The Role of Irrational Beliefs on Psychological Distress among Female Office Workers in Bali.

Objectives: This study examined the association between irrational beliefs and psychological distress among female office workers in Bali, and formulate general equation to predict psychological distress from the irrational belief scores. Methods: A cross-sectional study was conducted among 111 female office workers in Bali. The irrational beliefs were measured by the Smith Irrational Belief Inventory (SIBI) questionnaire and the psychological distress was assessed by a questionnaire quoted from the Brief Job Stress Questionnaire (BJSQ). Multivariable linear regression was performed to evaluate the role of irrational beliefs on psychological distress scores. Results: There was a moderate, positive correlation between irrational beliefs and psychological distress, which was statistically significant (r = 0.451, n = 111, p = 0.000). The R squared was 0.205, indicating that 20.5% of psychological distress variance can be explained by irrational beliefs. The F-ratio in the ANOVA test shows that the independent variables statistically significantly predict the dependent variable, F(3,107) = 9.187, p < 0.0005. The general form of the equation to predict psychological distress from irrational belief scores is: Predicted psychological distress (Y) = 17.909 + (0.392 x Irrational belief scores). Conclusion: Irrational beliefs are significantly associated with psychological distress among female office workers in Gianyar, Bali. This finding suggests the need for strategies anticipating better health and productivity among female workers.

Dengue virus transovarial transmission detection in Aedes aegypti from dengue hemorrhagic fever patients' residences in Denpasar, Bali.

Background and Aim: To effectively control dengue hemorrhagic fever (DHF), it is necessary to assess the risk of vertical virus transmission in Aedes aegypti mosquitoes. This study aimed to detect dengue virus (DENV) transovarial transmission in A. aegypti collected from DHF patients' residences in Denpasar, Bali. Materials and Methods: A. aegypti samples were acquired by rearing A. aegypti eggs collected from ovitraps placed in the homes of DHF patients. Ovitraps were installed for 7 days and viewed using a loupe to determine whether there were Aedes spp. eggs present. An immunocytochemical method was utilized with 200 samples, and virus detection was performed using a reverse transcriptase-polymerase chain reaction (RT-PCR). Results: Of the 10 DHF patient houses fitted with ovitraps, four produced positive ovitraps from which larvae developed (house index=40%). Of the 50 ovitraps mounted in the 10 homes, 14 ovitraps were positive and contained A. aegypti eggs (ovitrap index=28%). Of these 14 positive ovitraps containing A. aegypti eggs, 10 ovitraps produced larvae. Immunocytochemical tests were conducted on A. aegypti eggs from the four houses under study. It was found that from the 200 samples collected, 197 samples could be observed, and 11 samples (5.6%) were positive for DENV antigen. RT-PCR examination conducted on mosquitoes reared from the four houses studied obtained a negative virus content result. Conclusion: This study found the presence of DENV antigen to be as high as 5.6%. This means that potential for transovarial transmission exists within DHF patients' homes in Denpasar, Bali. Aedes control strategy in Denpasar should address this finding, in addition to the current approaches which have focused primarily on the elimination of larval breeding habitats and control of adults using insecticidal fogging during outbreaks.

Comprehensive Travel Health Education for Tour Guides: Protocol for an Exploratory Sequential Mixed Methods Research.

BACKGROUND: Tourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal. OBJECTIVE: This study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists. METHODS: This is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display. RESULTS: The qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage. CONCLUSIONS: A travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display. TRIAL REGISTRATION: ClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study.

PURPOSE: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. METHODS: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. RESULTS: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. CONCLUSION: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Forecasting COVID-19 Transmission and Healthcare Capacity in Bali, Indonesia.

OBJECTIVES: In the current early phase of the coronavirus disease 2019 (COVID-19) outbreak, Bali needs to prepare to face the escalation of cases, with a particular focus on the readiness of healthcare services. We simulated the future trajectory of the epidemic under current conditions, projected the impact of policy interventions, and analyzed the implications for healthcare capacity. METHODS: Our study was based on the first month of publicly accessible data on new confirmed daily cases. A susceptible, exposed, infected, recovered (SEIR) model for COVID-19 was employed to compare the current dynamics of the disease with those predicted under various scenarios. RESULTS: The fitted model for the cumulative number of confirmed cases in Bali indicated an effective reproduction number of 1.4. Interventions have decreased the possible maximum number of cases from 71 125 on day 86 to 22 340 on day 119, and have prolonged the doubling time from about 9 days to 21 days. This corresponds to an approximately 30% reduction in transmissions from cases of mild infections. There will be 2780 available hospital beds, and at the peak (on day 132), the number of severe cases is estimated to be roughly 6105. Of these cases, 1831 will need intensive care unit (ICU) beds, whereas the number of currently available ICU beds is roughly 446. CONCLUSIONS: The healthcare system in Bali is in danger of collapse; thus, serious efforts are needed to improve COVID-19 interventions and to prepare the healthcare system in Bali to the greatest extent possible.

Geo-mapping of hazards, risks, and travel health services in Bali: Results from the first stage of the integrated travel health surveillance and information system at destination (TravHeSID) project.

BACKGROUND: Currently, the main travel health surveillance system relies on ill-returned travelers data and has been mainly designed for countries of origin in developed regions. This study aims to develop an integrated travel health surveillance and information system for destination sites in Bali. METHODS: The first stage of the project included mapping and geo-tagging of health hazards and risks as well as travel health facilities, involving 197 tourist attractions in 8 regencies and 1 city in Bali. Hazard identifications were performed and risk levels were assessed using a qualitative risk assessment matrix. RESULTS: Health and safety hazards, risk levels, and travel health services with their geographical positions were mapped. Based on types of tourist attractions, 59 (29.9%) were beaches, 28 (14.2%) were temples, and 25 (12.7%) were waterfalls. Of the 197 tourist attractions, 107 (54.3%) were categorized as low-risk areas, 77 (39.1%) medium-risk areas, and 13 (6.6%) high-risk areas. The most common hazards included lack of proper access, risks of slips, trips, and falls, risks posed by water-based activities, mosquitoes as vectors of diseases, risks of bites or scratches from rabid animal, mixed brews containing methanol, and hyperbaric condition in diving sites. CONCLUSIONS: The opportunity of providing site-specific preventive measures to travelers was highlighted in this study.