty male Wistar rats were divided into five groups: normal control, diabetes control, metformin (treated with 9 mg/200 g/day metformin), magnesium citrate (treated with 3.6 mg/200 g/day magnesium citrate), and combination therapy (treated with 4.5 mg/200 g/day metformin + 1.8 mg/200 g/day magnesium citrate). Diabetes was induced in all groups except the normal control group using streptozotocin (STZ) and nicotinamide (NA). TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression levels were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: Significant differences in TNF-α, NF-κB p65, IL-6, CD4, and MMP-9 expression levels were observed across all groups (p

Abstract Background Social media is widely used by medical students, including for learning purposes since it facilitates their involvement in the communities of inquiry where they can share, express, and engage in the development of knowledge. Navigating the use of social media requires self-regulated learning (SRL) skills. Hence, studies on the relationships between social media use and SRL skills are necessary. Aim This study aims to investigate the relationships between social media use and students’ SRL skills. Methods A cross-sectional study was conducted using two validated questionnaires: the Social Networking Sites for Medical Education questionnaire (SNSME, 19 items) and the Motivated Strategies for Learning Questionnaire (MSLQ, 81 items). Cross-cultural adaptation and exploratory factor analysis (EFA) were also completed for the SNSME questionnaire, followed by descriptive and bivariate analysis. Results and discussion The SNSME questionnaire is valid for use in the current setting and consists of three subscales: (1) attitudes towards the use of social media for learning and knowledge development, (2) the use of social media for information sharing and interaction, and (3) the use of social media for knowledge development and research. Among 1,122 respondents, male students presented lower scores than female students in the total score of social media for learning (80 vs. 82, p 0.007), and public medical students showed higher scores in terms of attitudes towards the use of social media for learning and knowledge development compared to private medical students (83 vs. 81, p 0.007). The differences in SRL scores for different education stages and among students from public and private medical schools were statistically significant (426 vs. 418, p 0.003, and 436 vs. 418, p

Abstract Background The burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change. Methods The Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022. Results We found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results. Conclusion Culturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.

Objectives Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population’s health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia. Methods A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group’s validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL. Results Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score. Conclusions Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.

Background: There has been a decrease in physical activity among female students during the COVID-19 pandemic. This can be a risk factor for obesity in female students. This study was undertaken to analyze the relationship between physical activity, chronotype, and nutritional status in female students during COVID-19 pandemic. Methods: In a cross-sectional stud, 171 female students were enrolled as respondents in Jebres, Surakarta using multistage random sampling and simple random sampling methods. Data were analyzed using the Physical Activity Questionnaire for Adolescents (PAQ-A) and Morningness- Eveningness Questionnaire (MEQ). Results: Female students had mostly normal nutritional status, but 26.9% were overweight. There was a relationship between physical activity (p=0.032) and chronotype (p=0.004) with nutritional status among female students during the COVID-19 pandemic. Conclusion: Physical activity and chronotype showed significant relationship with nutritional status among female students during the COVID-19 pandemic.

Purpose The development of students’ clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students’ perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development. Methods The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis. Results There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p

Cat owners or keepers are at a heightened risk of contracting toxoplasmosis, making it crucial to take preventive measures against Toxoplasma gondii infection (T. gondii). However, there are limited studies on knowledge, attitudes, and behavior toward preventing T. gondii among cat owners. Therefore, this study aimed to investigate the relationship between knowledge, attitudes, and behavior in preventing T. gondii infection among cat owners. To achieve this objective, an analytical observation was conducted using a cross-sectional approach. An online questionnaire was given to cat owners through social media platforms such as Facebook, Twitter, and WhatsApp. Knowledge, attitudes, and behavior of 388 respondents were evaluated using the Spearman Correlation Test. The results showed positive correlations between knowledge and attitudes (r=0.105, p

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia.

IntroductionProfessionalism represents a contract between physicians and society, with humanism at its core. Humanism must be developed in medical education, especially in clinical settings, as students meet real-life professional situations. However, dynamic and unpredictable clinical settings might expose students to authentic yet unexpected far-from-ideal situations that might hinder the humanism and professionalism process. Furthermore, culture plays an influential role, highlighting the importance of developing an appropriate and contextual learning strategy. Hence, this study aims to conceptualize strategies to teach humanism and professionalism in high-power distance and collectivistic settings.MethodsThis multicenter qualitative phenomenological study used maximum variation sampling to recruit participants, consisting of clinical students, teachers, and coordinators from three medical schools in Indonesia. Data were collected through focus group discussions (FGDs) and in-depth interviews. Thematic analysis was conducted using the steps of coding and theorization methods.ResultsA total of 15 FGDs and one in-depth interview were conducted with 57 students, 39 teachers, and 18 coordinators. Socialization theory was used to analyze themes, leading to a culturally related approach to learning. Professional identity formation (PIF) was highlighted as the center of learning humanism and professionalism, with character building as the main principle. Designing a curriculum for humanism and professionalism for clinical learning should consider the longitudinal nature of PIF and ensure that professionalism explicitly exists in the curricula. As cultural impact might pose challenges, it must also be acknowledged and addressed. Meaningful integrated learning experiences, patient exposure, and reflection serve as the cornerstones of teaching-learning strategies while considering longitudinally explicit assessments.ConclusionNurturing humanism and professionalism in undergraduate clinical settings is a longitudinal character-building process, with PIF as its center. Longitudinal, explicit, and dynamic strategies should be considered as part of the framework of teaching-learning and assessment of humanism and professionalism, as well as faculty development efforts with close attention to cultural factors.

