Patient Experience Correlates with Willingness to Retain Service Utilization in Post-Pandemic Times Among Telemedicine Users in Indonesia.

Background: COVID-19 pandemic increases the use of telemedicine worldwide. Sustaining its use during post-pandemic times is important to overcome health care disparities, especially in countries with an inadequate number or uneven distribution of health care workers. This study aims to analyze factors associated with the willingness to retain telemedicine utilization after the COVID-19 pandemic. Methods: An online survey was administered during the COVID-19 pandemic. Demographic characteristics and patient experience were used as predictors. Chi-square was used to examine the relationship between the outcome variable and the predictors. Finally, binary logistics regression was conducted to determine factors associated with willingness to retain telemedicine utilization after the COVID-19 pandemic. Results: A total of 784 responses were included in the analysis. The result showed a high rate of willingness to retain telemedicine utilization (81%). Factors associated with outcome variable were satisfaction (adjusted odds ratio [aOR] 7.893; 95% confidence interval [CI]: 3.600-17.308; p < 0.001), telemedicine efficacy (aOR 1.747; 95% CI: 1.144-2.667; p = 0.010), ease of use (aOR 6.570; 95% CI: 3.029-14.250; p < 0.001), time efficiency (aOR 1.666; 95% CI: 1.092-2.540; p = 0.018), and cost efficiency (aOR 1.852; 95% CI: 1.005-3.411; p = 0.048). In contrast, patients who first used telemedicine during the COVID-19 pandemic were less likely to retain telemedicine utilization (aOR 0.437; 95% CI: 0.281-0.679; p < 0.001). Conclusions: The high willingness to retain utilization is a good indication of the sustainability of telemedicine services during post-COVID-19 pandemic. The stakeholders should focus on factors revealed in this study to increase the service uptake.

The Significance of Physician-Patient Communication on Telemedicine Patients' Health Outcomes: Evidence from Indonesia.

The importance of physician-patient communication on patient health outcomes has been globally known. Poor communication in clinical settings, including in telemedicine visits, has been identified as a key barrier to successful medical consultation. This barrier is even more prevalent among people from linguistically and culturally diverse communities. This study investigated the influence of physician-patient communication on telemedicine patient health outcomes in Indonesia, a developing country with great linguistic and cultural diversity. This study utilized secondary data from a telemedicine utilization survey conducted during the coronavirus disease 2019 (COVID-19) pandemic. Socioeconomic factors and communication features were included as predictors of patients' health improvement. Logistic regressions were utilized to examine the significance of the communication features on patients' health. The analysis results indicated that five communication features including the adequacy of consultation length, a timely physician response, the provision of an explanation of the medication and possible side effects, the patient's ability to utter their physical condition and opinion regarding medication goals, and the patient's ability to comprehend physician explanations and instructions were significantly associated with the patient's health outcomes. Physicians and healthcare providers should focus on the provision of communication features revealed in this study to elevate the likelihood of improved health conditions in telemedicine patients.

Gastrointestinal Presentation in COVID-19 in Indonesia: A Case Report.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently causing a widespread infection in the world. During the pandemic, physicians may need to raise the index of suspicion earlier in at-risk patients presenting with gastrointestinal symptoms, which are uncommon findings in coronavirus disease 2019 (COVID-19) patients. We report a patient in Indonesia with chest pain and gastrointestinal symptoms who was later confirmed to have SARS-CoV-2 infection after spending days of hospitalisation in the standard ward.

The Impact of Post-COVID-19 Conditions on Sleep and Quality of Life in Indonesia: A Nationwide Cross-Sectional Study.

