Immunization Simulation Using Actual-Size Infant Manikins for Medical Students in Indonesia: A Quasi-Experimental Study.

INTRODUCTION: Manikins are tools used in simulation training for medical students to develop important skills, one of which is immunization. However, conventional manikins often do not resemble the actual size of an infant's arm or leg. This study aimed to determine the impact of using actual-size manikins on students' knowledge and practical skills, evaluate their confidence in immunization practice, and assess students' responses and feedback regarding the practice using actual-size manikins. METHODS: This was a quasi-experimental study involving medical students at the Faculty of Medicine, Universitas Indonesia, from October 2020 to April 2021. Students in the intervention group used newly developed actual-size infant arm and leg manikins, while the control group used conventional manikins. All students underwent the objective structured clinical examination (OSCE) and the scores were compared between the 2 groups. Within the intervention group, data on pretest and posttest scores, feedback questionnaires, and self-confidence assessments were also obtained and analyzed. RESULTS: A total of 205 students were included. Statistically significant difference was found in the OSCE scores between the intervention and control groups (P < 0.01). Students in the intervention group (n = 108) showed significant improvement in knowledge scores after the workshop (P < 0.01). Most students (81.7%) expressed confidence in administering vaccines to live patients after practicing with manikins. In addition, 98.2% of students (n = 107) acknowledged the benefits of practicing with actual-size manikins in accurately determining the injection sites. CONCLUSIONS: Simulation with the actual-size manikins significantly improved students' knowledge and practical immunization skills, leading to increased confidence and competence in their immunization skills.

Tobacco Use among School-Age Adolescents in Indonesia: Findings from the 2015 Indonesia Global School-Based Student Health Survey.

BACKGROUND: Although Indonesia has a considerable proportion of adolescent smokers, nationally representative studies of its determinants remain limited. The 2015 Indonesian Global School-Based Student Health Survey (GSHS) was conducted with school-age adolescents and provided information about smoking behavior. This study aimed to examine the prevalence, determinants, and correlates of tobacco use among adolescents in Indonesia using the GSHS survey. METHODS: A secondary data analysis of a cross-sectional study was conducted using data from the 2015 Indonesian GSHS. Multivariate logistic regression was used to assess the determinants and correlates of tobacco use. RESULTS: Our analysis showed that 9.1% of school-age adolescents had used tobacco products in the past 30 days. Most were 13-15 years (61.7%) and had attempted to stop smoking (92.4%). After adjusting for covariates, significant risk factors associated with tobacco smoking were older age groups (prevalence odds ratio [POR], 3.01-9.40; 95% confidence interval [CI], 1.71-23.1), male (POR, 13.7; 95% CI, 8.71-21.5), psychological distress (POR, 1.41; 95% CI, 1.05-1.90), smoking exposure (POR, 1.98-2.15; 95% CI, 1.35-3.42), and when both parents smoked (POR, 2.96; 95% CI, 1.78-4.94). In addition, tobacco use was associated with other risky behaviors, including sex with multiple partners, using drugs, drinking alcohol, and being involved in physical fights. CONCLUSION: Tobacco use is high among Indonesian adolescents. This prevalence highlights the need for a more stringent tobacco control policy and tailored cessation programs for adolescents by considering important modifiable determinants of tobacco use among adolescents, including risky smoking-related behaviors.

The misconception of plastic surgery scope amongst general practitioners in East Nusa Tenggara, Indonesia.

