Lymph Node Metastasis in Papillary Thyroid Carcinoma, A Study of BRAF V600E and TERT Promoter Mutations.

OBJECTIVE: This study was designed to determine the role of BRAF V600E and TERT mutations in the incidence of neck lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). METHODS: This was a cross-sectional study, involving PTC patients at Dr. Cipto Mangunkusumo Hospital, Jakarta. Data were obtained retrospectively based on medical records, except for BRAF V600E and TERT promoter mutations. Tumor tissue specimens of PTC's patients were transferred to the Integrated Laboratory of Faculty of Medicine, Universitas Indonesia. BRAF gene multiplication was performed with KOD One PCR Master Mix (Toyobo KMM-201), while TERT gene multiplication was performed with PCR Master Mix. Data analysis was performed with SPSS version 20. The data were analyzed using univariate and bivariate analysis with the Chi-Square test. RESULT: 42 PTC patients were included in the study; 19 (45%) had BRAF mutation, 20 (48%) had TERT mutation, and 20 (48%) had LN metastases. BRAF V600E mutation was associated with LN metastasis [p<0.001, OR = 25.33 (95% CI 4.92 - 130.34)], while TERT mutation was not. Patients with BRAF+ and TERT- mutations were 18.00 times (95% CI 2.01 - 161.05) more likely to develop LN metastasis than patients with BRAF- and TERT-. Furthermore, the presence of TERT mutation along with BRAF mutation increased the risk to 60.00 (95% CI 4.72 - 763.04) higher than patients with BRAF- and TERT-. CONCLUSION: BRAF mutation was associated with LN metastasis in PTC patients, but not TERT mutations. However, the presence of TERT mutation in PTC's patients with BRAF mutation increased the risk of LN metastasis.

Development and validation of the adolescent behavioural change Counselling Assessment Tool in Indonesia.

BACKGROUND: Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals' skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. METHODS: This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. RESULTS: An initial 13-item tool was developed using a 1-5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0-3 Likert scale. The scale was found to have a Cronbach's α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). CONCLUSION: The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals' behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals' skills in addressing adolescent behaviour-related health problems.

Development of an internet-based intervention to improve health professionals' counseling skills around adolescent weight management in Indonesia.

BACKGROUND: Obesity is a growing public health and clinical concern, worldwide. In many countries, including Indonesia, health professionals lack the capacity to promote behavior change around obesity prevention and management, especially with adolescents for whom a wider set of communication skills are required. This study describes the theoretical basis, approach to development of content, use and satisfaction of an internet-based educational intervention designed to improve the quality of health professional weight management counseling with adolescents in Indonesia. METHODS: This study is part of an exploratory sequential mixed methods design which was undertaken from 2020 to 2022. Following a needs analysis, an internet-based training resource was developed, informed by constructive alignment theory and active learning principles. Using both synchronous and asynchronous approaches over a four-week pilot study, a weekly interactive session was held online, using multifaceted training materials housed on a website (https://ramahremaja.id). The training resource was then tested in a two-arm study involving health professionals from 17 of 34 provinces across Indonesia. RESULTS: Sixty-four primary health professionals were recruited for the two-arm study. The completion rate for reviewing all materials and assignments on the website was 72% and the online meeting participation rate was 78%. Participants were highly positive about the clarity of the training material and the appropriateness of the delivery methods. The main challenges related to poor internet literacy and interrupted internet connectivity. CONCLUSION: Designed to support weight management in adolescents, this internet-based training program shows potential for enhancing Indonesian health professional behavior-change counseling skills.

The barriers of home environments for obesity prevention in Indonesian adolescents.

BACKGROUND: Obesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds. METHOD: In-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10-18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning. RESULTS: Nineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings. CONCLUSIONS: Healthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

Supporting newly graduated medical doctors in managing COVID-19: An evaluation of a Massive Open Online Course in a limited-resource setting.

