Determinants of Facility-Based Childbirth in Indonesia.

BACKGROUND: Reducing maternal mortality remains a significant challenge in Indonesia, especially for achieving the country's Sustainable Development Goals (SDGs) by 2030. One of the challenges is increasing delivery at healthcare facilities to ensure safe and healthy births. In Indonesia, research on factors affecting women's use of facility-based childbirth services is scarce. OBJECTIVE: This study was conducted to identify the determinants of facility-based deliveries in Indonesia. METHODS: This study used data from the Indonesia Demographic and Health Survey of 2012, with a cross-sectional design. An odds ratio with 95% confidence intervals (CI) was employed to outline the independent variables for the determinants, including maternal age and education, place of residence, involvement in decision-making, employment status, economic status, and number of antenatal care visits. The dependent variable in this study was the place of delivery: whether it took place in healthcare or nonhealthcare facilities. The statistical significance was set at p<0.05 using bivariate analysis and binary logistic regression. RESULTS: This study showed that a high level of education (OR: 3.035, 95% CI: 2.310-3.987), high economic status (OR: 6.691, 95% CI: 5.768-7.761), urban residence (OR: 2.947, 95% CI: 2.730-3.181), working status (OR: 0.853, 95% CI: 0.793-0.918), involvement in decision-making (OR: 0.887, 95% CI: 0.804-0.910), and having more than four visits to antenatal care centers (OR: 1.917, 95% CI: 1.783-2.061) were significant determinants of delivery at healthcare facilities. CONCLUSION: Efforts to improve facility-based childbirth in Indonesia must strengthen initiatives that promote women's education, women's autonomy, opportunities for wealth creation, and increased uptake of antenatal care, among others. Any barriers related to maternal healthcare services and cultural factors on the use of health facilities for childbirth in Indonesia require further monitoring and evaluation.

Independent and synergistic effects of self- and public stigmas on quality of life of HIV-infected persons.

Stigma has a potential impact on the quality of life of HIV-infected individuals over time. There is little empirical evidence regarding the first appearance and dynamic changes among different types of stigma, self-stigma and public-stigma, and their impacts on quality of life over time in HIV-infected persons. The purpose of this study was to assess the dynamic changes in self-stigma and public-stigma along the time course and determined their independent and synergistic impacts on quality of life. A Cross-sectional study was conducted at Two HIV-designed hospitals and two branches of non-government an-AIDS organizations in Wes Java, Indonesia. Persons diagnosed with HIV completed self-report measures of stigma and the questionnaire of World Health Organization Quality of Life (WHOQOL)-HIV brief version. Kernel smoothing method and multivariate linear regression were applied for statistical analysis. Two hundred fifteen adult HIV-infected persons agreed to participate in this study, with a response rate of 85.3%. The kernel smoothing means showed that one-third of subjects developed self-stigma immediately after HIV diagnosis while a higher public-stigma felt 6 months later, and both seemed to last continually. Beginning at about 48 months after diagnosis, participants with stigma showed consistently lower scores for all domains of quality of life. After control of potential confounding through multiple linear regression analyses, we found scores of all four domains and items of mobility, fatigue, activity of daily living, positive feeling, self-esteem, social support, and physical environment of WHOQOL were independently associated with both self-stigma and public-stigma. While self-stigma also affects items related to personal psychological feelings, public stigma alone associates with lower scores of items related to social and environmental domains. Our findings underscore the need to explore and control the complex structure and possible synergistic effects of multiple stigmatizations.

Mediating Effect of Motivation on the Relationship Between Lecturer Experience and Learning Environment With Caring Character Among Undergraduate Nursing Student in Indonesia.

Introduction: Caring is learned through faculty role-modeling and clinical interactions, enhancing nursing students' caring character. Relationship between caring, motivation, teacher experience, and learning environment remains uncertain. Objective: The present study aimed to explore the relationship between their caring characters, motivation, lecturer experience, and learning environment among undergraduate nursing students in Indonesia. Methods: A cross-sectional study was conducted between December 2022 and February 2023, recruiting 550 undergraduate nursing students from 10 universities in West Java province, Indonesia. The study included instruments such as students' perceptions of learning, academic motivation scale, service quality assessment of instructional laboratories, and caring character learning instrument. The Bootstrap analysis was used to analyze the mediating effect of study variable. Results: The study involved participants aged 20-25 years. The mean scores for caring characters, lecturer experience, motivation, and learning environment were 2.18 ± 0.97, 3.46 ± 1.20, 4.32 ± 1.53, and 5.96 ± 2.08, respectively. The results showed significant direct effects of lecturer experience on caring character, mediating effects of learning environment, motivation, and chain mediating effects of learning environment and motivation. The direct effect accounted for 44.34% of the total effect, while the indirect effect was 35.21%. Conclusions: The study found that learning environment and motivation mediate the relationship between lecturer experience and caring characters among undergraduate nursing students in West Java, Indonesia. Emphasizing best practices and creating a student-friendly environment is crucial for fostering guidance and support.

