Leadership of school principals for school health implementation among primary schools in Mataram, Indonesia: a qualitative study.

BACKGROUND: Health-promoting schools (HPS) are acknowledged as a comprehensive approach to improving children's health and educational outcomes through learning and school life. Principals are key players in HPS implementation. However, concrete leadership practices in HPS in low- to middle-income countries have not been clarified. Therefore, this study aimed to explore and generate themes surrounding the leadership practices of principals in implementation of school health in Indonesia, a predominantly Muslim country consisting of diverse religions that have expanded HPS at the national level. METHODS: In-depth interviews and focus group discussions (FGDs) were conducted with the principals, teachers, parent representatives, and school board committee members in 10 target schools. FGDs were conducted with school health supervisory board members in Mataram City. All interviews were recorded and transcribed. Thematic analysis was undertaken to generate themes. RESULTS: The principals demonstrated leadership practices based on their religious beliefs, values, and morals. This may suggest that beliefs and morals support an understanding of their responsibility to ensure the well-being of all school community members, regardless of religion, in a diverse environment that is predominantly Muslim but also multicultural and multi-religious. Further, these beliefs and morals might reinforce implementation of school health. Importantly, the principals' coordination skills in cooperating with multiple sectors might contribute to successful implementation of school health. Also, principals emphasized they were tasked to develop capacity for implementation of school health. Thus, principals should understand leadership in the implementation of school health as their duty from the training stage to encourage health at the school level. CONCLUSION: In this study, "have professional educators' beliefs and religious beliefs and Indonesia's morals" was generated as a new theme, whereas several common themes were found as in previous studies. The results of this study suggested the importance of leadership by principals in the implementation of school health. Strengthening the capacity of school principals by integrating the contents of school health leadership practice into pre- and in-service training through the development of a policy on principals' duties in school health might contribute to the successful implementation of school health.

Content analysis of health-related subjects in the K12 school curricula of Japan, Indonesia, Philippines, Guam, Micronesia, Marshall Islands, Palau, and Fiji.

BACKGROUND: As a component of health promoting school, a school curriculum for health education was considered a fundamental. This survey aimed to identify the components of health-related topics and in which subjects were they taught. METHODS: Four topics were chosen: (i) hygiene, (ii) mental health, (iii) nutrition-oral Health, and (iv) environmental education related to global warming in Education for Sustainable Development (ESD). Before gathering the curricula from partner countries, school health specialists were gathered to discuss the appropriate components of a curriculum that required evaluation. The survey sheet was distributed to and answered by our partner in each country. RESULTS: About hygiene, individual practices or items that improve health-related were widely covered. However, items that imparted health-related education from an environmental perspective were not widely covered. About mental health, two types of country groups were identified. The first group included countries that taught mental health topics mainly as part of morals or religion; the second group included countries that imparted mental health topics mainly as part of health. The first group focused mainly on communication skills or coping methods. The second group focused not only on communication and coping skill but also on basic knowledge of mental health. About nutrition-oral education, three types of country groups were identified. One group imparted nutrition-oral education mainly in terms of health or nutrition. Another group imparted this topic mainly in terms of morals, home economics, and social science. The third group was the intermediate group. About ESD, a solid structure for this topic was not identified in any country. Many items were taught as part of science, while some were taught as part of social studies. Climate change was the most commonly taught item across all countries. The items related to environment were relatively limited compared to those related to natural disasters. CONCLUSIONS: Overall, two different approaches were identified: the cultural-based approach, which promotes healthy behaviors as moral codes or community-friendly behaviors and the science-based approach, which promotes children's health through scientific perspectives. Policymakers should initially  consider the findings of this study while making decisions on which approach should be taken.

Teachers' conflicts in implementing comprehensive sexuality education: a qualitative systematic review and meta-synthesis.

INTRODUCTION: Comprehensive sexuality education (CSE) enables children and young people to learn about the cognitive, emotional, physical, and social characteristics of sexuality. Teachers experience conflicts in teaching CSE due to different cultural and religious backgrounds. This qualitative systematic review aimed to describe the conflicts experienced by teachers in the implementation of CSE in schools. Furthermore, this study aimed to identify the causes of conflict among teachers in implementing CSE. METHODS: This article focused on teachers' conflicts in implementing CSE from 2010 to 2022. Online bibliographic databases, such as PubMed, Web of Science, and ERIC, were used to search for relevant articles. The following search term was used: Teacher, Comprehensive Sexuality Education, and Conflict. RESULTS: A total of 11 studies were included in the review. All 11 studies were conducted in countries with a predominantly Christian population. The majority of the studies were conducted in Africa. The study respondents included teachers, school principals, and school coordinators. The studies identified that CSE implementation is related to multiple conflicts, depending on the context of the country. Five themes on the causes of conflict emerged from the thematic meta-synthesis: (1) Hesitancy in talking about sex education among teachers due to the cultural and religious context; (2) non-integration of traditional sex education into comprehensive sexuality education, (3) fostering effective facilitation of CSE among teachers, (4) determining the appropriate age to start sex education, and (5) roles of stakeholders outside the school. CONCLUSIONS: This qualitative systematic review and thematic meta-synthesis highlighted several conflicts among teachers in CSE implementation. Despite the teachers having a perception that sex education should be provided, traditional sex education has not yet transformed to CSE. The study findings also emphasize the need to identify the teacher's role in CSE implementation. The thematic meta-synthesis also strongly reflected the context of Christianity in Europe and Africa; thus, further research on the religious context in other regions is needed.

