Lactogenesis factors in the Asian population.

The increasing incidence of disrupted lactogenesis in Asian populations underscores the importance of timely identification and efficient intervention. This study acknowledges the influence of ethnicity on genetic variations and aims to investigate the genetic mechanisms that contribute to lactogenesis in individuals of Asian descent. This study examines the possibilities of genetic screening as a means of applying preventive measures, with a particular focus on epigenetic techniques. Additionally, the analysis looks into the underlying mechanisms involved in milk production. This review discusses the intricate mechanisms underlying breast milk production and the potential influence of genetic variables on lactogenesis. Specifically, it explores the association between lactogenesis issues and genetic conditions such as depression, obesity, gestational hypertension, and gestational diabetes. These genetic factors could potentially be found by genetic screening as contributors to disruption in lactogenesis. This study aims to promote future investigation in the subject of genetic testing and its potential association with lactogenesis issues, despite the current scarcity of direct research on this topic. The statement posits that the progress made in genetic testing has the potential to provide novel insights into the timely identification and treatment of disrupted lactogenesis.

The Relationship between Ethnicity and Health Seeking Behavior for Colorectal Cancer in East Java, Indonesia: A Case Study of Arek, Mataraman, and Pendalungan Ethnic Groups

OBJECTIVE: The rising incidence of colorectal cancer (CRC) in East Java has highlighted the need to investigate inter-ethnic causality. Previous studies have examined the relationship between ethnicity and health behavior in relation to CRC in East Java Province, but it is important to explore health-seeking behavior among CRC patients within the Arek, Mataraman, and Pendalungan ethnic groups, as these groups may have different behavioral patterns due to limited literacy. METHODS: This cross-sectional study included 230 respondents, with 86 from Arek, 72 from Mataraman, and 72 from Pendalungan. Data were collected from August 1 to October 30, 2022,, and analyzed using structural equation modeling with SmartPLS application analysis. RESULT: The P-values for the direct path between culture and health-seeking behavior was 0.009, indicating a statistically significant relationship. Similarly, the P-Values for the direct path between self-health awareness and health seeking behavior is 0.000, indicating a very strong and statistically significant relationship. P-Values for the direct path between health accessibility and health seeking behavior was 0.257, suggesting that the relationship was not statistically significant. CONCLUSION: Cultural values and self-health awareness are suggested as important predictors of health-seeking behavior among CRC patients in East Java.. The study highlights the need for tailored healthcare services for different ethnic groups. Overall, these findings can help healthcare providers in addressing the specific needs of CRC patients in East Java.

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement.

Background: The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. Methods: This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. Results: The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. Conclusion: This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.

Understanding COVID-19 vaccine hesitancy: A cross-sectional study in Malang District, Indonesia.

Introduction: Vaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia. Methods: Data come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined. Results and discussion: The results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195-1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026-1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027-1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998-1.040), need for chaos (OR = 1.044, 95% CI = 1.022-1.067), and populist views (OR = 1.028, 95% CI = 1.00-1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle "infodemics" are needed to address hesitancy during a new vaccine introduction program.

The effect of medical history and compressor on barotrauma.

BACKGROUND: Barotrauma causes damage to an enclosed cavity within the human body due to pressure changes inside and outside the body. This research aims to identify the effect of medical history and compressor on barotrauma. DESIGN AND METHOD: The case-control design and total sampling methods were used to obtained data from 174 respondents. RESULTS: The bivariate result showed that the value of medical history was at p=0.006, OR=2.47, with a compressor value of p=0.000, OR=16.29. Furthermore, the multivariate analysis indicated that the compressor has a dominant factor at OR= 7.175. CONCLUSIONS: Both medical history and compressor affected barotrauma incidence, with compressor as the most dominant factor.

Masticatory Functional Load Increases the mRNA Expression Levels of ACTN2 and ACTN3 and the Protein Expression of α-Actinin-2 in Rat Masseter Muscle.

OBJECTIVES: α-actinins play structural and regulatory roles in cytoskeletal organization. They form a lattice structure that secures actin in thin filaments, which generate and transmit muscle contractile forces. The morphological and biochemical characteristics of rat masseter muscles are known to change reactions to masticatory functional loads, but their effect on α-actinins remains unknown. This study aimed to determine the response of α-actinins to masticatory functional loads. MATERIALS AND METHODS: Twenty-four male Wistar rats aged 3 weeks were divided randomly into 3 groups of liquid diet (LD), soft diet, and hard diet (HD). The rats were then sacrificed at the end of 8 weeks. The middle part of superficial masseter muscles was examined to investigate the masticatory effect of functional load on the mRNA expression levels of ACTN2 and ACTN3 and the protein expression levels of α-actinin-2 and α-actinin-3. RESULTS: The mRNA expression levels of ACTN2 and ACTN3 and the protein expression levels of α-actinin-2 of the HD group were significantly higher than those of the LD group, which served as the control group. CONCLUSION: Masticatory functional load organizes the mRNA expression levels of ACTN2 and ACTN3 and the protein expression levels of α-actinin-2 in rat masseter muscles through stimuli during muscle physiological adaptation.

