Indah S. Widyahening
Department Of Community Medicine, Faculty Of Medicine Universitas Indonesia, Jakarta

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Is gluten free and casein free (GFCF) diet effective for individuals with autism? Widyahening, Indah S.; Ismail, Raden I.
Medical Journal of Indonesia Vol 20, No 2 (2011): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (44.354 KB) | DOI: 10.13181/mji.v20i2.440

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Background: Even though the etiology of autistic spectrum disorder (ASD) has not been clearly known, various types of therapies have been offered. One of the most popular therapies is Gluten Free and Casein Free Diet – GFCF diet.Methods: A structured internet literature search was conducted using Pubmed and Cochrane library. Titles and abstracts were screened using predetermined selection criteria. Critical appraisal was conducted based on standard criteria for relevance, validity, and levels of evidence.Results: Based on relevance, only four out of twelve selected articles can be used; one is a systematic review and three randomized controlled trials (RCTs). Several methodological problems which could lead to over-estimation of the effect were found in the studies including poor randomization and selective drop-out. Risk of under-estimation of report due to small number of participants and in-adequate duration of intervention was also found. Small to moderate improvement were found in some outcome measured including overall autistic traits, social isolation, and the ability in communication and interaction. However, insignificant differences also found in some area such as individual’s behavior, cognitive and motor function.Conclusion: Available studies fail to provide sufficiently credible and strong evidence to recommend the practice of GFCF diet in treating autism. (Med J Indones 2011; 20:114-8)Keywords: autism, gluten free and casein free diet
High level of work stressors increase the risk of mental-emotional disturbances among airline pilots Widyahening, Indah S.
Medical Journal of Indonesia Vol 16, No 2 (2007): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (115.209 KB) | DOI: 10.13181/mji.v16i2.267

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Civilian airline pilots have one of the most stressful occupations. The aim of this study was to identify the effect of work stressors and other factors on mental-emotional disturbances among airline pilots. A cross-sectional study was done by interviewing selected pilots of an airline using appropriate questionnaires, during their routine medical examination from May to July 1999 in Jakarta. Five aspects of work stressor were assessed: working conditions, physical conditions of working environment, career development, organization and interpersonal relationship. Mental-emotional disturbances were determined by using the Symptom Checklist 90 (SCL 90) questionnaire. Data analysis was carried out using relative risk by Cox regression with constant time. From 128 subjects interviewed, 109 could be analyzed. Most of the subjects were married (73.4%) and college graduates (91.7%). The number of captains and first officers were almost equal. The prevalence of mental-emotional disturbances was 39.4%. Mental-emotional disturbances were significantly related to work stressors and moderately related to household tension (P = 0.184). Compared to pilots with low levels of work stressors, those with high or very high levels of work stressors had a risk of 4.6 times of mental-emotional disturbances [adjusted relative risk (RRa) = 4.64; 95% confidence interval (CI) = 1.01 – 19.65]. Adequate guides to cope work stressors and household tension which related to mental-emotional disturbance is recommended. (Med J Indones 2007; 16:117-21)Keywords: mental-emotional disturbance, work stressors, household tension, airline pilots
Levothyroxine use and thyroid gland volumes in children with autoimmune thyroiditis: a systematic review and meta-analysis Annang Giri Moelyo; Indah Suci Widyahening; Bambang Tridjaja
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (764.737 KB) | DOI: 10.14238/pi59.4.2019.202-10

