An Important Strategy to Improve Adolescent Health Literacy: COVID-19 Modules in High School in Indonesia.

OBJECTIVES: During the second coronavirus disease 2019 (COVID-19) surge, cases increased sharply due to low awareness and compliance with measures to limit disease spread. Health literacy (HL) is an important component of public health initiatives, and schools are potential sources of health education to increase HL via the presentation of COVID-19 educational modules. METHODS: This cross-sectional study involved an online questionnaire administered to students from 5 high schools in Surabaya and Sidoarjo, Indonesia, 6-7 weeks after the start of government-issued directives restricting public gatherings. We collected data on each respondent's age, gender, parental education, and socioeconomic variables. HL was determined by the Health Literacy Measure for Adolescents. We additionally measured their attitudes and behaviors related to preventing the spread of COVID-19. The students were asked if they watched the COVID-19 module at school, their feelings about vaccination, and preferred online sources of COVID-19-related information. RESULTS: Most of the 432 respondents had viewed COVID-19 modules at school. Module exposure was associated with significantly higher total and domain-specific HL and more positive attitudes toward government-issued COVID-19 restrictions on travel and public gatherings (p<0.05). However, behaviors to prevent COVID-19 spread and vaccine acceptance were not associated with module exposure. Most students chose social media as their source of COVID-19-related information. CONCLUSIONS: Schools can provide information to increase adolescents' HL and the public's support for health initiatives to prevent or limit the spread of COVID-19.

Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic.

Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents' knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents' DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.

Societal influence and psychological distress among Indonesian adults in Java on the early Omicron wave of COVID-19.

Aim: Changes during the COVID-19 pandemic might create pressure on different people, thus this study aimed to measure respondents' psychological distress during the early phase of the Omicron wave in Java Island. Methods: A web-based survey on societal influence and COVID-19-related psychological distress was distributed through social media in November-December 2021, and received 396 responses. Results: This study showed that almost 50% of respondents faced psychological distress during the early phase of the Omicron variant, especially concerning hypervigilance and avoidance. Several sociodemographic factors might contribute to the incidence of psychological distress including comorbidity, age and education. Conclusion: Taken together, the incidence of COVID-19-related psychological distress was still found in the early phase of the Omicron variant, especially among young adults.

The COVID-19 pandemic hits every aspect of human life, including the social and psychological aspects. This study was conducted to measure these changes in Indonesian adults who stayed on Java Island during the early phase of the Omicron wave. Using an online questionnaire, 396 responses were received and analyzed. The results showed that almost half of the respondents still had symptoms of psychological distress. Several sociodemographic factors might contribute to the incidence of psychological distress including comorbidity, age, and education. Understanding these factors might bring benefits for future pandemic preparedness.

Dietary Supplement Consumption and Mental Health in Indonesian Adults During Second Wave of COVID-19 Pandemic.

Purpose: This study aimed to measure supplement consumption behavior and mental health status among Indonesian adults during the second year of COVID-19. Participants and Methods: Online questionnaire regarding supplement consumption, and Depression, Anxiety, Stress Scale 21 (DASS-21) was distributed from March to June 2021 and obtained 1006 valid and completed questionnaires. Descriptive and inferential analyses were conducted to determine the frequency and predictor factors of the respondents' supplement consumption behavior and mental health status. Results: Respondents were divided into two groups, vulnerable and non-vulnerable individuals. The finding showed that 34.5% respondents were vulnerable individuals, including the elderly and those with comorbid disease(s). The vulnerable and non-vulnerable groups exhibited a high prevalence of supplement consumption, with the vulnerable group demonstrating a greater tendency for regular use. The incidence of mental health problems in both groups did not significantly differ (23-38%), where anxiety was higher than depression and stress. Supplement consumption was associated with mental health status. Several positive predicting factors for supplement consumption behavior included older age, higher economic status, and higher education. While the younger age and unmarried respondents were more likely to develop mental health problems. Conclusion: Taken together, given dietary supplement consumption increased during the pandemic and the potential associations between supplement consumption and mental health, controlling the correct information and regulation regarding supplements, especially their risks and benefits, was important. Additionally, support for mental health issues was necessary, since it might affect self-medication behavior.