Background: Sleep disturbances are included in the six most commonly cited complaints in post-COVID-19 conditions. In order to find the optimal management approach and enhance Quality of Life (QoL), we intend to explore sleep disturbances that occur in post-COVID-19 conditions. Methods: This was a cross-sectional study conducted with interviews and questionnaires using the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, Insomnia Severity Index (ISI) for assessing insomnia, Epworth Sleepiness Scale (ESS) for assessing Excessive Daytime Sleepiness (EDS), STOP-BANG questionnaire for assessing Obstructive Sleep Apnea (OSA), and Short Form 36 (SF-36) for assessing QoL. We recruited respondents from several cities in Indonesia and performed an analysis to find the relationship between sleep disturbance and its association with QoL. Results: This study involved 757 respondents. They were predominantly female, with a median age of 39 years, no comorbidities, and had exhibited mild COVID-19 severity. Subjects with post-COVID-19 conditions experienced insomnia, poor sleep quality, normal sleepiness, and low risk of OSA. Sleep quality caused role limitations due to decreased physical and mental health. Insomnia caused role limitations due to emotional and social functioning problems. Meanwhile, OSA only affected physical functioning. Conclusion: Numerous aspects of patients' QoL are affected by sleep disturbance in post-COVID-19 conditions. A comprehensive approach and coordinated care pathways must be effectively managed to improve QoL among individuals experiencing sleep disturbance.

Development of Tuberculosis Vulnerability Assessment Conceptual Framework Using Automatic Content Analysis.

The tuberculosis prevention and control model needs to be explored. This study aimed to create a conceptual framework for measuring TB vulnerability to guide the prevention program's effectiveness. SLR method was employed, resulting in 1.060 articles being analyzed with ACA Leximancer 5.0 and facet analysis. The built framework consists of five components: risk of TB transmission, damage caused by TB, health care facility, the burden of TB, and awareness of TB. Future research is required to explore variables in each component to formulate the degree of TB vulnerability.

The Effects of Holothurin and Caspofungin on the Vaginal Cell Inflammation Parameters of the Rattus norvegicus Strain Post Induction of Candida albicans.

Purpose: Candida albicans (C. albicans) is a fungus that causes superficial and invasive candidiasis in its host. Caspofungin, has been widely used as a synthetic antifungal, whereas holothurin has been shown to have potential as a natural antifungal. The purpose of this study was to see how holothurin and caspofungin affected the number of C. albicans's colonies, LDH levels, and the number of inflammatory cells in vagina of Rattus norvegicus. Patients and Methods: Design of this research is using posttest only with control group design with 48 Rattus norvegicus Wistar strains used in this study were divided into six treatment groups. Each group was divided into three-time intervals of 12, 24, and 48 hours. LDH markers were tested using ELISA, inflammatory cells were counted manually, and the number of colonies was calculated using colonymetry before being diluted with NaCl 0.9% and planted in sabouraud dextrose agar (SDA). Results: According to the findings, inflammatory cells in the treatment of holothurin (48-hours) had an OR of 1.68 CI (-0.79-4.16) P = 0.09 and caspofungin had an OR of 4.18 CI (1.26-9.63) P = 0.09. Meanwhile, LDH in the holothurin (48-hour) treatment obtained OR 348, CI (286-410), P=0.03, and Caspofungin OR 393, CI (277-508), P=0.03. Colonies were obtained with zero numbers in the holothurin treatment (48 hours) and with Caspofungin OR 393, CI (273-508) P=0.00. Conclusion: Holothurin and caspofungin administration reduced the number of C. albicans colonies and the number of inflammatory cells (P 0.05), implying that holothurin and caspofungin could prevent C. albicans infection.

Development of a Conceptual Framework for Tuberculosis Management and Control; an Evidence Synthesis Using Text Mining Software: A Review.

