WHO reported that Environment contributed significantly as the causal of the disease in Asia Pacific. Indonesia is facing major health challenges, namely triple burden health problems, due to communicable diseases, non-communicable diseases and re-emerging disease. Primary care in Indonesia is conducted by Public Health Centers/Puskesmas and Primary Care Clinic covering around 86% of total health care facilities in Indonesia. Primary Care Physician plays important role as a gatekeeper and care coordinator. Primary care in Indonesia responsible for primary prevention and screening, should also be prepared to deal with various reasons for encounters of patient/community health problems, and conduct comprehensive management including referral management. It is therefore necessary to have teamwork with various health workers and patients/families at all levels of prevention.

Background: Obesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds. Method: In-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10–18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning. Results: Nineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings. Conclusions: Healthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, health institutions and hospitals are increasingly relying on e-learning for continuing education. However, in many countries there is still limited data on the effectiveness of online learning particularly in the healthcare field. This study aims to evaluate whether webinar as a form of online educational intervention is satisfactory and effective for the continuing education of health professionals in Indonesia. We collected participants' demographic information including health profession, place of work, work unit, and year of graduation. There were six independent webinars included in this study. Webinar outcomes included satisfaction and learning scores. Regarding satisfaction, participants were told to complete a satisfaction survey and asked whether they would recommend the webinar to their colleagues. Regarding learning, information on their mean pre-test and post-test scores was collected. A total of 3,607 health professionals were enrolled, with the highest participation in webinars about emergency cases and COVID-19 management. The response towards satisfaction was overwhelmingly positive. In all six webinars, post-test scores were statistically significantly higher than pre-test scores. Recently graduated physicians scored higher in learning than senior physicians, while place of work and work unit did not significantly affect the scores. The use of webinar for health professionals training in Indonesia was well-received amid the ongoing pandemic. In the future, health institutions and teaching hospitals should optimize the implementation of webinar training as it is associated with low cost, high flexibility, and less time commuting.

Introduction: BRAFV600E and RAS mutations are the most common gene mutations in papillary thyroid carcinoma (PTC) that may be correlated with its biological behavior. There are still limited data about BRAFV600E and RAS mutations in Indonesia. This study aims to determine the prevalence of BRAFV600E and RAS mutations, and their association with clinicopathologic characteristics. Methods: Patients who had total thyroidectomy from 2019 to 2021 and those who met our study criteria underwent PCR and DNA sequencing analysis for BRAFV600E, BRAFK601E, exon 2 and 3 of NRAS, HRAS, and KRAS. Analyses were performed to determine the associations of BRAFV600E and RAS mutations with clinicopathologic characteristics. Results: Of 172 PTC patients, BRAFV600E mutation was observed in 37.8% of the patients and RAS mutations were found in 21.5%. One patient harbored BRAFK601E mutation. There was a significant association of BRAFV600E with a high-stage (p = 0.033, OR: 3.279; 95% CI: 1.048– 10.259), tall-cell variants (p ≤ 0.001, OR: 41.143; 95% CI: 11.979– 141.308), non-encapsulated (p = 0.001, OR: 4.176; 95% CI: 2.008– 8.685), lymphovascular invasion (p = 0.043, OR: 1.912; 95% CI: 1.018– 3.592), extrathyroidal extension (p = < 0.001, OR: 3.983; 95% CI: 1.970– 8.054), and lymph node metastasis (p = 0.009, OR: 2.301; 95% CI: 1.224– 4.326). Follicular variant (p = 0.001, OR: 7.011; 95% CI: 2.690– 18.268), encapsulated (p = 0.017, OR: 2.433; 95% CI: 1.161– 5.100), and absent of extrathyroidal extension (p = 0.033, OR: 2.890; 95% CI: 1.052– 7.940) were associated with RAS mutations. Conclusion: A significant association between BRAFV600E mutation and high clinical stage, tall-cell variants, non-encapsulated morphology, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis in PTC was observed. RAS mutations were associated with the follicular variant, encapsulated tumor, and no extrathyroidal extension. HRAS-mutated PTC frequently exhibited tumor multifocality.

Santi T, et al. Clin Exp Vaccine Res. 2023 Jul;12(3):240-248. https://doi.org/10.7774/cevr.2023.12.3.240

Purpose: To assess knowledge retention of physicians after participating in a webinar series and its perceived benefits on daily practice and career development.Methods: The webinar series comprised six separate webinars about daily practice. Online questionnaires were sent to all participating physicians via email 3 months after the webinars. The questionnaire assessed knowledge retention through the difference between initial and follow-up post-test as well as the webinar series’ benefits on daily practice and career development. Participants’ demographic information, including their age, gender, education, year of graduation, and work details, were collected to compare outcomes between demographic groups.Results: A total of 689 responses were gathered, and 622 were analyzed. At follow-up, the median knowledge score was significantly lower than the initial median knowledge score (Z=-6.973, p<0.001). Participants’ perception of the webinar series’ benefits on daily practice and career development was very positive. A significant weak negative correlation was found between age and knowledge score at follow-up (rs=-0.157, p<0.001). Physicians who graduated more recently and worked for less than 3 years scored significantly higher on knowledge tests at follow-up. Meanwhile, perception score towards webinar series’ benefits on daily practice was significantly higher among physicians with more extended work history. Male physicians scored significantly higher on perception score towards webinar series’ benefits on career development.Conclusion: Online continuing medical education programs like webinars can encourage physicians to maintain their competence, but further research on improving knowledge retention over time is necessary. Overall, physicians perceived webinars to be beneficial for their professional development.