One of the crucial health policies in hospitals is about physician payment methods. Indonesia had implemented the National Health Assurance since 2014 to achieve Universal Health Coverage by 2019. Most of hospital revenue is packaging from the National Health Insurance Agent (called BPJS). However, Fee-for-service (FFS) payment method is still dominant in many hospitals. How can hospitals make policy to rearrange the payment method to attain hospital performance? The purpose of this research is to analyze the payment system that can improve employee satisfaction and performances. Mix method was used to collect data and make an interpretation. Data collected from 185 respondents and four key informants. The result showed that the policy in private and public hospitals in Indonesia of the physician payment is diverse. Most of the hospitals use the pure FFS for self-employee physicians (part timer employee). For full time employee, they applied FFS mixed with salary, or remuneration. To improve employee satisfaction and performance, the hospitals should make a policy to link the FFS to pay for performances. The hospital should make the tailoring program by involving the physician in a designing method of the hospital remuneration.

Chlorella vulgaris, a unicellular microalgae, produces many intracellular phytochemicals namely carotenoids, tocopherols, ubiquinone and protein. Skin ageing which is induced by oxidative stress involves decreased extracellular matrix synthesis and increased expression of enzymes that degrade the collagenous matrix. The objective of this study was to determine the effect of C. vulgaris on the expression of genes encoded for collagen (COL) and matrix metalloproteinases (MMPs) which are involved in skin ageing. Human diploid fibroblasts (HDFs) were obtained from circumcision foreskin of 8-12 year-old boys. HDFs were cultured into 3 groups: untreated control cells, cells with stress-induced premature senescence (SIPS; cells were induced with H2O2 at passage 6 for 2 weeks) and SIPS treated with C. vulgaris (prolonged C. vulgaris treatment started at passage 4 and combined treatment with H2O2 at passage 6 for 2 weeks). Senescence-associated ß-galactosidase (SA ß-gal) was determined using senescent cells histochemical staining kit (Sigma, USA). Expression of COLI, COLIII, COLIV, MMPI, MMPII and MMPIII genes was quantitatively analysed with real-time RT-PCR method (iScript™ One Step real-time PCR with SYBR® Green; Biorad). HDFs treated with H2O2 (SIPS) exhibited senescent morphological features of flattening and enlarged with increased expression of SA ß-gal (p<0.05). Gene expression analysis showed COLI was downregulated in SIPS and SIPS treated with C. vulgaris (p<0.05) while COLIII decreased in SIPS and increased in SIPS treated with C. vulgaris (p<0.05). Expression of MMPI was increased in SIPS and SIPS treated with C. vulgaris (p<0.05) indicating its synergistic effect with H2O2 treatment. In conclusion, in skin ageing, COLI and COLIII genes were downregulated while MMPI was upregulated. C. vulgaris modulated the expression of COL and MMP genes by downregulating COLI and upregulating COLIII and MMPI but it did not exert anti-ageing effect.

A food premise’s sanitation level can be reflected by the cleanliness of its food contact surfaces. Contaminated foodcontact surfaces along with poor handling methods by food handlers may increase the risk of foodborne diseasesthrough cross-contamination events. This study aimed to assess the microbiological contamination levels on food contactsurfaces of 12 residential college cafeterias in a local university and its correlation with the cafeteria’s premise grade.The presence of selected indicator and pathogenic microorganisms (total viable count (TVC), total coliform, Escherichiacoli, Staphylococcus aureus, Salmonella spp., and Shigella spp.) on food contact surfaces were also determined. Cuttingboards, knives and utensils (cutleries, bowls and plates) that were used for ready-to-eat food were sampled for this study.The cafeteria’s premise grade was obtained based on the food premise inspection report by the university Health Centre.Three cafeterias have significantly higher (p < 0.05) bacterial counts (TVC) as compared to the international standard (1log CFU/cm2). E. coli was only found in 2 cafeterias while Salmonella spp. was only detected on 7 of the cafeterias. Cuttingboards were identified as the most contaminated food contact surface whereas utensils were the least contaminated. Therewas only a weak correlation between the microbiological levels on food contact surfaces and the cafeteria’s inspectiongrade (r = 0.02 p > 0.01). This study demonstrated that the sanitation level of food contact surfaces in the residentialcollege cafeterias was only average. Improvements need to be done to increase the sanitation level of the cafeterias, thusassuring the safety of the food for consumers.

