Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management)
Background: Responsiveness according to WHO is the result that can be achieved when an institutio... more Background: Responsiveness according to WHO is the result that can be achieved when an institution designed so that they areaware of and respond appropriately to the expectations of a legitimate, based on measurements through eight domains are: dignity,attention immediately, autonomy, choice of health care providers, clear communication, confidentiality, quality of basic amenities, andaccess to social support networks.Objective: To analyze the responsiveness of the hospitals and health centers in providing health services.Methods: A descriptive study with qualitative methods. This research uses descriptive type so that the researcher will analyze howresponsiveness in terms of health in providing health services to the community. This research was conducted in Buru Regency with 22 respondents.Results: The experience of respondents to the responsiveness in hospitals that view based on variable dignity officers have notprovided services to the fullest and less maintain patient privacy....
Latar Belakang. Iodium merupakan mikronutrien penting terutama bagi perkembangan otak janin dan a... more Latar Belakang. Iodium merupakan mikronutrien penting terutama bagi perkembangan otak janin dan anak. Iodium berperan untuk proses pertumbuhan dan perkembangan sebagian besar organ terutama otak. Konsumsi iodium yang rendah dalam jangka panjang merupakan salah satu faktor yang dapat menyebabkan gangguan akibat kekurangan iodium (GAKI). Tingkat pengetahuan mengenai GAKI dan garam beriodium berpengaruh terhadap ketersediaan dan praktik penggunaan garam beriodium. Pemerintah telah mengupayakan penanggulangan GAKI melalui fortifikasi garam dengan iodium. Tujuan. Penelitian ini bertujuan untuk menganalisis pengetahuan ibu tentang iodium dengan ketersediaan garam beriodium di rumah tangga dan faktor yang memengaruhinya. Metode. Penelitian ini merupakan penelitian cross-sectional. Data diambil dari 198 rumah tangga menggunakan teknik proportional stratified random sampling. Penilaian pengetahuan ibu dilakukan dengan menggunakan kuesioner dalam bentuk pertanyaan tertutup. Sementara itu, pen...
Introduction: Cancer patients experience significant physical symptoms and psychosocial problems ... more Introduction: Cancer patients experience significant physical symptoms and psychosocial problems during cancer treatment that negatively impact on quality of life which can be intervened by palliative care. However, the referral of cancer patients to palliative care is still low. Therefore, this study aimed to explore the need of palliative care among doctors working in oncology in order to develop an instrument of criteria for palliative care referral in oncology practice.Methods: A mixed method research with a sequential variant exploratory, quantitative dominant design was used. Using phenomenology orientation, the qualitative study exploring the needs of palliative care referral was conducted and data were obtained through in-depth interviews with 32 oncologic care doctors. Identified dimensions, criteria, sub-criteria and indicators were then used to develop the instrument. In the quantitative study, validity of the instrument was tested through expert judgement and Aiken’s V...
Background Previous studies show that teachers can feel disturbed by alarming cases brought up by... more Background Previous studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves. Methods This study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples. Results Four teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient’s rights and autonomy...
Background The primary objective of this study was to determine the effect of a training interven... more Background The primary objective of this study was to determine the effect of a training intervention in overall improvement in students' (santris) knowledge, behavior, and outcome. Methods A mixed-methods exploratory sequential design was applied. First, qualitative data were collected from three focus group discussions with 20 supervisors and one in-depth interview with school principal to explore current hygiene practices. The information was then used to develop training intervention using either video, poster, and leaflet. To measure the effect, a stepped wedge cluster design with pre-and post-test analyses was conducted. A total of 452 junior high school santris in one Islamic boarding school were non-randomly allocated to either three intervention groups. Outcome measures were knowledge, personal behavior, and room hygiene. Codes and categories were produced in the qualitative analysis, while paired t-tests and Wilcoxon rank tests test were used in the quantitative analysis. Results The qualitative study identified poor practices on personal and room hygiene among the santris and proposed a training intervention. Overall, there was a significant increase in knowledge and personal behavior after the intervention (7.22 ± 1.34 pre-intervention to 7.70 ± 0.74 post-intervention and 9.75 ± 2.98 pre-intervention to 12.16 ± 2.12 post-intervention, respectively, p < 0.001). Room hygiene was significantly improved among boys and those who received leaflets.
