Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders' perspectives.

OBJECTIVES: Cervical cancer is a significant public health concern in Indonesia, and effective screening methods are necessary to improve the detection and reduce mortality. This study aimed to explore the perspectives of high-level stakeholders involved in cervical cancer screening in Indonesia and whether the use of human papillomavirus-deoxyribonucleic acid (HPV-DNA) methods for cervical cancer screening is acceptable in Indonesian settings. METHODS: A qualitative research approach guided by realist evaluation was applied using focus group discussions (FGDs) between December 2021 and February 2022, conducted with stakeholders involved in cervical cancer screening in Indonesia. They were representatives of practitioners and policymakers involved in the screening, and were recruited through purposive recruitment. The data were analysed using inductive approach of thematic analysis. RESULTS: The analysis of two FGDs with 29 participants identified four main themes: (i) Visual inspection with acetic acid (VIA) method as the most common modality used for cervical cancer screening, (ii) the applied screening programs in the community, (iii) the perceived challenges on the screening program, such as limitations of the National Health Insurance benefits package and a lack of regulations regarding screening procedures, and (iv) the possibilities of HPV-DNA testing as another modality for cervical cancer screening. Incorporating HPV-DNA testing also needs to ensure the capacity of the workers and the readiness of healthcare facilities. CONCLUSION: Although HPV-DNA testing is a promising modality, challenges on the cervical cancer screening in Indonesia remain on the coverage, accessibility of the tools in practice and the women's awareness towards the screening. Ultimately, the findings of this study would help inform policies to improve cervical cancer screening programs in Indonesia.

A Brief Analysis on Clinical Severity of Mandibulofacial Dysostosis Guion-Almeida Type.

OBJECTIVE: Genetic variants in EFTUD2 were proven to influence variable phenotypic expressivity in mandibulofacial dysostosis Guion-Almeida type (MFDGA) or mandibulofacial dysostosis with microcephaly (MFDM). Yet, the association between the severity of clinical findings with variants within the EFTUD2 gene has not been established. Thus, we aim to elucidate a possible genotype-phenotype correlation in MFDM. METHODS: Forty articles comprising 156 patients were evaluated. The genotype-phenotype correlation was analyzed using a chi-square or Fisher's exact test. RESULTS: The proportion of patients with MFDM was higher in Caucasian relative to Asian populations. Although, in general, there was no apparent genotype-phenotype correlation in patients with MFDM, Asians tended to have more severe clinical manifestations than Caucasians. In addition, cardiac abnormality presented in patients with intronic variants located in canonical splice sites was a predisposing factor in affecting MFDM severity. CONCLUSION: Altogether, this article provides the pathogenic variants observed in EFTUD2 and possible genotype-phenotype relationships in this disease.

Functional status in relation to depression among elderly individuals in Indonesia: a cross-sectional analysis of the Indonesian National Health Survey 2018 among elderly individuals.

BACKGROUND: Depression among elderly individuals is related to physical illness, functional status, prolonged treatment and other factors. Depression is not effectively treated with medication but can be alleviated by treating the physical illness and improving functional status. Therefore, this study aims to determine the relationship between functional status and depression in elderly individuals in Indonesia. METHODS: The data used were obtained from a national survey dataset, namely, the Basic Health Research and Socio-Economic Survey in 2018, which was carried out in 34 provinces and 514 districts or cities. The total number of respondents was 93,829, aged ≥60 years. Functional status and depression were assessed using the Barthel index and MINI (Mini International Neuropsychiatric Interview), respectively. Furthermore, data processing was carried out with the Statistical Package for Social Sciences (SPSS) version 26 program and analyzed using the chi-square test and multiple logistic regression with the complex sample method. RESULTS: Elderly individuals with severe dependence were at the greatest risk of becoming depressed compared to those without functional impairment or with independence after considering sociodemographic factors and disease history have 5.730 (95% CI = 4.302-7.632) the adj odds. Furthermore, this figure was higher than that of individuals with total dependence have 4.147 (95% CI = 3.231-5.231) the adj odds. The physical illness experienced also played a role in the risk for depression, which was higher among elderly individuals with stroke and a history of injury. The sociodemographic factors involved include low education and economic levels. In contrast, the area of residence and marital status had no statistically significant effect on the relationship between functional disorders and depression. CONCLUSIONS: Elderly individuals with decreased functional status are prone to depression. The highest probability for depression was observed among those with severe dependence compared to those with total dependence. Consequently, interventions that involve various sectors, including social and family support, are needed.

Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders.

BACKGROUND: Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. METHODS: Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. RESULTS: Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings. CONCLUSIONS: Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.

Disparities of Health Program Information Systems in Indonesia: A Cross-Sectional Indonesian Health Facility Research 2019.

Although a recording and reporting format for health centers already exists for Indonesia's standard information system, numerous health applications still need to meet the needs of each program. Therefore, this study aimed to demonstrate the potential disparities in information systems in the application and data collection of health programs among Indonesian community health centers (CHCs) based on provinces and regions. This cross-sectional research used data from 9831 CHCs from the Health Facilities Research 2019 (RIFASKES). Significance was assessed using a chi-square test and analysis of variance (ANOVA). The number of applications was depicted on a map using the spmap command with STATA version 14. It showed that region 2, which represented Java and Bali, was the best, followed by regions 1, which comprised Sumatra Island and its surroundings, and 3, Nusa Tenggara. The highest mean, equaling that of Java, was discovered in three provinces of region 1, namely, Jambi, Lampung, and Bangka Belitung. Furthermore, Papua and West Papua had less than 60% for all types of data-storage programs. Hence, there is a disparity in the health information system in Indonesia by province and region. The results of this analysis recommend future improvement of the CHCs' information systems.

The Effect of Interleukin-2 -330 T/G Polymorphism in People with Schizophrenia Among The Batak and Javanese Ethnic Groups.

Background: Schizophrenia is a complex disorder involving multiple genes with mild to moderate effects and non-genetic risk factors such as environmental and psychological influences that alter brain chemistry. Significant reduction in interleukin-2 production by peripheral lymphocytes is an immunological finding replicated in schizophrenia across various countries. Investigations on the interleukin-2 -330 T/G polymorphism in people with schizophrenia (PWS) are still minimal, and the study location involves only a few countries with different results. Therefore, this study aims to examine the effect of interleukin-2 -330 T/G polymorphisms in people with schizophrenia among the Batak and Javanese ethnic groups in Indonesia, particularly in North Sumatra. Method: This study used purposive non-probability sampling to recruit people with schizophrenia with 120 Batak and 120 Javanese subjects who were hospitalized at Prof. M. Ildrem Mental Hospital, Medan, Indonesia. The interleukin-2 -330 T/G polymorphism was examined by the PCR method. Result: The results showed that the genotype frequency of the Batak people with schizophrenia is as follows: GG 11.7%, TG 53.3% and TT 35%. Furthermore, the group of Javanese people with schizophrenia is as follows: GG 23.3%, TG 44.2% and TT 32.5%. The OR for the genotypic comparison of GG was found to be 2.154 with 95% CI 0.992-4.678, p=0.053, while that of the TG genotype was 0.892 with 95% CI 0.505-1.574 and p=0.693. The T allele was higher than the G allele in Batak and Javanese ethnic groups, as demonstrated by p=0.713, OR=0.919 with 95% CI 0.641-1.318. Conclusion: There is no statistically significant difference between the occurrence frequency of alleles. In addition, there is no significant relationship between the GG and the TG genotype of the interleukin-2 - 330T/G polymorphism in people with schizophrenia among the Batak and the Javanese ethnic groups.

Efficacy and safety of medical cannabinoids in children with cerebral palsy: a systematic review.