The Relationship Between Bullying and Risk of Suicide Among Adolescents During the COVID-19 Pandemic in Indonesia.

Objectives: Although adolescents appear less vulnerable to coronavirus disease (COVID-19), the side effects of this pandemic can still be devastating. Bullying and suicidality are significant global issues with detrimental effects on young people, particularly during school closure. This study aimed to identify the relationship between bullying and suicide risk among adolescents in Indonesia during the COVID- 19 pandemic. Methods: A cross-sectional study was conducted on adolescents aged 14-18 years in May 2020 in Bandung, Indonesia, using a webbased closed survey. The Adolescent Peer Relations Instrument and the Suicide Behavior Questionnaire-Revised were used to measure bullying and risk of suicide. Multinomial logistic regression analysis was performed. Results: This study included 268 participants in 2020 and 175 participants in 2019. In 2020, the prevalence of perpetrators and victims of bullying combined was 74.6%. Meanwhile, in 2019, the prevalence of perpetrators and victims of bullying combined was 82.9%. Risk of suicide increased from 26.1% in 2019 (before the COVID-19 pandemic) to 36.5% in 2020 (during the first wave of the COVID-19 pandemic). The risk of perpetrators and suicide victims was higher than that of perpetrators and victims alone (odds ratio [OR]=4.0, 95% confidence interval [CI]=1.5-6.6 vs. OR=1.3, 95% CI=1.0-2.9 and OR=1.6, 95% CI=1.1-2.8, respectively). Conclusion: Bullying can enhance the likelihood of suicide among adolescents in Indonesia, and the risk was highest for the combination of victims and perpetrators. It is very important to provide early risk prediction for youths with bullying behavior and improve the knowledge and understanding of families and schools regarding the negative effects of bullying behavior.

Smart bed notification system base on Internet of Things for fall prevention in patients with stroke.

The Smart Bed Notification System is a system that alerts the movement of objects (patients with stroke) on the care mattress when patients are at risk of being dropped or falling. The notification device consists of two subsystems, namely hardware and software. In the hardware part, it consists of a camera to track patient movements, Raspberry Pi as a system controller that is equipped with a WiFi interface to transmit data wirelessly to smartphones that are equipped with Android-based applications. In the software part, however, openCV installed on Raspy is designed to picture the surveillance results of the webcam. Furthermore, the smartphone has an Android-based feature, which displays alerts of patient movement. Stroke patients may be tracked remotely over the Internet by nurses or their relatives.

Usability and Usefulness of a Mobile Heath App for HIV Prevention Among Adolescents in Indonesia.

BACKGROUND: Mobile health apps could help reduce human immunodeficiency virus (HIV) transmission in adolescents. A multidisciplinary group developed the HIV Info Corner app to provide information about HIV transmission, risk behaviors, and prevention. OBJECTIVES: This research aimed to evaluate the usability of the HIV Info Corner app and its usefulness as perceived by potential users. METHODS: 15 adolescents engaged in meetings and performed 5 tasks. Usability was evaluated using the System Usability Scale (SUS) and the Nielsen Severity Scale. Usefulness was evaluated using the Intrinsic Motivation Inventory (IMI). RESULTS: 10 usability problems were found; 8 were considered minor problems and 2 classified as major. CONCLUSION: Users considered the information in the HIV Data Corner app relevant, satisfying their requirements.

Working alliance among mental health nurses in Indonesia: A comparative analysis of socio-demographic characteristics.

