Indirect Effects of PM2.5 Exposure on COVID-19 Mortality in Greater Jakarta, Indonesia: An Ecological Study.

Background: Air pollution, including PM2.5, was suggested as one of the primary contributors to COVID-19 fatalities worldwide. Jakarta, the capital city of Indonesia, was recognized as one of the ten most polluted cities globally. Additionally, the incidence of COVID-19 in Jakarta surpasses that of all other provinces in Indonesia. However, no study has investigated the correlation between PM2.5 concentration and COVID-19 fatality in Jakarta. Objective: To investigate the correlation between short-term and long-term exposure to PM2.5 and COVID-19 mortality in Greater Jakarta area. Methods: An ecological time-trend study was implemented. The data of PM2.5 ambient concentration obtained from Nafas Indonesia and the National Institute for Aeronautics and Space (LAPAN)/National Research and Innovation Agency (BRIN). The daily COVID-19 death data obtained from the City's Health Office. Findings: Our study unveiled an intriguing pattern: while short-term exposure to PM2.5 showed a negative correlation with COVID-19 mortality, suggesting it might not be the sole factor in causing fatalities, long-term exposure demonstrated a positive correlation. This suggests that COVID-19 mortality is more strongly influenced by prolonged PM2.5 exposure rather than short-term exposure alone. Specifically, our regression analysis estimate that a 50 µg/m3 increase in long-term average PM2.5 could lead to an 11.9% rise in the COVID-19 mortality rate. Conclusion: Our research, conducted in one of the most polluted areas worldwide, offers compelling evidence regarding the influence of PM2.5 exposure on COVID-19 mortality rates. It emphasizes the importance of recognizing air pollution as a critical risk factor for the severity of viral respiratory infections.

Monitoring of toxic cyanobacterial blooms in Lalla Takerkoust reservoir by satellite imagery and microcystin transfer to surrounding farms.

Cyanobacterial harmful algal blooms (CyanoHABs) threaten public health and freshwater ecosystems worldwide. In this study, our main goal was to explore the dynamics of cyanobacterial blooms and how microcystins (MCs) move from the Lalla Takerkoust reservoir to the nearby farms. We used Landsat imagery, molecular analysis, collecting and analyzing physicochemical data, and assessing toxins using HPLC. Our investigation identified two cyanobacterial species responsible for the blooms: Microcystis sp. and Synechococcus sp. Our Microcystis strain produced three MC variants (MC-RR, MC-YR, and MC-LR), with MC-RR exhibiting the highest concentrations in dissolved and intracellular toxins. In contrast, our Synechococcus strain did not produce any detectable toxins. To validate our Normalized Difference Vegetation Index (NDVI) results, we utilized limnological data, including algal cell counts, and quantified MCs in freeze-dried Microcystis bloom samples collected from the reservoir. Our study revealed patterns and trends in cyanobacterial proliferation in the reservoir over 30 years and presented a historical map of the area of cyanobacterial infestation using the NDVI method. The study found that MC-LR accumulates near the water surface due to the buoyancy of Microcystis. The maximum concentration of MC-LR in the reservoir water was 160 µg L-1. In contrast, 4 km downstream of the reservoir, the concentration decreased by a factor of 5.39 to 29.63 µgL-1, indicating a decrease in MC-LR concentration with increasing distance from the bloom source. Similarly, the MC-YR concentration decreased by a factor of 2.98 for the same distance. Interestingly, the MC distribution varied with depth, with MC-LR dominating at the water surface and MC-YR at the reservoir outlet at a water depth of 10 m. Our findings highlight the impact of nutrient concentrations, environmental factors, and transfer processes on bloom dynamics and MC distribution. We emphasize the need for effective management strategies to minimize toxin transfer and ensure public health and safety.

Accumulation of Cd and Pb in sediments and Asian swamp eels (Monopterus albus) from downstream area of Cisadane River, Indonesia.