Background The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-bl... more Background The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Yogyakarta, Indonesia, with the aim of measuring the efficacy of Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting. Enrolment began in January 2018 and is ongoing. The original study protocol was published in April 2018. Here, we describe amendments that have been made to the study protocol since commencement of the trial. Methods The key protocol amendments are (1) a revised study duration with planned end of participant enrolment in August 2020, (2) the addition of new secondary objectives (i) to estimate serotype-specific efficacy of the Wolbachia intervention and (ii) to compare Ae. aegypti abundance in intervention versus untreated clusters, (3) an additional exposure classification for the per-protocol analysis where the Wolbachia exposure index is calculated using only the ...
Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result pa... more Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result partially from in management inefficiency, causing in obstruction of flow, underutilized resources, and imbalance between the number of patients with the availability of care facilities and the alternative care strategies. One of the strategies that can be applied to reduce lead time is Lean Six Sigma (LSS). Therefore, the purpose of this study was to evaluate the impact of Lean Six Sigma (LSS) methodology on patient lead time in Maternal Emergency of district government hospital. Methods: Researcher and the participants were involved in planning, gathering data, analyzing, and choosing the best solutions. The participants were trained on LSS methods, its implementation tools and procedures. Evaluations were conducted using lead time observation before and after implementation, and midwives were interviewed about their perceptions. The analysis was based on Value Stream Mapping tools. Results: Patients' lead time from being admitted in emergency unit definitive diagnosis was decreased by 26.04 minutes or 16.4% in Caesarean Section (CS) and 15.25 minutes or 21.7% in other maternal high risk. For emergency CS, the improvement was 33.06 minutes or 26% from decision until incision. The benefit of LSS implementation was primarily in accelerating service processes and improving communication and team work. Conclusion: This study showed that the implementation of LSS had great potential benefit in a maternal emergency unit. Participation of the midwives is crucial for successful implementation of LSS to reduce patients lead time.
Latar belakang: Stroke masih menjadi masalah kesehatan dunia. Dibutuhkan solusi manajemen klinis ... more Latar belakang: Stroke masih menjadi masalah kesehatan dunia. Dibutuhkan solusi manajemen klinis yang lebih baik guna mengupayakan pelayanan stroke yang berkualitas. Sebagai sebuah instrumen yang menstandarisasi proses dan outcome pelayanan, clinical pathway selayaknya mampu menjadi solusi perbaikan manajemen kualitas berkelanjutan. Hingga kini bukti mengenai efektivitas clinical pathway masih diperdebatkan. Tujuan: Untuk mengevaluasi dampak clinical pathway terhadap perbaikan kualitas pelayanan stroke berdasarkan indikator proses dan outcome. Metode: Metode yang digunakan dalam penelitian ini adalah metode before-after without control group quasi exsperimental, dimana dilakukan penilaian pre dan post implementasi pada dua kelompok tanpa randomisasi. Kelompok intervensi adalah kelompok subyek yang ditatalaksana dengan clinical pathway sedangkan kelompok kontrol adalah kelompok pasien sebelum pemberlakuan pathway (diambil dari data sekunder rekam medis). Outcome mortalitas sebagai ou...
Studies have shown that students may feel emotional discomfort when they are asked to identify et... more Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our s...
Background The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instru... more Background The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instruments for measuring the multidimensional burden of family caregivers. To date, there is no available validated instrument to assist healthcare professionals in measuring the caregiver’s burden in Indonesia. Objective To translate the CRA from English into Indonesian and to conduct psychometric testing of this CRA–Indonesian version (CRA-ID) with family caregivers of patients with cancer. Methods Cross-cultural translation and psychometric testing were conducted. Confirmatory factor analysis and exploratory factor analysis were performed to check, explore, and confirm the best model for the CRA-ID; internal consistency was also measured. Results A total of 451 respondents participated, of whom 40 were involved in the feasibility testing. Confirmatory factor analysis with the original factors of the CRA revealed that the fit was not satisfactory, and adaptation was needed. Through explorat...
Objective To determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and... more Objective To determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and associated factors. Methods A total of 431 pregnant women who were indicated for emergency cesarean delivery were included. Clinical information and timing of process after decision until delivery and pregnancy outcomes were evaluated. Results Mean age was 30 years, and 59.4% were nulliparous. Mean gestational age at delivery was 37.9 weeks. The decision was made during normal office hour in 33.2%. Median decision-to-operating room interval, decision-to-incision interval, and DDIs were 45, 70, and 82 minutes, respectively. Only 3.5% of patients had DDI ≤30 minutes, while 52.0% had DDI >75 minutes. During after office hours, every time interval was significantly shorter and 4.9% had DDI ≤30 minutes compared to 0.7% in normal office hours (P=0.001). Compared to other indications, time intervals were significantly shorter in those with non-reassuring fetal heart rate (FHR), and DDI ≤30 minutes was achieved in 18.8% vs. 0.8% (P<0.001). Shortest DDI was observed among those with non-reassuring FHR during after office hours. Neonatal outcomes were comparable between different DDIs. Conclusion Only 3.5% of emergency cesarean delivery had a DDI ≤30 minutes (median 82 minutes). Significant shorter time intervals were observed in those with non-reassuring FHR during after office hours.