Background: Working alliance between therapist and client in psychotherapy practice has become proven to compensate for a significant difference in various psychotherapy modalities. However, few studies have investigated the structure of alliance in the context of nurses working at mental health hospitals in Indonesia. Objective: This study aimed to compare the working alliance of mental health nurses according to socio-demographic characteristics. Methods: A cross-sectional research was performed at the Mental Health Hospital in West Java, Indonesia, as a referral hospital in Indonesia from May to December 2019. The inclusion criteria were nurses with a minimum of one year of working experience and a Diploma III certificate in nursing. Convenience sampling was used to recruit 120 nurses who agreed to join in this study. The working alliance was measured using Working Alliance Inventory-Short Revised-Therapist (WAI-SRT). Results: The majority of the respondents were female (77.5%), holding a Diploma III degree in nursing (49.17%), having working experience ranged from 11 to 15 years (34.17%), and working at the chronic unit (32.5%). The mean score of the working alliance was 44.46 (SD = 11.32). The domain of agreement on goals had a higher mean score (17.65 ± 3.45), followed by the task domain (16.56 ± 5.81) and bond domain (22.10 ± 7.23). There was a significant difference in working alliance according to education level and working experience (p < 0.05), while no significant differences in terms of gender and working unit. Conclusion: Mental health nurses with higher education levels and more vast working experience had higher working alliances. Thus, nurse managers and hospital policymakers should provide Continues Nursing Education (CNE), working alliance training, and therapeutic strategies for nurses to improve their working alliances. It is also essential to cooperate with nursing schools to include working alliances as learning objectives.

A 10-Years Risk of Cardiovascular Disease Among HIV-Positive Individuals Using BMI-Based Framingham Risk Score in Indonesia.

INTRODUCTION: Cardiovascular disease (CVD) is the primary cause of death in HIV patients. The number of HIV patients suffering from cardiovascular disease is almost twice as high as that of patients who are not HIV-positive. OBJECTIVE: The purpose of this study was to evaluate risk of cardiovascular disease among HIV-positive persons. METHODS: We conducted a cross-sectional study with HIV positive individuals at public health center and non-AIDS govermental organization. We enrolled people diagnosed with HIV, age over 30 years old, and on CVD medications. We collected data of demographic, anthropometric and clinical information, smoking history, and non-fasting cholesterol and blood glucose. Estimation of 10-years CVD risk was calculated using the BMI-based Framingham Risk Score. RESULTS: Of 150 participants enrolled, 66.7% were male and mean age was 38.09 (SD = 7.99) years. The mean current CD4 counts was 493.3 (SD = 139.8) cells/mm3. Female were younger, had a shorter duration living with HIV and a shorted duration of receiving ART than males. About 8.7% of respondents had a high risk of developing a CVD event in the next 10 years, and higher among females than males. The most common CVD risk factors were smoking, high blood pressure, and hypercholestrolemia. CONCLUSION: Our study demonstrates that HIV positive persons who are at risk for developing CVD in the next 10-years. There is an increasing need for educational programs on CVD prevention for the HIV-positive person and to further facilitate the identification of persons at elevated risk in routine practice.

Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence.

Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.

HIV-related knowledge level among Indonesian women between 15 years and 49 years of age.

BACKGROUND: Women are a highly vulnerable population for HIV-infection, influenced by biological, cultural, social and economic factors. Inadequate knowledge about the risk for exposure to HIV will impact the prevention and treatment of HIV. OBJECTIVES: The aim of this study was to examine HIV-related knowledge among women in Indonesia and the associated demographic determinants that influence their access to accurate HIV-related information. METHODS: This was a secondary analysis of the Indonesia Demographic and Health Survey in 2012. Level of HIV-related knowledge was determined by analyzing nine items on the 2012 IDHS instrument. RESULTS: The percentage of women in Indonesia between the ages of 15 and 49 years of age, more than half (53.6%) had high score of HIV-related knowledge. The results from logistic regression showed that women aged 30-34 years old had 2.2 times higher knowledge level about HIV compared to older women. Married women, living in rural area, with a lower level of education, reported to have limited or no access to HIV related information; thus, had a correspondingly lower knowledge level of HIV. CONCLUSION: Study findings underscore the lack of knowledge-level among Indonesian women about HIV, especially the prevention, transmission, and prevention mother to child transmission (PMCT).

Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors.

INTRODUCTION: People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. OBJECTIVE: The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). METHODS: PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. RESULTS: The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8-11.1) with pooled odds ratio of 1.9 (95%CI: 1.1-3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95% CI: 7.9-14.5) with incidence rate ratio (IRR) of 1.5 (95% CI: 1.3-1.8) compared to the general population. Risk factors for fracture incidence were older age (aHR 1.4, 95% CI: 1.3-1.6), smoking (aHR 1.3, 95% CI: 1.1-1.5), HIV/HCV co-infection (aHR 1.6, 95% CI: 1.3-1.9), and osteoporosis (aHR 3.3, 95% CI: 2.2-5.1). CONCLUSIONS: Our finding highlights a higher risk of fracture among PLWH compared to the general population. Osteoporosis, smoking and HIV/HCV coinfection as the significant modifiable risk factors should be prioritized by the HIV health providers when care for PLWH.