Background: The use of electronic systems supported by text-mining software applications that support the End TB strategy' needs to be explored. This study aimed to address this knowledge gap, and synthesis of evidence. Methods: The PubMed database was searched for structured review articles published in English since 2012 on interventions to control and manage TB. Nine hundred twenty-five articles met the inclusion criteria. The included articles were synthesized using the text and content analysis software Leximancer. The themes were chosen based on the hit words that emerged in the frequency and heat maps. After the themes were chosen, the concept built the themes based on likelihood. Results: The framework resulting in the study focuses on early detection and treatment to minimize the chance of TB transmission in the population, especially for highly susceptable populations. The main area highlighted is the appropriate screening and treatment domains. The framework generated in this study is somewhat in line with the WHO Final TB Strategy. This study highlights the importance of improving TB prevention through a patient-centered approach and protecting susceptible populations. Conclusion: Our findings will be helpful in guiding TB practice, policy development and future research. Future research can elaborate the framework and elicit feedback from TB management stakeholdesr to assess its utility.

Synergistic Cytotoxic and Antimigratory Effect of Brazilein and Doxorubicin on HER2-Overexpressing Cells.

OBJECTIVE: The present research aims to report cytotoxic and antimigratory activities of the oxidized form of brazilin, i.e., brazilein, and the effects of the combination of brazilein-doxorubicin on MCF-7/HER2 cells. METHODS: The MTT assay was conducted to test the cytotoxic activity, while flow cytometry with PI and PI-annexin V staining were respectively performed for cell cycle and apoptosis analyses. Migration and invasion analyses were assessed via Boyden chamber assay, while HER2, Rac1, p120, MMP2, and MMP9 protein levels were determined by immunoblotting and gelatin zymography. Molecular docking of ligands with HER2, Src, PI3Kα, PI3KΔ, and PI3Kγ proteins was evaluated using MOE 2010. RESULTS: The MTT assay showed that the IC50 value of brazilein against MCF-7/HER2 cells was 51 ± 2.1 µM. Moreover, brazilein and its combination with doxorubicin-induced G2/M accumulation and apoptosis. Combination of brazilein-doxorubicin inhibited cell migration and tended to decrease HER2, Rac1, p120, MMP2, and MMP9 protein expression levels. Based on our molecular docking study, the docking score of brazilein with PI3Kγ is comparable to that of the native ligand. CONCLUSION: Taken together, a combination of brazilein-doxorubicin exhibited synergistic cytotoxic and antimigratory effects on MCF-7/HER2 cells.
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Relationship of spirituality, health engagement, health belief and attitudes toward acceptance and willingness to pay for a COVID-19 vaccine.

PURPOSE: To explore the wider determinant factor of citizens' spirituality, health engagement, health belief model, and attitudes towards vaccines toward acceptance and willingness to pay for a Coronavirus disease 2019 (COVID-19) vaccination. METHODS: A community-based cross-sectional online investigation with convenience sampling was utilized to recruit 1423 citizens from 18 districts across Indonesia between December 14, 2020 and January 17, 2021. Descriptive statistics, One-way analysis of variance, Pearson correlation, Independent t-tests, and multiple linear regression were examined. RESULTS: Spirituality, health engagement and attitude toward vaccines, as well as health beliefs constructs (all scores of perceived benefits and barriers) were significant key factors of acceptance of vaccines. Interestingly, the spirituality, attitude toward vaccine, and health beliefs constructs including perceived susceptibility, and benefits indicated a significantly higher willingness. CONCLUSIONS: Results demonstrated the utility of spirituality, health engagement, health belief model, and attitudes towards vaccines in understanding acceptance and willingness to pay for a vaccine. Specifically, a key obstacle to the acceptance of and willingness to pay COVID-19 vaccination included a high score of the perceived barrier construct. Moreover, the acceptance of and willingness to pay could be impaired by worries about the side-effects of a COVID-19 vaccination.

Determinant factors of weight status among under two years children received the complementary feeding program.

