Adherence to ARV, Clinical Stages of AIDS, and Self-Perceived Risk of HIV Infection are Predictors of Immunologic Success on PLHIV in Surabaya and Sidoarjo, East Java

Background People living with HIV (PLHIV) are very dependent on the antiretroviral therapy (ART) during their lifetime, and CD4 cell count is an indicator of ART effectiveness. The objective of this study is to determine the predictors of the immunologic success on PLHIV at Dr. Ramelan Naval Hospital, Surabaya and Sidoarjo Regency General Hospital. Methods: This research was conducted on 29 PLHIV at Dr. Ramelan Naval Hospital, Surabaya and Sidoarjo Regency General Hospital. All subjects had taken ART for six months. CD4 count, ART card and questionnaires were used in the study. The data was analysed using multiple linear regression with SPSS version 21.0. Results: 92.9% subjects were from the key population aged 20-54 years. 73.9% subjects were in the second clinical stage of AIDS, 68.9% subjects reported high adherence (≥ 95%) to ART, 24.1% subjects were not aware of the risk of getting HIV infection when having sexual intercourse without using a condom. The results of the multiple linear regression analysis showed there were six predictors of immunologic success: adherence to ART (p = 0.047), clinical stages of AIDS (p = 0.004) and the awareness of getting HIV infection when having sexual intercourse without using a condom (p = 0.045). Conclusion:Monitoring adherence to ART, clinical condition and condom use were very important to achieve immunologic success. Keywords: PLHIV, absolute CD4 cell count, adherence to ART, clinical stages of AIDS, condom us

Educating for HIV prevention in Papua and West Papua Provinces, Indonesia : an experimental approach

