Hari Gizi Nasional
Safira Putri Saifudidn–Vice NPO for Internal Affairs SCOPH
Malnutrition is one of the issues that has the biggest impact and is still one of the main areas of focus for national health development in Indonesia. Malnutrition, according to the WHO, is characterized by a person's intake of energy and/or nutrients being insufficient, excessive, or unbalanced.
According to the results of the Ministry of Health's 2021 Indonesian Nutrition Status Study (SSGI), 24.4% of toddlers in Indonesia are stunted, 7.1% are wasted, and 17.0% are underweight. Numerous elements, such as parental style, the environment, and access to healthcare services, have an impact on this high number.ThereforeSCOPHCIMSAwants to survey to find out public awareness, knowledgeandviewsaboutMalnutrition and Food Security in Indonesia as a basis for implementing the National Nutrition Day campaign in February 2023.
The HGN SCOPH CIMSA consists of 3 main events. On the first day, we conduct a volunteering program in Puskesmas Kemirimuka, we are welcomedverywarmlybyallofthe
cadres there, and we do general checkups as well as educate them with pamphlets that we made. It was a full success because the participants exceededthetarget.
Not stopping there, The second day's agenda is a talk show held in the Seminar Room of the Rectorate of Yarsi University. This talk show discusses holistically regarding malnutrition and food security from the perspectives of policy, field, and the food industry. The discussion begins by highlighting the role of interprofessional in community- based malnutrition prevention by Safarah Risvie, Program Support & Impact Officer of the 1000 Days Fund NGO. The conversation is then continued with the perspective of food securityraisedbyM.HendroUtomo,the founder of the Foodbank of Indonesia. The government's policy aspects in controlling malnutrition are also presented by DR. dr. Rr. Brian Sri
Prahastuti, MPH, is the Senior Expert of the Office of the President of the RepublicofIndonesia.
Thelastdaywasclosedwithaground 12
campaign and general check-up on Car Free Day in Taman Spot Budaya Dukuh Atas. We do high blood pressure, cholesterol, and uric acid test freely for them. Also, we are collaborating with Sahabat Gizi as a provider of nutrition experts for nutrition consultations. We were fulfilled and surprised by the crowd there. Not to mention that our event was also featured by Sultan TV at the very end.
Through the National Nutrition Day
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The Breath-taking Ways to Breathe Freely
Cahyadi Budi Sulistyoaji from CIMSA UI
Early May is always celebrated as World AsthmaDay.Asthmaisachronicairway diseasethataffectspeopleofallages.It is estimated that 262 million people have asthma, which caused 461,000 deaths in 2019. Meanwhile, in Indonesia, based on the Riset Kesehatan Dasar (Riskesdas) 2018, 2.4% ofthepopulationhasasthma.Asthma's symptoms include coughing, wheezing, shortness of breath, and a feeling of heaviness inthechest.Thenarrowingof the airways can be caused by inflammation or muscle tension around theairways,causingbreathingdifficulty.
Genetic and environmental factors influence the incidence of asthma attacks. Someone who genetically has an increase in IgE production, hypersensitivity in the airways, and the production of inflammatory mediators is prone to developing asthma. Meanwhile, environmental factors such as house dust mites, animal allergens, pollen, cigarette smoke, cold air, and others can be asthma triggers. About a third to a half of asthma cases are accompanied by severe symptoms that interferewithdailylife.
Therefore, it is essential to recognize simplestepsthatcanbetakentoreduce asthma symptoms. Some breathing exercisescanbenefitasthmapatientsby improving breathing patterns, increasingrespiratorymusclestrengthor endurance, and increasing chest cavity flexibility. These breathing exercises include diaphragmatic breathing, nasal breathing, the Papworth method, Buteyko breathing, pursed lip breathing,andyogabreathing.
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To do diaphragmatic breathing, you must lie down with your knees bent or sit comfortably.Placeonehandonyour chest and the other on your stomach. Then, inhale slowly through the nose and exhale through the mouth. However, some studies suggest breathing through your mouth can worsen asthma symptoms. That is because the air inhaled through the mouth is dry and cold. Therefore, nasal breathing is recommended because it can inhale warm, moist air to help relieveasthmasymptoms.
