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PubMed2006

A methodology for assessing the professional development needs of nurses and midwives in Indonesia: paper 1 of 3.

BACKGROUND: Despite recent developments, health care provision in Indonesia remains suboptimal. Difficult terrain, economic crises, endemic diseases and high population numbers, coupled with limited availability of qualified health care professionals, all contribute to poor health status. In a country with a population of 220 million, there are currently an estimated 50 nurses and 26 midwives per 100,000 people. In line with government initiatives, this series of studies was undertaken to establish the training and development needs of nurses and midwives working within a variety of contexts in Indonesia, with the ultimate aim of enhancing care provision within these domains. METHODS: An established, psychometrically valid and reliable training needs instrument was modified for use within the Indonesian context. While this technique has had widespread international use in the developed world, its application for developing countries has not yet been established. The standard form consists of a biographical cover sheet and a core set of 30 items (all health-related tasks), which have to be rated along two seven-point scales. The first of these scales asks respondents to assess how important the task is to their job and the second scale is a self-assessment of respondents' current performance level of the task. By comparing the importance rating with the performance rating, an index of training need can be obtained (high importance and low performance indicating a significant training need). The modifications incorporated for use in this series of studies were a further 10 items, which were constructed following expert group and focus group discussions and a review of the relevant literature. Pilot trials with 109 respondents confirmed its feasibility and acceptability. The instrument was then administered to 524 nurses and 332 midwives across Indonesia. RESULTS: The data were subjected to a retrospective factor analysis, using a Varimax rotation and Cronbach's alpha to check the instrument's validity and reliability following modification. The results yielded six factors, which accounted for >53% of the variance, each of which had a Cronbach's alpha score of between 0.8644 and 0.7068. CONCLUSION: The results suggest that the modified instrument remained valid and reliable for use in the Indonesian nursing and midwifery context.

Journal Article↗
PubMed1998

Molecular Basis of beta-Thalassemia in Indonesia: Application to Prenatal Diagnosis.

Background: To facilitate an effective prevention program, the beta-thalassemia mutations in the different ethnic groups in Indonesia were characterized. Methods and Results: The amplification refractory mutation system and artificially created restriction site were used to detect seven known mutations previously described in the Indonesian population. Other mutant alleles were identified by chemical cleavage mismatch, double-stranded sequencing, and Southern blotting. With these methods 78% of beta-thalassemia mutant alleles have been detected so far. Thirteen different beta-thalassemia mutations were characterized, nine of which had previously been described in the Jakarta population. The most frequent mutation is HbE (29%), followed by IVS1-nt5 (19%), and Cd 35 (8%). The frequencies of the other mutations varied from 4% to less than 1%. Two large gene deletions, Filipino beta-deletion and Hb Lepore, were identified in patients from the eastern part of Indonesia. Conclusions: The ethnicity and clinical hematology of cases in the region should be considered in the screening strategy for carriers and antenatal diagnosis of beta-thalassemia in Indonesia. Direct sequencing proved to be the appropriate method for detecting the unknown mutations, and Southern blotting had to be used for large deletions.

Journal Article↗
PubMed1994

A relation between c-myc expression and prognosis of leukemia patients in Indonesia.

Overexpression of c-myc, c-myb and c-fos proto-oncogene has been observed in many leukemia cells. However, a relation between those oncogene expressions and prognosis of the leukemia is not known in Indonesia. In order to elucidate the relation, expression of those oncogenes in leukemia cells from 52 patients in Indonesia was examined by Northern blot analysis and was compared with prognosis of the disease. The leukemia patients who survived for more than 2 years were 37% of the 52 patients. Many of the samples expressed c-myc mRNA (92%). Although strong expression of c-myb and c-fos mRNA was detected in the samples (c-myb expression in 35% of the leukemia cells and c-fos in 52%), those co-expressions with c-myc mRNA did not alter the prognosis. On the contrary, all of the 4 patients suffering from leukemia which did not express c-myc mRNA survived for more than 2 years. Therefore, c-myc expression in leukemia cells may be used as an indicator for deciding prognosis of the leukemia patients in Indonesia.