OBJECTIVE: The study explored determinant factors of weight status among children aged 12-24 months who received complementary feeding program of the Ministry of Health in Luwu Timur, South Sulawesi Province. METHODS: The study used case-control design. It involved 82 children from poor families who received complementary feeding program. Forty-one children as a case group with constant body weight and forty-one children as a control group with increasing body weight within the last two months selected with a purposive sampling technique. RESULTS: Exclusive breastfeeding (OR=3.485; 95% CI=1.380-8.798), the duration of complementary feeding consumption (OR=0.299; 95% CI=0.095-0.939), history of diarrhea (OR=3.071; 95% CI=1.174-8.028) and milk consumption pattern (OR=0.233; 95% CI=0.069-0.791) were significant determinant of body weight status. Exclusive breastfeeding was the most dominant variable for body weight status (B=6.152). CONCLUSIONS: Exclusive breastfeeding during the first six months is crucial to support complementary feeding programs in increasing the body weight status of children aged 12-24 months.

Combination model in reducing HIV-related stigma: A systematic review.

OBJECTIVE: This article identifies and explains the various research models related to HIV stigma. METHODS: This systematic review is done using the PRISMA 2015 guidelines. Source of this review uses 3 online journal databases which are Pubmed, Scinapse, Elsevier. Search criteria include articles published this past 10 years between 2010 and 2020. RESULT: 4146 articles were obtained and 9 articles which are suited with the inclusion criteria and were chosen in the literature review. It was discovered that stigmatization is a cultural construct and its experiences varies between countries and communities. Models which differentiate are interpersonal and intrapersonal process in handling the stigma. CONCLUSION: Stigmas are still an important issues because often times it became an obstacle in the effort to reduce the prevalence of HIV/AIDS. Therefore there needs to be a gold standard scenario in reducing HIV related stigma, one of them being cultural in source.

Is Youth Smoking Related to the Density and Proximity of Outdoor Tobacco Advertising Near Schools? Evidence from Indonesia.

BACKGROUND: Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. OBJECTIVE: To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. METHODS: We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. RESULTS: We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. CONCLUSIONS: There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.

Psychometric Testing of the Bahasa Version of the Brief Illness Perception Questionnaire among Indonesians with Type 2 Diabetes Mellitus.

The Brief Illness Perception Questionnaire (B-IPQ) has been recommended to validate illness perception. Nevertheless, this measurement has yet to be validated with an assessment of the construct and convergent validities and reliability in Indonesia. Our study aimed to psychometrically test the 8-item B-IPQ among Indonesians with type 2 diabetes mellitus (T2DM). Data included 294 patients with T2DM with stratified multistage clustering. The 36-item Short Form Survey, 21-item Depression Anxiety Stress Scale, and fasting blood glucose (FBG) were used to examine convergence and divergence. The validity analysis included the construct and convergent validities with significant person correlations. Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE) were used to assess reliability. Confirmatory and exploratory factor analyses indicated a multidimensional structure, including cognitive with a five-item structure and emotional illness representation with a three-item structure, with an acceptable goodness of model fit. The tool revealed good internal consistency for the cognitive, emotional, and overall domains and was positively moderately correlated with FBG, stress, anxiety, and depression but negatively correlated with the overall quality of life and mental and physical component scores. Findings provide empirical evidence that the Bahasa version of the B-IPQ showed adequate internal consistency, exploratory and confirmatory, and thus is valid and reliable for illness perception assessments among Indonesians with T2DM.

Homogeneity and Possible Replacement of Populations of the Dengue Vectors Aedes aegypti and Aedes albopictus in Indonesia.

Currently, Aedes aegypti, the principal vector of dengue virus in Indonesia, has spread throughout the archipelago. Aedes albopictus is also present. Invasion and high adaptability of the Aedes mosquitoes to all of these areas are closely related to their ecology and biology. Between June 2016 and July 2017, larval and adult mosquito collections were conducted in 43 locations in 25 provinces of Indonesia using standardized sampling methods for dengue vector surveillance. The samples collected were analyzed for polymorphism and phylogenetic relationship using the mitochondrial cox1 gene and the nuclear ribosomal internal transcribed spacer 2 (ITS2). Almost all Ae. aegypti samples collected in this study (89%) belonged to the same haplotype. A similar situation is observed with the nuclear ITS2 marker. Populations of Ae. aegypti characterized few years ago were genetically different. A closely related observation was made with Aedes albopictus for which the current populations are different from those described earlier. Ae. aegypti populations were found to be highly homogenous all over Indonesia with all samples belonging to the same maternal lineage. Although difficult to demonstrate formally, there is a possibility of population replacement. Although to a lower extent, a similar conclusion was reached with Ae. albopictus.