Next is the Papworth method, which consists of diaphragmatic breathing and relaxation exercises. The Papworth method helps patients avoid breathing thatistoo deeporfast.Apartfromthat, there is also a unique breathing technique called the Buteyko technique. The Buteyko technique is performed by breathing normally for the first few minutes. After exhaling, you must hold your breath by pinching your nose with your thumb and forefinger.Holdyourbreathuntilthereis an urgency to take in the air. Then breathe normally and repeat the steps severaltimes.
In addition to breathing exercises, asthmasymptomscanbepreventedand reduced through exercise or physical activities such as swimming, walking, hiking, and leisurely cycling. Swimming is one of the most recommended physical exercises for people with asthma. People with asthma can well receive swimming because it has a minor bronchoconstrictive effect compared to other physical activities. Lying body position while swimming can reduce the resistance in the airways.
Swimming also allows moist air to enter whenbreathing,whichcanreducethe
concentration of mucus in the airways, asoneofthecausesofasthma.Evenso, it is essential to pay attention to the presence of chlorine used as a disinfectant in swimming pool water because it can trigger asthma and allergies.
Avoiding asthma risk factors is also an important step that needs to be taken to prevent asthma. Obesity is a significant risk factor for asthma and is associated with morbidity in children and adults. However, obesity-related asthma can occur through various mechanisms, such as dietary factors, lung anatomy and physiology changes, andgenetics.
Obesity can interfere with lung function due to increased resistance by fatty tissue around the chest wall and abdomen. An increase in abdominal fat will push the diaphragm upward, interfering with lung expansion and reducing lung capacity. Moreover, obesity is a risk factor for bronchial hyperresponsiveness, which can disturb bronchodilation ability and cause asthma.
Diets high in fructose and saturated fatty acids and low in fiber and antioxidants are known to cause asthma. Foods high in saturated fat can increaseinflammationinthe airways
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anddecreasebronchodilation.Thehighfructose diet can cause systemic metabolicdisordersandoxidativestress in the airways. Therefore, maintaining an idealbodyweightthroughahealthy andbalanceddietisvitaltopreventthe onsetof obesity-relatedasthma.
Another risk factor for asthma is cigarette smoke. Cigarette smoke can cause asthma through various mechanisms. Cigarette smoke can damage the cilia in the airway epithelium. That means dust and dirt cannot be swept out of the airways. In addition, cigarette smoke also contains carcinogenic substances, such as tar, which can cause lung cancer and emphysema. Therefore, we must intensify the smoking cessation program and create a smoke-free environment.
Breathing exercises and minimizing exposure to risk factors cannot prevent asthma attacksalone.Thesestepsmust still be accompanied by asthma medications that consist of relievers or controllersbasedontheusetime.Ifthe symptoms become more exaggerated, contactyourdoctorimmediately.Donot everletasthmatakeyour dayaway.
REFERENCES
World Health Organization. Asthma [Internet]. Geneva: World Health Organization; 2023 May 4 [cited 2023 May 10]. Available from: https://www.who.int/news-room/fact sheets/detail/asthma
Global Asthma Network. The Global Asthma Report. Int J Tuberc Lung Dis.2022; 26:S1–S102.
Quirt J, Hildebrand KJ, Mazza J, Noya F, Kim H. Practical guide for allergy and immunology in Canada 2018. Allergy Asthma Clin Immunol. 2018Sep12;14:50.
Watson S. Breathing exercises for severe asthma [Internet]. San Francisco: Healthline; 2019 Oct 18 [cited2023May10].Availablefrom: https://www.healthline.com/health/ get-serious-about-severe-asthma/ breathing exercises-severeasthma#Should-you-try-breathingexercises?
Nunez K. All about asthma and exercise [Internet]. San Francisco: Healthline; 2020 Jan 28 [cited 2023 May 10]. Available from: https:// www.healthline.com/health/asthma/ exercise-for-asthma
Bernard A. Asthma and swimming: weighing the benefits and the risks. Jornal de Pediatria. 2010;86(5):351-2.
Peters U, Dixon A, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018Apr; 141(4):1169-79.
