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Mulyanto J, Wibowo Y, Ernawati DA, Lestari DWD, Kringos DS. Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance. Health Equity 2023; 7:644-652. [PMID: 37786529 PMCID: PMC10541918 DOI: 10.1089/heq.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction Access to diabetes management programs is crucial to control the increasing contribution of diabetes to the global burden of disease. However, evidence regarding whether such services are equally accessible for all population groups is still lacking, particularly in the context of low-middle-income countries and under the National Health Insurance (NHI). This study aimed to assess the extent of socioeconomic and geographical inequalities in the use, quality, and outcome of a diabetes management program for beneficiaries of Indonesian NHI. Methods A total of 628 participants in the NHI diabetes management program in Banyumas District, Indonesia, were included in 2021 in this cross-sectional study. The main variables measured were regular visits to primary care facilities, standard medication, and glycemic control. The rate difference and rate ratio of age-sex standardized prevalence rates, as well as multiple logistic regressions, were used to measure the extent of inequalities. Results Around 70% of participants regularly visited primary care facilities and received standard medication, but only 35% had good glycemic control. Highly educated participants were more likely to have regular visits compared to low-educated participants (odds ratio [OR] 1.92; 95% confidence interval [95% CI]: 1.04-3.56). Based on employment and type of NHI beneficiaries, a small extent and even reverse inequalities were found although these findings were insignificant statistically. Urban residents were also more likely to have regular visits (OR 6.61; 95% CI: 2.90-15.08), receive standard medication (OR 9.73; 95% CI: 3.66-25.90), and have good glycemic control (OR 3.85; 95% CI: 1.68-8.83) compared to rural residents. Conclusions Evidence on the extent of socioeconomic inequalities is inconclusive but substantial geographical inequalities in the use, quality, and outcome of diabetes management programs exist among Indonesian NHI beneficiaries. Future implementation policies of the program should consider particularly the geographical characteristics of participants to avoid and reduce inequalities and, hence, the disease burden of diabetes.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Yudhi Wibowo
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dwi Arini Ernawati
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Diyah Woro Dwi Lestari
- Department of Bioethics, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dionne S. Kringos
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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Andika YW, Jannah SR, Winarto, Wildan A, Rahmi FL, Prihatningtyas R, Mulyanto J, Maharani. Effects of oral Mirtogenol on retinal ganglion cell apoptosis index and intraocular pressure in the Wistar glaucoma model. J Adv Pharm Technol Res 2023; 14:258-262. [PMID: 37692015 PMCID: PMC10483914 DOI: 10.4103/japtr.japtr_29_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 09/12/2023] Open
Abstract
The purpose of this research is to determine how Mirtogenol affects intraocular pressure (IOP) and retinal ganglion cells (RGCs) of apoptosis index in Wistar glaucoma models, as well as the relationship between IOP and RGC apoptosis index. Twelve Wistar glaucoma models were divided into two groups for experimental research with a pretest-posttest and posttest-only. The treatment group got oral administration of Mirtogenol 12.3 mg twice a day for 2 weeks, whereas the control group received a placebo in the same way. Apoptotic index and IOP were evaluated both before and after the intervention. A parametric independent t-test was used to determine the difference between groups, and a parametric paired t-test was used to determine the difference within groups. The results showed that the RGC apoptosis index in treatment groups was considerably less when compared to control groups (P < 0.001). In the treatment group, the IOP is decreased compared to the control group (mean difference: -12.67 ± 3.79 vs. 0.69 ± 4.64, respectively, P = 0.002). A significant and solid correlation was found between IOP and RGC apoptosis index (R = 0.884, P < 0.001). Thus, Mirtogenol supplementation is expected to be used to prevent glaucoma progression.
