Respati Suryanto Dradjat

Aim: The lumbar spine is vital for supporting body weight and facilitating trunk mobility. Morphometric data of the lumbar spine in Southeast Asian populations, particularly the Indonesian population, remain limited. This study aimed to provide baseline morphometric parameters of the lumbar spine in Indonesia to enhance preoperative planning and surgical outcome. Methods: This descriptive study analysed 150 adult patients (ages 17-55) who underwent CT scans at Dr. Saiful Anwar General Hospital in Malang between 2021 and 2023. Lumbar spine parameters, including vertebral body dimensions, pedicle morphometry, spinal canal diameter, intervertebral foramen size, and segmental height, were measured by independent, trained observers to minimize inter-observer variability. Data were extracted from the hospital's Radiology Information System (RIS). Results: The mean vertebral body height (29.14 mm) and width (42.17 mm) were smaller than those reported in Western populations, but consistent with Indonesian data. The mean pedicle width at L3 was 10.78 mm, and the spinal canal diameter (13.9 mm) was narrower than in Western populations but similar to East Asian and Indian cohorts. These findings highlight anatomical differences that should be considered in spinal surgery, including implant sizing and preoperative planning. Conclusion: This study provides essential baseline lumbar spine morphometric data for the Indonesian population. The results emphasize the need for region-specific surgical approaches. Future studies with larger, diverse samples are recommended to refine these findings and enhance clinical applications.

Osteoarthritis (OA) is a degenerative joint disease characterized by pain, inflammation, and impaired physical function. Interleukin-1 beta (IL-1β) plays an important role in OA pathogenesis by promoting inflammatory and catabolic processes within the joint. Antioxidants have shown potential in modulating oxidative stress and inflammatory responses associated with OA. This systematic review evaluated the effects of antioxidant administration on IL-1β levels in knee osteoarthritis. A systematic literature search was conducted in five databases (PubMed, Cochrane Library, Epistemonikos, Scopus, and ProQuest) until January 2025, following PRISMA guidelines. Eligible studies included intervention studies involving human or animal models of knee OA, antioxidant administration, and assessment of IL-1β outcomes. Because of substantial heterogeneity among studies, a qualitative synthesis was performed. Risk of bias was assessed using the RoB 2.0 tool for randomized controlled trials and the SYRCLE tool for animal studies. A total of 13 studies were included, consisting of six randomized controlled trials and seven animal studies. Most studies demonstrated reductions in IL-1β levels or expression following antioxidant administration, including curcumin, vitamin E, resveratrol, cucumber extract, and L-carnitine. Several studies also reported improvements in inflammatory markers, pain, and cartilage-related outcomes. Overall, the included studies showed a low risk of bias. Current evidence suggests that antioxidants may reduce IL-1β levels and exert anti-inflammatory effects in knee OA. However, further well-designed clinical studies are needed to confirm their efficacy and safety.

Aim Osteoporosis is a global health concern, characterized by reduced bone density, microarchitectural changes, and an increased risk of fractures. The prevalence of osteoporosis is rising, particularly in developing countries. In Indonesia, the incidence of upper femur fractures due to osteoporosis is notably high. As human studies are limited, animal models are crucial for investigating osteoporosis, with several methods used to induce the condition. This study proposes an alternative model using leuprolide acetate, gonadotropin-releasing hormone (GnRH) agonist, combined with a low-calcium diet and immobilization, to induce secondary osteoporosis in animals. Methods This experimental study employed a post-test-only control group design with 12 groups of Wistar rats (Rattus norvegicus). Three control groups received no treatment, while nine experimental groups were administered leuprolide acetate along with a low-calcium diet and immobilization. The study measured tartrate-resistant acid phosphatase 5b (TRACP-5b) and procollagen type 1 N-terminal propeptide (PINP) levels in rat bone tissue. Results Significant increase in TRACP-5b and decrease in PINP levels were observed on days 21, 28, and 35 in the treated groups. Post hoc analysis revealed significant differences between treatment groups. Conclusion The experimental model successfully demonstrated a reliable and reproducible method for inducing secondary osteoporosis. Elevated TRACP-5b and reduced PINP levels indicate increased osteoclast activity and decreased osteoblast activity resulting from excessive bone remodelling. The combination of leuprolide acetate, a low-calcium diet, and immobilization is an effective and alternative method for inducing secondary osteoporosis in experimental animals.