Background: Dengue fever is a mosquito-borne viral disease with high incidence in over 128 countr... more Background: Dengue fever is a mosquito-borne viral disease with high incidence in over 128 countries. WHO estimates 500,000 people with severe dengue are hospitalized annually and 2.5% of those affected die. Indonesia is a hyperendemic country for dengue with an increasing number of cases in the last decade. Unfortunately, the trends of Indonesian dengue research are relatively unknown. Objective: This research aimed to depict bibliographic trends and knowledge structure of dengue publications in Indonesia relative to that of Southeast Asia (SEA) from 2007 to 2016. Methods: Bibliographic data were collected from PubMed filtered by Indonesia country affiliation. The annual growth rate of publication was measured and compared with neighborhood countries in the SEA region. Network analysis was used to visualize emerging research issues. Results: About 1,625 dengue-related documents originated from SEA region, of which Indonesia contributed 5.90%. The publication growth rate in Indonesia, however, is the highest in ASEAN region (28.87%). Total citations for documents published from Indonesia was 980, with an average of 14 citations per publication and h-index of 16. Within the first five years, the main research topics were related to insect vector and diagnostic method. While insect vector remained dominant in the last five years, other topics such as disease outbreak, dengue virus, and dengue vaccine started emerging. Conclusion: In the last 10 years, dengue publications' growth from Indonesia in international journals improved significantly, despite less number of publications compared to other SEA countries. Efforts should be made to improve the quantity and quality of publications from Indonesia. The research topics related to dengue in Indonesia are in line with studies in SEA. Stakeholders and policy makers are encouraged to develop a roadmap for dengue research in the future.
Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat s... more Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berartimempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jender.
Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika ... more Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika and chikungunya, present an increasing public health challenge in tropical regions. Current vector control strategies have failed to curb disease transmission, but continue to be employed despite the absence of robust evidence for their effectiveness or optimal implementation. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with Wolbachia bacterium, with a significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Modelling predicts this will translate to local elimination of dengue in most epidemiological settings. This study protocol describes the first trial to measure the efficacy of Wolbachia in reducing dengue virus transmission in the field. Methods/design: The study is a parallel, two-arm, non-blinded cluster randomised controlled trial conducted in a single site in Yogyakarta, Indonesia. The aim is to determine whether large-scale deployment of Wolbachia-infected Ae. aegypti mosquitoes leads to a measurable reduction in dengue incidence in treated versus untreated areas. The primary endpoint is symptomatic, virologically confirmed dengue virus infection of any severity. The 26 km 2 study area was subdivided into 24 contiguous clusters, allocated randomly 1:1 to receive Wolbachia deployments or no intervention. We use a novel epidemiological study design, the cluster-randomised test-negative design trial, in which dengue cases and arbovirus-negative controls are sampled concurrently from among febrile patients presenting to a network of primary care clinics, with case or control status classified retrospectively based on the results of laboratory diagnostic testing. Efficacy is estimated from the odds ratio of Wolbachia exposure distribution (probability of living in a Wolbachia-treated area) among virologically confirmed dengue cases compared to test-negative controls. A secondary per-protocol analysis allows for individual Wolbachia exposure levels to be assessed to account for movements outside the cluster and the heterogeneity in local Wolbachia prevalence among treated clusters.
The American journal of tropical medicine and hygiene, 2018
Dengue is endemic in Indonesia. Here, we describe the epidemiology of dengue in the city of Yogya... more Dengue is endemic in Indonesia. Here, we describe the epidemiology of dengue in the city of Yogyakarta, Central Java, as a prelude to implementation of a cluster-randomized trial of for the biocontrol of arboviral transmission. Surveillance records from 2006 to 2016 demonstrate seasonal oscillations of dengue incidence with varying magnitude. Two lines of evidence demonstrate a high force of infection; the hospitalized case burden of patients diagnosed with dengue hemorrhagic fever or dengue shock syndrome over the last decade consisted predominantly of children/adolescents, and a serosurvey of 314 healthy children aged 1-10 years found 68% possessed dengue virus-neutralizing antibodies. Finally, a mobility survey indicated children aged 1-10 years, and particularly 1-5 year-olds, spent most of their daytime hours at home. These findings inform the design of clinical trials to measure the impact of novel vector control methods such as introgression into mosquitoes, by providing base...