Determinants of smoking behavior among young males in rural Indonesia.

INTRODUCTION: A high prevalence of tobacco smoking has been reported among adolescents and young adults, especially men, in lower-middle-income countries such Indonesia. Understanding the extent and determinants of smoking within this population, particularly those living in rural areas where smoking rates are anecdotally higher than in city areas, is essential to inform development of targeted smoking prevention and reduction programs. This study analyzes the prevalence and determinants of smoking behavior among young men in rural Indonesia. METHODS: Secondary data analysis of the 2012 Indonesia Demographic and Health Survey: Adolescent Reproductive Health (IDHS ARH) were used. Data from 4811 rural males (15-24 years of age) were selected through two-stage stratified cluster sampling techniques. The chi-square (χ2) test and binary logistic regression were used to determine significant factors associated with tobacco smoking. RESULTS: More than half of this population in rural Indonesia were smokers. Significant factors associated with smoking were: age 20-24 years (odds ratio (OR) 2.8, 95% confidence interval (CI) 2.4-3.2), working status (OR = 2.24, 95% CI: 1.95-2.57), low education level (OR = 1.93, 95% CI: 1.52-2.45), access to magazines (OR = 0.78, 95% CI: 0.68-0.89) and access to the radio (OR = 1.28, 95% CI: 1.12-1.48) at least once a week. CONCLUSIONS: A significant proportion of adolescents and young men in rural Indonesia smoke tobacco. Exposure to media with likely cigarette advertising (radio and magazines) and access to money via employment in the context of lower socio-economic and education levels elevate the risk of smoking. While Indonesian government campaigns targeting smoking are in place, further work is required to decrease smoking rates and prevent a future smoking-related health crisis for rural Indonesia's young men.

Complex Problems, Care Demands, and Quality of Life Among People Living With HIV in the Antiretroviral Era in Indonesia.

People living with HIV (PLWH) suffer from physical and psychological distress that palliative care could alleviate. Our cross-sectional study identified HIV-related problems and demands for palliative care at different disease stages, and their interactions with quality of life (QOL) in 215 PLWH from a referral hospital and an AIDS nongovernmental organization in Indonesia. A brief survey of demographic information, the Bahasa version of Problems and Needs of Palliative Care, and the World Health Organization Quality of Live in HIV-infected Persons instrument (WHOQOL-HIV BREF; Cronbach's alpha = .89) were used for data collection. Mean age was 33.5 years (SD = 4.7); 66% were male. Fatigue (67%) was the most prevalent symptom, and the symptom sleeping problems (54.9%) was the priority for palliative care. Higher spiritual and financial demands were found in PLWH with stage IV HIV. Multivariable analysis indicated negative associations between QOL and psychosocial problems, and demands for social and financial support. Interventions focused on psychosocial issues would improve the QOL for PLWH.

El efecto de la relajación muscular progresiva en la reducción del síndrome de las piernas inquietas entre los pacientes sometidos a hemodiálisis en una unidad periférica en Indonesia / The effect of progressive muscle relaxation on reducing restless legs syndrome among patients undergoing hemodialysis in a satellite/hospital unit in Indonesia

Objetivo: Determinar el efecto de la relajación muscular progresiva (RMP) sobre el síndrome de piernas inquietas en pacientes sometidos a hemodiálisis.Metodología:Se llevó a cabo un estudio con diseño cuasi-experimental en la unidad de hemodiálisis. La muestra reclutada fue de 12 encuestados tanto en el grupo de intervención como en el de control, siendo el muestreo de conveniencia. El instrumento de investigación utilizado fue la Escala Internacional del Grupo de Estudio del SPI.Resultados:En el grupo de intervención, las puntuaciones medias del SPI antes y después fueron de 22,92 y 17,42, respectivamente. En el grupo de control, las puntuaciones medias del SPI antes y después de la intervención fueron de 24,33 y 23,50, respectivamente. La RPM fue eficaz para mejorar el SPI (p<0,005).Conclusión:La RMP podría ser una alternativa para reducir el SPI en pacientes sometidos a hemodiálisis. Se necesitan estudios futuros para aclarar los hallazgos utilizando métodos más robustos y un tamaño de muestra mayor. (AU)