INTRODUCTION: The increasing popularity of cannabinoids for treating numerous neurological disorders has been reported in various countries. Although it reduces tetrahydrocannabinol psychoactivity, it helps patients tolerate higher doses and complements the anti-spasmodic effects of tetrahydrocannabinol. One of the most important potential of cannabinoids are related to its potential to help children with cerebral palsy, a contributor of lifelong disability. Therefore, this systematic review aimed to assess the efficacy and safety of medical cannabinoids in children with cerebral palsy. METHODS: This review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Seven databases, namely, Scopus, PubMed, EBSCO Host, ProQuest, Google Scholar, Semantic Scholar, and JSTOR, were used to identify relevant studies. Studies examining pediatric patients with cerebral palsy and reporting the efficacy and safety of medical cannabinoids through clinical trials, observational cross-sectional studies, or cohort designs were included. The outcomes of the studies included the efficacy of medical cannabinoids administered for spasticity, motor components, pain control, sleep difficulties, adverse effects, and seizure control. RESULTS: Of 803 identified articles, only three met the inclusion criteria for data synthesis. One study exhibited a moderate risk-of-bias. A total of 133 respondents, mainly from Europe, were investigated. Overall effectiveness and safety were considered good. However, the results are inconsistent, especially regarding spasticity treatment variables. CONCLUSION: The anti-spasticity, anti-inflammatory, and anti-seizure properties of cannabinoids might be beneficial for patients with cerebral palsy, although their effectiveness has not been widely studied. Further studies with larger sample sizes and various ethnicities are warranted. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42022358383.

Depression and Psychological Stress Among Health Workers in Remote Areas in Indonesia.

Background: The Indonesian government launched the Nusantara Sehat program in 2015, under which teams of health workers were assigned to community health care centers in remote, border, and island areas for 2 years. The deployment to remote areas is likely to affect their psychological condition if they are not equipped with facilities and strong motivation. This study aimed to describe the psychological condition of health workers in remote areas in Indonesia, focusing on the proportion of the prevalence of depression and psychological stress. Materials and Methods: This cross-sectional study was conducted between April and December of 2018. Participants were 140 health workers placed in 26 community healthcare centers in 13 provinces. Interviews were conducted by enumerators using a questionnaire that included questions from the Mini International Neuropsychiatric Interview (MINI) and Self-Reporting Questionnaire-20 (SRQ-20). Results: Of the participants, 7.1% experienced depression and 10.0% experienced psychological stress. Motivation was related to psychological stress in participants with an odds ratio of 0,218 (95% confidence interval = 0.065-0.729, p = 0.013). Health workers with high motivation tend not to experience psychological stress compared to individuals with lower motivation. Conclusion: Health workers with high motivation experience relatively low levels of psychological stress. To overcome stress, high motivation is needed to control psychological risk factors before and during placement.

Determinants of Depression in Indonesian Youth: Findings From a Community-based Survey.

OBJECTIVES: This study investigated the determinants of depression in adolescents and young adults. METHODS: The present study analyzed data from the 2018 Indonesia Basic Health Survey (Riset Kesehatan Dasar; RISKESDAS). The study subjects were adolescents (15-17 years old) and young adults (18-24 years old). In total, 64 179 subjects were included. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between youths' characteristics, risky behavior, chronic disease, parents' health, and youths' depression. RESULTS: The prevalence of depression was 5.1% in adolescents and 5.6% in young adults. The risk factors for depression in adolescents were being women (adjusted odds ratio [aOR], 3.53; 95% confidence interval [CI], 2.89 to 4.30; p<0.001), an ex-smoker (aOR, 2.99; 95% CI, 2.10 to 4.25; p<0.001), or a current smoker (aOR, 2.60; 95% CI, 1.97 to 3.44; p<0.001); consuming alcohol (aOR, 2.00; 95% CI, 1.33 to 3.01; p=0.001), having a chronic disease (aOR, 2.64; 95% CI, 1.41 to 4.96; p=0.002); maternal depression (aOR, 2.47; 95% CI, 1.97 to 3.09; p<0.001); and paternal depression (aOR, 2.63; 95% CI, 1.98 to 3.50; p<0.001). In young adults, the risk factors were being women (aOR, 2.23; 95% CI, 1.82 to 2.75; p<0.001) or an ex-smoker (aOR, 2.47; 95% CI, 1.67 to 3.67; p<0.001), consuming alcohol (aOR, 2.42; 95% CI, 1.89 to 3.09; p<0.001), maternal depression (aOR, 3.12; 95% CI, 2.54 to 3.84; p<0.001), and paternal depression (aOR, 2.80; 95% CI, 2.17 to 3.63; p<0.001). CONCLUSIONS: Being women, smoking, drinking alcohol, having a chronic disease, and having a parent with depression were crucial factors associated with youth depression. Mental health screening, prevention, and treatment should involve collaboration among primary healthcare, schools, universities, professionals, and families.