Tuberculosis (TB) is a major public health problem in low and middle-income countries. Early dete... more Tuberculosis (TB) is a major public health problem in low and middle-income countries. Early detection and enrolment of TB cases is a challenge for National TB Programs. To understand the performance and feasibility for scale-up of Xpert MTB/RIF assay for the TB diagnosis in Nepal. Implementation research employed mixed-method sequential explanatory design. The results of Xpert MTB/RIF assay were analysed in 26 TB diagnostic centres where Xpert machines had been installed before 2015. In-depth interviews and focus group discussions were conducted with stakeholders, purposively selected to represent experiences in centres that were functioning well, poorly or not functioning. During a one-year period in 2015/16, 23,075 Xpert MTB/RIF assays were performed in 21 diagnostic centres with 22,288 people also tested by sputum microscopy. Among these, 77% had concordant (positive or negative) results, demonstrating fair agreement (Kappa score, 0.3) between test results. Test failure and posi...
Background: Reducing maternal mortality remains a major challenge for health care systems worldwi... more Background: Reducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon. Methods: A retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality. Results: The mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02-0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03-1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06-1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04-0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1. 05-11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01-0.91). Conclusions: The near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.
ABSTRACTBackground:Dementia, even more than cancer, demands long-term care. While in Indonesia ca... more ABSTRACTBackground:Dementia, even more than cancer, demands long-term care. While in Indonesia cancer is accepted as a disease requiring caregiving, dementia is still considered "a normal condition." These differences might affect the experiences of caregivers, especially those relating to social health, the subject of our study. We aim to describe and compare the lived experiences of family caregivers of patients with cancer (PWC) with those of patients with dementia (PWD) in Yogyakarta, Indonesia, and to explore the role of their social health in these experiences.Method:A qualitative design was applied. In-depth face-to-face interviews were conducted with PWC and PWD caregivers in two outpatient clinics of a tertiary hospital. The constant comparative method was applied to analyze the data that were interpreted using the concept of social health to explore the experiences of the caregivers. We used Atlas.ti software.Results:Three themes were identified: problems with ca...
Objectives: To investigate the link between smoking exposure, telomere length and mortality, with... more Objectives: To investigate the link between smoking exposure, telomere length and mortality, with emphasis on secondhand smoke (SHS) exposure and the duration of smoking cessation. Results: A total of 1,018 participants died during follow-up (mean: 10.3 years). A 50 base-pair decrease in LTL was shown among cotinine-confirmed current versus never smokers. The 90 th quantile of LTL decreased with increasing cotinine among never smokers, indicating a role of SHS. Longer telomeres with smoking cessation were indicated but limited to a 3-16 year period of abstaining smoking. When assessing mortality, we observed a lower risk of all-cause death for the second quintile compared to the first among never smokers (HR: 0.67, 95% CI: 0.52-0.87), and a higher risk was found among current smokers (HR: 1.89, 1.19-2.92). Materials and Methods: We studied 6,456 nationally representative U.S. respondents with mortality follow-up through to 31 December 2011. Smoking status was assessed by interviews and cotinine levels. Relative leukocyte telomere length (LTL) was quantified by polymerase chain reaction (PCR). Multivariable linear regression was performed to examine LTL by smoking exposure, adjusted for age, sex, race/ethnicity, socioeconomic status, education, body mass index, alcohol consumption, and physical activity. We further estimated the association of LTL with cotinine levels using quantile regression, and with smoking cessation dynamics. Cox regression was used to estimate mortality by smoking status and LTL. Conclusion: Our findings indicated a complex association between smoking, telomere length, and mortality. LTL alterations with SHS and smoking cessation warrant further investigation for translation to public health measures.
Letters Contributions are welcome for the Letters section, in response to articles that have appe... more Letters Contributions are welcome for the Letters section, in response to articles that have appeared in the Bulletin or on matters of major public health importance. Letters are usually between 400 and 850 words, with a maximum of six references; they will be edited and may be shortened. Manuscripts should be submitted to the Bulletin via our submissions web site accessed at http://submit.bwho.org or via a link from www.who.int/bulletin where there are "Help" and "FAQ" (frequently asked questions) buttons to assist authors.
Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management)
Background: Responsiveness according to WHO is the result that can be achieved when an institutio... more Background: Responsiveness according to WHO is the result that can be achieved when an institution designed so that they areaware of and respond appropriately to the expectations of a legitimate, based on measurements through eight domains are: dignity,attention immediately, autonomy, choice of health care providers, clear communication, confidentiality, quality of basic amenities, andaccess to social support networks.Objective: To analyze the responsiveness of the hospitals and health centers in providing health services.Methods: A descriptive study with qualitative methods. This research uses descriptive type so that the researcher will analyze howresponsiveness in terms of health in providing health services to the community. This research was conducted in Buru Regency with 22 respondents.Results: The experience of respondents to the responsiveness in hospitals that view based on variable dignity officers have notprovided services to the fullest and less maintain patient privacy....
Latar Belakang. Iodium merupakan mikronutrien penting terutama bagi perkembangan otak janin dan a... more Latar Belakang. Iodium merupakan mikronutrien penting terutama bagi perkembangan otak janin dan anak. Iodium berperan untuk proses pertumbuhan dan perkembangan sebagian besar organ terutama otak. Konsumsi iodium yang rendah dalam jangka panjang merupakan salah satu faktor yang dapat menyebabkan gangguan akibat kekurangan iodium (GAKI). Tingkat pengetahuan mengenai GAKI dan garam beriodium berpengaruh terhadap ketersediaan dan praktik penggunaan garam beriodium. Pemerintah telah mengupayakan penanggulangan GAKI melalui fortifikasi garam dengan iodium. Tujuan. Penelitian ini bertujuan untuk menganalisis pengetahuan ibu tentang iodium dengan ketersediaan garam beriodium di rumah tangga dan faktor yang memengaruhinya. Metode. Penelitian ini merupakan penelitian cross-sectional. Data diambil dari 198 rumah tangga menggunakan teknik proportional stratified random sampling. Penilaian pengetahuan ibu dilakukan dengan menggunakan kuesioner dalam bentuk pertanyaan tertutup. Sementara itu, pen...
Introduction: Cancer patients experience significant physical symptoms and psychosocial problems ... more Introduction: Cancer patients experience significant physical symptoms and psychosocial problems during cancer treatment that negatively impact on quality of life which can be intervened by palliative care. However, the referral of cancer patients to palliative care is still low. Therefore, this study aimed to explore the need of palliative care among doctors working in oncology in order to develop an instrument of criteria for palliative care referral in oncology practice.Methods: A mixed method research with a sequential variant exploratory, quantitative dominant design was used. Using phenomenology orientation, the qualitative study exploring the needs of palliative care referral was conducted and data were obtained through in-depth interviews with 32 oncologic care doctors. Identified dimensions, criteria, sub-criteria and indicators were then used to develop the instrument. In the quantitative study, validity of the instrument was tested through expert judgement and Aiken’s V...
Background Previous studies show that teachers can feel disturbed by alarming cases brought up by... more Background Previous studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves. Methods This study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples. Results Four teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient’s rights and autonomy...
Background The primary objective of this study was to determine the effect of a training interven... more Background The primary objective of this study was to determine the effect of a training intervention in overall improvement in students' (santris) knowledge, behavior, and outcome. Methods A mixed-methods exploratory sequential design was applied. First, qualitative data were collected from three focus group discussions with 20 supervisors and one in-depth interview with school principal to explore current hygiene practices. The information was then used to develop training intervention using either video, poster, and leaflet. To measure the effect, a stepped wedge cluster design with pre-and post-test analyses was conducted. A total of 452 junior high school santris in one Islamic boarding school were non-randomly allocated to either three intervention groups. Outcome measures were knowledge, personal behavior, and room hygiene. Codes and categories were produced in the qualitative analysis, while paired t-tests and Wilcoxon rank tests test were used in the quantitative analysis. Results The qualitative study identified poor practices on personal and room hygiene among the santris and proposed a training intervention. Overall, there was a significant increase in knowledge and personal behavior after the intervention (7.22 ± 1.34 pre-intervention to 7.70 ± 0.74 post-intervention and 9.75 ± 2.98 pre-intervention to 12.16 ± 2.12 post-intervention, respectively, p < 0.001). Room hygiene was significantly improved among boys and those who received leaflets.
