Sexual Dysfunction Following Breast Cancer Chemotherapy: A Cross-Sectional Study in Yogyakarta, Indonesia.

Introduction Sexual dysfunction is rarely studied in Indonesian patients with breast cancer. We aimed to assess the prevalence of sexual dysfunction symptoms following chemotherapy, as well as the pattern and the associated factors. Methods This cross-sectional study included 135 female breast cancer patients receiving primary chemotherapy. The present study measured the prevalence of sexual dysfunction symptoms using an e-questionnaire containing Common Toxicity Criteria for Adverse Events (CTCAE) version 4 at different time points. Other data included sociodemography, clinicopathology, treatment, and other concurrent symptom characteristics. Bivariate and multivariate logistic regression tests were used to analyze any association among variables. Results In the whole panel, 86 (63.7%) of 135 cases experienced sexual dysfunction. The most common symptom was vaginal dryness (45.9%), followed by decreased libido (45.2%), dyspareunia (13.3%), delayed orgasm (11.1%), and anorgasmia (8.9%). When observed at five different time points, the frequency of symptoms increased during chemotherapy and persisted until six months after completing treatment. Chemotherapy duration of >120 days was associated with a higher probability of vaginal dryness (p=0.012) and decreased libido (p=0.033). Spouse age ≥55 years old and body mass index (BMI) ≥23 kg/m2 were associated with a reduced probability of decreased libido (p=0.033 and 0.025, respectively). The presence of comorbidity was associated with a reduced probability of delayed orgasm (p=0.034). Conclusions A significant proportion of patients with breast cancer had sexual dysfunction following chemotherapy. Vaginal dryness, decreased libido, and dyspareunia were the commonest symptoms observed. Duration of chemotherapy, spouse age, BMI, and comorbidity were associated with the risk of sexual dysfunction occurrence.

A Comprehensive Tobacco Control Policy Program in a Mining Industry in Indonesia: Did It Work?

Background: Risk factor controls, including smoking cessation and prevention, impact health costs. This study aimed to describe the Kaltim Prima Coal (KPC), one of Indonesia's largest coal mining operations, comprehensive tobacco control policy program in 2015 and its impact on smoking behavior among the employees. Method: A survey among 404 employees was conducted to assess the impact of the smoke-free KPC programs. In addition to the descriptive analysis, logistic regression was used to measure the association of intention to the smoking behavior change and the association between intention and the determinants using the Theory of Planned Behavior in 102 smokers. Results: A series of tobacco control programs: advocacy, health education, brief interventions for smoking cessation, peer counselor training, media campaigns, and policy regulations were implemented. About 95.5% of the respondents attended the KPC Smoke-Free 2015 programs, and 97.8% reported they already knew that KPC is a total smoke-free area. Nearly 50% of the respondents expressed that the staff complied with the rules and no longer smoked in KPC. Majority of smokers (76.6%) reduced their consumption, and 5.6% of them quit smoking. Among smokers, we found that attitude toward smoking cessation, subjective norm, and perceived control for quitting were related to the intention to stop smoking. Conclusions: The KPC smoke-free policy has been comprehensively implemented. Regulations on smoking and tobacco controls should be maintained, and monitoring should be consistently done. Media campaigns on the regulations and the availability of trained peer educators for smoking cessation help need to be applied continuously.

Smoking Cessation Experience in Indonesia: Does the Non-smoking Wife Play a Role?

OBJECTIVE: More than 63% of Indonesian men are smokers, and smoking has long been a part of Indonesian culture and the concept of masculinity in Indonesian culture. Given the pro-smoking environment, we were interested in examining why smokers would willingly quit and whether their wives played a role in their quitting process as social factors are mentioned second most frequent as a reason for quitting smoking. DESIGN: In-depth interviews. METHOD: We interviewed 11 couples (N = 22)-ex-smoking husbands and non-smoking wives-in Yogyakarta, Indonesia. The data were analysed by using the thematic analysis approach. RESULTS: Four themes were discussed: (1) reasons for stopping smoking, (2) the process of quitting smoking, (3) the wives' attitudes toward smoking, and (4) the families' attempts to make the (ex-)smokers quit. The most commonly cited reasons for quitting were family and personal motivation. The (ex-)smokers preferred to quit without assistance and in private. The wives' attitude toward smoking ranged from dislike to tolerance, and most did not know when their husbands were trying to quit. Both husbands and wives reported that the wives did not influence the smoking cessation process. CONCLUSION: Indonesian ex-smokers often had multiple reasons for quitting smoking. The process was typically difficult and kept private. While wives had little influence on the cessation process, they provided support and could institute a smoking ban in the house.

