Siti Fadlilah

Background: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes, yet the combined roles of smoking behavior and cardiometabolic factors in shaping neuropathy risks remain insufficiently understood. Objectives: To examine the associations of smoking behavior and cardiometabolic factors with DPN risk and evaluate their independent, combined, and mediating effects. Methods: This cross-sectional study included 905 adults with type 2 diabetes attending primary care services in Indonesia. DPN risk was assessed using the Michigan Neuropathy Screening Instrument. Tobacco smoking behavior was assessed using a structured questionnaire, while cardiometabolic factors were obtained from clinical examinations and laboratory measurements. Associations were analyzed using multinomial logistic regression, and mediation pathways were examined using partial least squares-structural equation modeling. Results: Both active smoking and secondhand smoke exposure were associated with an increased DPN risk, particularly among active smokers also exposed to secondhand smoke. Cardiometabolic factors, including elevated glycated hemoglobin, high fasting blood glucose, and an abnormal ankle-brachial index, showed independent associations with neuropathy risks. Combined exposure analyses demonstrated a cumulative pattern, with increasing numbers of abnormal risk factors associated with progressively higher odds of neuropathy. A pathway analysis indicated that the association between smoking behaviors and DPN was primarily mediated through metabolic dysfunction and impaired peripheral perfusion, whereas the mediating role of blood pressure was limited. Discussion: These findings support the multifactorial nature of DPN and suggest that behavioral and cardiometabolic factors interact in shaping neuropathy risks. Integrating smoking exposure assessments with glycemic and vascular risk management may strengthen prevention strategies in primary care populations with type 2 diabetes.

Foot–ankle and walking exercises have been proposed as potential strategies for managing symptoms in people with diabetic peripheral neuropathy (DPN), yet evidence from primary care remains limited. This pilot study assessed the feasibility and acceptability of these interventions and explored preliminary outcome patterns in DPN, stress, and quality of life (QoL). A three‐arm pilot randomized controlled trial was conducted in three public health centers in Yogyakarta, Indonesia ( n = 108; 36 per group). The control group received usual care and health education. The foot‐ankle group received education, leaflets, demonstrations, and guided practice, while the walking group received education and leaflets supporting a structured walking routine. Participants in the intervention groups then performed the exercises independently for 12 weeks. Outcomes were assessed at baseline, week 6, and week 12. Feasibility included recruitment, retention, data completeness, adherence, and adverse events. Adherence to the ≥ 150 min/week activity target was assessed using participant‐reported exercise logs. Acceptability was explored through open‐ended questions. Exploratory outcomes were analyzed using generalized estimating equations under an intention‐to‐treat approach. Feasibility indicators were favorable, with retention > 90%, minimal adverse events, and ≥ 80% adherence. Exploratory analyses suggested possible trends toward changes in DPN indicators, diabetes‐related distress, QoL barriers, fasting blood glucose, blood pressure, and ankle–brachial index in the intervention groups compared with controls. These findings suggest that the interventions are feasible and acceptable in primary care and provide preliminary estimates to inform a future fully powered randomized trial.

Background: Diabetes‐related quality of life (DR‐QoL) is shaped by interactions between cardiometabolic dysfunction and psychological stress, yet these mechanisms are rarely examined within a unified framework. Aims: To evaluate the independent, interactive, and mediating effects of cardiometabolic factors and stress on DR‐QoL obstacles. Methods: A cross‐sectional study was conducted among 1815 adults with type 2 diabetes from 15 Indonesian provinces (2023–2024). Stress and DR‐QoL obstacles were assessed using validated instruments. Independent and synergistic effects were examined using logistic regression, and mediation was tested via path analysis. Results: Overweight, obesity, stage 2 systolic hypertension, and abnormal fasting blood glucose (FBG) significantly predicted high stress (AOR = 1.982–20.889; p < 0.001), with synergistic interactions markedly amplifying the risk (AOR up to 53.972). DR‐QoL obstacles were strongly associated with cardiometabolic abnormalities (AOR = 1.352–18.420) and high stress (AOR = 18.930), with the highest risk observed in participants with multiple concurrent abnormalities (AOR = 52.097). Mediation analysis identified FBG and stress as key mediators, with stress showing the strongest direct effect on DR‐QoL obstacles ( β = 0.397). Linking Evidence to Action: These findings highlight FBG and stress as central mechanistic targets for interventions aimed at reducing DR‐QoL obstacles.

