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IntroductionDiabetes mellitus is a chronic disease with a high prevalence world wide. This disease has also been reported to affect the quality of life (QOL) of the patient and their family due to its chronic nature and multi organ involvement. The aim of this study was to analyze the association between adherence to prescribed diabetes medication and diabetes-specific QOL in patients attending Secondary Health Care Facility in Bandung City, Indonesia.MethodsA cross-sectional survey was conducted in the Secondary Health Care Facility in Bandung City, Indonesia. Data were collected between February and April 2014 using consecutive sampling. Adherence was assessed using the eight-item Morisky Medication Adherence Scale while diabetes-specific-QOL was assessed using the Diabetes 39 instrument.ResultsThe results showed that among the patients, 49.4% exhibited low adherence, 29.7% exhibited medium adherence, and 20.9% exhibited high adherence to diabetes medication. Diabetes-specific QOL proved to be highly affected in the sexual functioning domain. Social-burden domain scores were better than overall QOL scores. There was a significant association between adherence and diabetes-specific QOL (p = 0.009) using The Kruskall-Wallis test of significance. The results of the post hoc Mann–Whitney tests (high vs medium adherence, p = 0.084; medium vs low adherence, p = 0.86; and high vs low adherence, p = 0.001) indicated that higher adherence to prescribed diabetes medication contributed to an improved QOL. Multiple regression analysis showed that the predictors of diabetes-specific QOL were adherence and patient income.ConclusionsAdherence to prescribed medication showed a positive effect on diabetes-specific QOL in patients. Patients with a high adherence to medication had an improved QOL. This result is important not only in developing intervention programs for patients but also in improving their QOL through sustainable health promotion.

BACKGROUND: Cytokines might be helpful to diagnose late onset sepsis (LOS) in newborn infants. Many studies on cytokines did not discriminate culture-proven from clinically-suspected sepsis; however, such differentiation is clinically useful. OBJECTIVES: To evaluate the feasibility to differentiate among culture-proven LOS, clinical LOS and controls using a battery of cytokines. STUDY DESIGN: This prospective study was conducted at the NICU of Harapan-Kita Women and Children's Hospital, Jakarta-Indonesia. Three groups of infants with postnatal age >72 hours of age were enrolled in the study: culture-proven sepsis group (PS) (n = 18), clinical sepsis group (CS) (n = 25) and control group (n = 34). A battery of 25 cytokines was measured in each infant five times: at enrollment, after 4 hrs, 12 hrs, 24 hrs, and 48 hrs using Invitrogen-immunoassays-Luminex TM 100. RESULTS: There were no significant differences in gestational age or mode of delivery among the three groups. IL-1␤, IL-2r, IL-6, IL-8, IL-10 and MIP-1a were significantly higher at all measurement points in group PS compared to controls. IL-13 was lower at all measurement moments in group CS compared to controls, IL-12 was lower and IP-10 higher between 0 and 24 hrs. IL-1Ra, IL-6, IL-8, IL-13, IL-15, TNF␣, MIP-1a and MIP-1b were higher at all the measurement moments in group PS compared to group CS. The ROC curves show that IL-6, IL-8, IL-15, MIP-1a, MIP-1b and TNF␣ have a sensitivity and specificity between 80 and 85% during the first 24-48 hours after the onset of infection. IL-6, IL-15, MIP-1a, MIP-1b and TNF␣ showed the best likelihood ratios. CONCLUSIONS: IL-6, IL8, IL 15, MIP-1a, MIP-1b and TNF␣ are potentially good markers for detecting a proven LOS. In case these cytokines are not elevated in sick infants, other causes than an infection have to be identified.

To assess the effects of a targeted and tailored pharmacist-led intervention among patients with type 2 diabetes (T2DM) who are nonadherent to antihypertensive drugs. Methods: A cluster-randomised controlled trial was conducted in 10 community health centres (CHCs) in Indonesia among T2DM patients aged ≥18 years who reported nonadherence to antihypertensive drugs according to the Medication Adherence Report Scale (MARS-5). Patients in CHCs randomised to the intervention group received a tailored intervention based on their adherence barriers (eg, forgetfulness, lack of knowledge, lack of motivation and/or other drug-related problems) using a simple question-based flowchart at baseline and 1-month follow-up. Patients in control CHCs received usual care. Primary outcome was the between-group difference in change in MARS-5 score from baseline to 3-month follow-up. Secondary outcomes included changes in patients' blood pressure and their medication beliefs. Differences in difference in primary and secondary outcomes between groups were assessed using general linear models. Results: In total, 201 patients were screened for eligibility, 113 met the inclusion criteria and participated, and 89 (79%) patients had complete follow-up. Forgetfulness (42%) and lack of knowledge (18%) were the most common adherence barriers identified at baseline. The intervention improved medication adherence by 4.62 points on the MARS-5 scale (95% CI 0.93 to 8.34, P value = 0.008). There were no significant changes in blood pressure levels and beliefs about antihypertensive drugs. Conclusion: A tailored low-cost pharmacist-led intervention aimed at nonadherent T2DM patients resulted in an improvement in medication adherence to antihypertensive drugs. There were no significant changes in secondary outcomes. The authors confirm that the principal investigator for this paper is S.D.A. and that she had direct clinical responsibility for patients.