This study examined the presence of two heavy metals (Cd and Pb) in the sediments and Asian swamp eels (Monopterus albus) in the downstream area of Cisadane River. The average concentrations of Cd and Pb in the sediments from all sampling locations were 0.594 ± 0.230 mg/kg and 34.677 ± 24.406 mg/kg, respectively. These concentrations were above the natural background concentration and the recommended value of interim sediment quality guidelines (ISQG), suggesting an enrichment process and potential ecological risk of studied metals to the ecosystem of Cisadane River. The increase in contamination within this region may be attributed to point sources such as landfill areas, as well as the industrial and agricultural land activities in surrounding area, and experienced an increasing level leading towards the estuary of Cisadane River. Meanwhile, the average concentrations of Cd and Pb in the eels from all sampling locations were 0.775 ± 0.528 µg/g and 28.940 ± 12.921 µg/g, respectively. This study also discovered that gill tissues contained higher levels of Cd and Pb than the digestive organ and flesh of Asian swamp eels. These concentrations were higher than Indonesian and international standards, suggesting a potential human health risk and therefore the needs of limitations in the consumption of the eels. Based on the human health risk assessment, the eels from the downstream of Cisadane River are still considered safe to be consumed as long as they comply with the specified maximum consumption limits.

A socio-technical systems approach of the accident analysis in Indonesian multiple train accident cases: An application of AcciMap methodology.

The number of cases of train accidents in Indonesia continues to be large in the past few years. This paper analyzes train accident cases in Indonesia using a socio-technical system approach accident model called AcciMap, developed by Jens Rasmussen. The source of data comes from train accident investigation reports from 2015 to 2021 published by the National Transportation Safety Committee. This study uses a qualitative approach with thematic analysis to identify contributing factors and their interactions within the reports. Based on the socio-technical system approach, there are roles and contributions from the five levels of the socio-technical railway transportation system in Indonesia that interact with each other in the occurrence of accidents, including the railway regulatory bodies; other organizations; management of railway service company; processes and physical actions by staff; and condition of equipment and environment. This study has shown that the AcciMap methodology can provide a comprehensive view of the problems and their interactions across the socio-technical levels that influence each other in the occurrence of train accidents in Indonesia. The results also suggest that the socio-technical system approach is expected to be applied in the accident investigation process for the related industry to get more comprehensive insights into the accident.

Spatial distribution and pollution assessment of metals in sediments along the industrialized coast of East Java, Indonesia.

The eastern coastline of Gresik, located in East Java, Indonesia, experienced significant industrialization, leading to the development of numerous diverse sectors. These diverse industrial activities, in addition to other human activities, result in the contamination of sediment across the eastern coast of Gresik with a variety of metals. Metals like arsenic (As), cadmium (Cd), copper (Cu), and zinc (Zn) have exceeded the international standards for sediment quality, potentially causing significant harm to the aquatic ecosystem in this coastal region. The results of the multivariate analysis indicate that the metals found in the sediment are related to a combination of anthropogenic inputs, specifically those originating from industrial effluents in the area under study. Based on the assessment of enrichment factor, contamination factor, geo-accumulation index, degree of contamination, ecological risk index, and pollution load index, it can be concluded that the metals examined displayed different degrees of sediment contamination, ranging from minimal to severely contaminated.

Effective food waste management model for the sustainable agricultural food supply chain.

The extensive research examines the current state of agricultural food supply chains, with focus on waste management in Bandung Regency, Indonesia. The study reveals that a significant proportion of food within the agricultural supply chain goes to waste and discusses the various challenges and complexities involved in managing food waste. The research presents a conceptual model based on the ADKAR change management paradigm to promote waste utilization, increase awareness and change people's behaviors. The model emphasizes the importance of creating awareness, fostering desire, providing knowledge, implementing changes, and reinforcing and monitoring the transformation process. It also addresses the challenges, barriers, and drivers that influence waste utilization in the agricultural supply chain, highlighting the need for economic incentives and a shift in public awareness to drive meaningful change. Ultimately, this study serves as a comprehensive exploration of food waste management in Bandung Regency, shedding light on the complexities of the issue and offering a systematic approach to transition towards more sustainable waste utilization practices.

Stunting and its association with education and cognitive outcomes in adulthood: A longitudinal study in Indonesia.