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Background Autoimmune thyroiditis may manifest as overt hypothyroidism, subclinical hypothyroidism, euthyroidism, or hyperthyroidism in children. Although there is no consensus on treating euthyroidism and autoimmune thyroiditis in children, some studies have demonstrated the efficacy of levothyroxine in reducing thyroid volume, improving thyroid function, and stabilizing the immunological process. Objective To determine the effect of levothyroxine on thyroid gland volume changes, thyroid function, and thyroid antibodies in euthyroid children with autoimmune thyroiditis. Methods We performed a literature search of electronic databases (the Cochrane Library, MEDLINE, EBSCO, ProQuest, clinicaltrials.gov, and other sources, as well as a non-electronic search (searching journals and conference proceedings by hand) to identify studies of euthyroid children with autoimmune thyroiditis published by August 2018. Only English-language articles were included in the search (electronic and non-electronic). Randomized controlled trials that compared levothyroxine with a control (placebo or no treatment) in euthyroid children with autoimmune thyroiditis were selected. The outcome measures were thyroid volume changes, thyroid function, and thyroid antibody levels in euthyroid children with autoimmune thyroiditis. Two authors independently extracted the data, assessed the risk of bias, and analyzed the pooled data from the included studies using a random effects model. The same authors performed a sensitivity analysis. Results We identified 57 studies. Of these, three studies, involving 97 subjects (51 subjects in an intervention group and 46 subjects in the control group) were selected for inclusion in a systematic review/meta-analysis. The meta-analysis revealed a significant difference in mean thyroid volume changes between the two groups (-1.10 SDs; 95%CI -1.56 to -0.64; P<0.0001; I2=6%). The mean difference in the thyroid-stimulating hormone (TSH) change of the two groups was -1.82 mU/L (95%CI -3.52 to -0.11; I2=87%; P=0.04). The standardized mean difference in free thyroxine (fT4) change of the two groups was 0.82 pmol/L (95%CI -1.14 to 2.78; I2=89%; P=0.41). Conclusion In euthyroid children with autoimmune thyroiditis, levothyroxine treatment reduces the thyroid volume better. The TSH level change in the intervention group is better than those in the control group. Levothyroxine treatment did not significantly improve free T4.
Comparison of Students’ Characteristics, Self-Motivation, and Readiness of Self-Directed Learning Implementation among Medical Students at Maranatha Christian University Gunanegara, Rimonta F; Wahid, Mardiastuti H; Widyahening, Indah S
Journal of Medicine and Health Vol 1, No 5 (2017)
Publisher : Maranatha Christian University

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Self-Directed Learning (SDL) is an important skill that must be achieved by medical students.The aim of this study is to identify the level of self-motivation and SDL readiness in the medicalstudents as well as to identify factors affecting SDL. This is is a mixed method research,involving first-year and clinical year medical students. A quantitative research is conducted bydistributing self-motivation (MSLQ) and SDL questionnaire (SDLRS). A total sampling isapplied to select the respondents. Furthermore, focus group discussion (FGD) on students andtutors/preceptors is carried out. Informants are chosen by purposive sampling method. Thisresearch reveals that most of medical students have a good level of self-motivation but a lowlevel of SDL readiness. Nevertheless, the mean scores of SDL readiness in both groups showsno significant differences. The research also identifies four major factors affecting the SDLreadiness, namely the students’ characteristics, learning process, the role of tutors/preceptorsand supporting facilities for learning. There is no significant difference between SDL readinessof the first-year and clinical year of medical students. Unprepared students’ characteristics,sub-optimal learning process, unsupported role of tutors/preceptors and inadequate learningresources are found to be the mayor factors influencing SDL readiness.Keywords: self-directed learning readiness; self-motivation; problem-based learning
Does the establishment of universal health coverage drive the foundation of postgraduate education for primary care physicians? Widyahening, Indah S.; Tanoto, Rodri; Rinawan, Fedri; Setiawati, Elsa P.; Leopando, Zorayda E.
Medical Journal of Indonesia Vol 26, No 2 (2017): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (486.652 KB) | DOI: 10.13181/mji.v26i2.1857

