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Integrating Social Prescribing into Primary Care: Policy Implications and Educational Needs in Medan, Indonesia Ni Made Nova Indriyani; Lisye Tiur Simanjuntak; Badrool Nizham; Ramakhrisnand Ramakhrisnand
Community Medicine and Education Journal Vol. 6 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i1.699

Abstract

Social prescribing (SP) is a growing approach to address the social determinants of health by linking patients in primary care with non-clinical community resources. Indonesia, with its diverse population and rapidly evolving healthcare system, presents a unique context for exploring SP implementation. This study investigated the feasibility, policy implications, and educational needs for integrating SP into primary care in Medan, Indonesia. A mixed-methods approach was employed. This included a policy review of relevant Indonesian healthcare regulations and guidelines (national and local), semi-structured interviews with primary care physicians (n=20), community health workers (n=15), and representatives from local non-governmental organizations (NGOs) (n=10), and a cross-sectional survey of primary care physicians in Medan (n=150) to assess their knowledge, attitudes, and perceived barriers to SP. Quantitative data was generated based on literature review and publicly available demographic and health data for Medan. Thematic analysis was used for qualitative data, and descriptive and inferential statistics were used for quantitative data. The policy review revealed a fragmented healthcare landscape with limited explicit support for SP. Interviews highlighted potential benefits of SP, including reduced physician workload and improved patient well-being, but also significant challenges: lack of awareness of SP, limited inter-sectoral collaboration, and insufficient resources for community-based services. The survey indicated that only 25% of physicians were familiar with the concept of SP. Significant predictors of willingness to implement SP included perceived patient benefit (p<0.001) and availability of referral pathways (p<0.01). Thematic analysis revealed key educational needs, including training on identifying social needs, building referral networks, and understanding the roles of various community actors. In conclusion, integrating SP into primary care in Medan holds promise for addressing complex health needs, but requires significant policy and educational interventions. Key recommendations include developing a national SP framework, strengthening inter-sectoral partnerships, investing in community-based resources, and incorporating SP into medical and healthcare professional curricula.
Metatranscriptomic Profiling of the Subgingival Microbiome in Peri-implantitis versus Healthy Implants: Identifying Key Dysbiotic Pathways Rheina Weisch Fedre; Ramakhrisnand Ramakhrisnand; Firman Hadi; Mahmood Abbas
Crown: Journal of Dentistry and Health Research Vol. 3 No. 1 (2025): 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.v3i1.237

Abstract

Introduction: Peri-implantitis is a primary cause of dental implant failure, characterized by inflammatory destruction of supporting tissues. While microbial dysbiosis is implicated, the functional activities of the subgingival microbiome that drive disease pathogenesis remain poorly understood. This study aimed to elucidate the key functional and metabolic shifts in the subgingival microbiome associated with peri-implantitis using metatranscriptomic analysis. Methods: This cross-sectional study involved twenty patients, ten with healthy implants (HI) and ten diagnosed with peri-implantitis (PI). Subgingival biofilm samples were collected from the deepest peri-implant sulcus of each subject. Total RNA was extracted, followed by library preparation and sequencing on an Illumina NovaSeq platform. Bioinformatic analysis included quality control, taxonomic profiling using Kraken2, and functional annotation against the KEGG and Gene Ontology databases. Differential gene expression analysis was performed using DESeq2 to identify microbial transcriptional signatures distinguishing the PI and HI groups. Results: The metatranscriptome of the PI group exhibited significantly higher microbial diversity and a distinct taxonomic composition, with a notable enrichment of transcripts from species such as Porphyrononas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum. In contrast, the HI group was dominated by transcripts from commensal streptococci. Functional analysis revealed a significant upregulation of pathways related to bacterial virulence, including lipopolysaccharide (LPS) biosynthesis, bacterial secretion systems (Type IV), and iron acquisition in the PI group. Furthermore, pathways associated with amino acid metabolism, particularly arginine and tryptophan degradation, were highly active, suggesting a proteolytic environment. Conversely, the HI metatranscriptome showed enrichment in carbohydrate metabolism and fermentation pathways. Conclusions: The subgingival microbiome in peri-implantitis is not only taxonomically distinct but also functionally primed for pathogenicity. The active transcription of genes related to virulence, inflammation induction, and proteolytic metabolism highlights the key dysbiotic pathways that likely contribute to tissue destruction. These findings provide a deeper understanding of the functional gene expression profile in peri-implantitis and suggest potential targets for future diagnostic and therapeutic strategies aimed at modulating microbial activity rather than merely eliminating specific taxa.