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All Journal Scientia Psychiatrica Indonesian Community Empowerment Journal Sriwijaya Journal of Neurology Enigma in Education
Lestini Wulansari
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Religion Humanities Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Languange, Linguistic, Communication & Media Mathematics Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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The Impact of Gestational Diabetes on Long-Term Cognitive Function: A Prospective Cohort Study with Neuroimaging Correlates in Bandung, Indonesia Miranda Aisah; Lestini Wulansari; Vania Delma; Reza Andrianto; Zahra Amir; Dedi Sucipto; Agnes Mariska; Saurie Hernandez
Sriwijaya Journal of Neurology Vol. 2 No. 1 (2024): Sriwijaya Journal of Neurology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjn.v1i2.91

Abstract

Introduction: Gestational diabetes mellitus (GDM) is a growing public health concern with potential long-term consequences for both mother and child. Emerging evidence suggests that GDM may impact maternal cognitive function, but the underlying mechanisms remain unclear. This prospective cohort study investigates the association between GDM and long-term cognitive function in mothers, exploring potential neuroimaging correlates. Methods: Pregnant women were recruited from antenatal clinics in Bandung, Indonesia, between 2018 and 2020. GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Cognitive function was assessed at 6 months, 1 year, and 3 years postpartum using a comprehensive neuropsychological battery. A subset of participants underwent structural and functional magnetic resonance imaging (MRI) at 3 years postpartum. Results: Women with GDM exhibited lower scores on tests of executive function, processing speed, and memory compared to women without GDM at all follow-up assessments. MRI analysis revealed alterations in brain structure and function inwomen with a history of GDM, including reduced gray matter volume in the prefrontal cortex and hippocampus, and altered functional connectivity within the default mode network. Conclusion: GDM is associated with long-term cognitive impairment in mothers, possibly mediated by structural and functional brain changes. These findings highlight the importance of early identification and management of GDM to mitigate potential long-term cognitive consequences.
Impact of Maternal Anxiety and Stress During Pregnancy on Fetal Neurodevelopment: A Longitudinal Cohort Study in Jakarta, Indonesia Leonardo Simanjuntak; Tomiola Owkwulu; Tanvir Ahmed; Reza Andrianto; Lestini Wulansari
Scientia Psychiatrica Vol. 6 No. 1 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i1.182

Abstract

Introduction: Maternal anxiety and stress during pregnancy are increasingly recognized as significant factors influencing fetal neurodevelopment. This study investigated the impact of maternal anxiety and stress levels during pregnancy on various aspects of fetal neurodevelopment in a cohort of pregnant women in Jakarta, Indonesia. Methods: A longitudinal cohort study was conducted at three major hospitals in Jakarta, involving 500 pregnant women in their first trimester. Maternal anxiety and stress levels were assessed using the State-Trait Anxiety Inventory (STAI) and the Perceived Stress Scale (PSS) at three time points: first trimester (10-14 weeks), second trimester (20-24 weeks), and third trimester (30-34 weeks). Fetal neurodevelopment was assessed using fetal movement counting, fetal heart rate variability (using Doppler ultrasound), and later, infant neurodevelopmental assessments at 6 and 12 months postpartum using the Bayley Scales of Infant Development III. Data analysis involved correlation and regression analyses to examine the relationship between maternal anxiety/stress and fetal/infant neurodevelopmental outcomes. Results: The study found a significant positive correlation between maternal anxiety and stress levels across all trimesters. Higher maternal anxiety and stress, particularly in the second and third trimesters, were associated with reduced fetal movement counts (p < 0.05) and altered fetal heart rate variability patterns (p < 0.01). Furthermore, higher maternal anxiety and stress during pregnancy were associated with lower scores on the cognitive and motor scales of the Bayley Scales at both 6 and 12 months (p < 0.001). Specifically, maternal anxiety in the third trimester was the strongest predictor of lower cognitive scores at 12 months. Conclusion: Maternal anxiety and stress during pregnancy, particularly in the second and third trimesters, have a demonstrable impact on fetal neurodevelopment and subsequent infant development. These findings highlight the importance of screening for and managing maternal anxiety and stress during pregnancy to promote optimal fetal and infant neurodevelopment. Interventions targeting stress reduction and anxiety management should be integrated into routine prenatal care.
The Power Imbalance Personified: A Mixed-Methods Analysis of Senior-to-Junior Bullying in Indonesia's Medical Residency Programs Alex Putra Pratama; Henry Clifford; Ahmad Erza; Ericca Dominique Perez; Fakhrul Setiobudi; Dedi Affandi; Lestini Wulansari; Fachrudin Sani; Vita Amanda; Zahra Amir
Enigma in Education Vol. 3 No. 1 (2025): Enigma in Education
Publisher : Enigma Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61996/edu.v3i1.92