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Background: Studying the formation of postgraduate training in primary care within countries which has attained Universal Health Coverage (UHC) is important to support the development of similar training in low-and middle-income countries aiming to achieve UHC by 2030. This review aims to describe the state of postgraduate training for primary care physicians in UHC-attaining countries.Methods: A literature review of published literature and official documents from the websites of regional and global health/primary care organizations or societies such as World Health Organization (WHO), World Organization of Family Doctors (WONCA), European Forum for Primary Care, European Union of General Practitioners (GP)/Family Physicians (FP), European Academy of Teachers in GP/Family Medicine (FM), as well as the websites of GP/FP organizations in each of the respective countries. The list of UHC attained countries were identified through WHO and International Labor Organization databases.Results: A total number of 72 UHC-attained countries were identified. Postgraduate education for primary care physicians exists in 62 countries (86%). Explicit statements that establish primary care postgraduate training were corresponded with the policy on UHC is found in 11 countries (18%). The naming of the program varies, general practice and family medicine were the commonest. In 33 countries (53%), physicians are required to undertake training to practice in primary level. The program duration ranged from 2–6 years with 3 years for the majority.Conclusion: Although UHC is not the principal driving force for the establishment of postgraduate training for primary care physicians in many countries, most UHC-attaining countries make substantial endeavor to ensure its formation as a part of their health care reform to improve national health.
Epidemiology of Microorganisms in intraabdominal infection/complicated intraabdominal infections in six centers of surgical care in Indonesia: A preliminary study Moenadjat, Yefta; Lalisang, Toar JM.; Saunar, Rofy S.; Usman, Nurhayat; Handaya, Adeodatus Y.; Iswanto, J.; Nasution, Safruddin; Karuniawati, Anis; Loho, Tony; Widyahening, Indah S.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Data of complicated intraabdominal infections (cIAI) and the epidemiology of causative microorganisms which is Indonesian characteristics is required to develop a guideline. Thus, a preliminary study run to find out such characteristics. Method. Data of subjects with cIAI managed in six centers of teaching hospital in Indonesia in period of 2015–2016 were collected. Those data of source of infection, the epidemiology of microorganism and susceptibility of antibiotics were descriptively provided. Results. Source of infection were perforated appendicitis (26.64%), perforated gastric and duodenal ulcer (22.70%), small bowel perforation (11.84%), large bowel perforation (13.16%), postoperative (9.54%), and others (16.2%). Escherichia coli and Klebsiella pneumonia were the most microorganisms found in the pus specimen. The sensitivity of Escherichia coli and Klebsiella pneumonia to cephalosporins were in range of 14.1– 42% and 28.7–35.6%, respectively. Conclusion. Perforated appendicitis, perforated gastric and duodenal ulcer, small bowel perforation, large bowel perforation, and postoperative in sequent are the main causal of cIAIin Indonesia. The epidemiology predominated by Gram negative, particularly Escherichia coli and Klebsiella pneumonia.
Association between Helicobacter Pylori Infection and Graves’ Disease: A Meta-Analysis Darmawan, Guntur; Simadibrata, Marcellus; Widyahening, Indah Suci
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, August 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (540.463 KB) | DOI: 10.24871/182201767-72

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Background & Aims: Helicobacter pylori (H. pylori) infection is proposed to be related with autoimmune diseases, such as Graves’ Disease (GD). This study aimed to assess the association between H. pylori infection and GD. Methods: A systematic literature review was conducted using Pubmed and Cochrane library. The quality of enrolled studies was assessed by the Critical Appraisal Skills Program Oxford. A fixed-effect model approach was used if there was no heterogeneity; otherwise, a random-effect model was used. Heterogeneity was assessed using I2. Publication bias was assessed by funnel plot. All data were analyzed using REVIEW MANAGER 5.3. Results: Six studies from Europe and Asia involving 983 patients were included. Overall H. pylori infection was significantly associated with GD (OR 2.7; 95% CI: 1.47-4.99; p < 0.001). In subgroup analysis of 3 studies using non-serological diagnostic method, the prevalence rate of H. pylori infection was higher in GD group (78.26% VS 42.42%) with significant relationship (OR 4.93; 95% CI: 3.16-7.69; p < 0.00001; I2 = 0%). The CagA antibody prevalence was significantly higher in GD group (46.57% VS 20.29%; OR 4.41; 95% CI: 2.65-7.33; p < 0.00001; I2 = 56%). No publication bias was observed. Conclusion: Our study showed association between H. pylori infection and GD. It might suggest the need of H. pylori examination in GD patients and the impact of H. pylori eradication in the treatment of GD.
Extracoporeal shockwave treatment decreases pain, functional limitations and medial collateral ligament thickness in subjects aged 50-70 years with knee osteoarthritis Kokok, Andwi Setiawan; Tamin, Tirza Z; Murdana, Nyoman; Widyahening, Indah Suci
Universa Medicina Vol. 40 No. 2 (2021)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2021.v40.121-132