The acquired immunodeficiency syndrome (AIDS) case rate is increasing in Indonesia, especially in Papua and West Papua Provinces. As of September 2011, Papua's AIDS case rate was the highest among all 33 provinces in Indonesia, at 180.7/100,000 population, which was 16.3 times higher than the national rate of 11.1/100,000 population. The second highest rate was in West Papua at 51.5/100,000 population. Even more alarming is the fact that young Papuans aged 15-29 years of age comprised 55 percent of cumulative AIDS cases up to March 2011. Studies have shown that sexual permissiveness is becoming more common among young people in Indonesia and in both provinces. However, young Papuans still have a low level of comprehensive knowledge on Human Immunodeficiency Virus (HIV) and AIDS, do not perceive themselves at risk of HIV infection, and rely mostly on the media as the main source of information on HIV and AIDS. Therefore, education of young Papuans for HIV prevention is important in reducing new HIV infection. This thesis is based on the '2009 Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' program that I developed. This research is the first cluster-randomized trial on senior high school students carried out in Indonesia, and the first study to evaluate the efficacy of a comprehensive reproductive health education module on senior high school students in Indonesia. This research explores perspectives related to the social norms of sexuality and reproductive health education; evaluates the effectiveness of the 'Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' program in changing young people's knowledge, attitudes, behavior intentions and sexual practices based on the results of pre-tests and post-tests and self-reported sexual practices among senior high school students in different intervention groups; and analyzes determinants of students' sexual practices. The study uses a combination of quantitative and qualitative methods. The 'Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' module consists of a handbook and a PowerPoint presentation that has several advantages. It is delivered through interesting methods that enable active participation of the students. It helps students develop positive feelings about their changes during puberty and how to deal with the changes. It provides unbiased information about HIV and AIDS and other sexually transmitted infections (STIs), risk involved in unprotected sexual intercourse, revealing the truth about sexual myths related to Papuan cultures, teenage pregnancy, unsafe abortion, sexual and reproductive rights, how to use condoms and lubricants, available health services, and motivation to achieve a better future. It provides a framework for decision-making and communication about safer sexual practices. Therefore, the program helps students perceive whether they might be at risk for HIV, increases the motivation and intentions to reduce risk, and builds the skills required to protect themselves from acquiring HIV infection or other STIs, as well as unintended pregnancies in the real world. 'Reducing the Risk of HIV Infection Logic Model' is created and used by the author to show clearly and concisely the causal mechanisms through which specific interventions (Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' program) can affect certain determinants (students' risks and protective factors) that affect behaviors, which in turn (through maintenance) will achieve a health goal (reduction of new HIV infection). The results of in-depth interviews of educators and policy makers confirm the need for a comprehensive reproductive health education module in the school curriculum, the need to raise quality of teachers, and to achieve openness between parents and children. Health professionals suggest young Papuans are reluctant to visit Voluntary Counseling and Testing (VCT) clinics, health centers and private doctors to discuss STIs, due to ignorance, stigma and availability over-the-counter medicine. Further, many young patients come to hospital with late stage of AIDS. A stratified cluster randomized trial is used to assess the efficacy of my intervention strategy A total of 16 senior high schools (1,082 Year 11 students) was selected out of 89 senior high schools in Jayapura city and Jayapura district of Papua Province, and Manokwari district and Sorong city of West Papua Province. These schools were randomly assigned to either receive the reproductive health education program after pre-test (being in the intervention group) or acted as a control group that received the program two months later, after the post-test. The questionnaire consisted of 128 questions: 25 true or false questions in the knowledge test; 30 questions in the attitude test; 18 questions in the behavior intention test; and 55 questions covering demographic characteristics, previous sexual experience, contraception, pregnancy, unsafe abortion, STI symptoms, treatment-seeking behavior, interest in reproductive health matters, alcohol and drug use. Total loss to follow-up on individual level was 8.7 percent (94 students), corresponded to 988 students in the analysis. Changes in knowledge, attitudes, behavior intentions and sexual practices between the two groups were compared using linear mixed models and generalized linear mixed models to account for the cluster randomized design. Of the 988 students in the analysis, 48.8 percent were in the control groups, and 51.2 percent were in the intervention group. The mean age of respondents was 18.9 years. The characteristics of intervention and control groups were similar with respect to sex, school type, ethnicity, sexual orientation, previous sexual experience, alcohol and drug use, source of HIV and sexuality information and enthusiasm to know about reproductive health education. However, the two groups were dissimilar with respect to religion; which was likely to be due to the clustered nature of the data. Results of linear mixed model indicated that 'Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' module achieved an efficacy with almost three more correct answers (difference score was 2.6 points, 95% CI 2.1, 3.1) for the overall knowledge test, 2.5 points (95% CI 0.3, 4.8) better mean score for the overall attitude test, and 2.4 points (95% CI 0.5, 4.2) better mean score for the overall behavior intention test different from pre-test to post-test between intervention and control group. Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans module showed an efficacy of 0.4 times (95% CI 0.3, 0.7) in reducing the risk of having sexual intercourse and five times (95% CI 1.5, 14.9) in increasing condom use in the last sexual intercourse. The study supports the hypothesis that 'Reducing the Risk of HIV Infection: Intervention Trial for Young Papuans' module has been effective in changing young people's knowledge, attitude, behavior intention and sexual practices related to HIV and sexuality towards more positive results

Evaluation of a Guest Lecture on Medical Emergency of Box Jellyfish Envenomation Pathophysiology and First Aid for Medical Students

Introduction: Lethal box jellyfish envenomation has been reported in Indonesia and other countries; therefore, medical students should be equipped with related knowledge. The aim of this study was to evaluate the results of summative exams by student cohort and gender and determine the factors that contribute to success in the summative exams after novel intensive instruction in box jellyfish envenomation pathophysiology and first aid in undergraduate medical students in Surabaya, Indonesia.Methods: This study used explanatory sequential mixed methods, consisting of a cross-sectional study and interviews. A total population sampling of 203 sixth-semester students was employed. Student cohort, gender, previous semester grade point average (GPA), and English proficiency test (EPT) were considered. All statistical tests were carried out using IBM SPSS Statistics version 24.0 for Macintosh. The study was complemented by interviews conducted with 20 students.Results: The one-way ANOVA test showed that students from the 2016 cohort had significantly higher mean scores in the exam than the 2015 and 2014 cohorts (P=0.002). Independent samples t-test showed that such differences were not gender-specific (P=0.249). In the binary logistic regression, the GPA in the previous semester was the only factor that contributed to success in the summative exam (OR 3.031, 95% CI: 1.520-6.044). All students commented that the lecture and practicum were interesting and beneficial. However, some considered that the language barrier might haveprevented them from understanding the topic well.Conclusion: Results of the summative exam differed by the student cohorts, and previous semester GPA was a predictor of success in the summative exam