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Affiliation(s)
- Yustiadenta Widya Andika
- Department of Ophthalmology, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Silka Roudhatul Jannah
- Department of Ophthalmology, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Winarto
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Arief Wildan
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Fifin Luthfia Rahmi
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Riski Prihatningtyas
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Joko Mulyanto
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
| | - Maharani
- Department of Ophthalmology, Glaucoma Division, Faculty of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia
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Pratiwi AB, Padmawati RS, Mulyanto J, Willems DL. Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence. BMC Health Serv Res 2023; 23:400. [PMID: 37098522 PMCID: PMC10131468 DOI: 10.1186/s12913-023-09394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/15/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC. METHODS We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis. OUTCOME The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility. CONCLUSIONS This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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Wibowo Y, Mulyanto J, Siswandari VMW, Munfia S. Study of Knowledge, Attitude, Anxiety and Perception of Mental Health Service Needs Related to the COVID-19 Pandemic in Banyumas Regency, Central Java, Indonesia: A Cross-sectional Study. J HEALTH PROMOT BEHAV 2022. [DOI: 10.26911/thejhpb.2021.07.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mulyanto J, Kunst AE, Kringos DS. The contribution of service density and proximity to geographical inequalities in health care utilisation in Indonesia: A nation-wide multilevel analysis. J Glob Health 2021; 10:020428. [PMID: 33312501 PMCID: PMC7719271 DOI: 10.7189/jogh.10.020428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Geographical inequalities in access to health care have only recently become a global health issue. Little evidence is available about their determinants. This study investigates the associations of service density and service proximity with health care utilisation in Indonesia and the parts they may play in geographic inequalities in health care use. Methods Using data from a nationally representative survey (N = 649 625), we conducted a cross-sectional study and employed multilevel logistic regression to assess whether supply-side factors relating to service density and service proximity affect the variability of outpatient and inpatient care utilisation across 497 Indonesian districts. We used median odds ratios (MORs) to estimate the extent of geographical inequalities. Changes in the MOR values indicated the role played by the supply-side factors in the inequalities. Results Wide variations in the density and proximity of health care services were observed between districts. Outpatient care utilisation was associated with travel costs (odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.70-0.97). Inpatient care utilisation was associated with ratios of hospital beds to district population (OR = 1.23, 95% CI = 1.05-1.43) and with travel times (OR = 0.72 95% CI = 0.61-0.86). All in all, service density and proximity provided little explanation for district-level geographic inequalities in either outpatient (MOR = 1.65, 95% CrI = 1.59-1.70 decreasing to 1.61, 95% CrI = 1.56-1.67) or inpatient care utilisation (MOR = 1.63, 95% CrI = 1.55-1.69 decreasing to 1.60 95% CrI = 1.54-1.66). Conclusions Supply-side factors play important roles in individual health care utilisation but do not explain geographical inequalities. Variations in other factors, such as the price and responsiveness of services, may also contribute to the inequalities. Further efforts to address geographical inequalities in health care should go beyond the physical presence of health care infrastructures to target issues such as regional variations in the prices and responsiveness of services.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.,Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health research institute, Amsterdam, Netherlands
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Ivanković D, Barbazza E, Bos V, Brito Fernandes Ó, Jamieson Gilmore K, Jansen T, Kara P, Larrain N, Lu S, Meza-Torres B, Mulyanto J, Poldrugovac M, Rotar A, Wang S, Willmington C, Yang Y, Yelgezekova Z, Allin S, Klazinga N, Kringos D. Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards. J Med Internet Res 2021; 23:e25682. [PMID: 33577467 PMCID: PMC7906125 DOI: 10.2196/25682] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/09/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed. Objective The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users (“why”), content and data (“what”), and analyses and displays (“how” they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards. Methods We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question. Results A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are “close to home”; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues. Conclusions COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified.
