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All Journal Eureka Herba Indonesia Sriwijaya Journal of Forensic and Medicolegal Scientific Journal of Pediatrics
Yi-Fen Huang
Department of Biomolecular and Translational Medicine, Thimphu Medical Institute, Thimphu, Bhutan
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health

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Early Childhood Feeding Practices and the Development of Severe Early Childhood Caries (S-ECC): A Prospective Cohort Study in Medan, Indonesia Andhika Kurnianta Kusuma; Muhammad Ashraf; Yi-Fen Huang; Aprilia Sari; Firman Hadi; Sohyuk Kim
Scientific Journal of Pediatrics Vol. 3 No. 1 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v2i2.175

Abstract

Introduction: Severe early childhood caries (S-ECC) is a significant public health problem, particularly in developing countries like Indonesia. Early childhood feeding practices are recognized as major risk factors, but prospective data from specific regions like Medan, Indonesia, are limited. This study aimed to investigate the association between various feeding practices and the development of S-ECC in a cohort of children in Medan. Methods: A prospective cohort study was conducted involving 450 mother-child dyads recruited from Posyandu (integrated health posts) in Medan, Indonesia. Baseline data on maternal demographics, socioeconomic status, oral health knowledge, and infant feeding practices were collected via questionnaires and interviews. Children were followed up at 6-month intervals for 36 months. Dental examinations were performed by calibrated dentists using the dmft index (decayed, missing, filled teeth) to diagnose S-ECC. Cox proportional hazards regression was used to analyze the association between feeding practices and S-ECC development, adjusting for potential confounders. Results: The incidence of S-ECC at 36 months was 38.2% (n=172). Prolonged bottle feeding (beyond 12 months) (Hazard Ratio [HR] = 2.15; 95% Confidence Interval [CI]: 1.55-2.98; p<0.001), nocturnal bottle feeding with sweetened liquids (HR = 2.85; 95% CI: 2.01-4.03; p<0.001), and frequent consumption of sugary snacks/drinks (≥3 times/day) (HR = 1.92; 95% CI: 1.38-2.67; p<0.001) were significantly associated with an increased risk of S-ECC. Exclusive breastfeeding for the first 6 months showed a protective effect (HR = 0.62; 95% CI: 0.45-0.86; p=0.004), even after adjusting for socioeconomic status and maternal oral health knowledge. Conclusion: This study confirms the significant impact of early childhood feeding practices on S-ECC development in Medan, Indonesia. Prolonged and nocturnal bottle feeding, particularly with sweetened liquids, and frequent consumption of sugary snacks/drinks were key risk factors. Promoting exclusive breastfeeding for the first six months and educating mothers about appropriate feeding practices are crucial for S-ECC prevention in this population.
Comprehension as the Gatekeeper of Valid Surgical Consent: A Cross-Sectional Medicolegal Analysis of 320 High-Risk Indonesian Surgical Patients Mustafa Mahmud; Cinthya Callathea; Yi-Fen Huang; Delia Tamim
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 2 (2025): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v3i2.249