Health information system concept in health services in the national health insurance (JKN) era in Indonesia: An environment and one health approach.

The health information system is a component of the healthcare system. The health information system in health services in Indonesia has experienced many problems in getting support for policy making, the implementation of the industrial revolution 4.0, and national health insurance (JKN). To answer the above problems, it is necessary to make a concept of health information systems in health services that based on environment and one health perspectives. This research was part of the thematic research of the 2019 JKN National Health Facilities Survey (Rifaskes) in Indonesia. The systems approach and cross-sectional research were carried out by collecting quantitative data. A structural equation model with Lisrel 88 software was used to model the health information system. The health information system produced a concept that included the following structured input components: governance, human resources, infrastructure, types of information system (IS) (program, JKN, management), and financing; process components: funding, technical guidance, and verification and validation; and output components: open access, standards and quality, utilization, bridging, and security. The concept for strengthening the health information system prioritizes improving the output components (standards, utilization, bridging, open access, and security) in the process components (funding, verification, technical guidance) while the input components (financing, human resources, governance, IS programs, infrastructure, IS JKN, IS management).

Efficacy and safety of medical cannabinoids in children with cerebral palsy: a systematic review

ABSTRACT Introduction The increasing popularity of cannabinoids for treating numerous neurological disorders has been reported in various countries. Although it reduces tetrahydrocannabinol psychoactivity, it helps patients tolerate higher doses and complements the anti-spasmodic effects of tetrahydrocannabinol. One of the most important potential of cannabinoids are related to its potential to help children with cerebral palsy, a contributor of lifelong disability. Therefore, this systematic review aimed to assess the efficacy and safety of medical cannabinoids in children with cerebral palsy. Methods This review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Seven databases, namely, Scopus, PubMed, EBSCO Host, ProQuest, Google Scholar, Semantic Scholar, and JSTOR, were used to identify relevant studies. Studies examining pediatric patients with cerebral palsy and reporting the efficacy and safety of medical cannabinoids through clinical trials, observational cross-sectional studies, or cohort designs were included. The outcomes of the studies included the efficacy of medical cannabinoids administered for spasticity, motor components, pain control, sleep difficulties, adverse effects, and seizure control. Results Of 803 identified articles, only three met the inclusion criteria for data synthesis. One study exhibited a moderate risk-of-bias. A total of 133 respondents, mainly from Europe, were investigated. Overall effectiveness and safety were considered good. However, the results are inconsistent, especially regarding spasticity treatment variables. Conclusion The anti-spasticity, anti-inflammatory, and anti-seizure properties of cannabinoids might be beneficial for patients with cerebral palsy, although their effectiveness has not been widely studied. Further studies with larger sample sizes and various ethnicities are warranted. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42022358383.

One Step Back, Two Steps Forward: An Economic Evaluation of the PEN Program in Indonesia.

Abstract-The economic and health burden of noncommunicable diseases (NCDs) is significant globally. To counteract this problem, the World Health Organization (WHO) introduced the Package of Essential Noncommunicable disease (PEN) interventions. Several countries, including Indonesia, implemented the PEN program. To assess the value of the investment in the current program, an economic evaluation of the program was conducted with collaboration between the Ministry of Health in Indonesia, the WHO, and the International Decision Support Initiative (iDSI). Even in low- and middle-income countries (LMICs) such as Indonesia where there is lack of data and health technology assessment (HTA) expertise, the study aims not only to inform policy but to build HTA capacity in the country through the working partnership between international HTA experts and local partners. This study evaluated the delivery of screening and treatment for diabetes and hypertension, which are part of NCD interventions in the PEN program. Several screening strategies were compared to explore the options for improving the current PEN program. The findings show that implementing the PEN program is better than a base case of no policy in place, though it can be improved through a targeted screening policy of high-risk groups of population aged 40 and above (as opposed to screening for 15 years old and above as is the current practice). Adopting the recommended policy is a major challenge to policy makers due to a potential negative public perception of the disinvestment from an option that yields higher health outcomes. However, this study demonstrates that with the same budget currently invested in the program, the changes proposed will result in improvements on the current low uptake and poor coverage, thus yielding cost savings for the government and a possibility to reallocate resources to the country's priority health concerns, consequently leading to better health outcomes.