Baffi CW, Winnica DE, Holguin F. Asthma and obesity: mechanisms and clinical implications. Asthma Research and Practice. 2015 Jun
Cleveland Clinic. Smoking & asthma [Internet]. Ohio: Cleveland Clinic; 2021 Apr 30 [cited 2023 May 10]. Available from: https:// my.clevelandclinic.org/health/ articles/4584-smoking--asthma#
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How a Strong Mindset Can Be the Key to Prevent Smoking in Teenagers
Nayandra Reyhan Maheswara from CIMSA UGM
The problem of smoking in Indonesia is unlikely to be solved quickly. Although this issue seems to have disappeared from the radar due to the series of events we have experienced in recent years, the number of smokers in Indonesia has increased sharply. Despite some efforts to reduce the number of new smokers, such as the issuance of the Permenkes no. 28 Tahun 2013 concerning Health Warnings and Health Information on Tobacco Product Packaging, the Ministry of Health of Indonesia stated that the prevalence of smokers aged 10-18 years increased from 7.1% in 2013 to 9.1% in 2018. Based on data from the Ministry of Health, this high number of young smokers is considered inconsistent with the National Medium-Term Development Plan (RPJMN) 2019, which targets a reduction in the prevalence of smokers to 5.2%. Furthermore, the results of the Basic Health Research (Riskesdas)datain2010showedthatthe age when people start smoking in the Yogyakarta Special Region is mostly at the age of 15-19 years (38.7%), followed by10-14years(19.5%).
What many people may not realize is the abundance of cigarette advertising around us. Cigarette advertising targets young people by tending to show that smokers are a symbol of masculinity, which can trigger teenagers to imitate such behavior. The continuous exposure to cigarette advertising, both directly and indirectly (through various media), can enter the subconscious mind of teenagers and successfully persuade them that smoking is a common, normal, and very common thing to do. Teenagers who are in the process of forming their identity are attracted to the positive image offered by cigarette advertising. This "habituation and positive feeling" is also supported by manyfactors,including Family factors, where parents who smoke often smoke in front of their children and tend to allow their children to smoke. Parents who do not smoke also sometimes do not supervisetheirchildren'sbehavior,so thechildsmokessecretly.
School factors, many boys are pressured by their friends to smoke for various reasons. Habituation is alsooftensupportedbylow
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regulations, which make some teachers found smoking inside the school.
Individual factors who may experience stress, curiosity, or receive incorrect information about cigarettes.
Looking back at the data above, it is ironic that the age at which someone starts smoking is the same age when theyshouldreceiveeducationaboutthe dangers of smoking. Various steps have been taken to prevent the increase of young smokers, such as making a regulation that requires the display of warning signs about the dangers of smoking. These signs include scary photos on every cigarette advertisement, and even on the cigarette package itself. Furthermore, cigarette advertising is limited to not displaying cigarette products, and on television, cigarette advertisements can only be shown after 10 pm. Along with this,cigarettepricesarealsocontinually increased. These efforts are aimed to prevent people from trying cigarettes for the first time, but is it effective? The
One scientific explanation for why teenagers start smoking even though they know it is harmful is the delayed maturation of the cortex, which functions for critical thinking. In the stages of adolescent cognitive development, there are terms known as concrete thinking and abstract thinking. Concrete thinking is centered on tangible and real things, while abstract thinking is a more advanced mode of thinking that involves processing theoretical concepts and enables us to establish connections and recognize patterns. Individuals with a concrete mindset tend to prioritize immediate rewards and underestimate future costs anddamages,makingitharderforthem to improve their situations. Encouragingly, teenagers who can think in abstract ways tend to make better decisions and trust in their capacity to controltheirfutures.
Although the level of constructiveness tends to increase as individuals age, research has shown that it can change naturally or be altered through simple interventions. Before educating
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tailor the content to their reasons for being interested in smoking. Then, encouragethemtoadoptamindsetthat starts with "why" I shouldn't smoke, ratherthan"what"Ican'tdo.Emphasize thebenefitsofquittingsmoking,bothin the short and long term. Teach teenagers to politely but firmly refuse invitations to smoke, for example, "No, thank you, I don't smoke." This education can be delivered verbally or visually, such as posting signs on their bedroomdoors.
From what has been written above, it appears that despite many external factorsinfluencingsomeonetosmoke,it isoneselfwhoholdsthefinaldecisionto light up a cigarette for the first time. A strong mindset most often comes from withinoneselfandrarelyoriginatesfrom external factors. Nevertheless, healthcare professionals and medical students can assist in facilitating both personalandgroupeducationaswellas monitoring progress that has been made. A strong mindset has proven to beeffectiveinpreventingsomeonefrom smoking, as various temptations from the outside will immediately fade away when they recall the dangers of smoking.
