The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study.

BACKGROUND: The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30-59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer). METHODS: This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression. RESULTS: Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481-9.928; p<0.001). CONCLUSION: The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.

The Effort to Rationalize Antibiotic Use in Indonesian Hospitals: Practice and Its Implication.

An effective strategy for combatting AMR in Indonesia is to make the use of antibiotics in hospitals more rational with the help of an Antimicrobial Resistance Control Program (AMR-CP). This study aims to analyze the implementation of the AMR-CP in hospitals by conducting in-depth interviews with health professionals from ten hospitals and health officers of ten provincial health offices in ten different provinces and observation towards its documents. The sample location was selected by purposive sampling. Informants at the hospitals were hospital directors, chairmen of the AMR-CP team, chairmen of the medical committee, persons in charge of the microbiology laboratory, clinicians, nurses, clinical pharmacists, and those program managers at the provincial health offices who are responsible for administering antibiotics. Information is first collected and then a thematic analysis is applied along with triangulation to confirm the validity of information from multiple sources, including document observation results. The analysis is adapted to the framework of the system (i.e., input, process, and output). Results show that hospitals in Indonesia already have the resources to implement AMR-CP, including AMR-CP team and microbiology laboratories. Six hospitals examined also have clinicians trained in microbiology. Though hospital leadership and its commitment to implementing AMR-CP are favorable, there is room for improvement. AMR-CP teams organize routine activities for socialization and training, develop standard operating procedures (SOPs) for antibiotic use, antibiotic patterns surveillance, and bacterial mapping. Some obstacles to implementing AMR-CP policies are posed by the human resources, facilities, budget, antibiotics and reagent shortages, and clinician compliance with SOPs. The study concludes that there was an improvement in antibiotic sensitivity patterns, rational use of antibiotics, use of microbiological laboratories, and cost-efficiency. It recommends the government and healthcare providers continue to improve AMR-CP in hospitals and promote AMR-CP policy by making the regional health office of the hospital a representative of the regional government.

MALARIA SELF-CARE IN NIMBORAN SUBDISTRICT, JAYAPURA DISTRICT, PAPUA PROVINCE, INDONESIA.

Papua is one of five provinces with high malaria incidence in Indonesia. In 2009, the Indonesian Ministry of Health issued decree No 293 on malaria elimination. Socioeconomic, culture and psychological conditions, and perception of malaria are determining factors in seeking treatment. Health seeking behavior also are influenced by enabling factors, such as income and health insurance; and by health providers, such as availability of health care facilities, tariffs and living locationss. Self-care is one form of community participation in knowledge, prevention and early detection of malaria, and in seeking treatment and compliance to malaria treatment, especially among inhabitants in malaria endemic areas. This study was an observation in Nimboran Subdistrict, Jayapura District, Papua Province, Indonesia during 2013. Thirty individuals from 'Pengurus Rukun Tetangga' group were chosen randomly for the survey. Facts evaluated were knowledge of cause of malaria, disease transmission, symptoms and complication, diagnosis, treatment and side effects, medical seeking behavior and treatment, vector breeding sites, and attitude towards compliance of malaria treatment and use of mosquito nets. Self-care against malaria was considered important by 65% of the respondents. All participants had visited health centers and complied with prescribed drug regimen. All respondents with malaria-infected neighbors visited health centers. Regarding antimalarial malaria drugs, the majority of respondents knew of Darplex® and were aware that a common side effect of antimalarials was tinnitus. The majority of respondents identified ponds as malaria vector breeding places and recognized the importance of managing vectors in malaria prevention. The study concludes that malaria self-care was needed for awareness, prevention and treatment of this debilitating disease.

Research report: Frequencies of mica gene polymorphism: a comparison between Indonesians on Bacan Island and suburban Japanese.

MHC class I chain related gene A (MICA) is located near the HLA-B gene on the short arm of human chromosome 6. In the transmembrane (TM) of region of MICA, there is a trinucleotide repeat (GCT/AGC) microsatellite polymorphism in exon 5. Five alleles with 4, 5, 6 and 9 repetitions or 5 repetitions with 1 additional nucleotide insertion (GGCT) are identified and they were named A4, A5, A5.1, A6, and A9 respectively. We report the allele frequencies of 127 Indonesians on Bacan Island and 250 Japanese in the Kanto area. From the genotyping result, the frequency among Indonesians was as follows: A4 15.4%, A5 26.0%, A5.1 16.5%, A6 5.5%, and A9 36.6%. The frequency among Japanese was as follows: A4 20.6%, A5 28.1%, A5.1 10.8%, A6 27.2%, and A9 13.2%. Allele 9 is significantly increased and allele 6 significantly decreased in Indonesians compared with Japanese subjects. The results suggested that MICA microsatellite polymorphism are quite different in each race. Among Indonesians, the frequency of MICA-A9 allele, which was reported to be negatively associated with Behçet's disease, was significantly higher, whereas the MICA-A6 allele frequency, which was reported to be positively associated with Behçet's disease, was significantly lower among Japanese.