Background: Nutrition is one thing that is important and very needed by the body. Indonesia has various kinds of social media that several users often play. One social media that has quite a lot of users is Instagram. During this pandemic, knowledge can come from anywhere. They are starting from teachers, friends, webinars, and so on. This knowledge sharing can be done by utilizing various applications such as Zoom, Google Meetings, etc. In addition, social media applications such as Instagram can provide users with various information and knowledge. Objectives: The purpose of writing this article is to analyze the influence of using social media, Instagram, for nutrition education. Discussions: This type of article is written using qualitative research using literature studies. This study uses searches on the Google search website, Google Scholar, and Research Gate with the keywords "Influence of Instagram Media as an Instrument", Nutrition Education Media", "Effectiveness of Instagram Media", and "Nutrition Education Media". Articles were selected using the PRISMA flowchart. Conclusions: The results are that the young generation can study anytime and anywhere. The Instagram application can have a positive impact on users if managed properly. Not only that, by using the Instagram application, users can get useful information such as webinars related to nutrition and users can follow these activities properly.

Objective: Leprosy is an infectious disease that causes highly complex problems from the medical aspect to social, economic, cultural, security, and national defence issues. This research aimed to develop and analyse the effect of an integrative model on leprosy prevention and control programs to improve the life quality of leprosy survivors. Materials and Methods: This research was conducted in Madura, East Java, Indonesia. The study consists of 360 leprosy survivors. The exposed group in this study was a group of leprosy survivors living within the areas of the Ministry of Health's leprosy program, a total of 180 leprosy survivors. The unexposed groups were leprosy survivors living around the areas with the absence of Ministry of Health leprosy program, a total of 180 leprosy survivors. Results: The quality of life has a direct and positive relationship with health status (b= 0.56 ; 95% CI = 0.14 to 1.00; p=0.010), health status has a direct and positive relationship with healthy behavior (b= 0.55 ; 95% CI = 0.10 to 1.00; p=0.016), healthy behavior has a direct and positive relationship with self-efficacy (b= 0.91 ; 95% CI = 0.38 to 1.44; p=0.001), healthy behavior has a direct and positive relationship with family support (b= 0.54; 95% CI = 0.06 to 1.03; p=0.029), healthy behavior has a direct and positive relationship with attitude (b= 0.56 ; 95% CI = 0.05 to 1.09; p=0.032). Conclusion: Health status, healthy behavior, self-efficacy, family support, attitude and community support related to improving quality of life for leprosy survivors.

The quality of life of the elderly is determined by physical, emotional, intellectual, social, vocational, and spiritual. The importance of maintaining quality of life is always implemented by healthy living behaviors, eating safe and nutritious food balanced with physical activity to minimize the risk of degenerative diseases. Non-communicable diseases such as hypertension and diabetes mellitus often occur in the elderly. This is caused by so often eating high-fat foods, and lack of physical activity, which can decrease the quality of life in elderly. This study aims to analyze correlation between the level of fat intake and physical activity with quality of life of elderly. Method used was a cross sectional design with 200 respondents. Data on fat intake was obtained by interview using 2x24 hour food recall questionnaire, while physical activity and Quality of Life used the Social Disengagement Index and WHOQOL-BREF questionnaires. Data were analyzed using Spearman test (α = 0.05). This study shows that majority of respondents have a good quality of life at a moderate level of fat deficit intake and moderate activity. Results of statistical analysis, level of fat intake with quality of elderly life has a non-significant positive correlation (p> 0.05) with value of correlation is 0.086 or very weak, whereas physical activity has a significant positive correlation with quality of elderly life (p

Purpose – The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a child's life. However, while the national coverage was 61.33%, the coverage in Sukoharjo was 39.33%. Effective intervention is needed to promote the importance of exclusive breastfeeding, and this requires knowledge of the barriers and support structures in place. This study analyzed the supports and barriers of exclusive breastfeeding in Sukoharjo, Central Java, Indonesia. Design/methodology/approach – This qualitative study used in-depth interviews conducted from December 2017 to March 2018. The population consisted of 33 informants (29 mothers with babies over six months of age, a pregnant mother, two midwives working in the community health center and a staff member in the district health department). Findings – There were barriers to and support for exclusive breastfeeding in Sukoharjo, Central Java province, Indonesia. The district already has support systems in place, while the barriers emerge from society, the baby's condition, environmental and other sources. The government has tried to overcome the barriers. Research limitations/implications – The limitation of this study was that the triangulation method was not utilized. However, the use of various informants strengthened the findings. Practical implications – The district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home. Social implications – The district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home. Originality/value – There are barriers to exclusive breastfeeding in Sukoharjo, but the government has made effective attempts to overcome them. The support systems in place were in line with the theory of planned behavior (TPB) and social cognitive theory (SCT).