BIOMARKERS AND PROGNOSTIC SCORING IN CEREBRAL MALARIA

Malaria remains a public health concern and remain the deadliest in infectious disease in the world. Cerebral malaria is a particularly severe complication of this disease and associated with high mortality. This literature review is made up from 19 literatures consisting of journals, and book. The literature review used data base www.pubmed.com, and www.scholar.google.com using “cerebral malaria and biomarker, predictor of cerebral malaria and treatment of severe malaria”. The languages for this journal are English and Indonesian. From the collection of literatures in this literature review, severe consists of cerebral malaria, blackwater fever, acute kidney injury, pulmonary edema, electrolyte disturbance, hematology disturbance, and obstetrics emergency resulting from malaria which is postpartum hemorrhage. Cerebral malaria increases the mortality of the patient, so they have to be diagnosed early and treated precisely. Patients with infection of plasmodium falciparum and GCS<11 must be suspected as cerebral malaria. Biomarker examination such as Soluble ICAM-1, Specific muscle’s protein, Angiopoetin-1 and 2, and Plasma microparticles is the most precise way to detect malarial emergency earlier Coma Acidosis Malaria score is also found to be useful in predicting the prognosis in cerebral malaria. Early diagnosis should be made as early as possible to reduce mortality from malaria and its emergencies

The Surge of Dengue Cases during COVID-19 in Indonesia

Most healthcare resources in Indonesia have been engulfed by COVID-19 pandemic, and less attention has been given to the rising cases of dengue that has been endemic in many areas of Indonesia. Present study aimed to review the immunopathogenesis of dengue and COVID-19 infection, as well as their prevention strategies. This study is a narrative review based on the research articles and reports published between 2010-2020. A total of 60 articles and reports were obtained and after careful consideration 49 articles and reports were used as references of this study. The immune response in Dengue virus and severe acute respiratory syndrome coronavirus 2 infections aims to eliminate the virus, but it causes an increase in inflammatory mediators (cytokine storm) which can increase vascular permeability and organ damage. Secondary infection of Dengue virus with different strains may allow the occurrence of antibody-dependent enhancement. The possibility of antibody-dependent enhancement in severe acute respiratory syndrome coronavirus 2 infection has been studied in vitro and in animal studies. Dengue virus and severe acute respiratory syndrome coronavirus 2 infections have antigenic similarities and trigger memory B cells. The cross reactions between severe acute respiratory syndrome coronavirus 2 antibodies and Dengue virus antigens may cause false positive on rapid dengue infection serological tests. The prevention and control of Dengue virus and severe acute respiratory syndrome coronavirus 2 infections are based on the transmission mode, and people should comply to the related health protocols

Impact on Medical Education and the Medical Student’s Attitude, Practice, Mental Health, After One Year of the Covid-19 Pandemic in Indonesia