REFERENCES
Aguilar, P., Caballero, A., Sevillano, V., Fernández, I., Muñoz, D., & Carrera, P. (2020). The Relationships between Economic Scarcity, ConcreteMindsetandRiskBehavior: A Study of Nicaraguan Adolescents. International journal of environmental research and public health, 17(11), 3845. https:// doi.org/10.3390/ijerph1711384
Damang, S., Syakur, R., Andriani, R. 2019. Faktor yang Berhubungan dengan Perilaku Merokok pada Remaja di SMP Negeri 7 Langgudu Kabupaten Bima. Jurnal KomunitasKesehatanMasyarakat,1(1)
Fajriansyah, M. R., 2022. INTERNAL TRAINING MODULE SMOKING CESSATION.SCOPHCIMSA Horkovska, I., 2023. The Development of Concrete and Abstract Thinking Patterns. Available at : https://us.calmerry.com/blog/ psychology/the-development-ofconcrete-and-abstract-thinkingpatterns/ #:~:text=Abstract%20thinking%20an d%20concrete%20thinking%20are% 20two%20types%20of%20thought,m ake%20connections%20and%20see %20patterns
Sutha, D., Prabandari, Y. & Padmawati, R. 2023. Smoking behavior among junior high school students based on the theory of planned behavior in Madura, Indonesia. International Journal of Adolescent Medicine and Health, 35(1), pp.61-68. https://
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STUNTING : The Danger Behind Small Stature in Children
Iffa Adilla Putri Hariadi from CIMSA FK USK
Indonesia is still busy struggling with the problem of stunting. There is quite a long way to go in order to build healthy, productive and competitive human resources, due to the complexity of the causes of stunting that must be overcome. Stunting and short indeed both produce a body that is not too tall. However, stunting and shortness are different conditions that require different treatment.
Stunting is malnutrition in infants in the first 1000 days of life that lasts a long time and causes delays in brain development and child development. Due to chronic malnutrition, stunted babies grow shorter than the standard height for toddlers of their age. But remember, stunting must be short, while those who are short are not necessarily stunted.
According to WHO, a country is said to have a stunting problem if its cases reach above 20%. The results of the Indonesian Toddler Nutrition Status Survey (SSGBI) show that there has been a decrease in the stunting rate from 24.4% in 2021 to 21.6% in 2022.
However, this percentage is still said to be high and still requires efforts to eradicate it from all parties. The 5 provinces that still have the highest stunting rate are East Nusa Tenggara (35,3 %), West Sulawesi (35 %), Papua (34,6 %), West Nusa Tenggara (32,7 %), and Aceh (31,2 %). Data from the World Bank or the World Bank say that 54% of the workforce experienced stunting during their infancy. This means that as much as 54% of the current workforce are stunting survivors. This is what makes stunting a serious concern for the government.
Depending on the Indonesian Pediatrician Association (IDAI), there are two causes of stunting, namely environmental and genetic factors. The environment is an important aspect that can still be intervened so that short stature or stunting can be overcome. Environmental factors that play a role in causing short stature include the nutritional status of the mother, feeding patterns for children, environmental hygiene, and the incidence of infection in children. Besides being caused by the environment, stunting can be caused by genetic and hormonal factors. However, most stunting is caused by malnutrition. Among the 5 million babies born every year, as many as 1,2 million babies are born with stunting. Stunting is a product of pregnancy. Pregnant women who produce stunted babies. Currently, just born babies have 23% of the prevalence of stunting. Then after birth, many are born normally but then become stunted until the figure becomes 27,6%. This means that 23% comes from births that are not up to standard. Another thing that causes stunting is that as many as 11.7% of babies are born with malnutrition as measured by body length not reaching 48 centimeters and body weight not reaching 2,5 kilograms. Not only that, the high stunting rate in Indonesia is also compounded by babies who are born normal but grow up with a lack of nutrition so they becomestunted.
Toddlers can be said to be stunted if their height is below the normal range of standard child height based on age on two consecutive examinations. Apart from short stature, other features of stunting are as follows: slow growth, face looks younger than his age, weight does not increase even will tend to decrease, the ability to focus and study memoryisnotgood,childrentendtobe more quiet, the teething phase in children slows down, and children are more susceptible to various diseases. Stunting is failure to thrive due to lack of nutrition, which in the short term can disrupt brain development, metabolism, and physical growth in children. Meanwhile, in the long run, the impact of stunting is as follows: Difficulty learning, diseases of the heart and blood vessels, decreased cognitive development abilities, increases the risk of obesity in children, and the immune system is weak so it is easy to get infectedwithdisease.