Chronic Myeloid Leukemia (CML) merupakan penyakit mieloproliferatif yang ditandai dengan peningkatan sel mieloid dan ditemukan adanya kromosom Philadelphia yang disebabkan karena adanya translokasi respirok gen BCR-ABL. Nilotinib adalah Tyrosine Kinase Inhibitor (TKI) yang disetujui untuk pengobatan pasien dewasa yang baru di diagnosis CML dalam fase kronis (CML-CP) dengan kromosom Philadelphia positif (Ph+) atau pasien Ph+ CML yang resisten atau tidak toleran terhadap imatinib dalam fase kronis (CP) atau fase dipercepat (AP). Pada beberapa studi menunjukkan bahwa nilotinib berkaitan dengan munculnya efek samping obat. Salah satu efek samping obat yang terjadi pada penggunaan nilotinib yaitu musculoskeletal pain. Penelitian ini bertujuan untuk mengetahui frekuensi terjadinya musculoskeletal pain dan menganalisis pengaruh faktor usia, Indeks Masa Tubuh (IMT), dan riwayat Diabetes Mellitus (DM) pada pasien CML dengan kemoterapi nilotinib di RSUD Dr. Moewardi. Penelitian dilakukan sebagai studi observasional dengan desain cross sectional pada 35 subyek pasien CML dengan kemoterapi nilotinib pada bulan Januari 2016 – Maret 2019. Evaluasi dilakukan selama 1 tahun setelah subyek mendapatkan kemoterapi nilotinib dengan menggunakan rekam medis dan lembar pengumpul data.Hasil penelitian ini menunjukkan bahwa 13 pasien (37,1%) mengalami musculoskeletal pain. Hasil evaluasi dengan Algoritma Naranjo yaitu 7 pasien masuk dalam kategori possible dan 6 pasien dalam kategori probable. Indeks Masa Tubuh (IMT) berpengaruh secara signifikan terhadap terjadinya musculoskeletal pain dengan nilai p sebesar 0,041, nilai Odds Ratio sebesar 7, dan Interval Kepercayaan 95% sebesar 1,09 – 45,16. Sedangkan, faktor usia dan riwayat DM tidak berpengaruh secara signifikan terhadap terjadinya musculoskeletal pain.

Unhealthy eating habits among Indonesian occur not only in adults, but also in adolescents. Adolescence is a transitional period and most easily aff ected by the surrounding environment. Environmental infl uences such as peer infl uence and family eating habits are dominant factors for food they choose to consume. This study aimed at analyzing the relationship of peer infl uence and family eating habits on healthy food choices in overweight adolescents in Surakarta. It used observational study with cross sectional approach. Random sampling was used to determine its samples, consisting of 96 respondents. The data of peer infl uence, family eating habits, and healthy food choices were collected through structured questionnaires. They were analyzed by using the Pearson Product Moment statistical test. The results indicated that there is a relationship between peer infl uence and healthy food choices in overweight adolescents in Surakarta (p = 0.014; r = -0.250); and there is a signifi cant relationship between family eating habits and healthy food choices in overweight adolescents in Surakarta (p = 0.011; r = 0.258).

Nutritional needs are important for adolescent to accelerate growth. Good nutritional knowledge in adolescent can help them to consume healthy foods and prevent nutritional problems. Nutrition education with animation video is a great eff ort to improve adolescent nutritional knowledge. The use of attractive, eff ective and effi cient media ease adolescent to understand the nutrition material delivered. The objective of this research was to analyzes adolescent nutritional knowledge after given animation video. This research was quasi experimental with a nonequivalent control group design. There were 84 eeadolescents as research subjects chosen with purposive sampling technique. Animation video was given one time every week for one month with the duration of each video for seven minutes. The data was analyzed using Wilcoxon signed-rank. The results of study showed that nutrition education using animation video gave a positive infl uence on nutritional knowledge of adolescent (p=0.000). Animation video can be used as educational media to improve adolescent nutritional knowledge.

