Mark Alan Graber
Department of Family Medicine, University of Iowa, USA

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Clinical Symptoms Used for Screening Diabetic Populations with Family History of Type 2 Diabetes Mellitus Siti Marlina; I Dewa Putu Pramantara; Hari J. Kusnanto; Mark Alan Graber
Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Vol 1, No 1 (2018): January
Publisher : Faculty of Medicine, Public Health, and Nursing

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (563.481 KB) | DOI: 10.22146/rpcpe.33881

Abstract

Background: The annual prevalence of diabetes is increasing worldwide. With this growing concern, the identification of clinical symptoms in high risk populations, such as those with a family history of diabetes, is becoming increasingly important.Objectives: This study aimed to determine the use of clinical symptoms and history as a screening tool for diabetes mellitus (DM) in a population with a family history of Type 2 Diabetes Mellitus (T2DM).Methods: The design of this research was a cross sectional study. The subjects of this study were a sample population with family history of T2DM living in Kasihan and Sewon District of Bantul Regency. Data were collected through interviews with questionnaires, anthropometric measurements, total cholesterol tests, triglycerides and fasting blood glucose tests. Data analysis used univariate, bivariate and multivariate analyses. For screening purposes, validity was performed against risk factors with fasting blood glucose as a gold standard.Results: Prevalence of DM was 30.5%, and prediabetes 26.5%. Body Mass Index (BMI) prevalence =23 kg/m2 59.02%, hypertension 42.62%, physical inactivity 21.31%, and dyslipidemia 78.69%. Polyuria, polydipsia, and weight loss were significantly associated with T2DM. Birth history of weight =4 kg or Gestational Diabetes Mellitus (GDM) was a risk factor associated with T2DM incidence (p = 0.018; OR: 1.93; CI 95%: 1.12-3.34). The sensitivity of a combination of several factors, birth history of baby =4 kg or GDM with dyslipidemia (sensitivity 87.3% specificity 40.9%), birth history of weight =4 kg or GDM with dyslipidemia and hypertension (sensitivity 94.7% specificity 26.7%), combination of the five factors studied (sensitivity 92.3% specificity 50%). Combination of birth history of heavy baby =4kg or GDM and BMI = 23 kg/m2  and hypertension had a likelihood ratio of 9.Conclusions: This study determined the prevalence of T2DM in populations with a family history of diabetes is high, with birth history of weight = 4 kg or GDM as a factor associated with T2DM, and other clinical symptoms having a fairly high prevalence. Therefore, a comprehensive lifestyle change needs to be done.
Sharing Management of COVID-19 in America as well as Public Health Centers and Primary Clinics in Indonesia Siti Marlina; Hari Kusnanto; Mark Alan Graber
Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Vol 5, No 1 (2022): January
Publisher : Faculty of Medicine, Public Health, and Nursing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/rpcpe.65665

Abstract

Since the Coronavirus-2019 (COVID-19) was declared by the World Health Organization (WHO) as a pandemic on March 11, 2020, and then Indonesia declared COVID-19 a national disaster on March 14, 2020, COVID-19 cases in Indonesia and the world have increased rapidly. Puskesmas and clinics are at the forefront of handling and preventing the transmission of COVID-19. Puskesmas and clinics must prepare their own resources and service protocols in order to serve the community without neglecting the safety and health of patients and health workers from the risk of transmission of COVID-19. Health workers meet with patients and visitors to health facilities every day, sometimes even with inadequate personal protective equipment (PPE), so they are very much at risk of being exposed to COVID-19, from patients or vice versa. With the increase in COVID-19 cases, a comprehensive effort is needed in case management and efforts to break the chain of transmission and keep health workers protected in conducting their duties. Modification of health service facilities in Puskesmas and clinics, changes in service flow, standard operating procedures for health services must be adjusted by paying attention to the safety of health workers and patients/visitors to avoid COVID-19 transmission. Preparedness of Puskesmas and clinics in facing the COVID-19 pandemic should be done by strict management according to the patient's condition by paying attention to PPE principles, conducting strict surveillance of suspected and positive COVID-19 cases, case reporting system within 1x 24 hours to the District/City Health Office, conducting epidemiology investigations and providing risk communication to the community as well as improving networks with stakeholders, across sectors and local community leaders.