BACKGROUND: Stunting is associated with adverse outcomes in adulthood. This article specifically aims to analyse the relationship between childhood stunting and education as well as cognitive outcomes for adults in Indonesia. METHODS: Pooled data from wave one (1) and two (2) of the Indonesia Family Life Survey (IFLS) in 1993 and 1997 identified a sub-sample of 4,379 children aged 0-5 by their height-for-age (HAZ) to be compared for their differences in educational outcomes and cognitive abilities in 2014. HAZ was used to proxy relative height to determine stunting status based on 2006 WHO child's growth standards. Education and cognitive abilities outcomes include years of schooling, age of school entry, grade repetition, and scores for cognitive and math tests. The study employs estimation models of pooled regressions and instrumental variable (IV) to address problems of endogeneity and bias from omitted variables. RESULTS: Stunting and relatively small stature had significant associations with cognitive development, and they worked as intermediaries to cognitive developmental barriers as manifested in reduced educational outcomes. A lack of one SD in HAZ was associated with 0.6 years shortened length of the school, 3% higher chances of dropouts from secondary school, and 0.10-0.23 SD lowered cognitive and numerical scores. Similarly, stunting is associated with decrease cognitive test scores by 0.56-0.8 SD compared to non-stunting, two years less schooling, and 0.4 years of delayed entry to school. As for cognitive abilities, stunting is associated with lower cognitive and numerical abilities by 0.38-0.82 z-scores. CONCLUSION: Growth retardation during childhood in Indonesia was associated with lower cognitive abilities, particularly during school age, and this correlation faded as individuals grew up. Subsequently, growth retardation is significantly linked to lower educational outcomes. Impaired growth has implications for reduced lifetime earnings potential mediated by diminished cognitive capacity and lower educational attainment. The finding suggests that development in Indonesia during recent decades has not provided an adequate environment to enable children to achieve their potential educational outcomes.

Relationship between blood lead (Pb) concentration with risk of diabetes mellitus in women living in mining area.

Diabetes is a global health concern with significant implications for individuals and societies. Diabetes results from a complex interaction between genes and environmental factors, including metal exposure. Lead or plumbum (Pb) is a heavy metal pollutant and is predicted to be associated with the morbidity of diabetes. The aim of this study was to assess the relationship between blood Pb level and possible risk factors (body mass index insulin resistance, carbohydrate intake, sugar intake, and physical activity) with fasting blood sugar (FBS) level in women living in the mining area. A cross-sectional study was conducted in a mining area of Indonesia located in Pemali District, Bangka Belitung Regency, involving women aged 30-49, selected through purposive sampling. Logistic regression was used to assess the relationship between the risk factors and FBS level, while the Spearman correlation was used to analyze the correlations between the risk factors and FBS level. Our data indicated that blood Pb concentration and other risk factors (carbohydrate intake, sugar intake and physical activity) were neither associated nor correlated with FBS level. However, as predicted, insulin resistance was associated with FBS level with OR: 9.66; 95%CI: 1.13-82.29; p=0.038. In addition, the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) score was also correlated with FBS level (r=0.316, p=0.002). This study highlights the level of Pb is not associated with the risk of diabetes in women living in mining area.

Cytokine profiles in dengue fever and dengue hemorrhagic fever: A study from Indonesia.

Recent studies have demonstrated that cytokine dysregulation has a critical role in the pathogenesis of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The aim of this study was to investigate the association between tumor necrosis factor (TNF- α), interleukin 6 (IL-6), interleukin 10 (IL-10), and interleukin 17 (IL-17) with infection status, and severity of dengue. A prospective cross-sectional study was conducted at three hospitals in Gianyar regency and Denpasar municipality, Bali, Indonesia, from June to December 2022. Sixty-four dengue infected patients were involved. Patients' serum was tested for dengue infection using NS1 antigen rapid test, dengue virus immunoglobulin M (IgM) and immunoglobulin G (IgG) test, and reverse transcription polymerase chain reaction (RT-PCR). Cytokine levels (TNF-α, IL-6, IL-10, and IL-17) were measured using enzyme-linked immunosorbent assay (ELISA). Infection status was determined by combining serological and RT-PCR results, categorizing patients into primary and secondary infections. The present study found that DF patients had lower TNF-α, IL-6, and IL-17 but higher IL-10 levels compared to DHF patients (p<0.001). Elevated TNF-α, IL-6, and IL-17 levels were higher in secondary infection, while IL-10 level was higher in primary infection (p<0.001). In conclusion, cytokines play a crucial role in the interplay between cytokine dysregulation and dengue infection dynamics.