Perceived social support is essential for improving psychological well-being, self-efficacy, and treatment adherence among people living with HIV (PLHIV), particularly in collectivist contexts such as Indonesia. To date, no culturally validated instrument has been available to measure this construct in Indonesian PLHIV. This study aimed to translate, culturally adapt, and psychometrically validate the Indonesian version of the Perceived Social Support in HIV scale. Using a cross-sectional design, 200 Indonesian adults with HIV were recruited. A six-step cross-cultural adaptation process was applied, followed by psychometric evaluation including content validity, confirmatory factor analysis, construct validity, and reliability testing. The scale demonstrated excellent validity (S-CVI = 0.97), strong model fit (CFI = 0.995, TLI = 0.994, RMSEA = 0.037, SRMR = 0.018), and high correlations with self-efficacy and perceived stress. Reliability was outstanding (Cronbach's alpha = 0.962; ICC = 0.963). This validated instrument provides a robust tool for psychosocial assessment and intervention planning in HIV care.

Aim: To adapt and validate the Problem Areas in Diabetes scale in type 2 diabetes patients in Indonesia. Design: This was a cross‐sectional study. Methods: The study with 1044 participants was conducted at public health centers. The construct validity used an exploratory factor analysis to measure the scale structure, and a confirmatory factor analysis was used to assess model suitability. Reliability was calculated using Cronbach's alpha, composite reliability, average variance extracted and test–retest results. The sample was divided into equal numbers for the exploratory factor analysis and confirmatory factor analysis. Results: The exploratory factor analysis showed that the Kaiser‐Meyer‐Olkin test was 0.899, and Bartlett's test of sphericity was significant. Three factors were obtained with a factor loading of > 0.34. Cronbach's alpha for all items was 0.858, and individual factors ranged from 0.636 to 0.864. An interclass correlation coefficient and test–retest reliability analysis of all question items exhibited good results. Pearson correlations for all items or each factor showed significant results. The confirmatory factor analysis showed that the instrument had an acceptable model fit. Patient or Public Contribution: Type 2 diabetes patients and nurses in charge at public health centers were involved in this study. The findings show that the instrument is valid and reliable; it can be an option for measuring the stress diabetes mellitus. The subscales in this instrument can be used simultaneously or separately, according to each individual's needs. Indonesian PAID can be used for stress screening in diabetes mellitus patients starting from the primary health service level so that initial treatment can be provided more quickly.

Diabetic peripheral neuropathy (DPN) remains under‐detected in primary care despite available bedside tests and laboratory markers. We assessed whether lipid profile components mediate and synergize with systemic inflammation, indexed by the neutrophil‐to‐lymphocyte ratio (NLR), in relation to DPN. In a cross‐sectional study in Indonesia (July 2023–January 2024), 738 participants completed questionnaires, laboratory testing, and sensory screening with a 10‐g Semmes–Weinstein monofilament and 128‐Hz tuning fork. Multivariate logistic regression showed that an abnormally increased NLR (AOR 8.39; p < 0.001), total cholesterol (AOR 3.10; p < 0.001) and LDL‐C (AOR 2.25; p < 0.001) were independently associated with a higher DPN risk. Combined abnormalities markedly amplified the risk (AOR 33.30; p < 0.001). Path analysis supported partial mediation of the NLR‐DPN association via LDL‐C and total cholesterol (total indirect β = 0.03; 95% CI 0.02–0.05; p < 0.001). Integrating NLR and lipid monitoring with routine foot screening in nurse‐led primary care may enable earlier identification and risk stratification, particularly among individuals with longer duration or suboptimal glycemic control, thereby supporting targeted education and prevention to reduce disability and advance diabetes care.