Adult↗
PubMed2001

New fossil hominid calvaria from Indonesia--Sambungmacan 3.

A morphologically distinct partial calvaria of Homo cf. erectus from Java, Indonesia is described. The fossil hominid Sambungmacan 3 (Sm 3) was first discovered in 1977 from the banks of the Solo River near the village of Poloyo, Sambungmacan district, in central Java. It was later recovered in a New York City natural history establishment in 1999 and quickly returned to the Indonesian authorities. Examination of Sm 3 shows that the calvaria is well preserved with only portions of the cranial base missing. The most striking characteristics of Sm 3 include: the presence of a vertically rising forehead, more open occipital/nuchal and frontal angles, a more globular vault, and a cranial capacity within the Homo erectus range. Most notably absent in Sm 3 are a number of the classic characters attributed to Homo erectus, such as a strongly expressed angular torus and a continuous supratoral sulcus. The absence of such characters would normally place the calvaria outside the range of Homo erectus (sensu stricto), however, overall quantitative and qualitative morphological assessments of Sm 3 place it within the Homo erectus spectrum. The combination of the morphological characters in Sm 3 may be interpreted in several ways: 1.) the known cranial variation of H. erectus from Indonesia and China is extended; 2.) this calvaria shows evidence of evolutionary change within H. erectus; or 3.) more than one species of Homo existed in the (presumed) Middle Pleistocene of Java.)

Animals↗
PubMed1994

Hepatitis B virus subtypes and hepatitis C virus genotypes in patients with chronic liver disease or on maintenance hemodialysis in Indonesia.

Hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) RNA were surveyed in patients in Yogyakarta, Indonesia, and their subtypes and genotypes were determined by serological methods and polymerase chain reaction with type-specific primers, respectively. Of 149 patients with chronic liver disease including 24 with chronic hepatitis, 86 with liver cirrhosis, and 39 with primary hepatocellular carcinoma, HBsAg was detected in 40 (27%) and HCV RNA in 48 (32%); one patient was positive both for HBsAg and HCV RNA. Thus, the cause of chronic liver disease was not identified in 62 (42%) patients. Of 58 patients on maintenance hemodialysis, four (7%) were positive for HBsAg and 44 (76%) for HCV RNA. Subtype adw was found in 34 (74%) of 46 HBsAg samples and adr in five (11%); compound subtypes, such as adyw and adyr were detected in the remaining seven (15%). Among HCV RNA samples from 48 patients with chronic liver disease, 23 (48%) were of genotype II, 17 (35%) of genotype III and one (2%) of genotype V, in a distribution strikingly different from that of 44 samples from patients on maintenance hemodialysis, 39 (89%) of which were of genotype I and only one (2%) of genotype II. Genotypes were not classifiable in seven (15%) patients with liver disease and four (9%) patients on hemodialysis despite high HCV RNA titers in them all. These results indicate that different HCV genotypes prevail in patients with distinct diseases, as well as unclassifiable HCV genotypes in Indonesia.

Adult↗
PubMed2002

Characterization of Norwalk-like virus associated with gastroenteritis in Indonesia.

Norwalk Virus and Norwalk-like viruses (NLVs) are reportedly responsible for 2.5-4.0% of nonbacterial acute gastroenteritis (NBAG) worldwide. To help clarify the impact of NLVs on NBAG in Indonesia, stool specimens from 102 patients, 74 with NBAG and 28 with BAG, were screened for the presence of NLVs, using a reverse transcription-polymerase chain reaction (RT-PCR) assay. The specimens were subtyped using prototype-specific oligonucleotide probes and were sequenced and compared with published NLV sequences. Of the 102 specimens examined, 31 (30%) were found to be positive for NLVs. Type-specific probe analysis of the RT-PCR products indicated that 31 isolates hybridized to UK1 (Taunton agent) and UK3/4 (Hawaii agent/Snow Mountain agent) prototype strains. The results of this study indicate that prototype strains of NV or NLVs co-circulate in Indonesia and contribute to the overall level of acute gastroenteritis throughout the region.