Abstract

Background. Documented consent without demonstrable comprehension is medicolegally insufficient, yet comprehension-based informed consent (IC) failure in collectivistic surgical populations is largely unquantified. Objective. To estimate the prevalence of adequate IC efficacy among high-risk surgical patients and to test whether comprehension or cultural collectivism predicts adequacy. Methods. This cross-sectional study, reported per STROBE, assessed 320 consecutive adults undergoing high-risk elective surgery (ASA physical status III–IV) at Private Hospital X, Palembang, Indonesia, in 2024. Six instruments standardised to 0–100 included the IC Comprehension Score (ICCS) and the five-domain composite IC Efficacy Score (ICE); adequacy was ICE ≥ 70. Analyses used exact intervals, permutation tests, effect sizes, E-values and fragility indices. Results. Only 19 of 320 patients (5.9%, 95% CI 3.6–9.1) achieved adequate IC efficacy, below published comparators (exact binomial P < 0.001 versus 14.0% and 35.8%); standardisation to lower-education distributions reduced this to 2.74–3.79%, so 5.9% is an upper bound. Adequacy rose monotonically with education from 0.0% to 13.3% (exact Cochran–Armitage z = 3.66, P = 0.0003; tertiary versus lower education, odds ratio 8.27, 95% CI 2.36–29.00). ICCS was the only independent predictor in an exploratory multivariable model (odds ratio 13.75 per SD, 95% CI 3.32–56.92), partly constitutively because comprehension is an ICE domain. Family influence and collectivism did not predict adequacy. Conclusion. Comprehension, not cultural collectivism, gates valid surgical consent. Adequate consent was rare in this high-risk population, so verified patient understanding, rather than a documented signature, should be the medicolegal standard, and larger multicentre studies should confirm these findings.
Synergistic Effects of Standardized Moringa oleifera Leaf Extract and a Probiotic Consortium on Intestinal Permeability and Environmental Enteric Dysfunction Biomarkers in Indonesian Children: A Randomized Controlled Trial Habiburrahman Said; Aline Hafidzah; Yi-Fen Huang
Eureka Herba Indonesia Vol. 7 No. 1 (2026): Eureka Herba Indonesia
Publisher : HM Publisher in collaboration with CMHC Research Center

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v7i1.145

Abstract

Background: Environmental enteric dysfunction (EED) underlies much of the residual stunting and anemia that persist in Indonesian children despite nutrition programs. Moringa oleifera Lam. (Moringaceae) leaves contain quercetin, kaempferol, chlorogenic acid, β-sitosterol and glucomoringin-derived isothiocyanates that reinforce tight junctions and dampen mucosal NF-κB signaling, whereas Lactobacillus and Bifidobacterium probiotics generate short-chain fatty acids and displace enteropathogens. Objective: To determine whether standardized M. oleifera leaf extract co-administered with a defined probiotic consortium reduces intestinal permeability and EED biomarkers in Indonesian children aged 12–59 months. Methods: In a three-arm, double-blind, placebo-controlled randomized trial, 150 children aged 12–59 months with biomarker-confirmed EED received, for 12 weeks, either standardized 50% ethanolic M. oleifera leaf extract 500 mg/day plus a probiotic consortium of Lactobacillus rhamnosus GG, Bifidobacterium animalis subsp. lactis Bb-12 and Lactobacillus plantarum Dad-13 (1×1010 CFU/day) [Moringa + Probiotic], M. oleifera plus placebo probiotic [Moringa alone], or double placebo [Placebo]. The primary outcome was the change in the urinary lactulose-to-mannitol (L:M) ratio at week 12. Results: In intention-to-treat analysis the L:M ratio fell from 0.42 ± 0.09 to 0.18 ± 0.06 with Moringa + Probiotic, from 0.41 ± 0.10 to 0.27 ± 0.08 with Moringa alone and from 0.43 ± 0.09 to 0.39 ± 0.10 with placebo (p < 0.001; d = 1.42 for Moringa + Probiotic versus placebo). EED remission occurred in 62.0%, 36.0% and 18.0% of recipients, respectively (OR 4.82, 95% CI 2.31–10.06, p < 0.001). Fecal myeloperoxidase, alpha-1-antitrypsin and neopterin, serum zonulin, lipopolysaccharide-binding protein and hs-CRP, hemoglobin and height-for-age Z-score all improved more with the combination, and adverse events were comparable across arms. Conclusion: Co-administration of standardized M. oleifera leaf extract with a multi-strain probiotic consortium restored intestinal barrier function and suppressed EED biomarkers in Indonesian children, supporting a scalable herbal–microbial complementary therapy.
Co-Authors Aline Hafidzah Andhika Kurnianta Kusuma Aprilia Sari Cinthya Callathea Delia Tamim Firman Hadi Habiburrahman Said Muhammad Ashraf Mustafa Mahmud Sohyuk Kim