Background The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-bl... more Background The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Yogyakarta, Indonesia, with the aim of measuring the efficacy of Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting. Enrolment began in January 2018 and is ongoing. The original study protocol was published in April 2018. Here, we describe amendments that have been made to the study protocol since commencement of the trial. Methods The key protocol amendments are (1) a revised study duration with planned end of participant enrolment in August 2020, (2) the addition of new secondary objectives (i) to estimate serotype-specific efficacy of the Wolbachia intervention and (ii) to compare Ae. aegypti abundance in intervention versus untreated clusters, (3) an additional exposure classification for the per-protocol analysis where the Wolbachia exposure index is calculated using only the ...
Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result pa... more Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result partially from in management inefficiency, causing in obstruction of flow, underutilized resources, and imbalance between the number of patients with the availability of care facilities and the alternative care strategies. One of the strategies that can be applied to reduce lead time is Lean Six Sigma (LSS). Therefore, the purpose of this study was to evaluate the impact of Lean Six Sigma (LSS) methodology on patient lead time in Maternal Emergency of district government hospital. Methods: Researcher and the participants were involved in planning, gathering data, analyzing, and choosing the best solutions. The participants were trained on LSS methods, its implementation tools and procedures. Evaluations were conducted using lead time observation before and after implementation, and midwives were interviewed about their perceptions. The analysis was based on Value Stream Mapping tools. Results: Patients' lead time from being admitted in emergency unit definitive diagnosis was decreased by 26.04 minutes or 16.4% in Caesarean Section (CS) and 15.25 minutes or 21.7% in other maternal high risk. For emergency CS, the improvement was 33.06 minutes or 26% from decision until incision. The benefit of LSS implementation was primarily in accelerating service processes and improving communication and team work. Conclusion: This study showed that the implementation of LSS had great potential benefit in a maternal emergency unit. Participation of the midwives is crucial for successful implementation of LSS to reduce patients lead time.
Latar belakang: Stroke masih menjadi masalah kesehatan dunia. Dibutuhkan solusi manajemen klinis ... more Latar belakang: Stroke masih menjadi masalah kesehatan dunia. Dibutuhkan solusi manajemen klinis yang lebih baik guna mengupayakan pelayanan stroke yang berkualitas. Sebagai sebuah instrumen yang menstandarisasi proses dan outcome pelayanan, clinical pathway selayaknya mampu menjadi solusi perbaikan manajemen kualitas berkelanjutan. Hingga kini bukti mengenai efektivitas clinical pathway masih diperdebatkan. Tujuan: Untuk mengevaluasi dampak clinical pathway terhadap perbaikan kualitas pelayanan stroke berdasarkan indikator proses dan outcome. Metode: Metode yang digunakan dalam penelitian ini adalah metode before-after without control group quasi exsperimental, dimana dilakukan penilaian pre dan post implementasi pada dua kelompok tanpa randomisasi. Kelompok intervensi adalah kelompok subyek yang ditatalaksana dengan clinical pathway sedangkan kelompok kontrol adalah kelompok pasien sebelum pemberlakuan pathway (diambil dari data sekunder rekam medis). Outcome mortalitas sebagai ou...
Studies have shown that students may feel emotional discomfort when they are asked to identify et... more Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our s...
Background The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instru... more Background The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instruments for measuring the multidimensional burden of family caregivers. To date, there is no available validated instrument to assist healthcare professionals in measuring the caregiver’s burden in Indonesia. Objective To translate the CRA from English into Indonesian and to conduct psychometric testing of this CRA–Indonesian version (CRA-ID) with family caregivers of patients with cancer. Methods Cross-cultural translation and psychometric testing were conducted. Confirmatory factor analysis and exploratory factor analysis were performed to check, explore, and confirm the best model for the CRA-ID; internal consistency was also measured. Results A total of 451 respondents participated, of whom 40 were involved in the feasibility testing. Confirmatory factor analysis with the original factors of the CRA revealed that the fit was not satisfactory, and adaptation was needed. Through explorat...
Objective To determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and... more Objective To determine the decision-to-delivery interval (DDI) in emergency cesarean delivery and associated factors. Methods A total of 431 pregnant women who were indicated for emergency cesarean delivery were included. Clinical information and timing of process after decision until delivery and pregnancy outcomes were evaluated. Results Mean age was 30 years, and 59.4% were nulliparous. Mean gestational age at delivery was 37.9 weeks. The decision was made during normal office hour in 33.2%. Median decision-to-operating room interval, decision-to-incision interval, and DDIs were 45, 70, and 82 minutes, respectively. Only 3.5% of patients had DDI ≤30 minutes, while 52.0% had DDI >75 minutes. During after office hours, every time interval was significantly shorter and 4.9% had DDI ≤30 minutes compared to 0.7% in normal office hours (P=0.001). Compared to other indications, time intervals were significantly shorter in those with non-reassuring fetal heart rate (FHR), and DDI ≤30 minutes was achieved in 18.8% vs. 0.8% (P<0.001). Shortest DDI was observed among those with non-reassuring FHR during after office hours. Neonatal outcomes were comparable between different DDIs. Conclusion Only 3.5% of emergency cesarean delivery had a DDI ≤30 minutes (median 82 minutes). Significant shorter time intervals were observed in those with non-reassuring FHR during after office hours.
