Objectives: Previous studies have shown that diabetic foot ulcers are principally associated with improper foot selfcare. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors. Results: Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.

Background: Diabetic foot ulcer will cause a reduction in quality of life (QOL), high care burden, and even mortality. An assessment of QOL and associated factors in patients with diabetic foot ulcer is important to provide evidence for establishing a care plan program for such patients. However, up to the present, there is no evidence of a published study that investigates the QOL and its associated factors in patients with diabetic foot ulcer in Indonesia. Purpose: The purpose of this study was to investigate the QOL in patients with diabetic foot ulcer in each domain and investigate the factors associated with this condition. Methods: The design of this study was a cross-sectional study. The total sample for this study was 55 patients. The QOL data were collected using a Diabetic Foot Ulcer Scale questionnaire. Statistical analyses were conducted using Mann-Whitney U-test and Kruskal-Wallis test. Results: The result showed that the QOL in the domains of emotions, positive compliance, family life, and friend were high, while the QOL in the domains of daily activities, physical health, leisure, finances, positive attitude, and treatment ranged from low to average. Significant differences were found between income (p=0.004), grade of the wound (p=0.047), number of wounds (p=0.029), and blood glucose (p=0.013) with QOL of patients. Other variables did not have a significant relationship with QOL, but marital status had a significant correlation with the domain of leisure (p=0.004) and duration of the ulcer had a significant correlation with the domain of emotions (p=0.001) Conclusion: There is a correlation between income, grade of the wound, the number of wounds, and blood glucose with QOL of patients with a diabetic foot ulcer. This study recommends to take into account economic status, grade and number of wound, and blood glucose level in order to improve the QOL of patients for an effective patient care plan.

Background It is well known that diabetes mellitus (DM) affects health-related quality of life (HRQOL) in both younger (aged 18–64 years) and older adults (aged ≥ 65 years). However, to date, no study has compared HRQOL and its predictors between younger and older adults with DM in Indonesia. Such a comparison is important because the results can guide nurses and clinicians to establish evidence-based educational programs that are specific and suitable for patients. Therefore, the aim of this study was to investigate the difference in HRQOL and its predictors in younger and older adults with DM in Indonesia. Methods A cross-sectional study was conducted on 641 patients with type 2 diabetes mellitus (T2DM) who were recruited via simple random sampling from 16 primary health centers in Banyumas Regency, Indonesia. A self-administered questionnaire containing the Summary of Diabetes Self-Care Activities, the DDS17 Bahasa Indonesia, the Beck Depression Inventory II, the Self-Efficacy for Diabetes Scale, the Family APGAR, and the 36-item Short-Form Health Survey was used to measure diabetes self-management (DSM), diabetes distress (DD), depression, self-efficacy, family support, and HRQOL, respectively. Independent t-tests were used to compare the physical component summary (PCS) and mental component summary (MCS) scores between younger and older adults with T2DM. Hierarchical multiple regression analyses were used to examine the factors associated with HRQOL in both groups. Results PCS scores were significantly different between the two groups. Older adults reported lower PCS scores than younger adults. No differences between the two groups were observed in the MCS scores. The hierarchical multiple regression analysis showed that level of education, employment status, number of diabetes-related complications, DSM, DD, depression, and self-efficacy were significant predictors of HRQOL in younger adults, while income, depression, DD, and self-efficacy were significant predictors of HRQOL in older adults. DD was the strongest predictor of HRQOL in younger adults, and depression was the strongest predictor in older adults. Conclusion Older adult patients had lower PCS scores than younger adult patients. This study is the first to show that the predictors of HRQOL differ between younger and older adults with T2DM. It provides insights for nurses and clinicians in Indonesia to establish evidence-based, age-specific educational programs.

Implication for health policy/practice/research/medical education:This study revealed that date seeds can be considered as a supplementary and natural source of immune-stimulant to maintain health.Please cite this paper as: Saryono S, Taufik A, Proverawati A, Efendi F. Dietary supplementation of Phoenix dactylifera L. seeds decreases pro-inflammatory mediators in CCl 4 -induced rats.

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