Sociodemographic and behavioural risk factors associated with low awareness of diabetes mellitus medication in Indonesia: Findings from the Indonesian Family Life Survey (IFLS-5)

IntroductionLow awareness of the necessity of taking medication is common among patients with diabetes mellitus (DM) due to their lack of understanding of the disease. Therefore, it is essential to determine the underlying risks influencing low awareness to design effective intervention strategies. This study aims to evaluate the association of sociodemographic and behavioural factors with low awareness to take medication among patients with DM in Indonesia.MethodRetrospective data were obtained from the Indonesian Family Life Survey (IFLS-5), a national cross-sectional population-based survey among respondents with DM aged ≥15 years. DM status was confirmed by HbA1c testing, while sociodemographic and other health-related information was obtained from self-reported data. Gender, age, educational level, marital status, economic status, comorbidity, religiosity, residence and health insurance status were considered sociodemographic, whereas blood glucose monitoring status, sleeping problems, depression status, having a general medical check-up, satisfaction with healthcare needs and happiness status were considered behavioural risk factors. Awareness of DM medication was determined by self-reported responses to the question asked by the surveyor. Logistic regression analysis was used to evaluate the association between sociodemographic and behavioural factors and low awareness of DM medication. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.ResultMost of the 706 respondents were female (58.8%) and aged 55–65 years (28.8%). Most of them showed low awareness of diabetes medication (87.7%). Irregular blood glucose monitoring (OR: 23.61, 95% CI 11.46–48.65; p < 0.001), without any comorbidity (OR: 2.03, 95% CI 1.05–3.90; p = 0.034), never had any general medical check-up (OR: 2.52, 95% CI 1.12–5.36; p = 0.016), 26–35 years of age (OR: 4.96, 95% CI 1.06–23.19; p = 0.042), 36–45 years of age (OR: 5.04, 95% CI 1.17–21.69; p = 0.030) and having no health insurance coverage (OR: 2.08, 95% CI 1.12–3.87; p = 0.021) were significantly associated with low awareness of diabetes medication.ConclusionHealthcare professionals should regularly evaluate blood glucose level, perform routine medical check-ups, prioritise patient satisfaction by providing appropriate care, involve patients in decision-making by determining their needs and then tailor an intervention to meet the need for, and improve their awareness of, DM medication

Knowledge, acceptance and willingness to pay for Dengue vaccine in Yogyakarta and Jakarta

Despite the fact that Dengue Hemorrhagic Fever (DHF) is one of diseases with the highest incidence rate in Indonesia, its prevention strategies remain ineffective. One of the most cost-effective strategies to prevent DHF is through vaccination. This study aimed to investigate correlations between the knowledge of DHF, the behavior of DHF prevention and the knowledge of vaccine with the acceptance of dengue vaccine and willingness-to-pay (WTP) of dengue vaccine in Yogyakarta and Jakarta, Indonesia. A cross-sectional study was conducted by collecting data from people visiting primary healthcare centers (PHCs) through a valid and reliable questionnaire. A purposive sampling was applied, which resulted in 838 respondents among PHCs in Yogyakarta (two selected districts: Bantul and Kulon Progo) and Jakarta (two selected districts: West Jakarta and Central Jakarta). The result showed that the percentage of respondents who had good knowledge of vaccine was estimated to be 67-77% in all districts. The percentage of respondent who had good acceptance of vaccine was estimated to be 68-81%. WTP of dengue vaccine among respondents was estimated to be IDR 10,000-50,000. The result showed that the knowledge of DHF was significantly correlated (p<0.05) with the acceptance of dengue vaccine in districts of West Jakarta, Bantul and Kulon Progo. In particular, the behavior of DHF prevention and the knowledge of dengue vaccine were significantly correlated (p<0.05) with the acceptance of dengue vaccine in all districts. Additionally, the knowledge and acceptance of vaccine were significantly correlated (p<0.05) with WTP in West Jakarta only. It can be concluded that correlation among variables in all districts are not the same. Hence, specific approach is required to be applied in each district

IDENTIFICATION OF FLAVONOIDS FROM ACALYPHA INDICA L. (EUPHORBIACEAE) AS CASPASE-3 ACTIVATORS USING MOLECULAR DOCKING AND MOLECULAR DYNAMICS

Objective: The purpose of this study was to determine the structural-based molecular interactions between flavonoids contained in Acalypha indica L. and caspase-3 by molecular docking and molecular dynamics (MD) simulations. Methods: In a computer simulation, ten flavonoids contained in A. indica L. were evaluated for caspase-3 using the X-ray crystal structure of human caspase-3 (PDB ID 1NME). The AutoDock 4.2 software was used to study molecular docking, and MD simulations were done with GROMACS v2018. Results: The results of molecular docking identified the top four compounds, namely nicotiflorin, naringenin, hesperetin, and kaempferol, with docking scores of-6.81,-6.45,-6.33, and-6.10 kcal/mol, respectively. According to the MD simulation results, nicotiflorin was most effective in stabilizing the complex with caspase-3, with a total energy (ΔGbind, MM-PBSA) of-96.315 kcal/mol. Conclusion: This study showed that nicotiflorin was the flavonoid in A. indica L. that activated caspase-3 the best