A quasi-experimental text messaging trial to improve adolescent sexual and reproductive health and smoking knowledge in Indonesia.

Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia. METHODS: A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test. RESULTS: In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%). CONCLUSIONS: An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.

Training on modified model of programme for enhancement of emergency response flood preparedness based on the local wisdom of Jambi community.

The community's role during a disaster within the first 24-72 hours before having government's aid is crucial in making the condition under control in a timely manner. Disaster management institution, especially at local level, has not had any models for flood preparedness training through participative approach based on the local wisdom of Jambi community to reduce disaster risks. This study tries to evaluate the effectiveness of training programme for flood preparedness based on the local wisdom designed for Jambi community, Indonesia. This research is an experimental study with pre- and post-test control design, in-class training followed by field practice and evaluated using three components: pre-test and post-test evaluations (score scale: 0-100), skill observation during disaster training (score scale: 1-4). The participants consisted of 24 local people chosen from the disaster-prone area; all participated in the disaster training. The score of pre- and post-test evaluations indicates improved post-test result with 71.4 (p < 0.005). There was also a skill improvement in the final simulation with 75% excellent score using model modification of programme for enhancement of emergency responses based on the local wisdom. This study completely evaluates the effectiveness of training for flood preparedness based on the local wisdom to improve the knowledge, ability and skill of people in disaster-prone areas.

Is there a relationship between personal reflection ability and moral reasoning ability in Indonesian medical students?

OBJECTIVES: To determine the relationship of personal reflection ability and moral reasoning ability of medical students of the Faculty of Medicine Universitas Gadjah Mada (UGM). METHODS: A cross-sectional study was conducted by distributing questionnaires to 293 medical students in Year-3 at the Faculty of Medicine, Public Health, and Nursing after obtaining their agreement to participate in this research by signing an informed consent form. Personal reflection ability was measured by the Groningen Reflective Ability Scale (GRAS) questionnaire; moral reasoning ability was measured by the Defining Issues Test (DIT) questionnaire. Descriptive statistics, T-test, and regression analysis were used to analyze the anonymized results. RESULTS: The mean GRAS score of all students was 89.59 (SD = 6.80) (GRAS score ranged 0-110) which showed a high level. The mean score of Principled Morality Score (P) DIT of all students was 32.39 (SD=11.04), ranging between 28-41 which indicated a moderate level. In general, personal reflection ability scores of all students were positively correlated with their moral reasoning ability score. However, this correlation was not significant statistically (r=0.080, p=0.239). CONCLUSIONS: Personal reflection ability of medical students was correlated positively with their moral reasoning ability, however, statistically it was not significant . The high level of personal reflection ability needs to be maintained. The moderate moral reasoning ability needs some efforts to improve it. Further studies are necessary to assess other factors which influence the moral reasoning ability so that appropriate interventions can be developed.

Impact of a Pilot Intervention to Increase Physician-Patient Communication About Stroke Risk in Indonesia.

In Indonesia, where stroke is the leading cause of death, we designed and tested a brief intervention to increase physician-patient conversations about stroke prevention in community health centers. The pilot study used a quasi-experimental design involving repeated cross-sectional data collection over 15 weeks to compare pre- and during-intervention differences within four centers. We conducted exit interviews with 675 patients immediately following their medical appointments to assess whether physicians discussed stroke risks and provided recommendations to modify their risk behaviors. From pre-intervention to during intervention, patients reported more frequent physician recommendations to modify their stroke risk behaviors. We also conducted interviews with eight providers (physicians and nurses) after the intervention to get their feedback on its implementation. This study demonstrated that a brief intervention to motivate physician-patient conversations about stroke prevention may improve these conversations in community health centers. While interventions to reduce risk hold considerable promise for reducing stroke burden, barriers to physician-patient conversations identified through this study need to be addressed.