Background: The reading interest rate of Indonesian society is relatively low (approximately 0,001). Meanwhile, during their study, medical students have to read numerous English literatures. Previous research showed that reading activity can be improved by reading motivation. However, studies about Indonesian medical students reading motivation on English literature are still limited. This study aims to assess the effect of students’ English literature reading motivation to the block exam average score. Methods: This was a cross-sectional study conducted in January 2018. We used stratified random sampling, and we found 274 samples that fit with inclusion and exclusion criterias selected. The motivation was assessed using the English literature reading motivation scale, block exam test results were obtained through the academic database. Data were analyzed with multiple linier regression test. Result: Students’ English reading motivation increased the block exam average score of Medical Students. Every increase of one score of motivation significantly increase 0,10 score block exam average (p

Background: They are expected to be able to apply principles of family-based health treatments by prioritizing preventive, coordinative, and collaborative services. Based on the principles, identifying and managing diphtheria cases at some of health centres should be evaluated because there have been an increase of diphtheria cases, especially in Banda Aceh city. Objective: This study aimed to evaluate roles of doctors in the health centres to prevent the diphtheria. Furthermore, this research also aimed to determine obstacles of the diphtheria treatments encountered by the doctors. Methods: This study was a multiple case study. Its data were collected by in-depth interviews with doctors at five health centres in Banda Aceh. Data from the interviews were verified by using source and technical triangulation methods at the health offices and governmental hospitals in Banda Aceh. Result: Doctors’ efforts at the health centres in Banda Aceh to apply principles of family medicine for the immunization experienced some obstacles. For example, they had less understanding about developing problems in their societies, namely issues of illegitimate (haram) vaccines and KIPI (post-immunization follow-up events). They also did not make active efforts to identify diphtheria cases by making coordination with their colleagues in other health service units. Conclusion: The doctors at the health centres of Banda Aceh had not fully implemented the principles of family medicine.

Background: Jaminan Kesehatan Nasional (JKN) is the health policy of the Indonesian government to achieve Universal Health Coverage (UHC), where each City or District has a varied regional policy in implementing it. Surakarta City is one of the regions that has been able to reach UHC. Policy analysis triangle is used to understand the various factors involved in each policy process. Objective: This study aims to explore deeply the implementation of JKN policy in Surakarta City to be able to achieve UHC based on a policy analysis triangle. Methods: This type of research is a qualitative study with a case study approach. The study was conducted in Surakarta City, Central Java, from September 2018 to March 2019. Data collection was carried out through in-depth interviews and document analysis. Sampling technique with criterion sampling. The research informants were five people who were the leaders of the Surakarta City Government, and 10 people from the Surakarta City community. Data validity was done by triangulation, member check, and peer debriefing. Results: The implementation of JKN policy in the city of Surakarta to reach UHC was influenced by: actors who were highly committed and competent in the success of the JKN program, a dynamic process in adjusting central policy to the regions by implementing various strategies and innovations to increase JKN membership coverage; political factors with policy making that support the achievement of UHC, environmental factors where population density in Surakarta City is the most densely populated in Central Java, there is a high awareness and willingness of the people of Surakarta City to have JKN, and technological support that facilitates JKN coordination and implementation. Conclusion: Achieving UHC in Surakarta City is the result of optimizing the four factors in the triangle analysis policy.

Background: Jaminan Kesehatan Nasional (JKN) is Indonesia's health policy to achieve universal health coverage (UHC). Towards 2019, not all regions have succeeded in achieving UHC. One of the reasons is the uneven distribution of information regarding JKN policies. Socialization is needed so that the JKN policy is understood by the people of Indonesia. Objective: This research was design to describe the importance of JKN policy socialization to reach UHC. Methods: Qualitative research was conducted in September 2018- February 2019 in two districts in Central Java, that were the district that had reached UHC and districts that had not yet reached UHC. The informants consisted of leaders of regional organizations and also the community. The researcher conducted an interactive model analysis on the interview transcript. Results: In districts that had reached UHC, socialization was conducted directly and indirectly through the government, community cadres and BPJS cadres. The district government provided support by issuing circulars letters. The district socialization effectively increases JKN participants. Meanwhile, in districts that had not yet reached UHC, there was found differences between community and the government. The government said that they had conducted effective socialization. But the community said that the information provided has not been effective and there is no detailed information about JKN. Conclusion: An effective socialization of JKN policies is needed to increase the understanding and awareness of the community to achieve UHC.

Background: Needs of health workers, especially general practitioners, relatively high in Indonesia. Career choices among medical students are various, such as general practitioner, specialist, medical researcher, etc. Many factors affect medical students’ career choices, one of them is learning environments. This study aims to prove the correlation between clerkship students’ perceptions of clinical learning environments and their career choices. Methods: This research was an analytical observational research with cross sectional approach. The subjects were clerkship students who underwent clinical rotation. The samples were 178 clerkship students from all departments. They were chosen by probability proportional to size sampling. Every respondent was given career choices questionnaire and PHEEM questionnaire which has analyzed for its validity and reliability with α≥0,6 (α=0,826) and r≥0,30 (r=0,442). The result of this study was analyzed by Chi-square test and followed by Contingency Coefficient with 95% confidence level (α = 0,05). Result: The result showed that students’ perception of clinical learning environment “good but still need improvement” category was nearly the same as “plenty of problems” category. The result on the students’ career choices, most students choose clinical career. There was significant correlation between perception of clinical learning environment and career choices on clerkship students of medical faculty, Sebelas Maret University with p x2 table (x2=3,841) and also very weak correlation (C= 0,189). Conclusion: There was very weak correlation between perception of clinical learning environments and career choice on clerkship students.