Introduction: The COVID-19 pandemic has caused disruptions in educational institutions across the country, prompting medical schools to adopt online learning systems. This study aims to determine impact on medical education and the medical student’s attitude, practice, mental health after 1 year of the Covid-19 pandemic in Indonesia. Methods: This study utilized a cross-sectional design. An online questionnaire was distributed digitally to 49 medical schools in Indonesia from February–May 2021. A total of 7,949 medical students participated in this study. Sampling was carried out based on a purposive technique whose inclusion criteria were active college students. This research used questionnaires distributed in online version among 49 medical faculties that belong to The Association of Indonesian Private Medical Faculty. Instruments included demographic database, medical education status, experience with medical tele-education, ownership types of electronic devices, availability of technologies, programs of education methods, career plans, attitudes toward pandemic, and the mental health of respondents. Univariate and bivariate statistical analysis was conducted to determine the association of variables. All statistical analyses using (IBM) SPSS version 22.0. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Conclusion: The infrastructure and competency of its users are required for E-learning to be successful. The majority of medical students believe that e-learning can be adopted in Indonesia and that their capacity to use electronic devices is good. However, access to the internet remains a problem. On the other side, the pandemic has disrupted the education process and mental health, with fears of being infected with SARSCoV- 2, the loss of opportunities to apply for specialty training, and the potential for increased financial difficulties among medical students. Our findings can be used to assess the current educational process in medical schools and maximize e-learning as an alternative means of preparing doctors for the future. Keywords: COVID-19, e-learning, Indonesia, medical education, student

Delayed Speech Dengan dan Tanpa Gangguan Pendengaran pada Anak Usia 6 Bulan sampai 3 Tahun di Jala Puspa RSPAL Dr. Ramelan Surabaya Periode 2017-2020

Late or untreated delayed speech can be a risk for social, emotional, behavioral and cognitive problems in adulthood. Delayed speech is associated with hearing loss, mental retardation, autism spectrum disorder (OSD), bilingualism, and lack of psychosocial stimuli. Objectives: To determine the prevalence of delayed speech with and without hearing loss in children aged six months until three years. Methods: This study used 872 medical records of delayed speech children aged six months until three years with and without hearing loss in 2017 until 2020 period at Jala Puspa RSPAL Dr. Ramelan, Surabaya. The presence or absence of hearing loss was examined using Brainstem Evoked Response Audiometry (BERA), and the degree of hearing loss was examined using Auditory Steady-State Response (ASSR) test. Results: From a total of 872 medical records data studied, 558 (64.0%) were males and 314 (36.0%) were females. The majority (44.8%) of delayed speech children were from the two-year age group. There were 565 (64.8%) delayed speech children with hearing loss and 307 (35.2%) without hearing loss. Of those with hearing loss, 48.0% showed a profound degree. There was an increase in delayed speech children without hearing loss compared to those with hearing loss, from 1:2.04 in 2017 to 1:1.12 in 2020. Conclusion: There was an increase in delayed speech children without hearing loss compared to those with hearing loss.Keywords:  ASSR, BERA, delayed speech, hearing los

Beyond sexual desire and curiosity: sexuality among senior high school students in Papua and West Papua Provinces (Indonesia) and implications for HIV prevention

When it comes to sexuality and norms, young Indonesians are becoming more open. Concern about this is related to the rapid increase in HIV prevalence in Indonesia, especially in Papua and West Papua Provinces. While much research has been conducted amon

PENGEMBANGAN WISATA BAHARI PULAU GILI LABAK MELALUI DIGITAL MARKETING

Gili Labak Island is located in Kombang Village, Talango District, Sumenep Madura Regency. Marine tourism in Gili Labak is in the form of beach tourism (white sand) and snorkeling tours, because Gili Labak has an unspoiled and shallow coral reef ecosystem that is easily accessible to visitors. The current problem is the socio-economic gap between the local residents of Gili Labak Island and tour agents who are people from outside the island. In addition, there is a threat of damage to the coral reef ecosystem due to the activities of tourists who do not understand the code of conduct while traveling on coral reefs. The mentoring method used in this community service is PAR (Participatory Action Research). The UHT community service team built a website with the name https://wonderfulgililabak.com/ for the promotion of Gili Labak coral reef tourism. The dissemination of tour guides on coral reefs using leaflets in the local language (Madura) was quite effective in making local people and visitors understand the importance of preserving coral reef ecosystems. The use of websites for digital marketing of marine tourism in Gili Labak is still not effective due to the limited ability of local people to manage websites