BACKGROUND: The scope of plastic reconstructive and aesthetic surgery is often misunderstood amongst both public and professionals, including the general practitioners (GP) who play vital roles in referring patients. Unlike other subspecialties, which are circumscribed by subgroup patients, specific organs, or diseases, the versatility of plastic surgery is driven by the principle of the surgical technique being malleable to each clinical case. This study aimed to demonstrate how well general practitioners in Kupang City acknowledge the scope of plastic surgery. METHODS: The 30-Question electronic survey was filled out by GPs in several hospitals, PHCs, and clinics whose certificate of registration is based in Kupang City. Respondents should match the given cases to one subspecialist surgeon that the GPs think fits best. RESULTS: In total, 83 GPs participated; 63.9% (n = 53) were female, aged 27.95 (±3.53 years), 77.1% (n = 64) practised in a hospital, and 67.5% (n = 56) graduated from medical school in Java. Only 2.4% (n = 2) chose a plastic surgeon whom they will refer to among three hand cases, 6% (n = 5) in four craniomaxillofacial cases, and 10.8% (n = 9) in five reconstructive cases. CONCLUSION: The GPs tend to associate cosmetic procedures with plastic surgeons, while reconstructive surgery cases like hand or craniomaxillofacial cases were correlated with non-plastic surgeons. The scope of plastic surgery needs to be further introduced in the medical student curriculum; thus, GP can be more exposed to the field and refer patients accurately.

Improving knowledge, attitude, and practices of complementary feeding using practical intervention training for parents living in central Lombok, Indonesia: A community-based study.

Background: Stunting remains a major public health concern in Indonesia despite many interventions. This study aimed to assess the effectiveness of interventions in the form of education and demonstration on preparing complementary feeding (CF) to increase knowledge, attitude, and practices (KAP) of CF among parents living in villages with high stunting prevalence in Central Lombok, Indonesia. Materials and Methods: This is a quasi-experimental community-based study, conducted from June to August 2019. Three villages were divided into three groups, i.e., control group (CG), education alone (EA) group, and education-cum-demonstration (ED) group. We assessed KAP before and after intervention with a 4-week interval. Results: A total of 205 participants were enrolled in this study, consisting of 67, 70, and 68 participants in the CG, EA, and ED groups, respectively. In within-group analysis, parents' attitudes (P = 0.015) and practices (P = 0.014) improved in the ED group while only parents' practices (P = 0.034) improved in the EA group. In between-group analysis, parental attitude (P = 0.039) and practices (P = 0.008) improved in the ED group when compared to the CG. In the EA group, only parents' practices improved when compared to the CG (P = 0.006). There was no significant difference in KAP score in the EA and ED groups. Conclusion: A combined approach of education and demonstration works better to promote healthy CF practices among mothers.

Slaughtering to serving: a reflection on healthcare leadership in Indonesia.

Climate and culture within health institutions are strongly determined by healthcare leadership. Studies have shown how workers' motivations and satisfactions not only improve their performances but also impact quality of care. Every healthcare leader should make reasonable policies that meet population needs and ensure safe, effective and good quality services. Effective leadership is very crucial to create and maintain a supportive work environment in maximising the potentials of health services. This article aimed to reflect about the importance of healthcare leadership and encourage us to start asking ourselves about our work motivation, strengths and weaknesses, and aspects we aimed to develop, which will help to create a good and healthy workplace environment.

Mental health problems and hypertension in the elderly: Review from the HOPE Asia Network.

The "triple burden" of aging population, hypertension, and mental health problems making elderly in Asia is more vulnerable. There is evidence of a bidirectional relationship between mental health and hypertension, which results in lower quality of life, lower rate of treatment adherence, and higher mortality among elderly individuals. It is essential to overcome known barriers and care for the elderly with high-risk factors in order to address these burdens. This review revealed that elderly with hypertension were more likely to suffer from depression and anxiety. Therefore, debunking myths, creating awareness regarding mental health, and increasing access to mental health resources through holistic community-based programs would greatly reduce such problems and optimize the chances of success in controlling hypertension-related problems.

Hypertension and stroke in Asia: A comprehensive review from HOPE Asia.