Aging is associated with increased risk of frailty and malnutrition. However, food insecurity has rarely been highlighted in the elderly population, especially among the low income group. Thus, a cross-sectional study was conducted to determine the association between nutritional status, food insecurity and frailty among elderly in low income residences in Klang Valley. A total of 72 elderly individuals aged 60 years and above was selected (mean age 66 ± 6 years) through convenient sampling. Participants were interviewed to obtain information on socio-demographic, health status, food insecurity and cognitive status. Anthropometrics parameters and frailty assessments was measured using standard criteria. Results showed that 75.0% of the participants had abdominal obesity. Nearly half of the participants were overweight (41.7%), followed by normal (43.0%) and underweight (15.3%). With respect to food insecurity, most of them reported that they had enough food (93.1%). There were significant correlation (p < 0.05) between food insecurity with height (r = -0.263, p = 0.026). Most of the participants were pre-frail (58.3%), frail (27.8%) and followed by non-frail (13.9%). Calcium intake is inversely associated with frailty (t = -2.62, p = 0.011). In conclusion, food insecurity was not a problem, however, half of the subjects were overweight and pre-frail. Three out four subjects had abdominal obesity. There is a need to investigate further the pathogenesis of fat frail in this low income elderly population and formulate effective intervention strategies.
Aged ; Income

Plant-derived triterpenoids commonly possesses biological properties such as anti-inflammatory, anti-microbial, anti-viral and anti-cancer. Luvunga scandens is one of the plant that produced triterpenoids. The aims of the study was to analyze cell cycle profile and to determine the expression of p53 unregulated modulator of apoptosis (PUMA), caspase-8 and caspase-9 genes at mRNA level in MCF-7 cell line treated with two triterpenoids, flindissol (1) and 3-oxotirucalla-7,24-dien-21-oic-acid (2) isolated from L. scandens. The compounds were tested for cell cycle analysis using flow cytometer and mRNA expression level using quantitative RT-PCR. The number of MCF-7 cells population which distributed in Sub G1 phase after treated with compound 1 and 2 were 7.7 and 9.3% respectively. The evaluation of the expression of genes showed that both compounds exhibited high level of expression of PUMA, caspase-8 and caspase-9 as normalized to β-actin via activation of those genes. In summary, the isolated compounds of L. scandens plant showed promising anticancer properties in MCF-7 cell lines.
Apoptosis ; Caspase 8 ; Caspase 9 ; Cell Cycle Checkpoints* ; Cell Cycle* ; Flow Cytometry ; G1 Phase ; Gene Expression* ; MCF-7 Cells* ; Plants ; Puma ; RNA, Messenger

Introduction: Most women with postpartum depression (PPD) remain undiagnosed and untreated, despite the adverse effects known to be felt by women and children. The aim of this study was to examine the coping strategies and help seeking behavior used by women having symptoms of postpartum depression. Methods: Using a mixed-method study design, the researcher used the Edinburgh Postnatal Depression Scale (EPDS), Brief COPE and General Help Seeking Behavior (GHSQ) inventories for the quantitative approach, while the qualitative approach was conducted by a semi-structured interview based on the topics listed. A total of 30 respondents participated in the quantitative study while seven respondents were chosen for the qualitative study. Results: Data analyses identified coping strategies with domains of emotion-focused and religion-focused subscales as the main coping styles, while help seeking behavior identified that families were the main groups of people that were sought by them. Conclusion: Women with symptoms of postpartum depression tended to cope with their mental health issues by strengthening their spiritual bonds and with help and support from their family members.

