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A psychometric evaluation of the Indonesian version of the collaborative practice assessment tool (CPAT) for assessing interprofessional education and collaborative practice among health practitioners and students
Get PDFResearch focus has transitioned from interprofessional collaborative practice among qualified health practitioners to the involvement of pre-qualifying students in practicing interprofessional education. It is essential to establish outcome measures to enhance the seamless integration of interprofessional education and collaborative practice. The aim of this study was to develop a culturally appropriate quality measure for assessing interprofessional education and collaborative practice for health practitioners and students in Indonesia by performing cross-cultural validation of the collaborative practice assessment tool (CPAT). The consensus-based standards for the selection of health measurement instruments (COSMIN) standards of psychometric properties were used to guide the study. The evaluation of the psychometric properties was conducted, involving meticulous structural validity evaluation based on a three-step factorial analysis (exploratory factor analysis, confirmatory factor analysis, and multi-group confirmatory factor analysis) and measurement invariance. The parameters analyzed were related to the design requirements of a measure (i.e., targeted population, study sample, and size), the internal structure (structural validity, internal consistency, and measurement invariances), and hypotheses testing for construct validity based on a validated conceptual framework. This study involved 266 practitioners and 232 students. The COSMIN standards for general design requirements were fulfilled. Structural validity confirmed the 7-factor of 48-item structure; measurement invariances indicated configural, metric, and scalar invariants in both practitioner and student cohorts. Construct validity was confirmed by meeting the COSMIN requirement, with over 75% of the tested hypotheses accepted. In conclusion, the findings suggest the newly validated Indonesian CPAT has good psychometric properties concerning internal structure (i.e., structural validity, internal consistency, and measurement invariance) and hypotheses testing, and is therefore a quality measure for assessing interprofessional education and collaborative practice with health practitioners and students in Indonesia
Varicella challenges: A case of respiratory tract complications in an elderly patient
Get PDFVaricella, caused by the varicella-zoster virus (VZV), is rarely reported in the elderly but often complicates with pneumonia. In this case report, we present a case of varicella pneumonia in the elderly. A 60-year-old man presented to the emergency room with vesicles filled with clear fluid that had appeared all over the body for the past four days. The patient also reported fever, headache, pain when swallowing, and itching. Initially, the rash consisted of pink macules that progressed to papules, vesicles, pustules, and crusts. The patient experienced a cough and shortness of breath one day before the hospital visit but did not report any chest or abdominal pain. Notably, the patient’s two grandchildren had a history of chickenpox. The patient had been living with diabetes for five years and was undergoing treatment with insulin injections. The patient was also an active smoker for 40 years. On physical examination, several vesicles with varying degrees of redness were observed, along with yellow-black crusts, pustules, and erosions. Diagnostic tests revealed multinucleated giant cells on a Tzanck smear; pulmonary inflammation with thickening of the right hilum on a chest X-ray; extended-spectrum beta-lactamases Klebsiella pneumoniae in the sputum culture; and elevated hemoglobin A1c, blood sugar level, and liver and kidney function markers on laboratory examination. Based on the clinical findings, the patient was diagnosed with varicella, community-acquired pneumonia, diabetes, acute renal failure, and elevated transaminase enzymes. The patient was treated with acyclovir, paracetamol, salicylate 2% powder, fusidic acid 2% cream, moxifloxacin, N-acetylcysteine, curcuma, and insulin. The patient’s clinical condition improved, the complaint of dyspnea decreased, and the patient was discharged to outpatient care after eight days of hospitalization. This case highlights that while varicella is rare in the elderly, it often presents with severe varicella pneumonia, making early detection and comprehensive management essential to prevent complications and mortality
Risk factors for viral hepatitis in pulmonary tuberculosis patients undergoing treatment: A systematic review and meta-analysis