Acute Disease↗
PubMed2001

Latah in Jakarta, Indonesia.

OBJECTIVE: To investigate the characteristics of latah in modern Indonesia; to determine whether contemporary latah resembles the syndrome described in the nineteenth century; to compare the syndrome of latah to other disorders featuring tics or exaggerated startle responses. BACKGROUND: Latah, described centuries ago in Malay people, is characterized by an exaggerated motor startle response, often with associated involuntary vocalizations, echolalia, echopraxia, and forced obedience. Modern latah has not been systematically studied. DESIGN AND METHODS: Persons with latah living in Jakarta, Indonesia, were investigated using a standardized, videotaped protocol. RESULTS: Fifteen women were studied. All had exaggerated startle to touch, and 10 to frightening words. Echolalia was seen in 10, echopraxia in 11, and forced obedience in 13. The startle response did not habituate, but instead worsened in response to repeated stimuli. Startle and associated symptoms were only partially suppressible in fewer than half. CONCLUSION: Modern latah resembles that described over a century ago. Latah resembles other disorders with exaggerated startle response, but is clinically distinct from Tourette's Syndrome.

Adult↗
PubMed2000

Spatial distribution of trace metals in sediments from urban streams of Semarang, Central Java, Indonesia.

Elevated environmental concentrations of metals are usually associated with the impact of urbanization. The present study is focused on metal contamination in urban sediments. A field survey was carried out to determine the distribution of four metals, i.e., cadmium (Cd), lead (Pb), copper (Cu), and zinc (Zn), in the coastal urban area of Semarang, Central Java, Indonesia. Sediment samples were collected from 101 grids of 2x2 km. To map the spatial distribution of these metals, concentrations of each metal were plotted against the corresponding grid coordinate. Cd was below the detection limit (<0.03 microg/g) in all samples, whereas concentrations of Pb, Zn, and Cu fell into a wide range. Frequency distributions of Pb, Zn, and Cu concentrations indicated a similar pattern, in which the major proportion of the sites had a low metal concentration. Some sites, however, had extremely high metal concentrations, Zn up to 1257 microg/g, Pb up to 2666 microg/g, and Cu up to 448 microg/g. The data were used to define background concentrations for sediments in coastal zones of Indonesia ("reference values"). The proposed reference values are 25.6 microg/g, 132.2 microg/g, and 40.7 microg/g, respectively, for Pb, Zn, and Cu. The degree of metal contamination of each individual site was classified according to the calculated value of a combined pollution index, W. Four categories of the degree of metal contamination were proposed, i.e., unpolluted, slightly polluted, polluted, and heavily polluted. Based on this classification, from 101 sites investigated in the greater Semarang area, 51 are unpolluted, 36 slightly polluted, 9 polluted, and 5 heavily polluted.

Cadmium↗
PubMed2001

Application of the Australian river bioassessment system (AUSRIVAS) in the Brantas River, East Java, Indonesia.