SATISFACTION LEVEL OF PATIENTS, PHYSICIANS, AND PRIVATE PRIMARY HEALTHCARE CENTER MANAGERS WITH CHRONIC DISEASE MANAGEMENT PROGRAM IN INDONESIA

Objective:Program PengelolaanPenyakitKronis (PROLANIS) or Chronic Disease Management Program (CDMP) is a healthcare system that was conducted by Healthcare and Social Security Agency in Indonesia to improve patients' quality of life. The objective of this study was to analyze level satisfaction of patients, physicians, and private Primary Healthcare Centers (PHCs) with this program, focusing on hypertension care.Methods:This study was conducted in 7 private PHCs in Bandung City, Indonesia. A cross sectional study was performed to measure patient satisfaction with PSQ-18 on 143 PROLANIS patients with hypertension. A total number of 8 physicians and 7 private PHC managers were involved in this study. Level satisfaction of physicians and private PHC managers were observed by using in-depth interviews.Results:The results showed that patient satisfaction was estimated to be 68.52±8.54, which could be interpreted that patient satisfy with PROLANIS. In-depth interviews showed that physicians did not satisfy with PROLANIS due to several factors (e.g., unintegrated prescription systems, lack of medicines, uncompleted laboratory facilities, lack of physicians, unintegrated referral services, and lack of collaboration between primary and secondary healthcare system). On the other hand, private PHC managers were quite satisfied with PROLANIS due to its linearity with other activities in private PHCs.Conclusion:Level satisfaction of patients with PROLANIS is quite good, while physicians might not satisfy with this program. In particular, private PHC managers confirmed that they are satisfied with this progra

Comparison of Effectiveness between Combination of Beta-Lactam with Azyhtromycin or Levofloxacin for Adult Pneumonia Patients

Treatment for pneumonia has always been a challenge due to the difficulties in diagnosis and the growing incidence of antibiotic resistance. Beta-lactam antibiotics are the first line treatment for pneumonia. The combination of beta-lactam with other antibiotics are preferred than single antibiotic therapy. However, there was limited information regarding the effectiveness of combination between beta-lactam with either macrolides or fluoroquinolone for the treatment of pneumonia.The purpose of this study was to determine the most effective combination of antibiotics for hospitalized adults pneumonia patients. This was a cross-sectional study with prospective data collection. The data source was the medical record of the subjects. We included adult pneumonia patients hospitalized at Dr. Hasan Sadikin General Hospital during June-August 2015. We found that mean reduction of body temperature in group who received combination of a beta-lactam antibiotic and azithromycin was 1.53 0C, while in levofloxacin group, the reduction was 1.22 0C (p=0.210). Reduction in leukocytes and respiratory rate were 7800 and 2.29 times/minute, respectively, in the former group, while in the latter group the reduction of leukocytes and respiratory rate were 2600 and 5 times/minute. The differences were not statistically significant in both parameters (p=0.036 and 0.149, respectively). In conclusion, better clinical outcomes were observed in patients treated with combination of beta-lactam and azithromycin compared to combination of beta-lactam and levofloxacin, although the difference was not statistically significant. Keywords: pneumonia, pneumonia therapy, combination therapy for pneumoni

Prevalence of diabetes distress and associated factors among patients with diabetes using antihypertensive medications in community health centres in Bandung City, Indonesia

Diabetes distress is common among patients with type 2 diabetes mellitus (T2DM), which remains unrecognized in primary care settings. A higher level of diabetes distress was found among T2DM patients with comorbidities. The objectives of this study are to assess the prevalence rate of diabetes distress and its association with sociodemographic factors among T2DM patients using antihypertensive medication in Bandung City, Indonesia. An observational cross-sectional survey was performed in six community health centres in Bandung City, Indonesia, among T2DM patients aged at least 18 years who were using antihypertensive medications. Diabetes distress subscales (emotional, regimen, interpersonal, and physician-related distress) were evaluated using the validated Diabetes Distress Scale. Pearson χ2 and Mann–Whitney tests were performed to assess the associations of patients’ sociodemographic factors (age, gender, insurance type, education, and duration since diagnosed with diabetes and hypertension) with diabetes distress. Of 105 patients who participated and completed the survey (response rate 93.8%), most of them were female and were aged 60-69 years. A total of 38 patients (36.2%) had moderate-high diabetes distress with emotional (56.2%) and regimen (53.3%) distress as the most commonly reported distress. Moderate-high emotional and regimen diabetes distress were significantly higher among the elderly (p 0.014) and patients who could not afford to pay the health insurance premium (p 0.012). Emotional and regimen distress as dominant forms of diabetes distress was observed among T2DM patients using antihypertensive medications. A routine diabetes distress assessment is needed in T2DM patients with comorbidity in primary care settings