Sentiment analysis of Indonesian tweets on COVID-19 and COVID-19 vaccinations.

Background: Sentiments and opinions regarding COVID-19 and the COVID-19 vaccination on Indonesian-language Twitter are scarcely reported in one comprehensive study, and thus were aimed at our study. We also analyzed fake news and facts, and Twitter engagement to understand people's perceptions and beliefs that determine public health literacy. Methods: We collected 3,489,367 tweets data from January 2020 to August 2021. We analyzed factual and fake news using the string comparison method. The difflib library was used to measure similarity. The user's engagement was analyzed by averaging the engagement metrics of tweets, retweets, favorites, replies, and posts shared with sentiments and opinions regarding COVID-19 and COVID-19 vaccination. Result: Positive sentiments on COVID-19 and COVID-19 vaccination dominated, however, the negative sentiments increased during the beginning of the implementation of restrictions on community activities (PPKM).  The tweets were dominated by the importance of health protocols (washing hands, keeping distance, and wearing masks). Several types of vaccines were on top of the word count in the vaccine subtopic. Acceptance of the vaccination increased during the studied period, and the fake news was overweighed by the facts. The tweets were dynamic and showed that the engaged topics were changed from the nature of COVID-19 to the vaccination and virus mutation which peaked in the early and middle terms of 2021. The public sentiment and engagement were shifted from hesitancy to anxiety towards the safety and effectiveness of the vaccines, whilst changed again into wariness on an uprising of the delta variant. Conclusion: Understanding public sentiment and opinion can help policymakers to plan the best strategy to cope with the pandemic. Positive sentiments and fact-based opinions on COVID-19, and COVID-19 vaccination had been shown predominantly. However, sufficient health literacy levels could yet be predicted and sought for further study.

Medical student acceptance on gene therapy to increase children's well-being with genetic diseases: a study in Indonesia.

Aim: Gene therapy is expected to improve patients' quality of life. Medical students need to be aware about this technology as its application is becoming wider. Materials & methods: A web-based survey was conducted to measure the acceptance of Indonesian medical students regarding gene therapy. Results: Data from 621 valid responses showed that Indonesian medical students have little knowledge of this technology, with 34.4% of them ever heard of gene therapy. However, most of them support the approved gene therapy for health-related matters, but not on the non-health related matters. Their acceptance was determined by the sex, domicile and studentship status. Conclusion: Increasing medical students' knowledge of gene therapy is important to minimize the future conflict of gene therapy application.

Health literacy on COVID-19 and COVID-19 vaccinations in Indonesia.

Introduction: Health literacy on the coronavirus disease 2019 (COVID-19) affects people's capability to ascertain their health and health care quality during the pandemic. The objective of this study was to determine the levels of health literacy about COVID-19 vaccines and vaccinations (Vaccines and Vaccinations literacy-VL) in the Indonesian adult general population, assessing the perceptions of the respondents about current adult immunization and beliefs about vaccinations in general, and analyzing correlations of these variables with the VL levels. Methods: A cross-sectional study using a rapid survey was administered via the Internet. Data were analyzed using descriptive and inferential statistics; the internal consistency of the VL scales was evaluated using Cronbach's alpha coefficient; the inter-correlation between the functional and interactive-critical VL questions, the underlying components (factors) and each question's load on the components were identified using a Principal Component Analysis (PCA). An alpha level lesser than 0.05 was considered significant. Results: Responses to functional- and interactive/ critical- VL questions were acceptable and showed internal consistency (Cronbach's alpha = 0.817 and 0.699, respectively), lowest values observed were 0.806 for functional scale and 0.640 for the interactive-critical scale. The PCA demonstrated that there were two components accounting for 52.45% of the total variability. Approximately 60% of respondents were females (n=686). Almost all respondents used the internet to seek information regarding COVID-19 and COVID-19 vaccinations. Many used at least one social media actively with 74.4% of respondents sometimes believing the validity of this information. Conclusions: High scores were observed in both functional- and interactive/ critical-VL, and were quite in a balance between sexes in the prior VL and higher in females for the latter; these were also closely related to the educational level and age group. It is crucial to increase public health literacy in managing the pandemic.