Aim Orthopedic implants must meet specific criteria, including mechanical strength, durability, and biocompatibility. This study compares the immune response of zirconia, polyether ether ketone (PEEK), and stainless-steel implants in vivo, focusing on lymphocyte and fibroblast infiltration as indicators of immune activation. Methods A total of 27 New Zealand white rabbits were used, with nine animals in each group. Implants of zirconia, PEEK, or stainless steel were surgically placed in the thigh and observed for 4 weeks. Histological analysis measured lymphocyte and fibroblast infiltration at the implant site using a microscope at 400x magnification. Statistical analysis included the Kruskal-Wallis test for group comparisons, followed by Mann-Whitney and Bonferroni correction for pairwise comparisons. Results The Kruskal-Wallis test showed significant differences in lymphocyte (p=0.002) and fibroblast (p=0.003) counts among the groups. Zirconia exhibited significantly lower lymphocyte (median=0.5) and fibroblast (median=1.0) infiltration compared to stainless steel (lymphocytes: median=3.0, fibroblasts: median=2.0), and PEEK (lymphocytes: median=2.0, fibroblasts: median=3.0). Bonferroni correction confirmed zirconia showed the least immune activation (p<0.0167). Conclusion Zirconia offers superior biocompatibility with minimal immune response, making it an ideal material for orthopedic implants, particularly for patients with metal sensitivities. PEEK showed moderate immune activation but is helpful for non-load-bearing applications. Stainless Steel induced the highest immune response due to the release of metal ions and corrosion. Zirconia is the most biocompatible material tested, making it a promising choice for orthopedic implants.

RESUMEN Objetivo: Explorar las percepciones y experiencias de los ancianos sobre el sueño y las estrategias que utilizan para afrontar su mala calidad. Método: Se realizó un estudio descriptivo cualitativo con 27 ancianos seleccionados intencionadamente de entornos comunitarios e institucionales en Bangka Belitung. Los datos se recopilaron entre junio y agosto de 2025 mediante entrevistas en profundidad y se analizaron temáticamente con triangulación, verificación por parte de los participantes y cumplimiento de las directrices COREQ. Resultados: La mayoría de los participantes eran mujeres de entre 60 y 74 años, muchas de ellas viudas y con enfermedades crónicas. Surgieron dos temas principales: las malas experiencias de sueño y las estrategias para afrontarlas. Entre los problemas más comunes se encontraban la dificultad para conciliar y mantener el sueño, los despertares nocturnos, el despertar temprano y la fatiga diurna. Los trastornos del sueño se relacionaron con el distrés psicológico y la incomodidad ambiental. Las estrategias de afrontamiento incluyeron cambios de comportamiento, prácticas espirituales, siestas diurnas y ajustes en las actividades. Conclusión: Los resultados de este estudio sugieren que el sueño entre los ancianos participantes en Bangka Belitung se percibe como multidimensional, influenciado por factores fisiológicos, psicológicos, ambientales y espirituales, lo que subraya la necesidad de un apoyo comunitario y culturalmente sensible que vaya más allá de las estrategias autoiniciadas.

Objective: To explore older adults’ perceptions and experiences of sleep and strategies used to cope with poor sleep quality. Method: A qualitative descriptive study was conducted with 27 purposively selected older adults from community and institutional settings in Bangka Belitung. Data were collected from June to August 2025 through in-depth interviews and analyzed thematically with triangulation, member checking, and adherence to COREQ guidelines. Results: Participants were mostly women aged 60–74 years, many widowed and with chronic conditions. Two themes emerged: poor sleep experiences and coping strategies. Common problems included difficulty initiating and maintaining sleep, nighttime awakenings, early awakening, and daytime fatigue. Sleep disruption was linked to psychological distress and environmental discomfort. Coping strategies included behavioral changes, spiritual practices, daytime naps, and activity adjustment. Conclusion: The findings suggest that sleep among participating older adults in Bangka Belitung is perceived as multidimensional, shaped by physiological, psychological, environmental, and spiritual factors, highlighting the need for culturally sensitive, community-based support beyond self-initiated strategies.

Objectives: Out-of-hospital cardiac arrest (OHCA) presents a major medical challenge globally, with persistently low survival rates. Developing countries generally experience even lower survival outcomes. Various intra-hospital factors may affect survival to admission, but their roles are insufficiently studied in the management of OHCA, particularly in Indonesia. This study investigated intra-hospital factors associated with survival to admission among OHCA patients treated in the emergency department of Saiful Anwar General Hospital, Malang, East Java, Indonesia. Methods: An exploratory cross-sectional study was conducted using data from the Pan-Asian Resuscitation Outcomes Study (PAROS) OHCA registry between 2015 and 2023. The study included adult cases of OHCA, excluding traumatic arrests, pediatric patients, and coronavirus disease 2019 (COVID-19) cases. Variables assessed included patient demographics, comorbidities, cardiac arrest characteristics, and specific interventions such as defibrillation, advanced airway management, and cardiac catheterization. Statistical analyses comprised bivariate and multivariable logistic regression to identify factors significantly associated with survival to admission. Results: A total of 428 cases were analyzed. The overall survival to admission rate was 7.24%. Advanced airway management (odds ratio [OR], 13.286; 95% confidence interval [CI], 3.928-44.937), defibrillation (OR, 8.400; 95% CI, 1.909-36.968), and cardiac catheterization (OR, 13.307; 95% CI, 1.089-162.635) were each significantly associated with higher survival to admission. Conversely, hypertension negatively affected survival (OR, 0.369; 95% CI, 0.149-0.912). Conclusion: Intra-hospital interventions such as advanced airway management and cardiac catheterization significantly increase the likelihood of survival to admission for OHCA patients. However, comorbid hypertension reduces the chance of survival. These results underscore the importance of optimizing in-hospital care protocols among OHCA patients.

