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All Journal The International Journal of Medical Science and Health Research
Fifin Anisa
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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The Comprehensive Systematic Review of Relationship between Education Level and Self-Management in Patients with Type 2 Diabetes Mellitus Fifin Anisa
The International Journal of Medical Science and Health Research Vol. 32 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/dx433163

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) requires sustained self-management behaviors for optimal glycemic control and prevention of complications. While education level is frequently hypothesized to influence self-management capacity, evidence regarding this relationship remains inconsistent. Methods: A systematic review was conducted following PRISMA guidelines. A total of 95 quantitative studies examining the relationship between education level and diabetes self-management in adult T2DM patients were included. Studies were sourced from Indonesian healthcare settings including hospitals, primary care centers (Puskesmas), and community settings. Data were extracted regarding study characteristics, participant demographics, education measurement, self-management assessment, statistical associations, and moderating factors. Results: The majority of studies (approximately 65%) reported statistically significant positive associations between higher education and better self-management (r range: 0.263-0.739; p<0.05), particularly for medication adherence and dietary compliance. However, approximately 30% of studies found no significant association. Diabetes-specific knowledge, health literacy, self-efficacy, and family support consistently emerged as stronger direct predictors and significant mediators of the education-self-management relationship. Socioeconomic factors (income, employment) and healthcare access variables (Prolanis participation, health worker support) significantly modified this relationship. Discussion: The education-self-management relationship is indirect and context-dependent, primarily operating through modifiable cognitive and psychosocial mechanisms. Educational attainment serves as an enabling rather than deterministic factor. Conclusion: Interventions should target diabetes-specific knowledge, health literacy, self-efficacy, and family support systems, particularly for patients with lower formal education. Future research requires longitudinal designs, standardized measurement tools, and diverse populations beyond Indonesia.
The Comprehensive Systematic Review of Relationship Between Uric Acid Levels And The Risk Of Kidney Stones Fifin Anisa
The International Journal of Medical Science and Health Research Vol. 32 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/y3151730

Abstract

Introduction: Nephrolithiasis represents a significant global health burden with increasing prevalence. Although hyperuricemia has been implicated in kidney stone pathogenesis, evidence from Indonesian populations remains heterogeneous and has not been systematically synthesized. This systematic review aims to comprehensively evaluate the relationship between uric acid levels and kidney stone risk, quantify the strength of association, identify modifying factors, and address existing research gaps regarding population-specific evidence. Methods: A systematic review was conducted following standardized screening protocols. Eight electronic databases were searched for observational studies examining the association between serum/blood uric acid or dietary uric acid intake and kidney stone formation. Studies were included if they involved adult human participants (≥18 years), reported quantitative measures of association, and examined kidney stones broadly. Data were extracted regarding study design, population characteristics, uric acid measurement methods, kidney stone definition, effect estimates, and modifying factors. Results:  The proportion of kidney stone patients with elevated serum uric acid ranged from 55.3% to 66%, with mean levels between 6.7–7.3 mg/dL. Case-control studies demonstrated strong positive associations between high uric acid consumption and kidney stone risk (OR=6.756; 95% CI: 2.156–21.163; p=0.001). Dietary purine intake showed the strongest effect (OR=13.417; 95% CI: 3.042–59.171). The systematic review identified a dose-response relationship wherein nephrolithiasis risk increases progressively with rising serum uric acid levels. Age (p=0.050) and blood pressure (p=0.050) demonstrated significant associations with hyperuricemia in stone patients. Acidic urinary pH (<7) was observed in 77.1% of patients. Three studies reported no significant association, attributable to different stone type populations (calcium oxalate) versus uric acid nephrolithiasis. Discussion: This review provides the first synthesized evidence from Indonesian populations confirming hyperuricemia as a significant, dose-dependent risk factor for kidney stones, particularly among middle-aged males with metabolic comorbidities. The six- to seven-fold increased risk associated with high purine intake exceeds effect sizes reported in Western populations, suggesting possible population-specific genetic or dietary susceptibility. The dissociation between serum uric acid and urinary crystal excretion identified in one study challenges the adequacy of serum measurement alone as a risk stratification tool. Conclusion: Elevated uric acid levels are significantly associated with increased kidney stone risk in Indonesian populations, with dietary purine intake representing the strongest modifiable risk factor. Routine serum uric acid screening is recommended for adults with metabolic syndrome or family history of nephrolithiasis. Future prospective cohort studies with standardized uric acid measurement and stone composition analysis are urgently required.
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