Background: Dengue fever is a mosquito-borne viral disease with high incidence in over 128 countr... more Background: Dengue fever is a mosquito-borne viral disease with high incidence in over 128 countries. WHO estimates 500,000 people with severe dengue are hospitalized annually and 2.5% of those affected die. Indonesia is a hyperendemic country for dengue with an increasing number of cases in the last decade. Unfortunately, the trends of Indonesian dengue research are relatively unknown. Objective: This research aimed to depict bibliographic trends and knowledge structure of dengue publications in Indonesia relative to that of Southeast Asia (SEA) from 2007 to 2016. Methods: Bibliographic data were collected from PubMed filtered by Indonesia country affiliation. The annual growth rate of publication was measured and compared with neighborhood countries in the SEA region. Network analysis was used to visualize emerging research issues. Results: About 1,625 dengue-related documents originated from SEA region, of which Indonesia contributed 5.90%. The publication growth rate in Indonesia, however, is the highest in ASEAN region (28.87%). Total citations for documents published from Indonesia was 980, with an average of 14 citations per publication and h-index of 16. Within the first five years, the main research topics were related to insect vector and diagnostic method. While insect vector remained dominant in the last five years, other topics such as disease outbreak, dengue virus, and dengue vaccine started emerging. Conclusion: In the last 10 years, dengue publications' growth from Indonesia in international journals improved significantly, despite less number of publications compared to other SEA countries. Efforts should be made to improve the quantity and quality of publications from Indonesia. The research topics related to dengue in Indonesia are in line with studies in SEA. Stakeholders and policy makers are encouraged to develop a roadmap for dengue research in the future.
Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat s... more Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berartimempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jender.
Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika ... more Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika and chikungunya, present an increasing public health challenge in tropical regions. Current vector control strategies have failed to curb disease transmission, but continue to be employed despite the absence of robust evidence for their effectiveness or optimal implementation. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with Wolbachia bacterium, with a significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Modelling predicts this will translate to local elimination of dengue in most epidemiological settings. This study protocol describes the first trial to measure the efficacy of Wolbachia in reducing dengue virus transmission in the field. Methods/design: The study is a parallel, two-arm, non-blinded cluster randomised controlled trial conducted in a single site in Yogyakarta, Indonesia. The aim is to determine whether large-scale deployment of Wolbachia-infected Ae. aegypti mosquitoes leads to a measurable reduction in dengue incidence in treated versus untreated areas. The primary endpoint is symptomatic, virologically confirmed dengue virus infection of any severity. The 26 km 2 study area was subdivided into 24 contiguous clusters, allocated randomly 1:1 to receive Wolbachia deployments or no intervention. We use a novel epidemiological study design, the cluster-randomised test-negative design trial, in which dengue cases and arbovirus-negative controls are sampled concurrently from among febrile patients presenting to a network of primary care clinics, with case or control status classified retrospectively based on the results of laboratory diagnostic testing. Efficacy is estimated from the odds ratio of Wolbachia exposure distribution (probability of living in a Wolbachia-treated area) among virologically confirmed dengue cases compared to test-negative controls. A secondary per-protocol analysis allows for individual Wolbachia exposure levels to be assessed to account for movements outside the cluster and the heterogeneity in local Wolbachia prevalence among treated clusters.
The American journal of tropical medicine and hygiene, 2018
Dengue is endemic in Indonesia. Here, we describe the epidemiology of dengue in the city of Yogya... more Dengue is endemic in Indonesia. Here, we describe the epidemiology of dengue in the city of Yogyakarta, Central Java, as a prelude to implementation of a cluster-randomized trial of for the biocontrol of arboviral transmission. Surveillance records from 2006 to 2016 demonstrate seasonal oscillations of dengue incidence with varying magnitude. Two lines of evidence demonstrate a high force of infection; the hospitalized case burden of patients diagnosed with dengue hemorrhagic fever or dengue shock syndrome over the last decade consisted predominantly of children/adolescents, and a serosurvey of 314 healthy children aged 1-10 years found 68% possessed dengue virus-neutralizing antibodies. Finally, a mobility survey indicated children aged 1-10 years, and particularly 1-5 year-olds, spent most of their daytime hours at home. These findings inform the design of clinical trials to measure the impact of novel vector control methods such as introgression into mosquitoes, by providing base...
