Hiroshi Sugimoto

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.

Background: Infectious diseases, including dengue fever and waterborne infections, remain major public health concerns in Indonesia. Hand hygiene is essential for reducing healthcare-associated infections; however, nursing students often fail to practice it effectively despite having sufficient knowledge. Purpose: The present study evaluated the implementation of hand hygiene among Indonesian nursing students, assessed their adherence to the “Five Moments for Hand Hygiene” during clinical training, and examined the necessity for educational improvements using a hand hygiene checker and ATP swab testing. Methods: A cross-sectional study was conducted among nursing students from three national universities in Indonesia. Data were collected through a questionnaire survey on hand hygiene knowledge and practices, self-reported adherence to the 'Five Moments for Hand Hygiene' during clinical training, and an objective evaluation using a hand hygiene checker and ATP swab testing. Results: The majority of students understood hand hygiene techniques; however, 70% failed to meet the WHO recommended handwashing duration. Over 30% of students found it challenging to perform hand hygiene before patient contact and after touching objects in the patient’s surroundings. The hand hygiene checker revealed residual contamination on the nails and fingertips, while ATP swab testing showed that 60% of students did not meet the standard threshold. Conclusions: Despite their knowledge, nursing students face challenges in implementing the proper hand hygiene practices. Knowledge alone is insufficient; practical education with visual and numerical feedback is essential. Training with hand hygiene checkers and ATP swab testing can improve self-assessment skills and enhance adherence to hand hygiene protocols.

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