Promoting breastfeeding self-efficacy through self-directed learning requires behavior, goal setting, and self-reinforcement. This research aims to collect insights from health professionals on strategies for improving maternal confidence in breastfeeding using self-directed learning and existing knowledge. An in-depth exploration through a two-round Delphi method rooted in the self-efficacy theory of self-directed learning for breastfeeding mothers was conducted, involving expert input and an extensive literature review. Four key documents were identified, each undergoing rigorous expert rating to ensure quality. Six essential elements for health professionals to guide breastfeeding mothers were established, focusing on lactation physiology, successful initiation, confidence building, adversity management, cultural beliefs, and public breastfeeding. Three crucial topics, including prior knowledge, personal attributes, and autonomous processes, were designed to enhance self-efficacy through self-directed learning. In conclusion, the study emphasizes the vital role of health professionals in supporting mothers through comprehensive breastfeeding guidance and encouraging self-directed learning.

Interprofessional collaboration plays a crucial role in the preparation for elective surgeries to enhance the quality, safety, and efficiency of patient care. However, its implementation continues to encounter substantial obstacles, which require the creation of a customized maturity model to effectively resolve these concerns. The aim of this study was to develop an interprofessional collaboration maturity model that is specifically designed for the context of elective surgery preparation. This qualitative study employed a case study approach, conducted in 2024. This maturity model was developed through four stages: (1) a literature study to identify key interprofessional collaboration indicators in surgery; (2) in-depth interviews with ten healthcare professionals at Universitas Muhammadiyah Malang Hospital, Malang, Indonesia; (3) adaptation of existing maturity models (Fleming, Hudson, collaboration maturity model, and quality management system) as a framework for synthesizing data from the findings of stage 2 (in-depth interviews); and (4) expert panel review to evaluate the maturity model. We successfully developed an interprofessional collaboration maturity model specifically applied to elective surgery preparation, Preoperative Interprofessional Collaboration Maturity Model (P-ICMM), consisting of five maturity levels: emerging, developing, coordinated, integrated, and optimized. Each level’s assessment criteria are based on indicators of interprofessional collaboration. This maturity model has been evaluated by the experts in elective surgery preparation to ensure its validity and applicability. This maturity model is expected to help hospitals identify the level of interprofessional collaboration, design strategies to enhance collaboration, and ultimately improve the quality of healthcare services and patient safety in the preparation for elective surgeries.

Background: Breastfeeding self-efficacy is a critical factor influencing the initiation and continuation of breastfeeding among mothers. Low self-efficacy affects mothers’ ability to sustain breastfeeding. Several studies have investigated the factors influencing breastfeeding self-efficacy, but none have interconnected maternal, infant, and social support factors. Aims: This study aimed to measure the correlation between maternal and infant factors, social support, and breastfeeding self-efficacy. Methods: A cross-sectional approach was employed in Jember, Indonesia, among 200 breastfeeding mothers. The study population consisted of mothers 17-42 years old who were breastfeeding and who met the following inclusion criteria: mothers who have babies aged 1-6 months, term pregnancy history, wanted pregnancy, and baby weight born ≥ 2500 grams. Maternal and infant factors and social support were determined through interviews and questionnaires. Breastfeeding self-efficacy was examined using The Breastfeeding Self-efficacy Scale Short. The multiple logistic analysis was used for multivariate analysis. Results: Of a total of 200 breastfeeding mothers, 63% had low breastfeeding self-efficacy, and 59.5% of mothers did not exclusively breastfeed. The multiple logistic regression indicated that 74.2% of the factors included in the model influenced breastfeeding self-efficacy. Positive correlations were observed between breastfeeding self-efficacy and feeding type (OR=6.603), breastfeeding frequency (OR=6.220), breastfeeding intention (OR=4.993), and family type (OR=4.001). Conclusion: feeding type, breastfeeding frequency, and family support were the important factors that support breastfeeding self-efficacy.