Rini Sekartini

Sleep education in medical school curriculum: A glimpse across countries

BACKGROUND The objective of this study was to assess the prevalence of education about sleep and sleep disorders in medical school education and to identify barriers to providing such education. METHODS Surveys were sent to 409 medical schools across 12 countries (Australia, India, Indonesia, Japan, Malaysia, New Zealand, Singapore, South Korea, Thailand, United States, Canada and Viet Nam). RESULTS Overall, the response rate was 25.9%, ranging from 0% in some countries (India) to 100% in other countries (New Zealand and Singapore). Overall, the average amount of time spent on sleep education is just under 2.5h, with 27% responding that their medical school provides no sleep education. Three countries (Indonesia, Malaysia, and Viet Nam) provide no education, and only Australia and the United States/Canada provide more than 3h of education. Paediatric topics were covered for a mere 17 min compared to over 2h on adult-related topics. CONCLUSION These results suggest that there continues to be very limited coverage of sleep in medical school education despite an incredible increase in acknowledgement of the importance of sleep and need for recognition of sleep disorders by physicians.

Effect of current breastfeeding on sleep patterns in infants from Asia‐Pacific region

Aim:  The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia‐Pacific region.

Sleep education in pediatric residency programs: a cross-cultural look.

BackgroundThe objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education.MethodsSurveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam).ResultsOverall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood.ConclusionsThese results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents.

Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children

Background Indonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics. Methodology/Principal Findings To better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status. Conclusions/Significance This is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10 years or over have experienced dengue infection at least once. Prospective incidence studies would likely reveal dengue burdens far in excess of reported incidence rates.

The effect of lactose-isomaltulose-containing growing-up milks on cognitive performance of Indonesian children: a cross-over study.

Glycaemic response to dietary carbohydrates might have an impact on cognitive performance. The present study investigated the effects of growing-up milks (GUM) with isomaltulose and extra minerals and vitamins or lower protein content on cognitive parameters in children aged 5–6 years. In a blinded, partly randomised, controlled, cross-over study, four GUM were provided, each taken over 14 d (2 × 200 ml/d): standard (Std) GUM; Std GUM+5 g isomaltulose (Iso-5 GUM); Iso-5 GUM with 26 % less protein (Iso-5 LP GUM); Std GUM with 2·5 g isomaltulose and extra Mg, Zn, Se, D3, B1, B2, B12, folic acid and choline (Iso-2·5 GUM). At test days, when GUM replaced breakfast, repeated (0, 60, 120 and 180 min post-dose) cognitive tasks were performed (picture presentation, simple reaction time, digit vigilance, choice reaction time, spatial and numeric working memory and picture recognition). Task performance of all subjects (n 50) worsened over the morning. Best performance was seen on isomaltulose GUM, most notably at 180 min. Iso-2·5 GUM showed best performance on several parameters of attention and memory, Iso-5 GUM performed best on parameters of memory and Iso-5 LP GUM was positively associated with parameters of attention but less with memory. Std GUM showed only a benefit on one attention and one memory task. Thus, isomaltulose-enriched GUM positively affected parameters of attention and memory at 180 min post-dose when compared with Std GUM. Extra minerals and vitamins seem beneficial, whereas lowering protein content might improve attention in particular.