Effectiveness of ERKADUTA model to increase stunting prevention behaviors among mothers with toddlers in Indonesia: A quasi-experiment.

Stunting, a persistent nutritional issue arising from prolonged inadequate nutrient intake, poses substantial risks such as heightened morbidity, mortality, and compromised cognitive, psychomotor, and verbal development. In Indonesia, addressing stunting in children under two necessitates urgent community empowerment, given its multifaceted nature. The aim of this study was to assess the effects of an intervention targeting mothers of toddlers, called RT kawal baduta (ERKADUTA) model, a local community-based assistance for babies under two years old. A quasi-experiment using pre-test and post-test with a control group design was conducted. Employing a quantitative analytic approach with 112 respondents, the effectiveness of ERKADUTA model to improve the knowledge, attitude, and practice of stunting prevention among mothers with child under two years old was assessed. ERKADUTA program was run for three months. The Wilcoxon test was used to determine score changes before and after program in both groups, while the Mann-Whitney test was used to analyze the score differences of knowledge, attitude and practice between intervention and control groups. Our data indicated that there were changes in knowledge, attitudes, and practices in preventing stunting in both the intervention and control groups. There are significant differences in knowledge (p<0.001, effect size=-0.855), attitude (p<0.001, effect size=-0.864), and practice score (p<0.001, effect size=-0.924) between the intervention and control groups after the intervention. This study highlights that the ERKADUTA model emerged as a potent catalyst in improving stunting prevention behaviors among mothers with toddlers and this model holds promise for addressing the complexities of stunting in Indonesia.

Phytochemistry and antifatigue activities of Carica papaya leaf from geothermal, coastal and urban areas, Indonesia.

Fatigue, a condition of lack of energy and motivation resulting in the feeling of extreme tiredness or exhaustion, is usually prevented and treated with ergogenic aids, such as in the form of nutritional supplements. Papaya (Carica papaya) may be a potential candidate for ergogenic aids, considering its healthy secondary metabolite properties and number of metabolite compounds that could be affected by the location where the plant growing. The aim of this study was to identify the phytochemicals of papaya leaves from three different locations: geothermal, coastal, and urban areas in Aceh province, Indonesia. Concentrations of papaya leaf with the highest number of secondary metabolite compounds were tested in rats to measure blood lactate acid concentrations after strenuous exercise. The number of chemical compounds identified from the three locations was 24 compounds; 23 compounds and 17 compounds, respectively. The highest concentration of chemical compounds that have antifatigue activity contained in all papaya leaf samples were neophytadiene, linolenic acid, gamma tocopherol, hexadecanoic acid, vitamin E, carpaine, octadecatrienoic acid, nor lean-12-ene, squalene, and phytol. Furthermore, most of the compounds' highest concentrations were found in papaya leaves from the coastal area and, therefore, tested on the animal model. Treatment was provided in 12 male rats with different doses of papaya powder supplements for 15 days. The results showed that lactic acid levels of rats received a dose of 400 mg/kg of papaya leaf extract reduced the lactic acid concentration (p=0.014) compared with the control group. This study highlights that papaya leaves from the coastal area have the most potential activities as ergogenic herbal aid and were able to reduce lactic acid levels in rats after strenuous exercise.

Relationship between neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with the severity of COVID-19.