"Anti-COVID-19" Medications, Supplements, and Mental Health Status in Indonesian Mothers with School-Age Children.

PURPOSE: The COVID-19 pandemic affects all aspects of life and might cause stress for vulnerable groups such as mothers with school-age children, both housewives and working mothers. With the uncontrolled circulating information about medications, supplements, and herbs that are believed to treat COVID-19, self-medication and misused might escalate. Therefore, this study aims to determine the consumption of "anti-COVID" agents and the mental health of mothers with school-age children in Indonesia. METHODS: Online questionnaires regarding medications/supplements for COVID-19 prevention and treatment of "anti-COVID" consumption behavior and mental health using the Depression, Anxiety, and Stress Scales (DASS-21) were distributed among Indonesian mothers with school-age children. Data (n = 610) were analyzed; descriptive and association between sociodemographic factors, "anti-COVID" medications consumption, and mental health were presented. RESULTS: A quarter of the respondents were categorized as having mental disorders, with higher scores of DASS-21 was higher in the housewives' group. The incidence associated with age, family expenses, and marital status in the working mothers' group, and only with family expense in the housewives' group. Moreover, the result showed 80% of the respondents consumed "anti-COVID" medications or supplements to prevent COVID-19, with 75% did self-medication without consulting with a healthcare professional. Friends/family and social media were two primary sources of information regarding the "anti-COVID" products. In the housewives' group, their consumption behavior was influenced by education. Meanwhile in the working mothers' group, the consumption behavior was influenced by age, family income, and family expense. In addition, there was no association between the usage of medications/supplements with the respondents' mental health status. CONCLUSION: This study showed the importance of controlling information and expanding the mother's knowledge to find the correct information to minimize the unwanted effect in the post COVID-19 pandemic. Increasing awareness of mental health issues in the community, especially in the vulnerable population such as mother with school-age children, is necessary to avoid detrimental effects that might occur in the future.

Engineered U7 Small Nuclear RNA Restores Correct ß-Globin Pre-mRNA Splicing in Mouse ßIVS2-654-Thalassemic Erythroid Progenitor Cells.

Restoration of correct splicing of ßIVS2-654-globin pre-mRNA was previously accomplished in erythroid cells from ß-thalassemia/HbE patients by an engineered U7 small nuclear RNA (snRNA) that carried a sequence targeted to the cryptic branch point and an exonic splicing enhancer, U7.BP+623 snRNA. In this study, this approach was tested in thalassemic mice carrying the ßIVS2-654 mutation. While correction of ßIVS2-654 pre-mRNA splicing was achieved in erythroid progenitors transduced with a lentiviral vector carrying the U7.BP+623 snRNA, a high level of truncated U7.BP+623 snRNA was also observed. The discrepancy of processing of the modified U7 snRNA in human and mouse constructs hamper the evaluation of pathologic improvement in mouse model.

Attitudes of Indonesian Medical Doctors and Medical Students Toward Genome Editing.

PURPOSE: This study aimed to measure the attitudes of Indonesian medical doctors and students toward new technology in genome editing. MATERIALS AND METHODS: Online questionnaires regarding attitudes toward genome editing on health and non-health conditions, both in somatic cells and embryo, were distributed through researcher networks, email and social media specific to medical doctors and students. The data of 1055 valid questionnaires were processed; descriptive and association analyses between sociodemographic factors and attitudes toward genome editing were performed. Email in-depth interview was performed to explore the respondents' answers. RESULTS: The results showed that Indonesian medical doctors' and students' knowledge of genome editing was limited and correlated with gender, place of residence, religion, education, marital status, childbearing and experience abroad. More than half of respondents supported genome editing for the treatment of fatal and debilitating diseases both in somatic cells and embryos, implying their consent to edited gene inheritance. However, this approval decreased when applied to non-health-related aspects, such as physical appearance, intelligence and strength. Factors affecting their attitudes toward genome editing included their status as medical doctors or students, gender, age, education, religion, economic status and place of residence. CONCLUSION: Increasing knowledge and awareness of Indonesian medical doctors and students regarding genome editing is important. Even though its application in health-related matter was supported by a majority of the respondents, discussion from ethical and religious perspectives is necessary to ensure the acceptance.