Get PDFLiver injury in tuberculosis patients, associated with noncompliance with treatment, is further exacerbated by viral hepatitis, which not only directly harms the liver but also increases susceptibility to drug-induced liver injury. The aim of this study was to analyze the associated risk factors for viral hepatitis in tuberculosis patients. This systematic review and meta-analysis adhere to the PRISMA 2020 statement, and the protocol has been registered with PROSPERO (CRD42023477241). Screening and selection of articles were carried out according to predetermined inclusion and exclusion criteria, utilizing four databases: Embase, Medline, Scopus, and ProQuest. Baseline characteristics and patient-related risk factors from each included study were extracted, followed by a meta-analysis of factors that potentially had significance, with the heterogeneities also being analyzed. Of the 21 included studies out of 6,415 identified records, 12 potential risk factors for hepatitis B and 15 for hepatitis C were subjected to meta-analysis. Some key risk factors included for hepatitis B and C were HIV infection (OR: 3.42; 95%CI: 2.19–5.34 and OR: 6.99; 95%CI: 5.09–9.61, respectively), smoking (OR: 1.55; 95%CI: 1.19–2.02 and OR: 3.06; 95%CI: 1.63–5.75, respectively) and alcohol consumption (OR: 2.38; 95%CI: 1.06–5.37 and OR: 4.32; 95%CI: 2.76–6.78, respectively). Furthermore, meta-analysis indicated that other significant risk factors for hepatitis B and/or C include injecting and non-injecting drug use, multiple sexual partners, tattooing, ear-nose piercing, blood transfusion, dental interventions, homelessness, incarceration, living with prisoners, sexually transmitted diseases, and diabetes mellitus. In conclusion, patients with tuberculosis who have risk factors such as smoking, HIV, or alcohol consumption should be screened for hepatitis B and C to prevent liver injury
Employment of people with Down syndrome: A scoping review
Get PDFDown syndrome is the most prevalent genetic condition contributing to intellectual disability. Advancements in medical care have significantly increased the life expectancy of people with this condition, making employment a vital component for independent living and quality of life. The aim of this study was to examine the current literature on the employability and employment experiences of individuals with Down syndrome, focusing on the evolution of the employment rate and factors influencing employment such as cognitive and personal factors, societal attitudes, challenges, and effective support systems. Using Arksey and O’Malley's methodology, a scoping review of relevant qualitative and quantitative articles from PubMed, Scopus, Web of Science (WoS), CINAHL, and Medline was conducted. The search focused on the keywords found in the title and abstract of articles from 1980 to 2023. The search strategy utilized medical subject headings (MeSH), including "work", "Down syndrome", and "employment". All articles employing qualitative, quantitative, and mixed methods that were published in English were included. Of an initial 4,296 articles, 32 full-text articles were evaluated, and nine met the inclusion criteria. The data indicated improved employment rates for people with Down syndrome, with a recent employment rate of 53%. However, jobs are often limited to sectors like food service and are underutilizing their skills. Key factors associated with employment status include cognitive abilities, family support, and social attitudes. Despite positive perceptions, significant barriers such as systemic bias persist. Effective support systems are crucial but are often hindered by limited opportunities. In conclusion, employment opportunities for people with Down syndrome have improved, but challenges such as limited job diversity and systemic barriers remain. Comprehensive policies are recommended to promote inclusive employment practices and tailored support systems
Impacts of COVID-19 on malaria elimination strategies in Asia: A scoping review
Get PDFThe global malaria program has faced setbacks due to disruptions in health services caused by COVID-19 pandemic. Despite these challenges, Asia that primarily comprised of low and middle-income countries (LMICs), continues to make strides towards malaria elimination. This scoping review explored the impact of the COVID-19 pandemic on malaria control programs in Asian countries with varying levels of malaria endemicity. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was applied to search for articles published between January 2020 and May 2024 that examined the impact of COVID-19 on malaria control programs in Asia on six databases (PubMed, Scopus, Google Scholar, WHO COVID-19 Research Database, Garuda and Sinta). The findings of these articles were organized into five themes: epidemiology and surveillance, case management (including diagnosis and coinfection), vector control, prevention, and program management. Overall, 54 articles from countries with various endemicity levels were included. These studies focused on malaria epidemiology, surveillance, and case management, with few studies on vector control. The COVID-19 pandemic has affected malaria control differently in different regions. In malaria-free, low-, and high-endemic countries, malaria cases were reduced mainly due to strict public health measures such as travel restrictions, quarantines, and COVID-19-related stigma, which reduced clinic attendance. Conversely, increased malaria cases owing to increased imports, relapses of malaria cases triggered by COVID-19, social conflicts, and underreporting have contributed to this surge. The priority shift to COVID-19 has affected malaria centers, resulting in personnel shortages, budget limits, and an increased number of malaria cases and outbreaks. The pandemic has also spurred innovative malaria prevention methods, such as using social media to raise awareness in China. The COVID-19 pandemic has had a mixed impact on the number of malarial cases reported across Asia. The three main factors were travel restrictions, COVID-19-related stigma, and shifting priorities to COVID-19. Integrating malaria control and COVID-19 strategies, strengthening the healthcare system, developing flexible malaria control strategies during crises, and developing innovative solutions could mitigate these impacts