Fast Expansion of the Asian-Pacific Genotype of the Chikungunya Virus in Indonesia.

Chikungunya is repeatedly affecting Indonesia through successive outbreaks. The Asian genotype has been present in Asia since the late 1950s while the ECSA-IOL (East/Central/South Africa - Indian Ocean Lineage) genotype invaded Asia in 2005. In order to determine the extension of the circulation of the chikungunya virus (CHIKV) in Indonesia, mosquitoes were collected in 28 different sites from 12 Indonesian provinces in 2016-2017. The E1 subunit of the CHIKV envelope gene was sequenced while mosquitoes were genotyped using the mitochondrial cox1 (cytochrome C oxidase subunit 1) gene to determine whether a specific population was involved in the vectoring of CHIKV. A total of 37 CHIKV samples were found in 28 Aedes aegypti, 8 Aedes albopictus and 1 Aedes butleri out of 15,362 samples collected and tested. These viruses, like all Indonesian CHIKV since 2000, belonged to a genotype we propose to call the Asian-Pacific genotype. It also comprises the Yap isolates and viruses having emerged in Polynesia, the Caribbean and South America. They differ from the CHIKV of the Asian genotype found earlier in Indonesia indicating a replacement. These results raise the question of the mechanisms behind this fast and massive replacement.

Quality of Life People Living with HIV/AIDS and Its Characteristic from a VCT Centre in Indonesia.

BACKGROUND: The quality of life (QoL) construct has also contributed to understanding the comprehension of factors involved in the existence of people infected by the HIV/AIDS. The objective of this study is to assess the quality of life (QoL) of people with HIV/AIDS (PLWHA) in Wonogiri District, Indonesia. METHODS: A cross-sectional study was conducted from September to November 2017. Convenience sampling method was employed to recruit 39 people living with HIV/AIDS (PLWHA) at Voluntary Counselling and Testing (VCT) of Wonogiri, Indonesia. Research data were collected using a self-administered questionnaire of WHOQOL-HIV BREF. The data were further analysed using a t-test and a Chi-square test, while linear regression was used to evaluate factors that correlate with the PLWHAs' quality of life. RESULTS: The results showed that the gross mean score of social relationships domain is 13.59; psychological domain is 13.31; environment domain is 13.28; spiritual/personal beliefs domainis 13.15; physical domain is 13.10; and level of independence domain is 13.77. The symptom of HIV is associated with quality of life (B = 7.611, ß = 0.362, t = 2,046, p value = 0.049). CONCLUSION: Healthcare provider should increase providerinitiated testing and counselling (PITC) to contracting group, high risk group, susceptible group, and the community. The PLWHA are recommended to actively participate in peer support groups (PSGs) so that they can improve their quality of life.

Assessing large-scale violence against children surveys in selected Southeast Asian countries: A scoping review.

BACKGROUND: Violence against children (VAC) is a widespread, global issue with far-reaching social and economic consequences. In recent years, VAC has received substantial international attention, resulting in government initiatives to reduce VAC, in part, by strengthening data collection and information systems. OBJECTIVE: This scoping review was undertaken to map survey methodologies for VAC measurement in Indonesia and other Southeast Asian countries and to identify key considerations for developing both methodologically sound and culturally appropriate VAC surveys in Indonesia and similar contexts. METHODS: The authors conducted manual and automated searches in English and Bahasa Indonesia through PubMed, global databases, and websites, and consulted with partners from the government of Indonesia and the child protection field to identify surveys conducted from 2006 to 2016 in Indonesia and Southeast Asia. The search identified 275 records, of which 11 met all inclusion criteria. RESULTS: The 11 surveys utilized a wide range of methodologies and employed inconsistent definitions, different age ranges for respondents, and different combinations of self-administered and face-to-face modes. A majority of the studies utilized household-based sampling, did not include a qualitative component, and used a tablet for data collection. CONCLUSION: In developing VAC surveys, researchers should consider which groups of children are excluded from the sampling frame; how qualitative data can be used to strengthen the validity of survey results; how to maximize privacy in face-to-face interviews; and whether self-administered modes are feasible and acceptable. Researchers should also ensure that the survey and research protocol undergo rigorous ethical review.