Background: Teamwork in health care is beneficial because it allows a holistic approach to patient care. Interprofessional education (IPE) provides students with an opportunity to develop their professional roles and their functions as team members. Understanding Interprofessional Collaboration (IPC) from the perspective of student and academic staff is an essential assessment for creating IPE model. Methods: This was a qualitative study with phenomenology approach. We explored students’and academic staff’s perspective of IPE by focus group discussions. We selected fifteen midwifery student, twenty medical students and twenty-two lecturers (midwifery and obstetrician gynecologist doctor) who were involved in IPE project. Data analysis used thematic analysis technique. Results: Findings showed four themes that presented the most common perspective in collaborative experience, (1) interprofessional communication, (2) the role each profession, (3) IPE learning model, and (4) suggested IPE model. The major obstacle was poor communication in daily practices. Developing an IPE model is important to improve patient care. Conclusion: The main common problem of IPC was interprofessional communication. That poor communication problem can be solved by developing intra-curricular and extra-curricular IPE model and train the effective interprofessional communication.

Background: Reflection is one of important skills to be possessed by medical professional, which should be developed while studying at medical faculty. In clinical stage of medical education in many medical schools in Indonesia, a reflection-learning model has not developed yet. This often make clinical teacher confuse, how to facilitate the reflection learning correctly. Methods: We developed the reflection-learning model for clinical stage of medical education. The model development was started with a blueprint and a model’s draft development, which referred by reflection learning theory. The next step was a clinical teacher panel discussion and in-depth interviews of medical education experts. After these process, a reflective clinical learning model were developed and six clinical teachers were involved in the models’ trial. They adopted the model in their learning sessions. In-depth interviews were used to explore clinical teachers’ experience when they implemented the model. Result: a six-step clinical reflection learning model developed, consists of (1) case selection, (2) case presentation, (3) self-evaluation, (4) peers’ feedback, (5) teachers’ feedback and (6) reflection writing. The implementation problem is that students and lectureres have not been accustomed to reflective learning and lecturers’ limitation of time. Conclusion: This study shows that the six steps clinical reflection learning model could be used as an alternative learning method of reflection learning. However, in practice, both clinical teachers and students should have sufficient understanding about the model, and clinical teacher should provide sufficient time in the learning process.

Abstract Background Maternal health remains a persisting public health challenge in Indonesia. Postnatal complications, in particular, are considered as maternal health problems priority that should be addressed. Conducting adequate care for postnatal complications will improve the quality of life of mothers and babies. With the universal health coverage implementation, the Indonesian government provides free maternal and child health services close to clients at the village level, which include postnatal care. Our study aimed to explore barriers to utilization of postnatal care at the village level in Klaten district, Central Java Province, Indonesia. Methods A qualitative study was conducted in March 2015 – June 2016 in Klaten district, Central Java, Indonesia. We selected a total of 19 study participants, including eight mothers with postnatal complications, six family members, and five village midwives for in-depth interviews. We conducted a content analysis technique on verbatim transcripts of the interviews using open code software. Results This study found three categories of barriers to postnatal care utilization in villages: mother and family members’ health literacy on postnatal care, sociocultural beliefs and practices, and health service responses. Most mothers did not have adequate knowledge and skills regarding postnatal care that reflected how they lacked awareness and practice of postnatal care. Inter-generational norms and myths hindered mothers from utilizing postnatal care and from having adequate nutritional intake during the postnatal period. Mothers and family members conducted unsafe self-treatment to address perceived minor postnatal complication. Furthermore, social power from extended family influenced the postnatal care health literacy for mother and family members. Postnatal care in the village lacked patient-centered care practices. Additionally, midwives’ workloads and capacities to conduct postnatal information, education and counseling were also issues. Conclusions Despite the government’s efforts to provide free postnatal care closer to mothers’ homes, other barriers to postnatal care utilization remained. Specifically, among mothers, community, and health services. An innovative approach to increase the health literacy on postnatal care is required. In particular, improving the capacity of midwives to conduct patient-centered care. In addition, village midwives’ tasks should be evaluated and reoriented.

Background: Most clinical students still have difficulties in clinical reasoning process. Previous study mentioned that reflection and metacognition are factors could influence clinical reasoning. This study aimed to measure the effect of reflection, metacognition, age, sex, duration of clinical rotation, duration of undergraduate program taken by students, and students’ final remark on undergraduate program to students’ clinical reasoning. Method: This study was a quasi-experimental pretest postest control group design, conducted at RSUD Dr Moewardi Surakarta. We selected 185 clinical students by purposive sampling technique. The study used the Metacognitive Awareness Inventory (‘the MAI’), Motivation scale on Motivated Strategies for Learning Questionnaire (‘the MSLQ’), and Script Concordance Test as instruments. The analyses used multiple linier regressions. Results: The intervention of reflection learning increased clinical reasoning 1,11 unit (p=0,319); The increase of 1 unit score metacognition decreased clinical reasoning 0,01 score (p=0,806), increasing one semester duration of undergraduate program decreased clinical reasoning 1,17 score (p=0,297), increasing students’ final remark on undergraduate program increased clinical reasoning 15,98 score (p=0,006), female students had 1,97 lower score of clinical reasoning than male (p=0,103), increasing one month of duration clinical rotation increased clinical reasoning 0,01 score (p=0,958), increasing one score of motivation increased clinical reasoning 0,01 score (p=0,529). Conclusion: Clinical learning and metacognition can not influence clinical reasoning significantly. Clinical teacher and clinical students should be familiarized with reflection learning. Further researches are needed to exploring influencing factors to clinical reasoning.