Neuroprotective and inflammatory biomarkers in pediatric drug-resistant epilepsy: Interplay between GDNF, IL-1β and vitamin D 25-OH
Get PDFDrug-resistant epilepsy in pediatric patients is associated with neuroinflammation and neurodegeneration. Vitamin D 25-OH exerts neuroprotective effects, while glial cell line-derived neurotrophic factor (GDNF) and the proinflammatory cytokine interleukin-1β (IL-1β) are implicated in the mechanisms of neuroinflammation and epileptogenesis. The aim of this study was to investigate the relationship between vitamin D 25-OH, IL-1β, and GDNF levels with seizure severity and frequency in children with drug-resistant epilepsy. A cross-sectional study was conducted at Adam Malik Hospital, Medan, Indonesia, among children with drug-resistant epilepsy. Vitamin D 25-OH, IL-1β and GDNF levels were measured using enzyme-linked immunosorbent assay (ELISA). Epilepsy severity was assessed using the Hague Seizure Severity Scale (HASS), while seizure frequency was assessed using the Global Assessment of Severity of Epilepsy (GASE). The present study identified a significant correlation between GDNF levels and epilepsy severity, as measured by the HASS score (r=0.318; p=0.006). However, no significant correlation was observed between vitamin D 25-OH or IL-1β levels and epilepsy severity or seizure frequency (p>0.05). IL-1β levels correlated significantly with GDNF levels (r=0.525; p=0.001), but IL-1β did not directly correlate with seizure frequency or epilepsy severity. In conclusion, GDNF levels significantly correlated with epilepsy severity, suggesting that GDNF may serve as a potential biomarker for assessing epilepsy severity. However, further studies investigating the role of GDNF as a potential neurotrophic factor in the pathophysiology of epilepsy and its possible application as a therapeutic target are important
HOMA-IR value in predicting retinal microvascular dysfunction
Get PDFObesity and retinal microvasculature dysfunction are linked and impact visual acuity. The aim of this study was to determine the relationship between the HOMA-IR score and the presence of vascular dysfunction (perfusion index and flux index) of the optic nerve head (ONH) of the retina in obese patients and to determine its diagnostic performance to predict vascular dysfunction. A case-control study was conducted in 2022 involving individuals from obese and non-obese groups. Insulin resistance was measured using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score using the levels of insulin and fasting glucose. Optical coherence tomography angiography (OCT-A) was performed to evaluate the flux index and capillary perfusion of ONH. The correlation between HOMA-IR, flux index, and capillary perfusion was assessed using Pearson’s correlation, and the diagnostic performance of HOMA-IR, including sensitivity, specificity, and the area under the curve (AUC), was measured. Logistic regression was used to identify the association between the HOMA-IR cutoff score with the presence of retinal microvascular dysfunction. A total of 80 individuals were included from each obese and non-obese group. The HOMA-IR score showed significant negative correlations with the perfusion of the superior (p<0.001), inferior (p<0.001), and outer (p=0.008) regions of the retinal of ONH. For the flux index, the HOMA-IR score had significant negative correlations with the superior (p=0.001), inferior (p<0.001), nasal (p=0.003), and outer (p=0.035) regions of ONH of the retina. The receiver operating characteristic (ROC) curve analysis for the HOMA-IR score at a cutoff value of 5.51 demonstrated an area under the curve (AUC) of 0.819, with a 95% confidence interval (CI) ranging from 0.727 to 0.912, suggesting its effectiveness in detecting vascular dysfunction. Multivariate logistic regression revealed a significant association between the HOMA-IR cutoff score of 5.51 with capillary perfusion of the superior (p=0.005) and nasal region (p=0.043), as well as the flux index of the inferior (p=0.013) and outer (p=0.022) regions of the ONH. These findings suggest that HOMA-IR is a promising biomarker for predicting retinal microvascular dysfunction in obese patients
Role of estradiol and C-reactive protein levels on genitourinary syndrome in menopausal women