Assessment of river 'health' using biological methods, particularly those based on macro-invertebrates, is now commonplace in most developed countries. However, this is not the case in most developing countries, where physical and chemical methods are used to assess water quality, with very little use of biological assessment methods. This paper reports on a project that aimed to assess the possible introduction of biological assessment of river condition using the Australian River Assessment System (AUSRIVAS) into Indonesia. The paper addresses three components of the project: (1) science--does the bioassessment method work in this tropical region? (2) resources--are they adequate and if not what additional resources are needed? (3) politics--what needs to be done to convince the agencies (both central and provincial) to take up such a new philosophy and approach? A pilot study was run in the upper Brantas River, East Java. A total of 66 reference sites and 15 test sites were sampled and the macro-invertebrates collected were identified to family level. A rigorous quality-control protocol was introduced to ensure the data were reliable and reproducible. The macro-invertebrate data were used to develop a predictive model of the AUSRIVAS type for the upper Brantas River, and the model was then used to assess the 'health' of sites that were presumed to be damaged in this section of the river. A number of difficulties were experienced during the study, including: locating reference sites sufficiently unmodified by humans; lack of skills to identify animals collected; and a paucity of facilities required for aquatic macro-invertebrate identification (e.g. identification keys and good quality binocular microscopes). For resources, the major constraint to the introduction of a bioassessment capability in Indonesia is the lack of personnel trained in the bioassessment techniques. An 'on-the-job' training approach was adopted, largely because of the specialist nature of this work. Six Indonesians were trained and will now become the 'trainers' of further Indonesian scientists (we have called this process 'training-the-trainers'). For politics, it was hoped that the AUSRIVAS method would be suitable for introduction into the Indonesian national Clean River Program. A strategy was developed and implemented to ensure the method and its outputs were accepted technically by the Indonesian scientific community, and also by the resource managers and relevant government officials. Experience shows that if the latter do not see how the bioassessment information will be used for management purposes they will not accept the method even if it is scientifically sound.

Animals↗
PubMed1989

Rotavirus serotypes causing acute diarrhoea in hospitalized children in Yogyakarta, Indonesia during 1978-1979.

Rotavirus strains in stool specimens from 111 children aged 3-24 months admitted to hospital in Yogyakarta, Indonesia for treatment of acute diarrhoea were serotyped using VP7 serotype specific monoclonal antibodies in a double sandwich enzyme immunoassay. A serotype could be assigned to 59 of 111 specimens (53%). Inability to assign a serotype to 47% of specimens was probably due to loss of the outer capsid during transport of specimens from Indonesia to Australia. All four major human rotavirus serotypes were detected during the 15 month survey from June 1978 to August 1979, including one serotype 1, 5 serotype 2, 31 serotype 3, and 21 serotype 4 strains. One additional strain reacted with serotype 3 and 4 Mabs. Serotype 3 strains showed intratypic variation. The relative frequency of serotypes 2, 3, and 4 varied during the 15 months and appeared to be influenced by climatic changes associated with dry and wet seasons. Vaccine strategies must take account of comparatively rapid changes of predominant serotypes in a community and are only likely to be successful if comprehensive immunity can be established simultaneously against the four major human serotypes.

Acute Disease↗
PubMed1984

Risk of maternal death in Indonesia and Sweden. Patterns and trend in 3D display in teaching.

Epidemiological study of maternal death in Indonesia and Sweden suggests a link between two unrelated data sets. Fifty years ago ('1930'), the Swedish maternal death risk exhibited a pronounced J-shaped pattern by maternal age; and a similar pronounced J-shaped pattern is observed 50 years later in Indonesia for women with prolonged/obstructed labor attended at the top referral and teaching institutions. Epidemiological documentation of 'North data sets' may possibly be used for teaching on factors affecting 'South mortality transition'. The documentation of a 'North-South transition' could accelerate the current dynamics of needed mortality decline by pointed programmatic intervention. The two figures are self-contained reference baselines.

Adult↗
PubMed1997

Deletion of twenty seven nucleotides within exon 11 of the band 3 gene identified in ovalocytosis in Lombok Island, Indonesia.

This study reports the molecular characterization of ovalocytosis in Lombok Island, Indonesia. The analysis of genomic DNA by polymerase chain reaction shows that all 21 ovalocytotic individuals have two amplified products of different size from a region encompassing exon 11 of the band 3 gene. The sequence of the larger product matched perfectly with that of normal individuals. In the sequence of the smaller product, 27 nucleotides within exon 11 were deleted. The heterozygous presence of the deletion identified in other parts of Southeast Asia was confirmed in patients with ovalocytosis in an isolated island of eastern Indonesia.