Kemampuan belajar mandiri adalah otonomi pembelajar dalam me-ngontrol proses pembelajarannya. Kemampuan belajar mandiri bisa dikem-bangkan dalam proses pembelajaran. Penelitian terdahulu tentang pembel-ajaran pendidikan profesi dokter menyatakan masih adanya hambatan dalam kemampuan belajar mandiri mahasiswa. Tujuan penelitian ini adalah mengetahui perbedaan kemampuan belajar mandiri mahasiswa tahap pen-didikan profesi sebelum dan sesudah menjalani pembelajaran di suatu departemen klinik. Penelitian ini merupakan penelitian observasional de-ngan pendekatan comparative cross sectional. Subjek penelitian adalah maha-siswa pendidikan profesi dokter yang menjalani pendidikan profesi di satu bagian dengan masa pembelajaran 4 minggu, selama Agustus- September 2012, sejumlah 33 orang, dengan teknik purposif sampling. Lokasi peneli-tian di salah satu rumah sakit pendidikan di Surakarta. Instrumen yang digunakan merupakan alih bahasa dan modifikasi kuesioner yang dikem-bangkan oleh Fischer, King dan Tague tahun 2001. Analisis data dilakukan dengan uji-t. Hasil penelitian menunjukkan tidak ada perbedaan yang sig-nifikan secara statistik antara rerata kemampuan belajar mandiri mahasiswa sebelum (149,6) dan sesudah (151,9) menjalani pembelajaran tahap pendi-dikan profesi di satu bagian pendidikan profesi dokter (p=0,47). Ini berarti tidak ada perbedaan yang signifikan secara statistik antara kemampuan belajar mandiri mahasiswa sebelum dan sesudah menjalani pembelajaran tahap pendidikan profesi di satu departemen. Perlu penelitian lebih lanjut tentang alternatif intervensi yang perlu dilakukan untuk meningkatkan kemampuan belajar mandiri mahasiswa dalam pembelajaran profesi dokter. Kata kunci: kemampuan belajar mandiri, pendidikan profesi dokter, mahasiswa pendidikan profesi dokter ______________________________________________________________ MEASUREMENT ON SELF-STUDY PERFORMANCE OF MEDICAL EDUCATION PROFESSIONALS STUDENT Abstract The ability of self directed learning is learners’ autonomy to control their learning process. The ability to perform self-directed learning can be developed during the learning process. Previous studies showed potential barriers to perform self-directed learning among medical students. This study aimed to analyse difference of self-directed learning ability among medical students before and after undergoing professional education program in a certain clinical department.This study was an observational study with comparative cross-sectional approach. The subjects were medical students on the professional education program at a certain clinical department at a teaching hospital Surakarta city. Thirty-three students undergoing a 4-week program from August to September 2012, were selected by purposive sampling. The instrument used from Fischer, King and Tague was further translated into Bahasa Indonesia and validated. Data was analysed using t-test. The study found no statistically significant difference on average self-directed learning ability before (149,6) and after (151,9) following the professional education program at a certain clinical department (p=0,47). More studies are needed particularly to investigate alternatives of interventions to increase self-directed learning ability in the professional phase of medical education. Keywords: self-directed learning, medical professional education, medical students

Background Sepsis is a life-threatening disease, and animal models of sepsis are minimal. This study aims to find the optimal dose of LPS to make a sepsis mouse model by examining the presence of target organ damage. Methods This study used 30 mice divided into four groups. The control group (3 mice) injected 0.5 cc NaCl 0.9% intraperitoneally (i.p.). Group A (9 mice) was injected with lipopolysaccharides (LPS) 0.125 mg/kg B.W. i.p. given on the first and second day, group B (9 mice) was injected with LPS 0.15 mg/kg B.W. i.p. given on the first and second days, and group C (9 mice) was injected by LPS 0.3 mg/kg B.W. single dose i.p. On the third, fourth, and fifth days, the termination of each group of three mice and examination of the NF-κB, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), alanine aminotransferase (ALT), the expression of NF-κB in the liver and kidneys, and histopathology in the liver and kidneys were conducted. Results NF-κB, C-reactive protein (CRP), alanine aminotransferase (ALT), NF-κB examinations, and tumor necrosis factor-α (TNF-α) in all treatment groups increased when compared with the control. The highest degree of histopathological features of the kidneys and liver and the results of immunohistochemistry examinations on the liver and kidneys were shown in group C. Conclusions The optimal dose of LPS to make a sepsis mouse model was 0.3 mg/kgB.W with the most severe target organ damage dan significant increased of inflammatory markers.