INTRODUCTION: Newly graduated medical doctors in their internships are positioned to strengthen the front line in combating COVID-19. We developed a Massive Open Online Course (MOOC) to equip them with adequate knowledge for COVID-19 management. This paper aims to analyze the MOOC and evaluate participant satisfaction and increase in knowledge after completing the course. METHODS: An observational study was conducted. Quantitative data were obtained from questionnaires and pre- and post-tests. Responses to open-ended questions of the questionnaires were collected. Analysis using the Quality Reference Framework was also completed. RESULTS: The MOOC consisted of fundamental knowledge of COVID-19 (Part A) and further enrichment (Part B), and the content was written in the Indonesian language. A total of 3,424 and 2,462 participants completed the course in August and November 2020, respectively. Most participants agreed that the platform was easy to navigate, the design was interesting, and the content was aligned with their needs. Pre- and post-test scores in Part A's subjects increased significantly. Factors contributing to and inhibiting usability and areas for improvement were further highlighted. DISCUSSION: The use of a specific quality framework facilitated a comprehensive evaluation of the MOOC's strengths, weaknesses, and areas for future improvements. The participants' satisfaction and pre- and post-test results showed that the current MOOC holds great potential benefit for continuing education for medical interns joining the frontliners during the pandemic. Future implementation should consider increasing the quality of learning resources, scaling up the platform and its technical supports, and enhancing organizational supports.

Incidence Rate of Musculoskeletal Injuries among Professional Tennis Players during 2019 International Tournaments in Indonesia.

Several studies have indicated that musculoskeletal injuries are common during a professional tennis competition. However, data from a tropical country like Indonesia is lacking. This study aimed to obtain the incidence rate and injury characteristics and identify risk factors of musculoskeletal injuries among professional tennis players competing in Indonesia under the International Tennis Federation (ITF). The study was a prospective cohort during professional tennis tournaments in Jakarta, Indonesia in 2019, consisting of the ITF Women's Circuit Indonesia (two weeks) and ITF Men's Future Indonesia (three weeks). All athletes were enrolled in this study. Injuries were assessed based on the ITF Consensus Statement. Incidence rate was the number of injuries per 1000 player hours (i.e., the total duration from before the match starts to completion of the match after the final point). The magnitude of risk was expressed as a relative risk (RR) and its 95% confidence interval (CI). Independent risk factors were identified using multivariate analyses. A total of 161 tennis players were enrolled; 71 (44.1%) were men. Their mean age was 22 years old. The incidence rate of musculoskeletal injuries was 30.8 injuries per 1000 player hours (95% CI: 28.2-33.5). The most common onset was acute injuries (61.1%), while the most common location and type of injury was the trunk (38.9%) and muscle strain (61.1%). Risk factors associated with musculoskeletal injury were higher body height, skill level, history of previous injury, and wet bulb globe temperature (WBGT) zone. There was no injury during the doubles matches. Previous injury was an independent risk factor (adjusted RR: 48.1 (95% CI: 11.3-155.0; p < 0.001). The incidence of musculoskeletal injuries among professional tennis player is considerably high. Factors associated with injury are body height, skill level, previous injury, and WBGT zone. Future injury prevention programmes should incorporate the management of previous injuries and take into account the effect of environmental temperature.

The impact of Ramadan fasting on glucose variability in type 2 diabetes mellitus patients on oral anti diabetic agents.

Ramadan fasting is associated with changes in eating, physical activity, sleeping patterns, and medication. Unfortunately, only limited studies examine glucose variability in subjects with type 2 diabetes who fast in Ramadan. Our study aims to evaluate glucose variability in subjects with type 2 diabetes on oral antidiabetic agents using continuous glucose monitoring system (CGMS) during and after Ramadan fasting. This observational study was done in The Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, which recruited 10 subjects with type 2 diabetes who underwent Ramadan fasting in 2019. These subjects were free from cardiovascular disease, kidney disease, severe liver disease, chronic gastrointestinal disease and autoimmune disease. Insertion of CGMS for measuring interstitial glucose was performed after at least 2 weeks of Ramadan fasting and 4 weeks after the end of the Ramadan fasting, with a minimum of 3 days observation. The mean amplitude of glycemic excursion (MAGE) during and after Ramadan were similar (p = 0.94). In line with this, the average interstitial glucose (p = 0.48), the maximum interstitial glucose (p = 0.35), the minimum interstitial glucose (p = 0.24), and the duration of hypoglycemia (p = 0.25) were also similar in both periods. Overall, nutritional intake and energy expenditure during both periods were comparable. Ramadan fasting is not associated with increased glucose variability in subjects with type 2 diabetes. Thus, Ramadan fasting is safe in subjects with type 2 diabetes with no complications.

Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach.

BACKGROUND: Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course. METHODS: This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. RESULTS: Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'. CONCLUSION: By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.