The Cytotoxic and Antimigratory Activity of Brazilin-Doxorubicin on MCF-7/HER2 Cells.

Purpose: Breast cancer cells with overexpression of HER2 are known to be more aggressive, invasive, and resistant to chemotherapeutic agent. Brazilin, the major compound in the Caesalpinia sappan L. (CS) heartwood, has been studied for it's anticancer activity. The purpose of this study was to investigate the cytotoxic and antimigratory activity of brazilin (Bi) in combination with doxorubicin (Dox) on MCF-7/HER2 cells. Methods: Cytotoxic activities of Bi individually and in combination with Dox were examined by MTT assay. Synergistic effects were analyzed by combination index (CI). Apoptosis and cell cycle profiles were observed by using flow cytometry. Migrating and invading cells were observed by using a Boyden chamber assay. Levels of MMP2 and MMP9 activity were observed by using a gelatin zymography assay. Levels of HER2, Bcl-2, Rac1, and p120 protein expression were observed by using an immunoblotting assay. Results: The results of the MTT assay showed that Bi inhibited MCF-7/HER2 cell growth in a dose-dependent manner with an IC50 of 54 ± 3.7 µM. Furthermore, the combination of Bi and Dox showed a synergistic effect (CI <1). Flow cytometric analysis of Bi and its combination with Dox showed cellular accumulation in the G2/M phase and induction of apoptosis through suppression of Bcl-2 protein expression. In the Boyden chamber assay, gelatin zymography, and subsequent immunoblotting assay, the combination Bi and Dox inhibited migration, possibly through downregulation of MMP9, MMP2, HER2, Rac1, and p120 protein expression. Conclusion: We conclude that Bi enhanced cytotoxic activity of Dox and inhibited migration of MCF-7/HER2 cells. Therefore, we believe that it has strong potential to be developed for the treatment of metastatic breast cancer with HER2 overexpression.

Two Active Compounds from Caesalpinia sappan L. in Combination with Cisplatin Synergistically Induce Apoptosis and Cell Cycle Arrest on WiDr Cells.

Purpose: The aim of this study is to observe the synergistic effect of two active compounds of secang, brazilin and brazilein, combined with cisplatin on WiDr colon cancer cells. Methods: Cytotoxic activities of brazilin (Bi) and brazilein (Be) in single and in combination with cisplatin (Cisp) were examined by MTT assay. Synergistic effect was analyzed by combination index (CI) parameter. Apoptosis and cell cycle profiles were observed by using flow cytometry. Results: The result of MTT assay showed that IC50 value of brazilin and brazilein on WiDr cancer cells were 41 µM and 52 µM respectively. The combination of ½ IC50 of Bi-Cisp reduced cells viability up to 64% and showed synergistic effect with CI value less than 1 (CI = 0.8). The combinations of ½ IC50 of Be-Cisp also reduced cells viability up to 78% and showed synergistic effect (CI=0.65). Combination of Bi-Cisp and Be-Cisp induced apoptosis higher than the single treatments. Further analysis on the cell cycle progression showed that single treatment of ½ IC50 of Be and Bi induced S-phase and G2/M-phase accumulation, while combination of Be-Cisp and Bi-Cisp enhanced S-phase accumulation. Conclusion: Both combination of Bi-Cisp and Be-Cisp showed synergistic effect on WiDr cells through induction of apoptosis and halted the cell cycle progression, thus, WiDr cells growth were significantly reduced.