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All Journal 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: Indonesian Medical Research Organization

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

Abstract

Introduction: Documented consent without demonstrable comprehension is medicolegally insufficient, yet comprehension-based informed consent (IC) failure in collectivistic surgical populations is largely unquantified. Methods: This re-analysis of a previously reported cross-sectional dataset assessed IC efficacy among 320 consecutive adults undergoing high-risk elective surgery (ASA physical status III–IV) at Private Hospital X, Palembang, Indonesia, in 2024, reported per STROBE. Six instruments standardised to 0–100 were administered, including the IC Comprehension Score (ICCS) and the five-domain composite IC Efficacy Score (ICE); adequacy was ICE ≥ 70. Exact intervals and permutation tests, effect sizes, areas under the receiver operating characteristic curve recovered from Mann–Whitney U statistics, E-values, fragility indices, standardisation and a partial-identification audit were added. Results: Only 19 of 320 patients (5.9%, 95% CI 3.6–9.1) achieved adequate IC efficacy, below both published comparators reporting an explicit adequacy proportion (exact binomial P < 0.001 versus 14.0% and versus 35.8%); standardisation to lower-education distributions reduced this to 2.74–3.79%, so 5.9% is an upper bound. Adequacy rose monotonically across educational strata from 0.0% to 13.3% (exact Cochran–Armitage z = 3.66, P = 0.0003; tertiary versus secondary education or below, odds ratio 8.27, 95% CI 2.36–29.00; E-value 14.29; fragility index 8). ICCS was the only independent predictor in an exploratory multivariable model with 2.71 events per variable (odds ratio 13.75 per SD, 95% CI 3.32–56.92), an association partly constitutive because comprehension is one ICE domain. Neither family influence nor collectivism predicted adequacy. Conclusion: Comprehension, not cultural collectivism, gates valid surgical consent.
Co-Authors Andhika Kurnianta Kusuma Aprilia Sari Cinthya Callathea Delia Tamim Firman Hadi Muhammad Ashraf Mustafa Mahmud Sohyuk Kim