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Affiliation(s)
- Damir Ivanković
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Erica Barbazza
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Véronique Bos
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Óscar Brito Fernandes
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands.,Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Kendall Jamieson Gilmore
- Laboratorio Management e Sanità, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Tessa Jansen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Pinar Kara
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Nicolas Larrain
- OptiMedis AG, Hamburg, Germany.,Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Shan Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bernardo Meza-Torres
- Department of Clinical and Experimental Medicine, University of Surrey, Surrey, United Kingdom.,Nuffield Department of Primary Care and Health Services, University of Oxford, Oxford, United Kingdom
| | - Joko Mulyanto
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands.,Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Mircha Poldrugovac
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandru Rotar
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Sophie Wang
- OptiMedis AG, Hamburg, Germany.,Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Claire Willmington
- Laboratorio Management e Sanità, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Yuanhang Yang
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
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Mulyanto J, Wibowo Y, Kringos DS. Exploring general practitioners' perceptions about the primary care gatekeeper role in Indonesia. BMC Fam Pract 2021; 22:5. [PMID: 33397307 PMCID: PMC7780672 DOI: 10.1186/s12875-020-01365-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022]
Abstract
Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers. Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01365-w.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia. .,Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Yudhi Wibowo
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Affiliation(s)
- Giovanni van Empel
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.,Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Bayu Satria Wiratama
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Gerrits RG, Mulyanto J, Wammes JD, van den Berg MJ, Klazinga NS, Kringos DS. Individual, institutional, and scientific environment factors associated with questionable research practices in the reporting of messages and conclusions in scientific health services research publications. BMC Health Serv Res 2020; 20:828. [PMID: 32883306 PMCID: PMC7469341 DOI: 10.1186/s12913-020-05624-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Health Services Research findings (HSR) reported in scientific publications may become part of the decision-making process on healthcare. This study aimed to explore associations between researcher’s individual, institutional, and scientific environment factors and the occurrence of questionable research practices (QRPs) in the reporting of messages and conclusions in scientific HSR publications. Methods We employed a mixed-methods study design. We identified factors possibly contributing to QRPs in the reporting of messages and conclusions through a literature review, 14 semi-structured interviews with HSR institutional leaders, and 13 focus-groups amongst researchers. A survey corresponding with these factors was developed and shared with 172 authors of 116 scientific HSR publications produced by Dutch research institutes in 2016. We assessed the included publications for the occurrence of QRPs. An exploratory factor analysis was conducted to identify factors within individual, institutional, and environmental domains. Next, we conducted bivariate analyses using simple Poisson regression to explore factors’ association with the number of QRPs in the assessed HSR publications. Factors related to QRPs with a p-value < .30 were included in four multivariate models tested through a multiple Poisson regression. Results In total, 78 (45%) participants completed the survey (51.3% first authors and 48.7% last authors). Twelve factors were included in the multivariate analyses. In all four multivariate models, a higher score of “pressure to create societal impact” (Exp B = 1.28, 95% CI [1.11, 1.47]), was associated with higher number of QRPs. Higher scores on “specific training” (Exp B = 0.85, 95% CI [0.77–0.94]) and “co-author conflict of interest” (Exp B = 0.85, 95% CI [0.75–0.97]) factors were associated with a lower number of QRPs. Stratification between first and last authors indicated different factors were related to the occurrence of QRPs for these groups. Conclusion Experienced pressure to create societal impact is associated with more QRPs in the reporting of messages and conclusions in HSR publications. Specific training in reporting messages and conclusions and awareness of co-author conflict of interests are related to fewer QRPs. Our results should stimulate awareness within the field of HSR internationally on opportunities to better support reporting in scientific HSR publications.
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Affiliation(s)
- Reinie G Gerrits
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Joko Mulyanto
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Joost D Wammes
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Michael J van den Berg