Sepsis remains a complex clinical challenge, with experimental animal models being crucial for developing effective therapeutic strategies. Current approaches often struggle to establish clinically relevant animal models that accurately represent human sepsis pathogenesis. This study aimed to determine the optimal intraperitoneal Escherichia coli (E. coli) dose for inducing a reproducible sepsis state in male rats. A preliminary experimental study was conducted using male Rattus norvegicus rats divided into three groups: a control group and two sepsis groups induced with E. coli at doses of 1x106 and 1.5x106 CFU/kg. Biomarkers including neutrophils, procalcitonin (PCT), interleukin-6 (IL-6), and malondialdehyde (MDA) were measured at 24-, 48-, and 72-hours post-induction. Histopathological examinations of liver, kidney, spleen, and heart tissues were performed using hematoxylin and eosin staining. Both E. coli doses significantly increased inflammatory and infection biomarkers. Dose of 1.5x106 CFU/kg demonstrated higher biomarker levels and more severe organ damage compared to control group and 1x106 CFU/kg dose. In dose of 1.5x106 CFU/kg group, Neutrophil levels increased from baseline 1.4x10³ to 7.71x10³ mmol/dL, IL-6 from 20.72 to 77.49 pg/mL, MDA from 1.37 to 12.15 nmol/mL and PCT from a normal level of 3.1 to 5.79 ng/mL within 72 hours, meeting the criteria for sepsis. Histopathological examination revealed significant organ damage, with higher induction doses correlating with increased histopathological damage scores. Intraperitoneal E. coli induction at 1.5x106 CFU/kg effectively creates a reproducible sepsis model in rats, providing a valuable experimental approach for studying sepsis pathogenesis and potential interventions. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a life-threatening disease, and animal models of sepsis are minimal. This study aims to find the optimal dose to make a sepsis mouse model by examining the presence of target organ damage. Methods: This study used 30 mice divided into four groups. The control group injected 0.5 cc NaCl 0.9% intraperitoneally (i.p.). Group A was injected with lipopolysaccharides (LPS) 0.25 mg/kg B.W. i.p. given on the first and second day, group B was injected with LPS 0.3 mg/kg B.W. i.p. given on the first and second days, and group C was injected by LPS 0.3 mg/kg B.W. single dose i.p. Each group was terminated on the third, fourth, and fifth days. Results: NF-κB, C-reactive protein (CRP), alanine aminotransferase (ALT), NF-κB examinations, and tumor necrosis factor-α (TNF-α) in all treatment groups increased when compared with the control. The highest degree of histopathological features of the kidneys and liver and the results of immunohistochemistry examinations on the liver and kidneys were shown in group C. Conclusions: Inflammatory markers (CRP, TNF-α, NF-κB, and expression of NF-κB in liver and kidneys) and characteristics of organ damage (ALT, liver, and kidneys histopathology scores) increase on day 3. The highest increase was in the group administered with LPS 0.3 mg/kg B.W. single dose.

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia. [ABSTRACT FROM AUTHOR]

Introduction: Professionalism represents a contract between physicians and society, with humanism at its core. Humanism must be developed in medical education, especially in clinical settings, as students meet real-life professional situations. However, dynamic and unpredictable clinical settings might expose students to authentic yet unexpected far-from-ideal situations that might hinder the humanism and professionalism process. Furthermore, culture plays an influential role, highlighting the importance of developing an appropriate and contextual learning strategy. Hence, this study aims to conceptualize strategies to teach humanism and professionalism in high-power distance and collectivistic settings. Methods: This multicenter qualitative phenomenological study used maximum variation sampling to recruit participants, consisting of clinical students, teachers, and coordinators from three medical schools in Indonesia. Data were collected through focus group discussions (FGDs) and in-depth interviews. Thematic analysis was conducted using the steps of coding and theorization methods. Results: A total of 15 FGDs and one in-depth interview were conducted with 57 students, 39 teachers, and 18 coordinators. Socialization theory was used to analyze themes, leading to a culturally related approach to learning. Professional identity formation (PIF) was highlighted as the center of learning humanism and professionalism, with character building as the main principle. Designing a curriculum for humanism and professionalism for clinical learning should consider the longitudinal nature of PIF and ensure that professionalism explicitly exists in the curricula. As cultural impact might pose challenges, it must also be acknowledged and addressed. Meaningful integrated learning experiences, patient exposure, and reflection serve as the cornerstones of teaching–learning strategies while considering longitudinally explicit assessments. Conclusion: Nurturing humanism and professionalism in undergraduate clinical settings is a longitudinal character-building process, with PIF as its center. Longitudinal, explicit, and dynamic strategies should be considered as part of the framework of teaching–learning and assessment of humanism and professionalism, as well as faculty development efforts with close attention to cultural factors. [ABSTRACT FROM AUTHOR]