Anion Exchange Protein 1, Erythrocyte↗
PubMed1999

Low environmental selenium availability as an additional determinant for goiter in East Java, Indonesia?

Iodine deficiency, which is most visibly indicated by goiter, is highly prevalent in Indonesia. Since 1994, Indonesia has a decree that all salt used for human, livestock, and industry must be iodized. However, despite the increased distribution of iodized salt, pockets with significantly higher prevalence of goiter still remain. This situation may be consequence of selenium (Se) deficiency. This study aimed to assess the Se level in the environment of goiter prevalent areas. Five hundred eleven school children participated in this study. Goiter was measured using both ultrasound and palpation. Ninety-nine eggs were collected from free-living chicken in 11 villages, and the Se contents of egg yolk and egg white were determined by neutron activation analysis. In the villages studied, Se concentration in egg yolk ranged from 0.15 to 1.52 microg/g and in egg white from 0.18 to 2.97 microg/g. The prevalence of goiter measured by palpation ranged from 18.4% to 70% and by ultrasound from 0% to 100%. Because of the inconsistency of goiter rate measured by palpation and ultrasonography, the question remains whether low availability of Se in the environment might be an additional contributing factor for goiter.

Child↗
PubMed2005

Using satellite fire detection to calibrate components of the fire weather index system in Malaysia and Indonesia.

Vegetation fires have become an increasing problem in tropical environments as a consequence of socioeconomic pressures and subsequent land-use change. In response, fire management systems are being developed. This study set out to determine the relationships between two aspects of the fire problems in western Indonesia and Malaysia, and two components of the Canadian Forest Fire Weather Index System. The study resulted in a new method for calibrating components of fire danger rating systems based on satellite fire detection (hotspot) data. Once the climate was accounted for, a problematic number of fires were related to high levels of the Fine Fuel Moisture Code. The relationship between climate, Fine Fuel Moisture Code, and hotspot occurrence was used to calibrate Fire Occurrence Potential classes where low accounted for 3% of the fires from 1994 to 2000, moderate accounted for 25%, high 26%, and extreme 38%. Further problems arise when there are large clusters of fires burning that may consume valuable land or produce local smoke pollution. Once the climate was taken into account, the hotspot load (number and size of clusters of hotspots) was related to the Fire Weather Index. The relationship between climate, Fire Weather Index, and hotspot load was used to calibrate Fire Load Potential classes. Low Fire Load Potential conditions (75% of an average year) corresponded with 24% of the hotspot clusters, which had an average size of 30% of the largest cluster. In contrast, extreme Fire Load Potential conditions (1% of an average year) corresponded with 30% of the hotspot clusters, which had an average size of 58% of the maximum. Both Fire Occurrence Potential and Fire Load Potential calibrations were successfully validated with data from 2001. This study showed that when ground measurements are not available, fire statistics derived from satellite fire detection archives can be reliably used for calibration. More importantly, as a result of this work, Malaysia and Indonesia have two new sources of information to initiate fire prevention and suppression activities.

Calibration↗
PubMed2000

Genetic diversity of rice tungro spherical virus in tungro-endemic provinces of the Philippines and Indonesia.

The two adjacent genes of coat protein 1 and 2 of rice tungro spherical virus (RTSV) were amplified from total RNA extracts of serologically indistinguishable field isolates from the Philippines and Indonesia, using reverse transcriptase polymerase chain reaction (RT-PCR). Digestion with HindIII and BstYI restriction endonucleases differentiated the amplified DNA products into eight distinct coat protein genotypes. These genotypes were then used as indicators of virus diversity in the field. Inter- and intra-site diversities were determined over three cropping seasons. At each of the sites surveyed, one or two main genotypes prevailed together with other related minor or mixed genotypes that did not replace the main genotype over the sampling time. The cluster of genotypes found at the Philippines sites was significantly different from the one at the Indonesia sites, suggesting geographic isolation for virus populations. Phylogenetic studies based on the nucleotide sequences of 38 selected isolates confirm the spatial distribution of RTSV virus populations but show that gene flow may occur between populations. Under the present conditions, rice varieties do not seem to exert selective pressure on the virus populations. Based on the selective constraints in the coat protein amino acid sequences and the virus genetic composition per site, a negative selection model followed by random-sampling events due to vector transmissions is proposed to explain the inter-site diversity observed.

