Despite accumulating evidence demonstrating strong epidemiologic and mechanistic associations between cigarette smoking, hyperglycemia, and the development of type 2 diabetes, tobacco abuse has not been uniformly recognized as a modifiable risk factor in diabetes prevention or screening strategies. In this review, we highlight population-based studies that have linked cigarette smoking with an increased risk of type 2 diabetes and summarize clinical and preclinical studies offering insight into mechanisms through which cigarette smoking and nicotine exposure impact body composition, insulin sensitivity, and pancreatic β cell function. Key questions for future studies are identified and strategies for smoking cessation as a means to decrease diabetes risk are discussed.

Smoking and the Risk of Type 2 Diabetes

世界地図帖 = World atlas

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

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Primary health care policy and vision for community pharmacy and pharmacists in Indonesia.

Snacking patterns throughout the life span: potential implications on health.

....................................................................................................................... iii Acknowledgements ...................................................................................................... v Table of contents ......................................................................................................... xi List of tables ................................................................................................................. xv List of figures ............................................................................................................. xvii List of abbreviations................................................................................................... xxi Glossary .................................................................................................................... xxiii Section A – Introduction and literature review 1 Chapter 1: Introduction .......................................................................................................... 1 1.1 Background .......................................................................................................................... 1 1.2 Aims of the thesis .............................................................................................................. 4 1.3 The researcher’s personal motivation for the topic ............................................ 5 1.4 Indonesia .............................................................................................................................. 7 1.5 Overview of study locations ........................................................................................ 16 1.6 Scope of the thesis ........................................................................................................... 24 1.7 Structure of the thesis ................................................................................................... 25 2 Chapter 2: Literature review .............................................................................................. 27 2.

Understanding health-seeking behaviours of people in Indonesia; and developing, piloting, and evaluating a culturally appropriate intervention for people with diabetes

Objectives: The prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity in developing countries was high regardless the socioeconomic status, whereas the awareness and the control of these metabolic disorders were inadequate. The aim was to compare the cardiovascular risk based on numbers of metabolic disorders among lower socioeconomic subjects. Methods: The study was done with the analytical cross-sectional method. The subjects were selected with cluster random sampling from four villages. We included the subjects of 30-65 years old and signed the informed consent but excluded the subjects who had not fasted for 8-10 hrs. We analyzed the cardiovascular parameters among groups with ANOVA statistics, the difference between actual and heart vascular age (HVA) with paired t-test, and the change of six cardiovascular parameters with radar diagram. Results: The eligible subjects (n=222) comprised 0-4 metabolic disorders at 25.2%, 33.8%, 28.8%, 9.9%, and 1.8%, respectively; with age at 50.1±9.0 years; body mass index (BMI) 24.1±4.8 kg/m2; blood pressure (BP) 141.6±23.4/82.8±11.7 mmHg; fasting blood sugar (FBS) 98.7±37.4 mg/dL; total and high-density lipoprotein cholesterol 201.0±37.9 and 55.1±12.7 mg/dL; Framingham score was 11.4±8.9% (referred as medium risk); the difference between actual and HVA at 13.2±13.0 (p<0.05). Increasing metabolic disorders lead to higher BP, FBS, cholesterol, Framingham score, and the difference between actual and HVA (p<0.05) excluding BMI in the four metabolic disorder subgroup. Conclusion: The subjects had the medium cardiovascular risk with above normal BMI, BP, and total cholesterol profiles. The average age, BP, FBS, cholesterol, Framingham score, and HVA were likely to increase equivalent to the numbers of metabolic disorders. Keywords: Hypertension, Diabetes mellitus, Dyslipidemia, Obesity, Cardiovascular risk, Metabolic disorders.

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The metabolic disorders and cardiovascular risk among lower socioeconomic subjects in yogyakarta-indonesia

Background: Evidence from previous studies demonstrates that lifestyle modification reduces the incidence and complications of atherosclerotic cardiovascular disease. The study aimed to investigate...

https://journals.sagepub.com/doi/pdf/10.1177/2150132718773674

The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population.

Background Over recent years the pharmacy profession in Indonesia has adopted a stance of pharmaceutical care to expand their scope of practice. Asthma management presents a key opportunity for pharmacists to test expanded roles in health service provision. There is however no exploratory work on the willingness, experience or future practice needs of Indonesian pharmacists in the realm of specialised asthma service provision. Objectives The objectives of this study were to explore Indonesian pharmacists' experiences, perspectives, and needs regarding the provision of pharmaceutical care for asthma patients in Indonesia. Methods The study utilised conventional qualitative content analyses with two stages, i.e.: deductive analyses and inductive concept development. Data were collected using Focus Group Discussion (FGD) Method. FGDs were conducted using a topic guide and by facilitators trained in FGD conduct. FGDs were audio-recorded and transcribed verbatim prior to analysis. A maximum variation sampling methods targeted pharmacist across various settings of practice within Yogyakarta Indonesia. Results Nine focus groups with 103 pharmacist participants were conducted, with an average of 11 participants in each group. Inductively derived concepts that emerged included: willingness to adopt asthma service provision roles, pragmatism in recognising essential barriers/facilitators in adopting such roles, reflections regarding practice gaps and barriers to interprofessional collaboration mainly in relation to doctors. Inductive data analysis indicated clear differences in responses between hospital and non-hospital pharmacists. Key barriers to service provision included lack of training, lack of supportive professional frameworks, time and lack of reimbursement channels for services. Participants urged for a visionary leadership to facilitate pharmacists' role expansion into health services provision in Indonesia. Conclusions Indonesian pharmacists were willing to adopt change and reported universally recognised barriers and facilitators to changing roles, especially in the provision of asthma care. Given this universality of pharmacists expressions, it may be suggested that the experience of researchers and academics who have expended time and effort in developing and implementing asthma care models in other countries should be, to some extent, transplanted to regions where pharmacy organisations are now considering adopting roles additional to medicines supply.

Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study.

Aim : to evaluate the participant rate of the new universal health coverage (UHC) and its impact on the hypertensive subjects from the rural area in the Sleman-District of Yogyakarta during the early implementation. Methods : this epidemiological survey of the new UHC implementation was included as an analytical crosssectional study done with cluster random sampling. The subject criteria were aged 30-85 year, not in pregnancy, and signed the informed-consent. Subjects were grouped based on the health coverage disparity and analyzed with chi-square statistics for the hypertension prevalence, awareness, therapy, and control. The additional variables of BMI, education, occupation, income, smoking, diet control, physical activity, and health facilities were grouped into binomial data and analyzed based-on the health coverage disparity. Results : of 926 total subjects, 602 (65.0%) subjects had the health coverage including 9.2% of the new UHC. The groups of with and without health coverage were not significantly different in hypertension prevalence, the profile of age, blood pressure, and the proportion of the other variables (p>0.05) except for smoking and physical activities. In the high blood pressure sub-group (n=446), the subjects without health coverage had lower proportion of the hypertension awareness p 0.05). Conclusion : the participant rate of new UHC was relatively low at 9.2%. Among the subgroup with ≥140/90mmHg blood pressure, the subjects without health coverage were more likely to have lower hypertension awareness and suboptimal therapy than those with the health coverage program. Key words : universal health coverage, hypertension, awareness, therapy.

Dita Maria Virginia

Papers

The metabolic disorders and cardiovascular risk among lower socioeconomic subjects in yogyakarta-indonesia

The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population.

Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study.

Early Implementation of Universal Health Coverage Among Hypertension Subjects in Sleman District of Yogyakarta.

Seluk beluk hipertensi: peningkatan kompetensi klinis untuk pelayanan kefarmasian