Nugraheni MA, Indarto D, Pamungkasari EP, Susilawati TN, Jusup SA, Purwaningtyas N, Rahardjo SS, Wulandari S, Devina KE. 2024. The effects of Jebisa on nutrient intake and hematology profile in adolescent girls with anemia. Nusantara Bioscience 16: 210-218. Anemia is a public health problem that often occurs in adolescent girls in developing countries, including Indonesia, mainly due to iron deficiency. Iron supplementation has been implemented for anemia treatment, but there are some side effects for long-term use. The Indonesian Government also fortified wheat flour with iron and folic acid, but the efficacy of fortification remains unclear. Snake fruit seeds contain high iron (Fe) and vitamin C levels but they are usually thrown away. Therefore, this study aimed to analyze the effects of jelly-containing snake fruit seed flour (SSF) and sugar, now called Jebisa, on macro and micronutrient intake and hematological profile in adolescent girls with anemia. Thirty tree adolescent girls from five public high schools in Sukoharjo Regency, Central Java, Indonesia, were randomly grouped into three categories: Control group (C) was given plain jelly with Fe tablets, and Treatment groups (T1-T2) were given jelly-containing 18.52 g and 37.04 g SSF, respectively, for 60 days. Data were analyzed using the one-way and repeated measures ANOVA tests followed by the Post Hoc Tukey and the Kruskal-Wallis test for non-parametric data. A significant value was set to p<0.05. The results suggested that the average daily energy intake, carbohydrates, and fibers significantly increased in the T1 and T2 groups compared to the C group (p<0.05). The average Fe intake in the T2 (19.59±1.70 mg/day) was significantly higher than that of T1 (10.74±2.40 mg/day) and C group (4.74±3.43 mg/day) with p<0.001. The T1 group had higher hemoglobin (Hb) levels (11.44±2.01 g/dL) than the C (11.04±1.92 g/dL) and T2 groups (10.89±0.67 g/dL) but were not significantly different. In conclusion, regular consumption of jelly-containing SSF increased the daily intake of energy, carbohydrates, fibers, Fe, and Hb levels in adolescent girls with anemia. [ABSTRACT FROM AUTHOR]

Primary dysmenorrhea (PD) is a prevalent problem in gynecology affecting the quality of life for young women. This medical condition is often responsible for the absence of young women from school or work, increasing the risk of developing hyperemesis gravidarum in the future. Furthermore, PD causes pain due to the activation of the local PGF2α pathway in the endometrium, which triggers oxidative stress processes, uterine ischemia and spasmodic uterine contractions. The first-line therapies for PD, Nonsteroid anti-inflammatory drugs (NSAIDs) and oral contraceptives, can cause side effects such as headache, nausea, intestinal ulcers and platelet abnormalities. To overcome the impact of PD, cupping has been proven effective as an alternative pain therapy with minimal side effects. Therefore, this study aimed to evaluate the effects of cupping on writing latency threshold time, PGF2α levels and FP receptor expression in PD model rats. The experiment was conducted using female Sprague Dawley rats to analyze the effects of wet cupping therapy (WCT) on inflammatory repair in the uterus. The method used was a pre- and post-test control group design, with 35 female rats randomly divided into 5 groups. These consisted of normal control (NC), negative control (C-), positive control (C+) + ibuprofen 7.2 mg, as well as treatment groups, comprising dry cupping (DC) and WCT. The results showed that writhing time threshold of WCT was the same as C+ (p = 0.368), while PGF2α decreased in DC (43.43 pg/mL, p = 0.008) and WCT (189.25 pg/mL, p = 0.0154). Similar to C+, WCT significantly decreased serum PGF2α levels compared to C-. WCT also influenced the expression of PTGFR subunit similarly to NC, showing the capacity to control the inflammatory pathway. The study suggested that WCT was a promising therapeutic strategy for PD by decreasing PGF2α and PTGFR expression. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) is essentially applied in the medical professions curriculum to produce graduates ready for collaborative practice. Globally, competency frameworks and guidelines have been developed to guide the integration and implementation of IPE into formal curriculum. Developing student competencies to become collaborative-ready health professionals takes a long time. This is also influenced by the formation and development of an interprofessional team's maturity, which is a time-consuming process. Therefore, repetitive exposure to interprofessional learning throughout the curriculum (longitudinal education) should be implemented, since undergraduate level. This scoping review aims to explore the breadth of the longitudinal literature related to IPE. This article explores the global literature to identify, characterise, and summarise evidence from the published literature on longitudinal IPE. This scoping review considers the longitudinal activities of IPE in various contexts. The papers included report on the learning experiences of two or more types of students in a healthcare profession programme. This scoping review was conducted in accordance with the scoping review guidelines of the Joanna Briggs Institute (JBI). The PubMed, Scopus, ProQuest, EBSCOhost, and ScienceDirect databases were searched. The results were limited to papers published in the English language from 2016 to the present. Two independent reviewers screened the titles and abstracts, and extracted data from the full-text articles. The results are presented descriptively in diagrams, tables, or other relevant formats, followed by narrative summaries. [ABSTRACT FROM AUTHOR]