Abstract

Bullying within medical residency is a pervasive global issue with severe consequences for residents' mental health and patient safety. In Indonesia, where hierarchical structures in medicine are deeply entrenched, senior-to-junior bullying is a significant yet under-investigated problem. This study aimed to analyse the prevalence, forms, and lived experiences of bullying perpetrated by senior residents against their junior counterparts in Indonesian medical residency programs. A sequential explanatory mixed-methods design was employed. In the quantitative phase, an anonymous online survey was distributed to 584 junior medical residents across five major teaching hospitals in Indonesia. The survey included the validated Negative Acts Questionnaire-Revised (NAQ-R) and questions on demographics and specialty. In the qualitative phase, 25 junior residents who reported high levels of bullying were purposively selected for in-depth, semi-structured interviews to explore their experiences. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were subjected to reflexive thematic analysis. Quantitatively, 81.3% (n=475) of junior residents reported experiencing at least one bullying behaviour weekly. The most common forms were work-related, such as excessive workloads and meaningless tasks, and personal humiliation. Year of residency was significantly associated with bullying exposure. Qualitatively, four major themes emerged: (1) ‘The Hierarchy as an Unassailable Mandate for Abuse’; (2) ‘The Pedagogy of Fear: Bullying as a Misguided Educational Tool’; (3) ‘Silent Suffering and the Armour of Complicity’; and (4) ‘The Perpetuating Cycle: Victims on a Trajectory to Becoming Perpetrators’. The qualitative findings revealed that bullying was often rationalised by seniors as a necessary part of medical training. In conclusion, senior-to-junior bullying is alarmingly prevalent and deeply embedded in the culture of Indonesian medical residency programs. It is personified through a profound power imbalance, rationalised as an educational necessity, and sustained by a culture of silence. Urgent, multi-level interventions focusing on systemic change, faculty training, and robust confidential reporting systems are imperative to dismantle this destructive cycle.
Enhancing 'First 1,000 Days' Nutrition Literacy via a Posyandu Kader 'Train-the-Trainer' Model: A Mixed-Methods Impact Evaluation on Child Nutritional Status in Eastern Indonesia Fatimah Mursyid; Novalika Kurnia; Sana Ullah; Lestini Wulansari; Muhammad Yoshandi
Indonesian Community Empowerment Journal Vol. 5 No. 1 (2025): Indonesian Community Empowerment Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/icejournal.v5i1.53

Abstract

The 'First 1,000 Days' (HPK) period is critical for preventing stunting, a significant public health challenge in Indonesia, particularly in Eastern provinces. Posyandu kader (community health volunteers) are pivotal, but their effectiveness is often hampered by inadequate and unstandardized training. This study evaluates the impact of a structured 'Train-the-Trainer' (ToT) model on kader nutrition literacy and, subsequently, on child nutritional status. We conducted a quasi-experimental, convergent parallel mixed-methods study in two districts of East Nusa Tenggara (NTT) province, Indonesia. The intervention district (n=50 kader, n=312 mother-child dyads) received the ToT intervention, while the control district (n=50 kader, n=309 mother-child dyads) continued standard practices. The ToT model involved training Puskesmas (health center) staff as 'Master Trainers' who then cascaded structured training and mentorship to kader over 12 months. Quantitative data (kader literacy scores, child anthropometry [Height-for-Age Z-score, HAZ]) were collected at baseline and 12-month follow-up, analyzed using Difference-in-Differences (DiD) and linear mixed-effects models (LMM). Qualitative data (n=24 in-depth interviews, n=6 focus group discussions) explored the intervention's mechanisms, fidelity, and contextual facilitators. At 12 months, kader nutrition literacy in the intervention group increased significantly (mean score change: +29.8 points) compared to the control group (+2.1 points, p < 0.001). The LMM analysis, controlling for covariates, showed a significant 'time × group' interaction effect on child HAZ (β = 0.28, 95% CI [0.15, 0.41], p < 0.001), indicating a meaningful improvement in child growth attributable to the intervention. Stunting prevalence (HAZ < -2 SD) in the intervention group decreased by 8.7 percentage points, while it remained stagnant in the control group. Qualitative themes revealed that the ToT model enhanced kader self-efficacy, shifted their role from passive data collectors to active counselors, and provided mechanisms to address local socio-cultural barriers to nutrition. In conclusion, the 'Train-the-Trainer' model is an effective and scalable strategy for enhancing kader nutrition literacy and precipitating measurable improvements in child nutritional status in high-burden settings. This model provides a sustainable framework for strengthening community health systems to combat stunting, aligning with Indonesia's national strategy and Sustainable Development Goal 3.
Co-Authors Agnes Mariska Ahmad Erza Alex Putra Pratama Dedi Affandi Dedi Sucipto Ericca Dominique Perez Fachrudin Sani Fakhrul Setiobudi Fatimah Mursyid Henry Clifford Leonardo Simanjuntak Miranda Aisah Muhammad Yoshandi Novalika Kurnia Reza Andrianto Sana Ullah Saurie Hernandez Tanvir Ahmed Tomiola Owkwulu Vania Delma Vita Amanda Zahra Amir