The Role of Administrative and Secondary Data in Estimating the Costs and Effects of School and Workplace Closures due to the COVID-19 Pandemic

As a part of mitigation strategies during a COVID-19 pandemic, the WHO currently recommends social distancing measures through school closures (SC) and work closures (WC) to control the infection spread and reduce the illness attack rate. Focusing on the use of administrative and secondary data, this study aimed to estimate the costs and effects of alternative strategies for mitigating the COVID-19 pandemic in Jakarta, Indonesia, by comparing the baseline (no intervention) with SC + WC for 2, 4, and 8 weeks as respective scenarios. A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for the spread of infection during the latent period was applied by taking into account a 1-year time horizon. To estimate the total pandemic cost of all scenarios, we took into account the cost of healthcare, SC, and productivity loss due to WC and illness. Next to costs, averted deaths were considered as the effect measure. In comparison with the baseline, the result showed that total savings in scenarios of SC + WC for 2, 4, and 8 weeks would be approximately $24 billion,$25 billion, and $34 billion, respectively. In addition, increasing the duration of SC and WC would increase the number of averted deaths. Scenarios of SC + WC for 2, 4, and 8 weeks would result in approximately 159,075, 173,963, and 250,842 averted deaths, respectively. A sensitivity analysis showed that the wage per day, infectious period, basic reproduction number, incubation period, and case fatality rate were found to be the most influential parameters affecting the savings and number of averted deaths. It can be concluded that all the mitigation scenarios were considered to be cost-saving, and increasing the duration of SC and WC would increase both the savings and the number of averted deaths

A sensitive bioanalytical method for the simultaneous determination of amlodipine and glibenclamide

Type 2 diabetes mellitus triggers hypertension as a complication. The use of amlodipine and glibenclamide drugs simultaneously results in a synergistic and effective lowering of blood sugar and blood pressure. In the testing of bioavailability and bioequivalence, as well as the monitoring of drug concentrations in the blood, a sensitive bioanalytical approach that meets existing reference requirements, such as the European Medicines Agency (EMA) recommendation, is required. Presently, there is no simultaneous bioanalytical method of amlodipine and glibenclamide that meets EMA requirements. This study aimed to develop a sensitive bioanalytical method that fulfills EMA requirements for determining the levels of amlodipine and glibenclamide simultaneously. Amlodipine and glibenclamide in plasma were extracted with acetonitrile at 10°C. The derivatization was conducted using 0.08% 4-chloro-7-nitrobenzofurazan at pH 8.6 with Teorell and Stenhagen buffer for 20 min at 70°C, followed by the addition of 0.1 N sulfuric acid. High-performance liquid chromatography analysis used a LiChrospher RP 18 column with a size of 125×40 mm ID; mobile phase, acetonitrile: 0.01% phosphoric acid (52:48); flow rate of 1 mL/min; and emission and excitation wavelength for glibenclamide and amlodipine at 346 and 300 nm and 535 and 480 nm, respectively. The concentration ranges were 0.1-20 ng/mL for amlodipine and 1-200 ng/mL for glibenclamide. The average ranges of percentage coefficient of variation and percentage difference were 1.76%-14.62% and 4.48%-11.18% for amlodipine and 0.56%-11.92% and 2.92%-12.75% for glibenclamide. This sensitive and simultaneous bioanalytical method for amlodipine and glibenclamide fulfills the EMA requirements

The role of illness perceptions on medication nonadherence among patients with hypertension: a multicenter study in Indonesia

Introduction: Nonadherence to antihypertensive medications is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors, particularly from the patient's perspective, is essential for developing tailored intervention strategies. The objective of this study was to evaluate the associations between different domains of illness perception and medication nonadherence among patients with hypertension in Indonesia. Patients and methods: A multicenter cross-sectional study was conducted among patients with hypertension aged 18 years old and older who were using antihypertensive medications in the last 3 months in the community health centers in the three cities in Indonesia. The different domains of illness perception (e.g., consequences, timeline, personal control, treatment control, identity, concerns, comprehension, and emotional response) and medication nonadherence were assessed using a validated Brief Illness Perceptions Questionnaire (BIPQ) and Medication Adherence Report Scale (MARS), respectively. A logistic regression analysis was conducted to evaluate the associations between the different domains of illness perception and medication nonadherence adjusting for confounders. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: A total of 440 participants were included, 41.8% reported nonadherence to antihypertensive medications. The majority of the participants were females (64.3%) and aged between 60 and 69 years old (39.5%). The treatment control (OR: 0.80, 95% confidence interval: 0.7-10.90), patient's comprehension of hypertension (OR: 0.89, 95% CI: 0.820-0.97), and patient's emotions (OR: 0.93, 95% CI: 0.88-0.99) were significantly associated with medication nonadherence. No significant associations were observed between the other domains of illness perception and medication nonadherence. Conclusion: Different dimensions of illness perception were associated with non-adherence to antihypertensive medications. Educational interventions should be developed based on patient's perception of their illness.info:eu-repo/semantics/publishedVersio