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All Journal Scientific Journal of Pediatrics Sriwijaya Journal of Neurology Crown: Journal of Dentistry and Health Research
Venny Melinda
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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The Role of the Vestibular System in Balance Disorders and Falls in the Elderly: A Prospective Cohort Study with Posturography Assessment in Surabaya, Indonesia Venny Melinda; Johan Wirahadi Putro; Mariana Alifah; Michelle Birne; Abhimanyu Putra
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.v1i2.82

Abstract

Introduction: Falls in the elderly represent a significant public health concern, often leading to injury, disability, and reduced quality of life. The vestibular system plays a crucial role in maintaining balance, and its decline with age is a major contributor to falls. This study aimed to investigate the relationship between vestibular function, assessed through posturography, and the incidence of falls in elderly individuals in Surabaya, Indonesia. Methods: A prospective cohort study was conducted involving 150 participants aged 60 years and above residing in Surabaya. Baseline assessments included a comprehensive geriatric assessment, vestibular function tests using computerized dynamic posturography (CDP), and questionnaires on falls history. Participants were followed up for 12 months to record the occurrence of falls. Data analysis included descriptive statistics, correlation analysis, and logistic regression to identify predictors of falls. Results: The incidence of falls during the 12-month follow-up period was 32%. CDP revealed significant age-related decline in vestibular function, particularly in measures of sensory organization and balance strategy. Poor performance on CDP, especially in conditions with altered visual and proprioceptive inputs, was significantly associated with an increased risk of falls. History of previous falls, presence of comorbidities, and use of polypharmacy were also identified as significant predictors of falls. Conclusion: Vestibular dysfunction, as assessed by CDP, is a significant risk factor for falls in the elderly. Incorporating posturography assessment into routine geriatric evaluations may help identify individuals at high risk of falls, allowing for targeted interventions to prevent falls and associated complications.
Predictive Value of Drug-Induced Sleep Endoscopy (DISE) in Pediatric Obstructive Sleep Apnea: A Multicenter Cohort Study in Indonesia Sarah Istiqomah; Annisa Annisa; Dessy Agustina; Abhimanyu Putra; Zainal Abidin Hasan; Johan Wirahadi Putro; Venny Melinda; Nabila Saraswati; Made Swastika
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.v2i2.174

Abstract

Introduction: Obstructive sleep apnea (OSA) is a significant pediatric health concern in Indonesia, but diagnostic and treatment pathways are often resource-constrained. Drug-induced sleep endoscopy (DISE) offers a dynamic assessment of upper airway obstruction, but its predictive value for treatment outcomes in Indonesian children remains unclear. This study aimed to evaluate the predictive value of DISE findings for polysomnography (PSG)-determined OSA severity and surgical outcomes in a multicenter cohort of Indonesian children. Methods: A prospective, multicenter cohort study was conducted at three tertiary hospitals in Indonesia. Children aged 2-18 years with suspected OSA underwent DISE and overnight PSG. DISE findings were classified using the VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification system. The primary outcome was the correlation between DISE findings and the apnea-hypopnea index (AHI) on PSG. Secondary outcomes included the prediction of surgical success (defined as a postoperative AHI < 5 and >50% reduction from baseline) after adenotonsillectomy (T&A). Statistical analyses included Spearman's rank correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results: 250 children (mean age 8.2 ± 3.5 years, 60% male) were included. A significant positive correlation was found between the total VOTE score and AHI (ρ = 0.62, p < 0.001). Tongue base obstruction (VOTE-T) showed the strongest correlation with AHI (ρ = 0.58, p < 0.001). The area under the ROC curve (AUC) for the total VOTE score predicting severe OSA (AHI ≥ 10) was 0.85 (95% CI, 0.79-0.91). In the subgroup of 180 children who underwent T&A, a higher total VOTE score (particularly VOTE-T and VOTE-E scores) was significantly associated with a lower likelihood of surgical success (OR 0.45, 95% CI 0.28-0.72, p = 0.001). Conclusion: DISE, using the VOTE classification, demonstrates good predictive value for OSA severity and surgical outcomes in Indonesian children. Tongue base and epiglottic obstruction are particularly important predictors. DISE can be a valuable tool for guiding treatment decisions in resource-limited settings.
Biological Pathways of Oral Health Inequality: A Longitudinal Analysis of Stunting, Enamel Defects, and Salivary Immunity on Caries Trajectories in Indonesian Children Firman Hadi; Moon Kaeun; Fatimah Mursyid; Venny Melinda
Crown: Journal of Dentistry and Health Research Vol. 2 No. 2 (2024): Crown: Journal of Dentistry and Health Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/crown.v2i2.239

Abstract

Introduction: The syndemic of stunting and Early Childhood Caries (ECC) constitutes a major public health crisis in developing nations. While an association is established, the specific biological mechanisms remain poorly quantified. This study aimed to longitudinally determine the direct and indirect effects of early childhood stunting on caries increment, testing the mediating roles of enamel hypoplasia and salivary immunity after controlling for key confounders. Methods: We conducted a 3-year prospective cohort study of 542 two-year-old children in West Java, Indonesia. Stunting at baseline was defined as a height-for-age Z-score (HAZ) < -2 SD. The primary outcome was the 3-year increment in decayed, missing, and filled primary tooth surfaces (Δdmfs). Putative mediators—enamel hypoplasia and salivary secretory immunoglobulin A (s-IgA) and lactoferrin—were assessed. Longitudinal mixed-effects models and structural equation modeling (SEM) were used to analyze the pathways, adjusting for socio-demographic factors and fluoride exposure. Results: At baseline, 31.4% of children were stunted. After adjusting for confounders including fluoride exposure, stunting remained a powerful predictor of accelerated caries increment (an additional 1.95 surfaces/year; p<0.001). SEM analysis revealed the total effect of stunting on Δdmfs was substantial (Standardized β=0.45, p<0.001). This effect was significantly mediated by enamel hypoplasia (indirect effect β=0.17, accounting for 37.8% of total effect) and suppressed salivary s-IgA levels (indirect effect β=0.10, accounting for 22.2% of total effect). The direct effect of stunting, independent of these mediators, remained significant (β=0.18, p<0.001). Conclusion: Stunting in early life is a critical determinant of a high future caries burden, an effect that persists even after accounting for fluoride exposure. This relationship is substantially driven by two major biological pathways: compromised tooth structure (enamel hypoplasia) and impaired oral mucosal immunity (suppressed s-IgA). Public health strategies must integrate nutritional support within the first 1,000 days of life with oral health promotion to disrupt these pathways and combat the dual burden of stunting and ECC.
Co-Authors Abhimanyu Putra Annisa Annisa Dessy Agustina Fatimah Mursyid Firman Hadi Johan Wirahadi Putro Made Swastika Mariana Alifah Michelle Birne Moon Kaeun Nabila Saraswati Sarah Istiqomah Zainal Abidin Hasan