Stroke is the primary cause of disability and vascular death worldwide, including Asia. Asian characteristics that differ from the West lead to higher stroke incidence. Stroke epidemiology studies in Asia have shown varying levels of mortality, incidence, prevalence, and burden of disease. Hypertension is the most prevalent risk factor found in Asia. Besides ethnicity that is associated with stroke incidence, both systolic blood pressure, diastolic blood pressure, and blood pressure variability are positively correlated with stroke incidence. Post-stroke cognitive impairment is one of the sequelae that affect one-third of stroke survivors and has become a significant public health concern that is often neglected despite its increasing prevalence. Therefore, it is very important to prevent recurrence by treating stroke optimally and effectively. Increasing awareness and treatment adherence to hypertension, the leading risk factor for stroke, became the main goal in several countries in Asia.

High blood pressure in dementia: How low can we go?

Hypertension is an important public health concern. The prevalence keeps increasing, and it is a risk factor for several adverse health outcomes including a decline in cognitive function. Recent data also show that the prevalence of hypertension and age-related dementia is rising in Asian countries, including in the oldest old group. This study aims to discuss possible treatments for high blood pressure in the elderly and propose an optimal target for BP relative to cognitive outcomes. This review discusses several studies on related blood pressure treatments that remain controversial and the consequences if the treatment target is too low or aggressive. Longitudinal, cross-sectional, and RCT studies were included in this review. An optimum systolic blood pressure of 120-130 mm Hg is recommended, especially in nondiabetic hypertensive patients with significant risk factors. In the oldest old group of patients, hypertension might have a protective effect. The use of calcium channel blockers (CCB) and angiotensin receptor blocker (ARB) is independently associated with a decreased risk of dementia in older people. However, personalized care for patients with hypertension, especially for patients who are frail or very old, is encouraged.

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Indonesia.

Over one-third of the population in Indonesia has hypertension, almost two-thirds of treated patients have uncontrolled blood pressure (BP), and the majority of patients with hypertension also have comorbidities. Home BP monitoring (HBPM) is a useful tool for diagnosing and managing hypertension. The use of HBPM is recommended by the latest consensus from the Indonesian Society of Hypertension (2019), and nearly, all doctors recommend HBPM for hypertensive patients. However, the use of HBPM in Indonesia is limited by the cost of devices and a perception that these devices are unreliable. In addition, knowledge about proper procedures is lacking. Withdrawal of mercury sphygmomanometers from the end of 2018 is expected to encourage the use of digital sphygmomanometers and the implementation of HBPM. The most common antihypertensive agent used in Indonesia varies by patient age, being angiotensin-converting enzyme (ACE) inhibitors in those aged 40-60 years and calcium channel blockers (CCBs) in older patients. Across all age groups, combination therapy with a CCB plus an angiotensin receptor blocker was common (41%-42% of patients). The high prevalence of hypertension in Indonesia has an important economic impact, and approaches to increase awareness of the disease and adherence to therapy are needed, particularly given data showing the benefits of strict BP control.

Hypertension and Dementia: A comprehensive review from the HOPE Asia Network.

Approximately 365 million people in Asia were classified as elderly in 2017. This number is rising and expected to reach approximately 520 million by 2030. The risk of hypertension and cognitive impairment/dementia increases with age. Recent data also show that the prevalence of hypertension and age-related dementia are rising in Asian countries. Moreover, not many people in Asian countries are aware of the relationship between hypertension and cognitive impairment/dementia. Furthermore, hypertension control is poorer in Asia than in developed countries. Hypertension is known to be a major risk factor for damage to target organs, including the brain. Decreased cognitive function can indicate the presence of target organ damage in the brain. Twenty-four-hour blood pressure profiles and blood pressure variability have been associated with cognitive impairment and/or silent cerebral diseases, such as silent cerebral infarction or white matter lesions, which are predisposing conditions for cognitive impairment and dementia. Hypertension that occurs in midlife also affects the incidence of cognitive impairments in later life. Managing and controlling blood pressure could preserve cognitive functions, such as by reducing the risk of vascular dementia and by reducing the global burden of stroke, which also affects cognitive function.