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Mulyanto J, Kringos DS, Kunst AE. The accuracy of self-report versus objective assessment for estimating socioeconomic inequalities in disease prevalence in Indonesia. Int J Public Health 2019; 64:1233-1241. [PMID: 31531681 PMCID: PMC6811380 DOI: 10.1007/s00038-019-01301-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives To estimate socioeconomic inequalities in hypertension and asthma prevalence in Indonesia, to compare estimates based on self-report (SR) to those based on objective assessment (OA), and to assess the role of sensitivity and specificity of SR. Methods We used data from the 2014 Indonesia Family Life Survey (n = 34,257). We measured inequalities in hypertension and asthma prevalence in relation to educational level and income, using standardised prevalence rate and the relative index of inequality (RII). Using OA as standard, we calculated the sensitivity and specificity of SR. Results For hypertension, reversed inequalities were found when estimated by SR instead of OA (RII for education 0.86, 95% CI 0.74–0.99 vs. RII 1.29, 95% CI 1.16–1.44). For asthma, a similar but even larger reversal of inequalities was found. The sensitivity of SR was low overall, and especially for the lowest education or income group. Conclusions Results imply that the use of SR may lead to underestimation of socioeconomic inequalities in disease prevalence in a low-income country such as Indonesia. The use of OA is recommended for monitoring inequalities in non-communicable disease prevalence.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia. .,Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Dionne S Kringos
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Mulyanto J, Kringos DS, Kunst AE. Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia. Trop Med Int Health 2019; 24:1301-1310. [PMID: 31465584 PMCID: PMC6899976 DOI: 10.1111/tmi.13303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives To describe socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes (T2D) management services in the Indonesian population and to determine whether education level and geographical location contribute to inequalities. Methods Cross‐sectional study using data from the 2014 Indonesia Family Life Survey (N = 30 762 for hypertension; N = 6758 for T2D). Socioeconomic status was measured by household consumption. The prevalence of hypertension and T2D was determined using internationally standardised clinical measurement, while disease management was defined by participation in screening and current use of medication. The relative index of inequality (RII) was used to estimate inequalities, adjusted to education level and geographical location. Results For all household consumption quintiles, we observed low rates of screening participation for T2D and low medication use in both hypertension and T2D. We found socioeconomic inequalities in screening participation for hypertension (RII 2.68, 95% CI 2.42–2.96) and T2D (RII 7.30, 95% CI 5.48–9.72) and also for medication use in hypertension (RII 3.09, 95% CI 2.28–4.18) and T2D (RII 2.81, 95% CI 1.09–7.27). Education level contributed to socioeconomic inequalities in screening utilisation for both hypertension and T2D. Geographical location contributed to inequalities in screening utilisation and medication use for T2D. Socioeconomic inequalities in medication use for hypertension and T2D were larger among men than women. Conclusions Large socioeconomic inequalities were found in the utilisation of hypertension and T2D management services in Indonesia. Improving affordability, availability and approachability of services is crucial to reduce such inequalities.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.,Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Mulyanto J, Kringos DS, Kunst AE. Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview. BMJ Open 2019; 9:e026164. [PMID: 31326926 PMCID: PMC6661624 DOI: 10.1136/bmjopen-2018-026164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/30/2019] [Accepted: 07/01/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Monitoring inequality in healthcare utilisation is essential to reduce persistent inequalities in health in lower-middle income countries. This study aimed to assess socioeconomic inequalities in the utilisation of primary care, secondary care and preventive care in Indonesia. METHODS A cross-sectional study was conducted using data from the 2014 Indonesia Family Life Survey with a total of 42 083 adult participants. Socioeconomic status (SES) was measured by educational level and income. Healthcare utilisation was measured in: (1) primary care, (2) outpatient in secondary care, (3) inpatient care and (4) cardiovascular-related preventive care. The magnitude of inequalities was measured using the relative index of inequality (RII). RESULTS Small educational inequalities were found for primary care utilisation (RII 1.13, 95% CI 1.01 to 1.26). Larger educational inequalities were found for outpatient secondary care (RII 10.35, 95% CI 8.11 to 13.22) and inpatient care (RII 2.78, 95% CI 2.32 to 3.32). The largest educational inequalities were found for preventive care, particularly regarding blood glucose tests (RII 30.31, 95% CI 26.13 to 35.15) and electrocardiography tests (RII 30.90, 95% CI 24.97 to 38.23). Compared with educational inequalities, income inequalities were larger for primary care (RII 1.68, 95% CI 1.52 to 1.85) and inpatient care (RII 3.11, 95% CI 2.63 to 3.66), but not for outpatient secondary care and preventive care. CONCLUSIONS Socioeconomic inequalities in healthcare utilisation in Indonesia are particularly large in secondary and preventive care. Therefore, it is recommended to prioritise policies focused on improving timely, geographical and financial access to secondary and preventive care for lower SES groups.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dionne S Kringos