Get PDFMenopause leads to decreased estradiol levels affecting tissue health and causing local inflammation in the genital organs and urinary tract. The rise of blood C-reactive protein (CRP) levels in menopausal women may indicate systemic inflammation associated with estradiol decline. The aim of this study was to determine the relationship between serum estradiol and CRP levels on genitourinary syndrome in menopausal women. A cross-sectional study was conducted among menopausal women who had not experienced menstruation for at least 12 consecutive months at Prof. dr. Chairuddin P. Lubis Hospital, Medan, Indonesia, in 2023. Estradiol and CRP levels were measured using enzyme-linked immunosorbent assay (ELISA) and the presence of genitourinary syndrome was assessed using the Menopause-Specific Quality of Life (MENQOL) questionnaire. The mean levels of estradiol and CRP were compared to menopausal women with and without genitourinary syndrome with the Mann-Whitney test. To assess the correlation between estradiol and CRP levels, and between their levels with the presence of genitourinary symptoms, the Spearman correlation test was used. The genitourinary syndrome was reported in 25% of the total included menopausal women. Our data indicated that the mean estradiol levels were not significantly different between menopausal women with and without genitourinary syndrome (9.13±2.47 pg/mL vs 18.96±31.23 pg/mL, p=0.881). The mean serum CRP level of menopausal women with genitourinary syndrome (9.72±6.30 mg/L) was higher than that of women without the syndrome (2.09±1.26 mg/L) with p<0.001. In addition, serum CRP level, not estradiol, was correlated with the symptom score of genitourinary syndrome. This study highlights that to identify and manage genitourinary syndrome, monitoring of CRP levels is essential in menopausal women
Effects of stretching exercises on muscle tension, fatigue, strength, and lactic acid accumulation: A pre-experimental study among fish transport workers
Get PDFFish transport workers in Indonesia lift loads more than the specified limits, both in weight and frequency. This could cause lactic acid accumulation, fatigue and reduced physical performance. The aim of this study was to assess the effect of stretching intervention on muscle tension, fatigue, strength, and lactic acid level in fish transport workers in Indonesia. A pre-experimental study design with one group (pre- and post-test) design was conducted among male fish transport workers at the Tawang fish auction, Weleri, Central Java, Indonesia, in June 2022 for two weeks. We created a 1.5-minute stretching exercise video based on the University of New Castle's Manual Handling guideline, involving hand, feet, and shoulder movements. Participants performed these exercises independently before and during work every two hours, guided by the video. Data on lactic acid, muscle tension, fatigue, and strength were collected before and after the 2-week intervention. Data analysis was performed using Wilcoxon and paired Student t-tests to compare the outcome between post- and pre-intervention. A total of 18 fish transport workers were included in the study. The results showed a statistically significant increase in lactic acid levels following the intervention (p=0.016). However, the increase in muscle tension was not statistically significant (p=0.292). There was a significant increase in fatigue levels after the intervention (p=0.000). This could suggest that the stretching intervention may have had an unintended effect of increasing fatigue among the participants. On the other hand, there was a statistically significant decrease in muscle strength after the intervention (p=0.003). In conclusion, this study suggests that while stretching exercises can affect lactic acid accumulation, fatigue, and muscle strength, they do not influence muscle tension. Therefore, it is advised for workers to incorporate stretching exercises into their daily routine to mitigate potential injury risks
Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia
Get PDFChronic energy deficiency (CED) in pregnant women is a condition of energy and protein deficiency that lasts for years and causes problems in the mother and fetus. Due to its significant consequences, determining the determinants associated with CED incidence is of utmost importance. The aim of this study was to determine the determinants of the incidence of CED in pregnant women in Indonesia. A cross-sectional study was conducted on pregnant women in Banyumas, Central Java, Indonesia, in 2022. Plausible determinants included maternal age, pregnancy interval, parity, educational attainment, nutritional knowledge, employment, frequency of antenatal care (ANC), and nutritional intake. The Chi-squared test followed by multivariate logistic regression were used to determine the factors associated with the incidence of CED. Our data indicated that 32% of the pregnant women had CED. Univariate analysis found that maternal age (p=0.022), pregnancy interval (p=0.009), educational attainment (p=0.012), knowledge of nutrition and CED (p=0.023), frequency of utilization of ANC services (p=0.028), energy intake (p=0.002), protein intake (p=0.006), vitamin C intake (p=0.016), folate intake (p=0.011), and calcium intake (p=0.004) were significantly associated with CED incidence in the pregnant women. Multivariate analysis indicated that extreme maternal age (OR; 3.49; 95%CI: 1.10–11.05), low educational attainment (OR: 4.12; 95%CI: 1.37–12.33), short pregnancy interval (OR; 7.30; 95%CI: 1.84–28.99), low frequency of ANC (OR: 3.06; 95%CI: 1.01–9.19) and low protein intake (OR: 6.80; 95%CI: 1.62–28.59) were associated with CED incidence. This study underscores the importance of increasing nutritional intake, frequency of ANC, and pregnancy interval among pregnant women to reduce the risk of CED and its adverse health outcomes