Prevalence of insulin resistance in obese adolescence

Childhood obesity is a global health problem with several metabolic and cardiovascular complications. The prevalence of childhood and adolescent obesity is differed in each country with several affecting factors. Insulin resistance as one common feature of obesity is known to have a link with the risk of diabetes type 2 and cardiovascular complication. Insulin resistance is also a basic mechanism of metabolic syndrome. Several mechanisms proposed the link between obesity, insulin resistance, and metabolic syndrome. This study aimed to look at the characteristics of obese adolescence with metabolic syndrome and to look for the prevalence of insulin resistance among them with several risk factors that may affect. This was a cross-sectional study on 92 obese adolescent, aged between 12 and 15 years old, in Central Jakarta, Indonesia. All adolescent underwent blood sample tests, including fasting blood glucose, lipid profile, and fasting blood insulin. Insulin resistance was defined as a HOMA-IR index of 3.8 or more. The diagnostic of metabolic syndrome was defined according to International Diabetes Federation (IDF) criteria. Insulin resistance was found in 38% of the adolescent, with a higher rate among females (57.2%) than males (42.8%) (p = 0.673). Most of them had acanthosis nigricans as the marker of insulin resistance (71.4%) (p = 0.959). Among them, 82.8% had a family history of metabolic syndrome (p = 0.646). The prevalence of metabolic syndrome among obese adolescent was 19.6% with female predominant. The prevalence of each of the component was 48.9% for high blood pressure, 78,3% for abdominal obesity, 8.7% for impaired fasting glucose level, 22.8% for low levels of high-density lipoprotein cholesterol, and 21.7% for high triglyceride level. There was a strong correlation between impaired fasting glucose level and insulin resistance (p = 0.04), with the risk of 5.7 times to get insulin resistance. Insulin resistance has a prevalence of 38% in obese adolescent population in this study. Insulin resistance has a significant association with impaired fasting glucose level.

Immunogenicity and safety of a Trivalent Influenza HA vaccine in Indonesian infants and children

INTRODUCTION High rate of influenza infection in children made influenza vaccination strongly recommended for all person aged >6 months in Indonesia. Bio Farma Trivalent Influenza HA (Flubio®) vaccine has been used in adolescents and adults, resulted in increased seroconversion, seroprotection rates and geometric mean titer (GMT). However, no data is available regarding its efficacy and safety in children. This study aimed to assess the immunogenicity and safety of Flubio® vaccine in infants and children. MATERIALS AND METHODS This was a phase II, open-labeled, clinical trial conducted on healthy children aged 6 month-11 years, vaccinated with 1 or 2 doses of Influenza HA vaccine, with a 28-day interval. Flubio® vaccine composed of A/California/7/2009 (H1N1) pandemic 09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 strain. This study was held at East Jakarta, Indonesia from May until July 2014. A Total of 405 subjects were included and divided into three groups: A(6-35 months), B(3-8 years), and C(9-11 years). Antibody titer was measured at visit V1 (Day 0), V2 (28 days/+7days after the first dose) and V3 (28 days/+7days after second dose). The seroprotection and seroconversion rates were assessed. Safety was assessed up to 28 days following each dose. RESULTS A total of 404 subjects completed the study. After vaccination, all subjects achieved seroprotection and increased seroconversion rates, with post-vaccination antibody titer of ≥1:40 HI for all strains. The GMT also increased significantly. Within 30 min after vaccination, 14.6% and 2% had local and systemic reactions; meanwhile, between 30 min to 72 h after vaccination, 35.1% and 13.6% subjects had local and systemic reactions, respectively. Most reactions were mild. No serious adverse event (SAE) was reported related to vaccine. CONCLUSION Flubio® (Influenza HA Trivalent) vaccine is immunogenic and safe for children aged 6 months-11 years. TRIAL REGISTRATION The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT02093260.

An evening milk drink can affect word recall in Indonesian children with decreased sleep efficiency: A randomized controlled trial

Study objectives: Sleep is important for memory consolidation in children. This study intended to find out whether an evening milk-based drink could influence sleep efficiency and memory recall in a group of Indonesian children (5–6 years old) with sleep deprivation. Methods: Children were randomly allocated to one of three interventions: Reference product, satiety-stimulating product, and a relaxing product. The intervention lasted for 6 weeks and children consumed two servings per day of each 200 ml, the serving in the morning being the same for all children. All measurements took place at baseline and at the end of the intervention. Sleep parameters were studied using actigraphy and a sleep diary during three consecutive days. Memory consolidation was tested using a 20 word-pair list, which was memorized the evening before being recalled the next morning at home-base. Anthropometry was measured using standard equipment. Results: The Satiety group showed a significant decrease in word recall, and a significant increase in nocturnal awakenings that was inversely associated with sleep efficiency at the end of the intervention. Sleep efficiency did not differ between the three groups being 75.5 ± 8.6% and 75.7 ± 6.3% at baseline and end of the intervention, respectively. Despite the lower energy intake in the Standard (reference) group, this condition showed the highest increase in weight. Discussion: Evening growing-up milks can affect memory recall, sleep characteristics, and growth. However, to correct sleep efficiency and sleep duration, improvement of parental behavior may be the most important factor with nutrition providing a supplementary effect.