Adipose-derived stromal vascular fraction prevent bone bridge formation on growth plate injury in rat (in vivo studies) an experimental research.

The growth plate is cartilage tissue found at the end of long bones in children, responsible for longitudinal bone growth. Injuries to the growth plate cartilage often lead to unwanted bony repair, resulting in growth disturbances such as limb length discrepancy and angulation deformity in children. There is currently no clinical treatment that can fully repair an injured growth plate. Tissue engineering is promising for regeneration of growth plate. Adipose-derived stromal vascular fraction highlight the promising potential as tissue engineering therapy for inducing regeneration of injured growth plate and able to reduce the formation of bony repair that can lead to deformity and limb length discrepancy. Using an animal model of growth plate injury, bone bridge formation is evaluated after 28 days using Enzyme-linked Immunoassay, radiology, histopathology and Immunofloresence examination. Radiological analyses performed by evaluation of grey value using ImageJ software and diameter bone bridge measured from the end to end distance between uninjured growth plate evaluated by histopatology examination. Enzyme-linked Immunoassay and immunofloresence are used to evaluate chondrocyte and chondrogenic marker within the defect. The result shows in group with Adipose-derived stromal vascular fraction have a significant lower bone bridge formation compare to positive control group. This current study represents the first work that has utilized this animal model to investigate whether Adipose-derived stromal vascular fraction can be used to initiate regeneration at the injured growth plate.

Collagen scaffold for mesencyhmal stem cell from stromal vascular fraction (biocompatibility and attachment study): Experimental paper.

BACKGROUND: One of the most important part of tissue engineering (TE) is a matrix called scaffold. A good scaffold integrates with the host tissue and support the growth and differentiation of the cells. Collagen is the most abundant protein in the ECM and has been considered to be a group of proteins with a characteristic molecular structure-fibrillar structure, which contributes to the extracellular scaffolding. OBJECTIVE: In this research we study the biocompatibility and attachment of collagen scaffold by measuring the level of availability of mesenchymal stem cell (MSC) cluster from stromal vascular fraction (SVF). METHOD: This study was experimental invitro on MSC culture derived from SVF, with post-test control group design. Biocompatibility was measured by viability of MSC from SVF with marker Propidium Iodine through flowcytometry and electron microscope was used to assess the population density of MSC from SVF by measuring the number of cluster cells seen. RESULT: Oxidize cellulose has the greatest value of MSC cluster with average number of 2003 cell cluster. This result was significant with p < 0.05 using One-Way Anova and Tukey Test. CONCLUSION: Collagen scaffold is ideal for MSC from SVF because of its compatibility and attachment.

Factors associated with health care seeking behavior for musculoskeletal pain in Indonesia: A cross-sectional study.

AIM: To assess the factors defining healthcare-seeking behavior of people with musculoskeletal pain in the urban community of Malang City, East Java, Indonesia. METHODS: A cross-sectional survey was performed in Malang City, East Java, Indonesia. In total, 2067 participants aged 16-93 years were interviewed. The sociodemographic and socioeconomic factors of healthcare seeking behavior, musculoskeletal pain, disability, and adverse drug reactions were assessed using the validated Indonesian version of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) protocol by International League of Associations for Rheumatology and the World Health Organization core questionnaire. Chi-square test was applied to assess the determinants of health-seeking behavior for musculoskeletal pain. RESULTS: Slightly more than one-third of the respondents (36%) with musculoskeletal pain, described as osteoarthritis, low back pain, gouty arthritis, soft tissue rheumatism, and autoimmune arthritis, were assessed for their health-seeking behavior. About 73% of all those participants sought treatment for their musculoskeletal symptoms. Treatment modality used was modern healthcare, traditional healthcare, self-treatment using traditional medication, self-treatment using modern medication with the proportions of 20.94%, 25.23%, 33.95%, 25.77%, respectively. Disability significantly affected health-seeking behavior as the major determinant (prevalence ratio [PR] 1.087, 95% CI 1.031-1.146, P = 0.002), followed by age (PR 1.043, 95% CI 1.000-1.087, P = 0.049). Healthcare-seeking behavior was associated with the presence of adverse drug reactions (P < 0.001). CONCLUSION: Factors associated with musculoskeletal pain health-seeking behavior were disability and age. Self and traditional healthcare treatment were further associated with an adverse drug reaction.