Coronavirus disease 2019 (COVID-19) is an infectious disease that spreads rapidly causing a high case fatality rate in vulnerable populations. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are known to be inflammatory biomarkers in certain infections. The aim of this study was to determine the relationship between NLR and PLR with the severity of COVID-19. A cross-sectional study was conducted at Tabanan Regency General Hospital, Bali, Indonesia, from January 2021 to December 2022. All patients included in the study tested positive for COVID-19 by real-time polymerase chain reaction (RT-PCR), aged 18-50 years with no comorbid. Laboratory examinations were carried out on admission. The patients were categorized into two groups based on the severity: moderate and severe/critical. The Mann-Whitney test was used to determine the association between NLR and PLR with the severity of COVID-19. A total of 104 patients were included in the study, the majority of COVID-19 patients had moderate (77.9%) severity. The average NLR was 5.8 and the PLR was 21.7. There was a significant relationship between NLR (p=0.002) and PLR (p=0.001) with the severity of COVID-19. The defined cut-off values of NLR and PLR were ≥3.8 and ≥106, yielding sensitivities of 95% and 70%, and specificities of 74% and 50%, respectively. This study highlights the promising role of NLR and PLR as predictive biomarkers to assess COVID-19 severity.

Correlation between serum vitamin D levels and bone mass density evaluated by radiofrequency echographic multi-spectrometry technology (REMS) in menopausal women.

Osteoporosis is a common condition associated with an increased risk of bone fractures due to fragility. Bone mineral density (BMD) is lower in menopausal women due to estrogen deficiency, age-related decline in osteoblast function, decreased calcium absorption, and reduced synthesis of vitamin D, which lead to osteoporosis. The aim of this study was to determine the correlation between serum vitamin D levels and BMD assessed using radiofrequency echographic multi-spectrometry technology (REMS) in menopausal women. A cross-sectional study was conducted at Prof. Dr. Chairuddin P. Lubis Hospital of Universitas Sumatera Utara, Medan, Indonesia, from May 2023 to August 2023. Consecutive sampling method was employed to sample menopausal women with no history of hysterectomy or oophorectomy (unilateral or bilateral), and no history of hormone replacement therapy or vitamin D supplementation. Interviews and physical examinations were conducted to obtain the characteristics of the subjects (age, duration of menopause, and body mass index). The 25(OH)D level was measured using immunoassay and REMS examination was conducted to assess BMD. The Spearman correlation test was used to assess the correlation between serum vitamin D levels and BMD. A total of 32 menopausal women were included in this study with the average vitamin D level was 18.05±5.81 ng/mL, and the mean BMD level was -2.13±1.23. The data showed a significant positive correlation between serum vitamin D levels and BMD in menopausal women (r=0.710; p=0.020). This study highlights that REMS could be useful as an alternative to dual-energy x-ray absorptiometry (DXA) to assess DMD in postmenopausal women.

Autosomal dominant polycystic kidney disease (ADPKD) with multiple complications: Management challenges.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary polycystic kidney disease characterized by renal enlargement, resulting in renal failure. In Indonesia, the exact prevalence of ADPKD is unknown due to limited reports on the disease. The aim of this study was to report a case of a patient with ADPKD with multiple complications. A 54-year-old male presented to the emergency room of Dr. Soetomo Academic General Hospital, Surabaya, Indonesia, with a chief complaint of dark-red-colored urine for one week. There was a progressive abdominal enlargement over the past five years, which had become more tense and rigid for the past one month. The patient had a history of fatigue and hypertension with routine follow-up. Physical examination on admission showed normal vital signs, and the abdominal assessment revealed a palpable hard mass approximately 4 cm in size in the right upper abdomen. Laboratory test indicated anemia, leukocytosis, lymphopenia, proteinuria, hematuria, leukocyturia, and elevated serum creatinine and urea levels. Abdominal imaging using ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) revealed bilateral kidney and liver enlargement containing multiple cysts, suggesting polycystic kidney and liver disease. There was a ruptured cyst in the middle of the left kidney pole with minimal ascites found in the CT scan. The MRI exhibited the presence of multiple cysts in both kidneys, partially filled with blood. The patient was diagnosed with ADPKD, gross hematuria, acute or chronic kidney disease (CKD), urinary tract infection (UTI), normochromic-normocytic anemia, and metabolic acidosis. Dietary control with high-calorie, high-protein, and low-salt diet; fluid balance; and other symptomatic medications were initiated. It is critical to be aware of risk factors associated with the rapid progression of ADPKD in order to be able to provide a favorable impact on the disease prevention and management.

Mental health analysis and resilience psychological factors during pandemic among port health 0fficers: A study in Sabang, Indonesia.

The coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on the mental health of health workers worldwide. Many studies examined the mental health of the frontline health workers in hospitals, but similar research on health workers at the port entries has yet to be found. The aim of this study was to determine the mental health issue and its associated factors and to determine the psychological resilience factors of port health workers in Sabang, Indonesia during the COVID-19 pandemic. A retrospective mixed-method study was conducted among 38 port health officers. Total sampling included those working from January 2020 to March 2023. The information on age, gender, qualification, working time and working place of the respondents were collected and the mental health was assessed using the Depression Anxiety Stress Scale (DASS-21). The correlation and association between the socio-demographic data and mental health were tested with Spearman and chi-squared tests, respectively. The qualitative study on psychological resilience factors were performed with interviews and analyzed with NVivo. This study indicated that 47.4% of port health officers experienced depression, 63.1% anxiety and 50.0% stress. Age and working time significantly affected the mental health. Age correlated positively and significantly with anxiety (p<0.0001) and stress (p<0.0001), while working time significantly affected the anxiety (p=0.003). The psychological resilience factors identified were spirituality, positive emotions, official support, and personal well-being that helped the workers taking away learn lessons. In conclusion, mental health issues are high among frontline workers during the pandemic highlighting the importance of the prevention measures to ensure the work performance among employees.

Association between chest X-ray score and clinical outcome in COVID-19 patients: A study on modified radiographic assessment of lung edema score (mRALE) in Indonesia.

Radiological examinations such as chest X-rays (CXR) play a crucial role in the early diagnosis and determining disease severity in coronavirus disease 2019 (COVID-19). Various CXR scoring systems have been developed to quantitively assess lung abnormalities in COVID-19 patients, including CXR modified radiographic assessment of lung edema (mRALE). The aim of this study was to determine the relationship between mRALE scores and clinical outcome (mortality), as well as to identify the correlation between mRALE score and the severity of hypoxia (PaO2/FiO2 ratio). A retrospective cohort study was conducted among hospitalized COVID-19 patients at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from February to April 2022. All CXR data at initial admission were scored using the mRALE scoring system, and the clinical outcomes at the end of hospitalization were recorded. Of the total 178 COVID-19 patients, 62.9% survived after completing the treatment. Patients within non-survived had significantly higher quick sequential organ failure assessment (qSOFA) score (p<0.001), lower PaO2/FiO2 ratio (p=0.004), and higher blood urea nitrogen (p<0.001), serum creatinine (p<0.008) and serum glutamic oxaloacetic transaminase (p=0.001) levels. There was a significant relationship between mRALE score and clinical outcome (survived vs deceased) (p=0.024; contingency coefficient of 0.184); and mRALE score of ≥2.5 served as a risk factor for mortality among COVID-19 patients (relative risk of 1.624). There was a significant negative correlation between the mRALE score and PaO2/FiO2 ratio based on the Spearman correlation test (r=-0.346; p<0.001). The findings highlight that the initial mRALE score may serve as an independent predictor of mortality among hospitalized COVID-19 patients as well as proves its potential prognostic role in the management of COVID-19.

Hemostatic and liver function parameters as COVID-19 severity markers.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a disease newly discovered in December 2019 which affects coagulation cascade and liver functions. The aim of this study was to investigate the potential of hemostatic and liver function parameters as severity markers in COVID-19 patients. This study was an observational analytic with cohort retrospective design using total sampling method. Data were retrieved from medical record of COVID-19 patients admitted to provincial hospital in Banda Aceh, Indonesia from March 2020 to March 2022. There were 1208 data eligible for the study after applying certain criteria. Mann-Whitney, logistic regression, and receiving operating characteristic (ROC) analyses were used to analysis the data. Thrombocyte count (p<0.001), prothrombin time (p<0.001), activated partial thromboplastin time (p<0.001), D-dimer (p<0.001), fibrinogen (p<0.001), aspartate aminotransferase (p<0.001), and alanine transaminase (p<0.001) significantly increased in severe compared to mild COVID-19 patients. After being adjusted, age (odds ratio (OR); 1.026 (95% confidence interval (CI): 1.016-1.037) was the most significant factor in predicting COVID-19 severity. Fibrinogen (cut-off 526.5 mg/L) was the best parameter associated with COVID-19 severity with 70% sensitivity and 66.4% specificity. Meanwhile, D-dimer (cut-off 805 ng/mL) had a sensitivity of 72.3% and specificity of 66.4%. Combining the parameters resulted in improved sensitivity to 82.0% with a slight decline of specificity to 65.5%. In conclusion, fibrinogen and D-dimer level on admission could be used as biomarkers in predicting COVID-19 prognosis. Routine monitoring and evaluation of laboratory testing especially D-dimer and fibrinogen could be implemented in order to reduce morbidity and mortality rate of COVID-19.