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BackgroundPain from knee and hip osteoarthritis (OA) can have a significant impact on the physical function and quality of life of affected individuals worldwide. The objective of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pain, flexibility, function, and medial collateral ligament (MCL) thickness in knee osteoarthritis (KOA). MethodsA study of quasi experimental design was performed involving 15 subjects aged 50 – 70 years with Kellgren-Lawrence grade 2-3 KOA. All subjects were evaluated regarding baseline -pain using visual analogue scale (VAS), range of motion (ROM), functional outcome using Western Ontario and McMaster Universities Arthritis Index (WOMAC), and MCL size. Extracorporeal shock wave therapy was given 3 times, at baseline, and 4 and 8 weeks after intervention. All subjects were given 4000 shocks at intensities of 1.5 – 4 Bar (raised gradually) per session. The shocks were given in the supine position, knee flexed 90o, without topical anesthetic. Statistical analyses were conducted using a dependent t-test. ResultsAfter 8 weeks of intervention, ESWT significantly improved pain score (p<0.01), WOMAC (p<0.01) and MCL thickness (p<0.01) in patients with OA of the knee. However, there was no significant difference in knee ROM, both for degree of flexion and extension (p>0.05). ConclusionThe use of ESWT for treatment of knee OA had a beneficial effect on pain relief, function outcome and MCL thickness. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve maximum improvement.
Relationship of Night Shift Work and Breast Cancer Arnold Fernando; Muhammad Ilyas; Indah Suci Widyahening
The Indonesian Journal of Community and Occupational Medicine Vol. 1 No. 1 (2021): ijcom
Publisher : ILUNI MKK FKUI and PRODI MKK FKUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (263.904 KB) | DOI: 10.53773/ijcom.v1i1.3.15-22

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Background. Breast cancer is the most common cancer among women worldwide. 80% of breast cancer that has been identified in Indonesia has progressed into an advanced stage of malignancy. In 2007, the International Agency for Research on Cancer concluded: shift-work that involves circadian disruption is probably carcinogenic to humans (Group 2A) Aim. This study aims to justify the association between night shift work and breast cancer. Methods. Searching literature for the evidence-based has been conducted with a clinical question through "PICO" method. Then continued with literature searching using the electronic database "PubMed" and "google scholar" search engine. The keyword is "shift work" "night shift" "breast cancer" and combined with MeSH terms and Boolean operation. The inclusion criteria are research on humans, and the exclusion is inaccessible studies, case report studies, and retracted articles. Result. All of the ten prospective studies that have been combined, the weighted average RR was 0.99 (95% CI = 0.95 to 1.03) for any night shift work compared with none. There was no statistically significant heterogeneity across studies (P = .052). ). But if based on a study of more than 20 years, the RR was 1.01 (95% CI = 0.93 to 1.10). And if based on a study of more than 30 years, the combined RR was 1.00 (95% CI = 0.87 to 1.14, P heterogeneity = 0.067. Confidence intervals for the incidence rate ratios on this study are narrow, even for 20 or more years of night shift work (RR = 1.01, 95% CI = 0.93 to 1.10), so these findings exclude a moderate association of breast cancer incidence with long duration night shift work Conclusion. There are insignificant associations between night shift work and breast cancer.