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The problem of stunting is important to solve, because it has the potential to disrupt the potential of human resources and is related to the level of health and even child mortality. Actions to prevent stunting are certainly wiser to implement by everyone in their environment, especially those who have children under five and young couples for the possibility of stunting, rather than having to make efforts to deal with it after stunting has occurred. This also emphasizes the importance of preparing excellent health before stepping into
Thus, in order for all stunting prevention programs to be carried out optimally and effectively, the government needs interventions and counseling that are evenly distributed throughout the Indonesian island. Even though the obstacle lies in the different levels of education and knowledge of the community, each party must be able to come up with a creative program so that it can be well received by all of this very diverseIndonesiancommunity.
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A Ribbon for Lung Cancer
Radzikra Azahra from CIMSA UPH
With the prevalence of smoking in Indonesia so high, you can call yourself lucky if you do not know anyone who smokes. Nobody in my immediate family smokes, and I live in a nice neighborhood where the dads are only allowed to smoke if they are away from the children. I once had a childhood friend who went to the same school as me. She had a father whom I did not know much about, but he smoked and passed away because of lung cancer. At his funeral, I remember my neighbors asking the grieving family how he died, and when they hear the answer they always, always, ask: “Did he smoke?”. Even as a child I felt the incompleteness of that sentence, as if they were holding back their tongue, and the unvoiced words were: “Well, no wonder.” It left me uneasy, but they weren’t exactly
It is found that 80% of lung cancer is directly linked to cigarette smoking, but how does smoking actually cause cancer? The act of inhaling smoke from burned organic matter plays a big role in the pathogenesis of cancer. In addition, one component of cigarettes is tar, which is carcinogenic. One of the chemicals present in both the act of burning and tar itself is Benzo(a)pyrene. Benzo(a)pyrene is inhaled when smoking and processed by enzymes in the endoplasmic reticulum of the nasal mucosa, to produce a metabolic compound that can form a DNA adduct. DNA adduct is a complex of nucleobase and chemical that binds covalently to it. Why is this a problem? In a normal situation, deoxyribose is what binds to a nucleobase, and if something else binds to a nucleobase, the cell will try to repair itself. Severe DNA damage may also inflict the cell to undergo apoptosis. Exposure to Benzo(a)pyrene is not limited to cigarette smoking. Eating burned food and air pollution can also expose you to Benzo(a)pyrene but the difference with cigarettes lies in the duration and amount of exposure. Our body is smart, but mathematically, the
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stigma may delay diagnosis or even refuse therapies. This matter is worsened further if we remember that there is a positive correlation between smoking and mental health issues. A delayed diagnosis can cause prognosis to worsen; and it is also one of the culprits contributing to the high mortality of lung cancer. Lung cancer in general tends to be diagnosed at a later stage due to its clinical manifestation, which can appear later on. This includes coughing,dyspnea(shortnessofbreath), chest pain, haemoptysis (coughing up blood), and weight loss, all of which can be chalked up to many other etiologies that can be as usual as the common cold. Stigma in healthcare professionals may play into the un-eagerness for research and medical advances made in thetermoftherapyforlungcancer.
As future medical professionals, it is our duty to not judge those who have developed conditions based on their choice of actions and/or lifestyles. Instead,wemustlearntoempathizeand treat these people with our utmost care, without showing any signs of discrimination. Furthermore, it would be in everybody’s best interest if we collectively use the knowledge we have attained to promote healthy habits, such as quit smoking, in order to build a society of healthy and productive individuals.
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3936675/#R66
https://www.cdc.gov/cancer/lung/ basic_info/symptoms.htm
https://pubchem.ncbi.nlm.nih.gov/ compound/ Benzo_a_pyrene#:~:text=Benzo%5B a%5Dpy
rene%20is%20an%2Cagent%20and %20a%20mouse%20metabolite.
https://www.rgare.com/knowledgecenter/media/articles/smokinga-100-year-story-that-do esn-t-endhere#:~:text=In%201964%2C%20the %20U.S.
%20Surgeon,caused%20lung%20ca ncer%20and%20bronchitis.
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC9238180/
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