Objective: To examine the proapoptotic properties of Oroxylum indicum methanol extract on cervical cancer cells. Methods: Methylene blue assay was used to determine the IC

Hand, Foot, and Mouth Disease (HFMD) is mainly caused by Coxsackievirus A16 (CVA16) and human Enterovirus A71 (EV-A71). Severe cases of HFMD were reported in Malaysia in 2018, which led to a temporary closing of few nurseries and preschools. A good knowledge and prevention practices is one of the important factors that can effectively decelerate this rapid outbreak of HFMD. Therefore, we conducted a survey to assess current knowledge and prevention practices among parents and caregivers in Bandar Puncak Alam, Selangor. A cross-sectional, questionnaire-based study was conducted on 345 residences of Bandar Puncak Alam, Selangor. It comprised of 77.4% (n=267) parents and 22.6% (n=78) caregivers from different daycares, kindergartens and preschools. The study showed that the majority, 87.2% (n=301) of Bandar Puncak Alam residents, Selangor have a moderate level of knowledge on HFMD. No significant difference in knowledge was found between parents and caregivers (p = 0.553). Age, occupation, level of education, and income of respondents influenced the HFMD knowledge level (p<0.05). Most parents and caregivers know how to prevent HFMD by practising cleaning the children's toys using liquid disinfection, but they are still lacking knowledge on the role of handwashing in preventing HFMD. In conclusion, the lack of prevention practice among parents and caregivers would increase the cases of HFMD. Therefore, a proper education of HFMD should be done to increase the awareness towards the prevention practices to prevent HFMD from reoccurring.

Introduction: This preliminary study aimed to non-invasively evaluate choline (CHO), creatine (Cr) and intramyocellular lipid (IMCL) metabolites in skeletal muscles at pre- and post-functional electrical stimulation (FES) exercise among incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale (ASIA-AIS) D patients using proton magnetic resonance spectroscopy or 1 H-MRS. Methods: These metabolites were measured from the vastus lateralis and semitendinosus muscles of three incomplete SCI ASIA-AIS D patients who completed the FES exercise and later underwent 3 Tesla (T) MRI (repetition time/echo time; TR/TE of 3500ms/100ms, field-ofview; FOV of 20cm, slice thickness of 6mm) and 1 H-MRS (TR/TE of 2000ms/31ms, voxel size of 20mm x 20mm x 35mm). Results: Out of those selected metabolites, only CHO value of vastus lateralis showed a statistically significant difference between pre- and post FES exercise 1 H-MRS scanning (p = 0.01). Conclusion: Therefore, this preliminary finding has postulated that the quantification of muscle metabolites using 1 H-MRS imaging could be used as a potential indicator in evaluating the muscle strength for incomplete SCI ASIA-AIS D patients after the completion of FES cycling exercise.

ABSTRACT Various grafting materials are utilised to facilitate regeneration. There is currently a paradigm shift towards applying poly lactic-co-glycolic acid (PLGA), which is regarded as an excellent scaffold for tissue engineering. Concentrated growth factor (CGF) has also been reported to promote wound healing. Nevertheless, the role of PLGA microspheres as a substitute for bone graft material with CGF in bone regeneration remains unclear. This study was designed to evaluate the effect of CGF with PLGA on bone formation and the expression of alkaline phosphatase (ALP) following socket preservation. PLGA microspheres were prepared using double solvent evaporation method and observed under scanning electron microscopy (SEM). A 6 mL of rabbit’s blood was collected from the marginal ear vein and centrifuged to obtain CGF. Blood was also collected for ALP assessment from 24 New Zealand White (NZW) male rabbits subjected to the first upper left premolar extraction. Sockets were filled with CGF, PLGA, CGF+PLGA or left empty and observed with microscopic computed tomography (micro-CT) at four weeks and eight weeks. The SEM image revealed a spherical shape with interconnected pores on the surface of the PLGA particles. Repeated measures ANOVA were used to evaluate the effect of time and treatment (p < 0.05) with significant differences in bone width, height, volume, volume fraction and expression of ALP was observed with CGF+PLGA. Both CGF and PLGA have the potential as the alternative grafting materials and this study could serve as an ideal benchmark for future investigations on the role of CGF+PLGA in bone regeneration enhancement.
Bone Regeneration ; Platelet-Derived Growth Factor ; Polylactic Acid-Polyglycolic Acid Copolymer