Purpose: Smoking is a significant risk factor in developing cardiovascular disease pathogenesis through oxidative stress and inflammation mechanisms. This study used cotinine as a biomarker of nicotine exposure levels in the body, which was associated with levels of Interleukin-6 (IL-6) and Superoxide Dismutase (SOD) as markers of oxidative stress and vascular inflammation. The research aimed to analyze the effect of cotinine levels on the expression of IL-6 and SOD. Methods: This study used a cross-sectional design on 200 subjects, consisting 100 smokers and 100 non-smokers. Cotinine levels, IL-6 expression, and SOD were measured from the blood serum of each subject using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Then the data were analyzed using Generalized Structured Component Analysis (GSCA). Results: There was a significant effect of cotinine levels on the reduction of SOD mediated by IL-6 (CR = 4.006). Cotinine levels also increased IL-6 mediated by SOD (CR = 4.292). The structural model shows that higher cotinine levels will increase IL-6 expression, and conversely, SOD expression will decrease. Conclusion: High cotinine levels cause an increase in the inflammatory process and oxidative stress in the vasculature of smokers, which is characterized by high IL-6 expression and low SOD expression.

This study aims to explore the nature of community response to the initiation of smoking among Indonesian early adolescents. The study was a qualitative survey involving 100 selected participants (early adolescents, parents, teachers of junior high schools, and school nurses with 25 participants in each category) through snowball sampling method. Participants were interviewed with semi-structured open-ended questions. Data analysis was accomplished by the triangulation of data source. Smoking initiation arises reactive and assertive community response in rejecting negative impact of smoking-leading situation. Community response to the initiation of smoking among early adolescents has certain complex characteristics. Health professionals need to actively participate in building smoke-free community by constructing a practical model of public health nursing which is comprehensive to protect Indonesian early adolescents from negative impacts of culturally allowed smoking.

Introduction: Endothelial Progenitor Cells (EPCs) are part of hematopoietic stem cells that differentiate into endothelial cells during their blood vessels’ maturation process. The role of EPCs is widely known to contribute to repair of the vascular wall when endothelial dysfunction occurs....

Background: The pathomechanism of CVD is a complex and multifactorial process. The primary mechanism of CVD is atherosclerosis. Inflammation in atherogenesis raises the risk of hypoxia, which will activate hypoxia-inducible factor-1α (HIF1A). Also, together with lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory mediator for atherogenesis. Purpose: This study aims to measure the hypoxia-inducible factor-1α (HIF1A) expression and its correlation to Lp-PLA2 expression at low-risk, intermediate, and high-risk CVD populations. Patients and Methods: The study used a correlational analysis method with a total sampling technique in 160 individuals in the risk population. The atherosclerosis risk group was analyzed using the Framingham Risk Score and categorized into low, intermediate, and high-risk groups. Venous blood samples taken from respondents were measured using the ELISA method with Lp-PLA2 and HIF-1α as parameters. Data were analyzed using normality test, homogeneity test, one-way ANOVA, post hoc–Tukey HSD, and Pearson correlation. Results: The concentration of HIF1A had a very strong correlation with Lp-PLA2 expression, both in the low-risk group (r = 0.512), intermediate (r = 0.512), and high (r = 0.715) (P < 0.05). However, the concentrations of Lp-PLA2 did not match the FRS. Conclusion: HIF1A expression increased with increasing risk, while Lp-PLA2 expression decreased with increasing risk of atherosclerosis based on the FRS category. There is a significant correlation between HIF1A expression and Lp-PLA2 expression based on FRS.

Introduction: Acute Coronary Syndrome (ACS) is a life-threatening condition. Immediate and proper treatment will decrease mortality rate. Patient awareness on ACS is still lacking and as the consequence, ACS patients do not seek immediate help. Problem: The patients’ efforts to get rid of ACS symptoms. Methods: The study was a descriptive, qualitative study in which a semi-structured, in-depth interview became the instrument. The respondents were 34 participants (including 17 ACS patients and 17 family caregivers). Data analysis was done by triangulation of data sources. Results: Three themes were obtained, namely: (1) prefer traditional and self-treatment, for example (a) traditional medicine, (b) taking non-prescription drugs to overcome ACS symptoms, and (c) spontaneous action; (2) using available health resources and facilities that consisted of (a) getting initial treatment at home by nurses, (b) visiting a health center to take care of the symptoms, and (c) using non-ambulance service to visit the health centers; and (3) expectations on health care services to patients composed by sub-themes such as (a) the expectation to get information that supports the healing, and (b) the caring attitude of the heath professional. Conclusions: The results showed that in the prehospital setting when experiencing ACS symptoms, the patients try to overcome the symptoms independently. However, as the symptoms get worse, they utilize health facilities in different ways. At the time of obtaining health services, patients are satisfied with health professionals who show caring attitudes, explain the results of the examination, and provide health education on health care efforts. Thus, to prevent mortality and morbidity, it is important for a health professional to educate the public about ACS, including topics about ACS healthy lifestyles and potential threats if it is too late to get treatment. Furthermore, it is also important for the government to implement prehospital emergency services nation-wide. Kumboyono K , Refialdinata J , Wihastuti TA , Rachmawati SD , Aziz AN . Health-seeking behavior of patients with Acute Coronary Syndrome and their family caregivers. Prehosp Disaster Med. 2018;33(6):614–620.