Introduction: Muscle relaxation is considered as an alternative therapy for restless legs syndrome (RLS).Objective:To determine the effect of progressive muscle relaxation (PMR) on restless legs syndrome in patients undergoing hemodialysis.Methodology:This study was conducted using the quasi-experimental design in the unit hemodialysis. The sample recruited was 12 respondents in both intervention and control group using convenience sampling. The research instrument used the International RLS Study Group Scale.Results:The average score of RLS before and after PMR in the intervention group was 22.92 and 17.42, respectively. In the control group, the mean score of RLS before and after intervention was 24.33 and 23.50, respectively. PMR was effective to improve RLS (p<0.005).Conclusion:PMR could be an alternative to reduce RLS in patients undergoing hemodialysis. Future studies are needed to clarify the findings using more robust methods and large sample size. (AU)

Eficacia ejercicio basado en el hogar usando una aplicación móvil para mejorar las funciones cognitivas en pacientes con hipertensión: un sencillo diseño experimental / Home based-exercise using mobile application to improve cognitive functions in patients with hypertension: a quesy experimental design

OBJETIVO: El propósito de este estudio fue determinar el efecto del ejercicio en el hogar utilizando una aplicación móvil para mejorar las funciones cognitivas en pacientes con hipertensión. MÉTODOS: Este estudio se realizó utilizando un sencillo diseño experimental con un grupo de prueba previa y posterior en un centro de salud pública ubicado en Java Occidental, Indonesia, de febrero a julio de 2019. Un programa de ejercicios basado en dispositivos móviles era una actividad de caminar en casa todos los días durante un mes. La muestra en el estudio se seleccionó mediante muestreo de conveniencia para adultos mayores de 18 años y diagnosticados con hipertensión. La Evaluación Cognitiva de Montreal (MoCA) se utilizó para medir la función cognitiva. Una prueba t pareada utilizada para analizar datos con el nivel de significancia se estableció en 0.05. RESULTADOS: Un total de 120 participantes se inscribieron en este estudio. La edad media de la muestra fue de 56.42 ± 10.6 años, 70 (58.3%) eran hombres, 61 (50.8%) tenían un nivel educativo más bajo y 77 (64.2%) estaban desempleados. La puntuación media de MoCA mostró una mejoría después de la intervención, de 23.3 ± 3.42 a 26.7 ± 2.78, p = 0.010. Más detalladamente, hubo mejoría después de la intervención en el dominio de nomenclatura (2.930.34 vs. 3.141.06, p = 0.003), atención (2.39 ± 0.68 vs. 3.12 ± 1.04, p = 0.001) y abstracción (1.56 ± 0.49 vs. 2.01 ± 0.89, p = 0.043). CONCLUSIÓN: El uso de una aplicación de ejercicio móvil fue efectivo, fácil de hacer con bajo costo para mejorar la función cognitiva y prevenir la demencia en pacientes hipertensos

EFFECTIVENESS MAIN GOAL: The purpose of this study was to determine the effect of home based-exercise using mobile application to improve cognitive functions in patients with hypertension. METHODS: This study was conducted using a queasy experimental with one group pre-post test design at a public health center located in West Java, Indonesia on February to July 2019. A mobile-based exercise program was a walking activity at home every day for one month. The sample in the study was selected using convenience sampling to adults aged above 18 years old and diagnosed with hypertension. The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function. A paired t-test used to analyze data with the significance level was set at 0.05. RESULTS: A total of 120 participants were enrolled in this study. The mean age of the sample was 56.42 ± 10.6 years old, 70 (58.3%) were male, 61 (50.8%) had lower education level, and 77 (64.2%) were unemployed. The mean score of MoCA showed improved after intervention, from 23.3 ± 3.42 to 26.7 ± 2.78, p = 0.010. In more detail, there were improvement after intervention in domain of naming (2.930.34 vs. 3.141.06, p = 0.003), attention (2.39 ± 0.68 vs. 3.12 ± 1.04, p = 0.001), and abstraction (1.56 ± 0.49 vs. 2.01 ± 0.89, p = 0.043). CONCLUSION: Using a mobile-exercise App was effective, easy to do with low cost to improve cognitive function and prevent dementia in hypertensive patients