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Mulyanto J, Kringos DS, Kunst AE. The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993-2014. PLoS One 2019; 14:e0218519. [PMID: 31237901 PMCID: PMC6592526 DOI: 10.1371/journal.pone.0218519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/04/2019] [Indexed: 12/05/2022] Open
Abstract
Objective While the major policy changes in the Indonesian healthcare system over the last 25 years have been well documented, less is known about the accompanying changes in inequalities in healthcare utilisation during this period. Our study aimed to describe the trends in income-related inequalities in healthcare utilisation in Indonesia during the period 1993–2014. Methods A repeated cross-sectional study was conducted using data from the Indonesian Family Life Surveys from 1993, 2000, 2007, and 2014. We measured outpatient and inpatient healthcare utilisation in public and private provider as well as the overall utilisation. Standardised prevalence rate and relative index of inequality (RII) were used to measure the extent of inequalities in healthcare utilisation by income level (income-related inequalities). Results Relatively large income-related inequalities were observed in the utilisation of private outpatient care and public and private inpatient care in 1993. Income-related inequalities in public and private outpatient care utilisation decreased between 1993 and 2007 but increased in 2014. Income-related inequalities in public and private inpatient care utilisation continued to decrease between 1993 and 2014. The largest decrease was observed in private inpatient care utilisation. Conclusion Income-related inequalities in all types of healthcare utilisation decreased until 2007. This trend continued until 2014 only for public and private inpatient care utilisation. This phenomenon may be explained by the changes to the healthcare system (e.g. expansion of the government health insurance programme and health sector decentralisation), which coincided with the changes in inequalities in healthcare utilisation in Indonesia.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- * E-mail:
| | - Dionne S. Kringos
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Anton E. Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Gerrits RG, Jansen T, Mulyanto J, van den Berg MJ, Klazinga NS, Kringos DS. Occurrence and nature of questionable research practices in the reporting of messages and conclusions in international scientific Health Services Research publications: a structured assessment of publications authored by researchers in the Netherlands. BMJ Open 2019; 9:e027903. [PMID: 31097488 PMCID: PMC6530378 DOI: 10.1136/bmjopen-2018-027903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Explore the occurrence and nature of questionable research practices (QRPs) in the reporting of messages and conclusions in international scientific Health Services Research (HSR) publications authored by researchers from HSR institutions in the Netherlands. DESIGN In a joint effort to assure the overall quality of HSR publications in the Netherlands, 13 HSR institutions in the Netherlands participated in this study. Together with these institutions, we constructed and validated an assessment instrument covering 35 possible QRPs in the reporting of messages and conclusions. Two reviewers independently assessed a random sample of 116 HSR articles authored by researchers from these institutions published in international peer-reviewed scientific journals in 2016. SETTING Netherlands, 2016. SAMPLE 116 international peer-reviewed HSR publications. MAIN OUTCOME MEASURES Median number of QRPs per publication, the percentage of publications with observed QRP frequencies, occurrence of specific QRPs and difference in total number of QRPs by methodological approach, type of research and study design. RESULTS We identified a median of six QRPs per publication out of 35 possible QRPs. QRPs occurred most frequently in the reporting of implications for practice, recommendations for practice, contradictory evidence, study limitations and conclusions based on the results and in the context of the literature. We identified no differences in total number of QRPs in papers based on different methodological approach, type of research or study design. CONCLUSIONS Given the applied nature of HSR, both the severity of the identified QRPs, and the recommendations for policy and practice in HSR publications warrant discussion. We recommend that the HSR field further define and establish its own scientific norms in publication practices to improve scientific reporting and strengthen the impact of HSR. The results of our study can serve as an empirical basis for continuous critical reflection on the reporting of messages and conclusions.
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Affiliation(s)
- Reinie G Gerrits
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Tessa Jansen
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joko Mulyanto
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Michael J van den Berg
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Mulyanto J, Kringos DS, Kunst AE. Income inequalities in non-communicable diseases prevalence and management in Indonesia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Mulyanto
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
| | - DS Kringos
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
| | - AE Kunst
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
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Mulyanto J, Kringos DS, Kunst AE. The evolution of socioeconomic inequalities in healthcare utilisation in Indonesia: 1993 to 2014. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Mulyanto
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
| | - DS Kringos
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