Effect of face masks on dyspnea perception, cardiopulmonary parameters, and facial temperature in healthy adults.

Respiratory droplets, naturally produced during expiration, can transmit pathogens from infected individuals. Wearing a face mask is crucial to prevent such transmission, yet the perception of dyspnea and uncomfortable breathing remains a common concern, particularly during epidemics. The aim of this study was to investigate the impact of face mask use on the perception of dyspnea, cardiopulmonary parameters, and facial temperature during physical activity. A randomized crossover study was conducted on healthy adults at a physiology laboratory located in the Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, in November 2022. Participants underwent five stages of physical exercise tests based on the Bruce Protocol under three conditions: without any face mask (control), wearing a surgical mask, and an N95 mask, forming the study's main groups. Dyspnea perception (measured by the Modified Borg Dyspnea Scale), cardiopulmonary parameters (heart rate, oxygen saturation, respiratory rate, blood pressure, and mean arterial pressure) and facial temperature were measured before the exercise test (pre-workout), at the end of stage 1, 2, 3, 4, 5, and after the whole exercise test (post-workout). A two-way repeated measures ANOVA was conducted, considering two factors: the type of mask (control, surgical mask, N95 mask) and the various stages of the exercise test. A total of 36 healthy adults were included in the study. We found that dyspnea perception was much worse in the N95 mask group, particularly during vigorous exercise. There was no significant difference between groups in cardiopulmonary parameters. However, participants wearing N95 had a greater supralabial temperature than those wearing surgical masks or no mask at all. It is recommended to undertake a more in-depth evaluation of cardiopulmonary physiological measures.

Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

BACKGROUND: Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers. METHODS: The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage. RESULTS: The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight. CONCLUSION: The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.

When the smoke gets in your lungs: short-term effects of Indonesia's 2015 forest fires on health care use.

BACKGROUND: The forest fires that ravaged parts of Indonesia in 2015 were the most severely polluting of this century but little is known about their effects on health care utilization of the affected population. We estimate their short-term impact on visit rates to primary and hospital care with particular focus on visits for specific smoke-related conditions (respiratory disease, acute respiratory tract infection (ARTI) and common cold). METHOD: We estimate the short-term impact of the 2015 forest fire on visit rates to primary and hospital care by combining satellite data on Aerosol Optical Depth (AOD) with administrative records from Indonesian National Health Insurance Agency (BPJS Kesehatan) from January 2015-April  2016. The 16 months of panel data cover 203 districts in the islands of Sumatra and Kalimantan before, during and after the forest fires. We use the (more efficient) ANCOVA version adaptation of a fixed effects model to compare the trends in healthcare use of affected districts (with AOD value above 0.75) with control districts (AOD value below 0.75). Considering the higher vulnerability of children's lungs, we do this separately for children under 5 and the rest of the population adults (> 5), and for both urban and rural areas, and for both the period during and after the forest fires. RESULTS: We find little effects for adults. For young children we estimate positive effects for care related to respiratory problems in primary health care facilities in urban areas. Hospital care visits in general, on the other hand, are negatively affected in rural areas. We argue that these patterns arise because accessibility of care during fires is more restricted for rural than for urban areas. CONCLUSION: The severity of the fires and the absence of positive impact on health care utilization for adults and children in rural areas indicate large missed opportunities for receiving necessary care. This is particularly worrisome for children, whose lungs are most vulnerable to the effects. Our findings underscore the need to ensure ongoing access to medical services during forest fires and emphasize the necessity of catching up with essential care for children after the fires, particularly in rural areas.