Elbow Fracture in Children at Saiful Anwar General Hospital, Nine Years Experiences.

AIM: The frequency, incidence, and types of fracture of the elbow are different between children and adult. The epidemiology of elbow fracture in children has been the subject of a limited number of studies. This study aims to observe the pattern of elbow fractures in children 18 years of age and younger, during a nine years period. METHODS: This is a retrospective study about elbow fracture cases in children 18 years old and younger treated in Saiful Anwar General Hospital Malang in the period of June 2009 until December 2018. The data obtained from the medical record include the age at the time of accidents, fracture site, type of lesion and ipsilateral injuries, time of accidents, and the mechanism of injury. RESULTS: There is a total of 99 elbow fracture, and there are 62 male (63%) and 37 female patients (37%). The mean age for the entire group is 7.3 years (8.1 years for male and 7.1 years for female). Most cases are supracondylar fracture (n = 77, 78%). The supracondylar fracture is composed of 17 fracture classified to type II, and 60 fracture to type III as classified by Gartland. The most common etiology of fracture is associated with sports, recreational activities, and fall from height of less than two meters. Nerve injury involving the median, radial, and ulnar nerve is seen in eight patients with type III supracondylar fracture. Associated brachial artery injury is seen in four patients with type III supracondylar fractures. A group of 78 patients (79%) were treated surgically and 21 patients (21%) were treated conservatively. CONCLUSION: The incidence of elbow fracture in children treated in Saiful Anwar General Hospital during a nine years period is 99 patients, with supracondylar fracture Gartland type III being the leading type of this group. Male patients are more common than female patients. Nerve injury was seen in 13.33% of cases and brachial artery injury was seen 6.67% with type III supracondylar fracture. Most of the elbow fracture in our institution were treated operatively.

Autistic Children Are More Responsive to Tactile Sensory Stimulus.

OBJECTIVE: This research was an experimental study that was aimed to detect differences response of tactile sensory stimulus between normal children and children with sensory brain development disorders such as Autism Spectrum Disorder (ASD). MATERIALS & METHODS: A total of 134 children, in two groups including 67 healthy children (control) and 67 children with autism were studied. Tactile sensory stimulus responses in children were tested directly using a Reflex Hammer. In addition, tactile sensory sensitivity was also assessed via questionnaire Short Sensory Profile (SSP) filled out by the child's parents. All response data were analyzed using Fisher's Exact Test; questionnaire data was analyzed with the Mann-Whitney U Test. RESULTS: Autistic children were more sensitive to palpation and pain than children who were not autistic. Furthermore, the value of SSP was also significantly higher (P<0.05) in autistic children, which means that they always responded to all categories in the SSP questionnaire than children who are not autistic. CONCLUSION: Autistic children are more sensitive to tactile sensory stimulus and all categories of SSP than children who are not autistic.

3rd International Conference in Nursing (ICON), 20-21 May 2017, Indonesia.

The event was hosted in Malang, East Java, Indonesia, by the School of Nursing, Faculty of Medicine, Brawijaya University. Below is a selection of abstracts from among the 70 papers that were presented.

Darapladib inhibits atherosclerosis development in type 2 diabetes mellitus Sprague-Dawley rat model.

OBJECTIVE: Increase in the low-density lipoprotein (LDL) level in diabetes mellitus and atherosclerosis is related to lipoprotein associated phospholipase A2 (Lp-PLA2). Lp-PLA2 is an enzyme that produces lysophosphatidylcholine (LysoPC) and oxidized nonesterified fatty acids (oxNEFA). LysoPC regulates inflammation mediators, including intra-cellular adhesion molecule-1 (ICAM-1). Darapladib is known as a Lp-PLA2 specific inhibitor. The aim of this study was to reveal the effect of darapladib on the foam cell number, inducible nitric oxide synthase (iNOS), and ICAM-1 expression in aorta at early stages of the atherosclerosis in type 2 diabetes mellitus Sprague-Dawley rat model. METHODS: Thirty Sprague-Dawley male rats were divided into 3 main groups: control, rats with type 2 diabetes mellitus (T2DM), and T2DM rats treated with darapladib (T2DM-DP). Each group was divided into 2 subgroups according the time of treatment: 8-week and 16-week treatment group. Fasting blood glucose, insulin resistance, and lipid profile were measured and analyzed to ensure T2DM model. The foam cells number were detected using hematoxylin-eosin (HE) staining and the expression of iNOS and ICAM-1 was analyzed using double immunofluorescence staining. RESULTS: Induction of T2DM in male Sprague-Dawley rats after high fat diet and streptozotocin injection was confirmed by elevated levels of total cholesterol and LDL and increased fasting glucose and insulin levels compared to controls after both times of treatment. Moreover, T2DM in rats induced a significant increase (p<0.05) in the foam cells number and iNOS and ICAM-1 expression in aorta compared to controls after both treatment times. Darapladib treatment significantly reduced (p<0.05) foam cells number as well as iNOS expression in aorta in rats with T2DM after both treatment times. A significant decrease (p<0.05) in ICAM-1 expression in aorta was observed after darapladib treatment in rats with T2DM only after 8 weeks of treatment. CONCLUSION: Our data indicate that darapladib can decrease the foam cells number, iNOS, and ICAM-1 expression in aorta at the early stages of atherosclerosis in T2DM rat model.