| | - AE Kunst
- Department of Public Health Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands
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Mulyanto J, Kringos D, Kunst A. Socioeconomic inequalities in health care utilisation in Indonesia: a cross-sectional study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Mulyanto
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | - D Kringos
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
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Wibowo Y, Laksana ASD, Mulyanto J, Wicaksono MA, Purnomo AY. Incidence of malaria is clustered and buffers around plantations: a spatial analysis. UnivMed 2015. [DOI: 10.18051/univmed.2015.v34.138-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
<p>Background<br />Malaria is re-emerging because of imported cases and the presence of potential vectors that can transmit and spread malaria. Malaria is a health problem in Banyumas District. Mapping the spread of infectious diseases is epidemiologically important. The purpose of this study was to determine the relationship between the variables and the epidemiology of malaria that were spatially modeled using the geographic information system (GIS).<br /><br />Methods<br />This was a case-control study with ratio of 1:1. Cases were malaria-positive patients and controls were people without malaria, as diagnosed by microscopic examination. Minimum sample size was 139 per group and total sample size was 282 people. Chi-square was used to test the relationship between the variables, and GIS modeling to determine the spatial distribution of malaria cases.<br /><br />Results<br />There were significant relationships between level of income below minimum wage, not using mosquito nets, not using wire netting, not using insect repellents, habit of going out at night, history of malaria, cattle sheds not located between woods and residential area, history of going to endemic areas, residence at distances <1000 m from plantations, bushes, swamps and puddles, with incidence of confirmed malaria (p<0.001). The group of cases living <1000 meters from plantations numbered 141 (100%).<br /><br />Conclusions<br />Malaria incidence is clustered and buffers around plantations at <1000 m. Malaria hot spots are displayed as risk maps that are useful for monitoring and spatial targeting of prevention and control measures against the disease.</p>
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Abstract
Introduction: Lead is a well-known toxic agent that makes an organ’s failure. Lead serum itself is infl uenced by δ-ALAD gene polymorphisms (Amino Levulinic Acid Dehydratase). δ-ALAD gene encodes an ALAD enzyme used for heme synthesis. The Characteristic of gene polymorphism may result in Glomerulo Filtration Rate (GFR) value as mark of renal failure. The goal of this study was to fi nd correlations between blood lead levels with GFR in terms of δ ALAD gene polymorphisms. Method: A cross-sectional design was used to perform this research. Thirty-eight gas stations workers in Banyumas were recruited in this study. δ-ALAD gene polymorphisms were characterized using PCR-RFLP method, while lead serum levels were quantifi ed by Atomic Absorption Spectrophotometer (AAS). In addition, Creatinin serum was done with a spectrophotometer and GFR value was formulated by means of the Schwartz method. Result: The studyshowed that the proportion of ALAD genotype for ALAD 1-1, 1-2 and 2-2 were 94.7%, 5.3%, and 0% respectively. The mean of serum levels in homozygous 1-1 was 15.94 ppb and heterozygote 1-2 was 1.15 ppb. GFR of participants ranged from 71.11 mL/min to 185.20 mL/min with a mean of 117.34mL/min. There was no correlation between serum Pb and GFR (p = 0.19). Study also could not determine the correlation between GFR and ALAD gene Polymorphism. Discussion: Study then concluded that there was no correlation between blood lead levels in the GFR on each δ-ALAD genotypes.Keywords: Lead intoxication, GFR, δ-ALAD, gas station workers
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Rujito L, Hanief MN, Gozali P, Mulyanto J. GFR and Blood Lead Levels in Gas Station Workers Based on δ-Alad Gene Polymorphisms. J Ners 2015. [DOI: 10.20473/jn.v10i1.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Lead is a well-known toxic agent that makes an organ’s failure. Lead serum itself is infl uenced by δ-ALAD gene polymorphisms (Amino Levulinic Acid Dehydratase). δ-ALAD gene encodes an ALAD enzyme used for heme synthesis. The Characteristic of gene polymorphism may result in Glomerulo Filtration Rate (GFR) value as mark of renal failure. The goal of this study was to fi nd correlations between blood lead levels with GFR in terms of δ ALAD gene polymorphisms.Methods: A cross-sectional design was used to perform this research. Thirty-eight gas stations workers in Banyumas were recruited in this study. δ-ALAD gene polymorphisms were characterized using PCR-RFLP method, while lead serum levels were quantifi ed by Atomic Absorption Spectrophotometer (AAS). In addition, Creatinin serum was done with a spectrophotometer and GFR value was formulated by means of the Schwartz method.Result: The study showed that the proportion of ALAD genotype for ALAD 1-1, 1-2 and 2-2 were 94.7%, 5.3%, and 0% respectively. The mean of serum levels in homozygous 1-1 was 15.94 ppb and heterozygote 1-2 was 1.15 ppb. GFR of participants ranged from 71.11 mL/min to 185.20 mL/min with a mean of 117.34mL/min. There was no correlation between serum Pb and GFR (p = 0.19). Study also could not determine the correlation between GFR and ALAD gene Polymorphism.Conclusion: Study then concluded that there was no correlation between blood lead levels in the GFR on each δ-ALAD genotypes.
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