Nucleic Acid Therapy for ß-Thalassemia.

ß-thalassemia is caused by mutations in the ß-globin gene which diminishes or abolishes ß-globin chain production. This reduction causes an imbalance of the α/ß-globin chain ratio and contributes to the pathogenesis of the disease. Several approaches to reduce the imbalance of the α/ß ratio using several nucleic acid-based technologies such as RNAi, lentiviral mediated gene therapy, splice switching oligonucleotides (SSOs) and gene editing technology have been investigated extensively. These approaches aim to reduce excess free α-globin, either by reducing the α-globin chain, restoring ß-globin expression and reactivating γ-globin expression, leading a reduced disease severity, treatment necessity, treatment interval, and disease complications, thus, increasing the life quality of the patients and alleviating economic burden. Therefore, nucleic acid-based therapy might become a potential targeted therapy for ß-thalassemia.

Vitamin and mineral supplementation for ß-thalassemia during COVID-19 pandemic.

AIM: Low levels of immune-related micronutrients have been identified in ß-thalassemia samples. Moreover, the excess amount of iron, contributing to oxidative stress in the pathogenesis of the disease, alters the immune system in ß-thalassemia, which is important during the COVID-19 pandemic. MATERIALS & METHODS: Searches of PUBMED and EMBASE were conducted to identify the level and supplementation of micronutrients in ß-thalassemia, published from 2001-May 2020. RESULTS: The review found six observational and five interventional studies supporting the importance of supplementing vitamins and minerals among patients with ß-thalassemia. CONCLUSION: Supplementation of immune-related vitamins and minerals might bring benefits to the immune system, especially in reducing oxidative stress in ß-thalassemia.

Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study.

OBJECTIVE: This study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP). PATIENTS AND METHODS: A model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients' ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570). RESULTS: CBT would effectively increase the patients' LE and be cost-saving (dominant) as well. The ET group's hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT's dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case. CONCLUSION: Both sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.

Effects of 1α,25 Dihydroxyvitamin D3 on Pro-inflammatory Cytokines of Palmitic Acid Treated Thp-1 Cells.

The level of saturated fatty acids, such as palmitic acid (PA), correlates with chronic inflammation in obese and metabolic syndrome patients. However, low level of vitamin D3 is observed in those conditions. The aim of this study is to investigate effects of 1α,25(OH)2 D3 on PA-treated THP-1 cells. Using quantitative real-time polymerase chain reaction, we measure mRNA expression of pro-inflammatory cytokines: TNF-α, Interleukin (IL)-1ß, IL-6, and chemokine IL-8 under PA and 1α,25(OH)2 D3 influence. PA, at all concentrations (25-100 µM), enhanced LPS stimulatory effect on those mRNA expression compared to LPS-treated and -untreated cells. Combination with 1α,25(OH)2 D3 increased cytokine expression at high (10-6 M) and high-normal (10-8 M) concentrations compared to PA + LPS and LPS alone, both for 2 and 24 h. However, low-normal (10-10 M) and low (10-12 M) levels of 1α,25(OH)2 D3 could not enhance PA effect, but mRNA expression of pro-inflammatory cytokine was higher than LPS-treated cells. Upstream pathway of 1α,25(OH)2 D3 , which is cholecalciferol, also gave the similar result. Further, inhibition of calcium pathway does not play a role in this mechanism. Thus, these findings support pro-inflammatory effect of PA and vitamin D3 on innate immune response, especially on fat-induced inflammation. PRACTICAL APPLICATION: The effect of vitamin D3 on chronic inflammation in obesity is uncertain. This study shows an in vitro possibility that vitamin D3 could exaggerate inflammation when combined with high SFAs. The idea of using vitamin D3 supplement to modulate inflammation in fat-related inflammation needs further refined experiments before its clinical application.