Tuberculosis (TB) is a major public health problem in low and middle-income countries. Early dete... more Tuberculosis (TB) is a major public health problem in low and middle-income countries. Early detection and enrolment of TB cases is a challenge for National TB Programs. To understand the performance and feasibility for scale-up of Xpert MTB/RIF assay for the TB diagnosis in Nepal. Implementation research employed mixed-method sequential explanatory design. The results of Xpert MTB/RIF assay were analysed in 26 TB diagnostic centres where Xpert machines had been installed before 2015. In-depth interviews and focus group discussions were conducted with stakeholders, purposively selected to represent experiences in centres that were functioning well, poorly or not functioning. During a one-year period in 2015/16, 23,075 Xpert MTB/RIF assays were performed in 21 diagnostic centres with 22,288 people also tested by sputum microscopy. Among these, 77% had concordant (positive or negative) results, demonstrating fair agreement (Kappa score, 0.3) between test results. Test failure and posi...
Background: Reducing maternal mortality remains a major challenge for health care systems worldwi... more Background: Reducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon. Methods: A retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality. Results: The mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02-0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03-1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06-1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04-0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1. 05-11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01-0.91). Conclusions: The near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.
ABSTRACTBackground:Dementia, even more than cancer, demands long-term care. While in Indonesia ca... more ABSTRACTBackground:Dementia, even more than cancer, demands long-term care. While in Indonesia cancer is accepted as a disease requiring caregiving, dementia is still considered "a normal condition." These differences might affect the experiences of caregivers, especially those relating to social health, the subject of our study. We aim to describe and compare the lived experiences of family caregivers of patients with cancer (PWC) with those of patients with dementia (PWD) in Yogyakarta, Indonesia, and to explore the role of their social health in these experiences.Method:A qualitative design was applied. In-depth face-to-face interviews were conducted with PWC and PWD caregivers in two outpatient clinics of a tertiary hospital. The constant comparative method was applied to analyze the data that were interpreted using the concept of social health to explore the experiences of the caregivers. We used Atlas.ti software.Results:Three themes were identified: problems with ca...
Objectives: To investigate the link between smoking exposure, telomere length and mortality, with... more Objectives: To investigate the link between smoking exposure, telomere length and mortality, with emphasis on secondhand smoke (SHS) exposure and the duration of smoking cessation. Results: A total of 1,018 participants died during follow-up (mean: 10.3 years). A 50 base-pair decrease in LTL was shown among cotinine-confirmed current versus never smokers. The 90 th quantile of LTL decreased with increasing cotinine among never smokers, indicating a role of SHS. Longer telomeres with smoking cessation were indicated but limited to a 3-16 year period of abstaining smoking. When assessing mortality, we observed a lower risk of all-cause death for the second quintile compared to the first among never smokers (HR: 0.67, 95% CI: 0.52-0.87), and a higher risk was found among current smokers (HR: 1.89, 1.19-2.92). Materials and Methods: We studied 6,456 nationally representative U.S. respondents with mortality follow-up through to 31 December 2011. Smoking status was assessed by interviews and cotinine levels. Relative leukocyte telomere length (LTL) was quantified by polymerase chain reaction (PCR). Multivariable linear regression was performed to examine LTL by smoking exposure, adjusted for age, sex, race/ethnicity, socioeconomic status, education, body mass index, alcohol consumption, and physical activity. We further estimated the association of LTL with cotinine levels using quantile regression, and with smoking cessation dynamics. Cox regression was used to estimate mortality by smoking status and LTL. Conclusion: Our findings indicated a complex association between smoking, telomere length, and mortality. LTL alterations with SHS and smoking cessation warrant further investigation for translation to public health measures.
Letters Contributions are welcome for the Letters section, in response to articles that have appe... more Letters Contributions are welcome for the Letters section, in response to articles that have appeared in the Bulletin or on matters of major public health importance. Letters are usually between 400 and 850 words, with a maximum of six references; they will be edited and may be shortened. Manuscripts should be submitted to the Bulletin via our submissions web site accessed at http://submit.bwho.org or via a link from www.who.int/bulletin where there are "Help" and "FAQ" (frequently asked questions) buttons to assist authors.
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