Animals↗
PubMed1994

Institutional constraints to building social science capability in public health research: a case study from Indonesia.

The promotion of social sciences capabilities in public health research in universities frequently encounters unexpected barriers. This paper argues that, in Indonesia, historic factors and institutional structures of public health research have created constraints to success in public health research and international technical assistance. Donors are often frustrated by apparent inconsistencies between agreed intentions and the subsequent behaviour of recipient colleagues, thus resulting in poor relations and failure of collaborative links. For social sciences to be integrated into public health research, assistance is needed in graduate education, library development, computerisation, and research methodology. Contributions in these areas may be ineffectual if they are not preceded or accompanied by efforts by recipients to reform or circumvent existing institutional weaknesses. Some important barriers to the development of research capabilities in Indonesia are beyond the control of individual faculties of public health, or even universities, and are affected by regulations and budgeting procedures of the National Department of Education and Culture, or the civil service administration. There are, however, changes that can be made at faculty or university level to encourage a more productive 'research culture' and promote linkages between the social and health sciences.

Humans↗
PubMed1993

Oral contraceptive use and breast cancer in Indonesia.

A hospital-based case-control study was conducted in Ujungpandang, Indonesia, to determine the association of breast cancer and current and former oral contraceptive (OC) use. This study included 119 newly diagnosed, histologically-confirmed, breast cancer cases who were admitted to the four largest referral hospitals in Ujungpandang from 1990-1991. Controls were 258 women admitted to these same four hospitals with diagnoses unrelated to breast cancer or OC use. Thirty cases (32%) and 55 (19%) controls reported having ever used OCs. The odds ratio for ever using OCs and breast cancer was 1.8 (95% confidence interval 1.2-3.0) after adjustment for age, age at first pregnancy, and family history of breast cancer. Increasing duration of OC use did not increase risk of breast cancer. No latency trend of increasing years since first OC use among cases was observed; however, a younger age at first OC use was associated with increasing breast cancer risk. A significant recency effect was observed; women last using OCs within five years of study enrollment were at greatest risk of breast cancer (OR = 4.9, 95% CI: 2.1-11.4). This first study of breast cancer and OC use in Indonesia does not provide consistent data to indicate an increased risk of breast cancer associated with OC use. Although breast cancer cases were 80% more likely to have ever used OCs, neither duration nor latency of OC use were associated with cancer risk. The significant recency effect suggests that a detection bias might explain the observed relationship between ever OC use and breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The introduction of Cyclofem into national family planning programmes: experience from studies in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Task Force on Research on Introduction and Transfer of Technologies for Fertility Regulation, Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.

Studies on the introduction of Cyclofem into family planning programmes have been undertaken in Indonesia, Jamaica, Mexico, Thailand and Tunisia. Cyclofem is a once-a-month injectable contraceptive containing 25mg medroxyprogesterone acetate and 5mg estradiol cypionate. A total of 7927 subjects were followed in close to routine service delivery conditions in primary and secondary family planning outlets. The studies confirmed the high efficacy of the method with 12-month pregnancy rates ranging from 0 to 0.7%. Major differences were seen in reasons and rates of discontinuation between countries, the overall 12-month life table discontinuation rates ranging from 33.5% in Indonesia to 71.8% in Tunisia. The reasons for discontinuation in each of the five countries are described, differences between countries contrasted, and service delivery issues which should be addressed further, raised.

Adolescent↗