DETERMINATION OF ENVIRONMENTAL FACTORS AFFECTING DENGUE INCIDENCE IN SLEMAN DISTRICT, YOGYAKARTA, INDONESIA.

BACKGROUND: Dengue is a disease related to the environment that spreads rapidly. Prevention movement is considered ineffective; therefore, a more efficient early warning system is required. It is required strongly correlated variables to as predictor in early warning system. This study aims to identify the environmental conditions associated with dengue. MATERIALS AND METHODS: This ecological study was conducted on five sub-districts selected based on the trend of the incidence. Data land cover and elevation obtained using GIS. Climate data were obtained from Meteorology and Climatology and Geophysics Agency of Yogyakarta. RESULTS: There were 1.150 dengue cases from 2008-2013 obtained from District Health Office. The spatial pattern is clustered in all sub-districts (Z-score < -2.58). There is a positive correlation between land cover and dengue (p 0.000; r 0.284) and a negative correlation between elevation areas and dengue (p 0.000; r - 0.127). Multiple Regression Test shows the effect of humidity (p 0.000) and rainfall (p 0.002) with a contribution of 13.5% - 27.4% (r2 0.135 - 0.274), while temperature has no effect in all sub-districts (p > 0.05). There is no effect of climate parameters in sporadic dengue areas (p > 0.05). CONCLUSION: It is concluded that dengue in Sleman is clustered and associated with the environment parameter, even though it does not have close correlation. High elevated and small building area is consistent with the lower dengue cases. Humidity and rainfall affect dengue, but temperature does not affect dengue.

Early menarche and premature natural menopause in Indonesia.

BACKGROUND: An association has been suggested between early menarche and premature natural menopause. However, existing studies in developed countries show mixed findings. AIM: This study examined whether early menarche (first menstrual period ≤11 years old) is a factor for premature natural menopause (final menstrual period <40 years old) in the context of a developing country. SUBJECTS AND METHODS: Data came from the Indonesia Family Life Survey (IFLS) 2014, which consists of 1608 post-menopausal women. RESULTS: Results of hierarchical logistic regression show that women who experienced early menarche (first menstrual period ≤11 years old) were found to be at higher risk of premature natural menopause (ß = 0.94, p < 0.01, CI = 0.24-1.63). The results are robust against potential confounding factors including individual reproductive history, lifestyle and sociodemographic characteristics, as well as unobserved factors at the household and community levels. CONCLUSION: The findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with premature natural menopause.

Pre- and postprandial acylated ghrelin in obese and normal weight men.

BACKGROUND AND OBJECTIVES: The prevalence of obesity in Indonesia has increasing. We have assessed the relationship between plasma acylated ghrelin hormone and self-reported appetite ratings (hunger and desire to eat) in obese and normal weight men. METHODS AND STUDY DESIGN: Thirty-two men participated in an experimental study, where acylated ghrelin and self-reported appetite ratings were compared between a test group of 16 obese men and a control group of 16 men with normal body mass indices. The participants were administered isocaloric mixed meals, and measurements were taken at 0 (before eating), 30, 60, and 120 minutes postprandial. Data were analysed using an independent t test, the Mann-Whitney U test, the Pearson correlation, the Spearman rank-order correlation, trapezoidal rule analysis for the area under the curve, and receiver operating curve analysis to determine the optimal cut-off values, sensitivity, and specificity. RESULTS: Acylated ghrelin concentrations were higher in the test group than in the control group at all time points (p<0.01). There were no significant differences in the appetite ratings between the two groups at any time (p>0.05). There was no correlation between the acylated ghrelin concentration and appetite rating. According to the receiver operating curve analysis (sensitivity: 88%; specificity: 100%), the cut-offs for optimal acylated ghrelin immediately before eating and 30 minutes after eating, averaged 2332 pg/mL and 2710 pg/mL, respectively. CONCLUSIONS: The effect on obesity will depend on associated changes in deacylated ghrelin. Acylated ghrelin increases in obese individuals pre- and 30, 60, 90 and 120 minutes post prandial.