Background: The Diabetes Obstacles Questionnaire-Short Version is a tool for measuring the quality of life in patients with diabetes mellitus. However, the validity and reliability of this tool has never been tested in Indonesia. Purpose: This study was designed to adapt and validate a Bahasa Indonesia version of the Diabetes Obstacles Questionnaire-Short Version for Indonesians with type 2 diabetes mellitus. Methods: This was a cross-sectional study. Data were collected from July to November 2023, and accidental sampling was used to recruit and enroll 1,116 participants. Convergence testing used the Diabetes Quality of Life questionnaire. The validity test used construct and convergent validities with significant Pearson correlations, and construct validity included exploratory factor analysis and confirmatory factor analysis. Reliability testing used Cronbach’s alpha, composite reliability, and average variance extracted. Results: The results of the exploratory factor analysis showed nine factors with a factor loading per item of >.45, a Kaiser-Meyer-Olkin test score of .915, and significant Bartlett’s test of sphericity results. The Cronbach’s alpha value for all items was .930, and those of individual factors ranged from .730 to .848. The test-retest results with interclass correlation coefficients ranged from .910 to .973. The results of the confirmatory factor analysis indicate that this instrument has an acceptable model fit. Conclusions/Implications for Practice: The Bahasa Indonesia Diabetes Obstacles Questionnaire-Short Version produces valid and reliable results for measuring quality of life in people with type 2 diabetes mellitus in Indonesia. The sufficient but small number of items allows the questionnaire to be completed relatively quickly, making it useful in clinical settings. The subscales in this instrument may be used simultaneously or separately based on individual needs.

Chronic kidney disease,depression,family support,health-related quality of life,hemodialysis

Introduction: Pregnant women are a population vulnerable to health problems. The morbidity and mortality of pregnant women with COVID-19 are higher compared with the rest of the population. This study aims to determine the survival rate of pregnant versus non-pregnant women with COVID-19. Methods: The study used a retrospective observational cohort design. Data were collected from Dr Soeradji Tirtonegoro and Penembahan Senopati hospitals on patients treated between March 2020 and June 2022. A total of 923 women diagnosed with COVID-19 were included in the study. Sociodemographic and clinical data on patient characteristics were extracted from medical records. Data analysis was conducted using Kaplan-Meier and Cox regression analyses to estimate survival probability and investigate predictors of death, with a 5% significance level. Results: Among 932 women with COVID-19, 231 deaths occurred. The median survival time for all participants was 30.56 days, while for pregnant women, it was 11.21 days, and for pregnant women with comorbidities, it was 9.68 days. Years of treatment, age, comorbidities, number of comorbidities and pregnancy were associated with survival rate (P-value < 0.001). Consistent results were also obtained for pregnant women’s age and number of comorbidities (P-value < 0.05). Significant differences between pregnant and non-pregnant patients remained after adjustment for year, sex, age and hospital type (P-value < 0.001). Conclusion: Pregnant women with COVID-19 have a higher risk of death compared with non-pregnant women. Keywords: comorbidity; COVID-19, female; pregnant women; survival analysis

This study aimed to identify the independent and synergistic effects of body mass index, fasting blood glucose, and hemoglobin A1c on ankle‐brachial index in type 2 diabetes mellitus. This cross‐sectional study involved 1096 participants who were measured using questionnaires, a digital scale, and a height measurement device. Blood marker was examined using fasting venous blood. The ankle‐brachial index was measured using Doppler ultrasound. A multinomial logistic regression was applied for adjusting confounders. Participants who were obese significantly increased 2.12‐ and 1.86‐fold risk of a low and a high ankle‐brachial index (p < 0.05), respectively. Participants with abnormal fasting blood glucose significantly increased 1.79‐ and 2.05‐fold risk of a low and a high ankle‐brachial index (p < 0.05). Participants with hemoglobin A1c > 6.5% significantly increased 1.71‐ and 1.76‐fold risk of a low and a high ankle‐brachial index (p < 0.05), respectively. Participants with abnormalities for all three indices synergistically increased 12.31‐ and 5.31‐fold risk of a low and a high ankle‐brachial index (p < 0.001), respectively. Abnormal body mass index, fasting blood glucose, and hemoglobin A1c readings significantly, independently, and synergistically increased the risk of an abnormal ankle‐brachial index.