Dopamine transporter gene polymorphism in children with ADHD: A pilot study in Indonesian samples

INTRODUCTION Several studies showed that DAT1 polymorphism closed related with ADHD although the results were not consistently found. Studies in China, South Korea, Japan revealed that 10-repeat allele gave a risk for ADHD. Based on that understanding, this study tried to identify whether the similar polymorphism of DAT1 was also apparent in Indonesian children with ADHD. METHOD This was a case - control study. Case was 50 Indonesian origin children with ADHD and without any other mental disorders and metal retardation. Control is Indonesian origin children without ADHD, other mental disorders and mental retardation. ADHD diagnosis was taken after doing the psychiatric interview and observation based on the DSM-IV TR diagnostic criteria for ADHD at the Child and Adolescent Psychiatry Out-patient Clinic, Dr. Cipto Mangunkusumo National Referral Hospital - Faculty of Medicine Universitas Indonesia. DNA isolation, DNA purity and concentration were measured. PCR was done by using a primer based on Homo sapiens solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3), RefSeq Gene on chromosome 5 with accession number NG_015885.1. To identify the serial of repeated allele, we used the sequencing technique. RESULTS There were 47 children with ADHD and 48 children without ADHD that involved in the final analysis. The mean of age amongst ADHD group was 9.18 (2.42) and 8.10 (2.46) years old in non-ADHD group. The 10-repeated allele of DAT1 was the highest proportion in both. CONCLUSION This finding was apparently similar with other studies on DAT1 polymorphism across Asian.

Pengetahuan Sikap, dan Perilaku Ibu Terhadap Sirkumsisi pada Anak Perempuan

Latar belakang. Situasi mengenai pola sirkumsisi (sunat) perempuan di Indonesia masih belum banyak diketahui, sehingga mengakibatkan kurang pengetahuan masyarakat Indonesia. Beberapa tahun terakhir WHO telah menyatakan menentang segala bentuk medikalisasi sirkumsisi perempuan. Tujuan. Mengetahui pengetahuan, sikap, dan perilaku ibu mengenai sirkumsisi pada perempuan di Jakarta. Metode. Desain penelitian cross-sectional dengan menggunakan metode convenient sampling. Data diperoleh dari kuesioner yang diisi sendiri oleh para ibu (self administered questionnaire). Hasil. Hampir seluruh responden melakukan sirkumsisi pada anak perempuan mereka 97,2% dari 106 orang responden. Agama merupakan alasan utama melakukan sirkumsisi 61,2%. Surat edaran dari Departemen Kesehatan RI mengenai larangan bagi tenaga medis untuk melakukan sirkumsisi pada anak perempuan tidak diketahui oleh sebagian besar responden (83%). Orang tua atau teman menjadi sumber yang paling berkesan untuk melakukan sirkumsisi 34%. Sedangkan dari tenaga medis, informasi yang paling berkesan datang dari perawat atau bidan 21,7%. Sebagian besar sirkumsisi dilakukan pada usia di bawah 5 tahun. Bidan merupakan pelaku sirkumsisi pada sebagian besar anak 73,9%. Sebagian besar responden memiliki tingkat pengetahuan rendah (87,7%), sikap kurang (90,6%), dan perilaku kurang (78,3%). Kesimpulan. Hampir seluruh anak perempuan responden disirkumsisi (97,1%). Mayoritas responden memiliki pengetahuan, sikap, dan perilaku yang kurang mengenai sirkumsisi pada anak perempuan (87,7%, 90,6%, dan 78,3%). Sirkumsisi dilakukan seluruhnya pada usia di bawah 5 tahun, terutama karena alasan agama. Pelaku sunat pada anak perempuan adalah bidan. Delapanpuluhtiga persen responden tidak mengetahui tentang surat edaran Departemen Kesehatan mengenai larangan medikalisasi sunat pada perempuan.