The process of overcoming conflicts among teachers in the implementation of comprehensive sexuality education at ordinary public senior high schools in Mataram City, Indonesia: a qualitative study.

BACKGROUND: Comprehensive sexuality education (CSE), which aims to help young people make responsible choices and acquire scientific knowledge and skills, has been promoted by UNESCO. Teachers experience conflicts in implementing CSE when teaching sexual topics in the local context, especially as the delivery of sexual knowledge and contraceptive methods is often prohibited by religious and traditional cultural norms. It was reported that there were multiple challenges in the implementation of sex education due to the religious and cultural background of societies and communities in Islamic countries. This study aimed to clarify the process of overcoming the conflicts, explore teachers' recognition and perception related to the implementation of CSE, and to suggest recommendations for promoting CSE in Islamic areas. METHODS: This qualitative study combined the methods of focus group discussions (FGDs) and in-depth interviews (IDIs) to explore the conflict among teachers. Ten ordinary public senior high schools in Mataram City, Indonesia, agreed to participate, and in total, 59 participants were involved in this study. FGDs were conducted with teachers (n = 49), and IDIs were focused on school principals (n = 10) in each school. The collected interview data were analyzed using a deductive thematic analysis and the findings triangulated for both the FGDs and IDIs. RESULTS: Overall, the teachers experienced conflicts in relation to religion, cultural background, and gender inequality in implementing CSE. The present study revealed the mutual recognition among teachers and acceptance of diverse backgrounds in the implementation of CSE at ordinary public senior high schools in Mataram City. Despite teachers reporting multiple conflicts, they made efforts to overcome these conflicts through mutual recognition and provided comprehensive guidance. The present findings indicated that teachers adapted CSE to follow multiple religions and cultural backgrounds. CONCLUSIONS: The teachers accepted diverse backgrounds and provided CSE by collaborating with related educational subjects and external institutions to overcome conflicts. To provide more specialized education, it would be necessary to advocate a formal policy that might be accepted by diverse societies. Further research is necessary to apply the findings and recommendations for CSE implementation globally in the contexts of different countries.

Measuring the Possibility of Middle Ear Discharge for COVID-19 Test Material.

The COVID-19 pandemic is still ongoing, and new variants continue to emerge. Various examination methods and sampling specimens are continuously being developed and published. The standard for sampling is in the nasopharynx. However, in children, this is often uncomfortable and at risk of eliciting complications. Therefore, it is necessary to look for other alternative sampling sites such as fluid from the middle ear. Scientific evidence shows that the middle ear can be a place for the attachment and growth of the SARS-CoV-2 virus. Currently, to the best of the author's knowledge, there have been no publications on middle ear discharge as a sample for the determination of the diagnosis of COVID-19. Based on this, the authors would like to explore the possibility of middle ear discharge for COVID-19 test material. A narrative review on the use of middle ear discharge as a potential diagnostic specimen for COVID-19 was conducted. The searches were conducted in the PubMed and ProQuest databases.

The role of the rapid molecular test (RMT) and the provision of a negative pressure mortuary room in reducing COVID-19 corpse handling protocol rejection: experiences with religious conservative groups.

BACKGROUND: This study explores the difference in COVID-19 corpse handling protocol rejection before and after the innovation in rapid molecular test (RMT) postmortem examination and providing negative pressure mortuary rooms. This study is a retrospective observational study. Each of the corpse's immediate family was explained the procedure for handling the body based on the fatwa of the religious institution and the hospital's standard operating system. The acceptance or rejection of the protocol, general characteristics of the corpse, and the reasons for refusal are documented. RESULTS: From March to May 2020, there were 16 probable COVID-19 corpses and 3 confirmed COVID-19 corpses. Rejection of the COVID-19 corpse protocol occurred six times. The main reason for rejection is that the death might not necessarily be caused by COVID-19, the body's handling in the hospital is not following religious law, and the negative stigma of COVID-19. From June to August 2020, there were 42 probable COVID-19 corpses and 49 confirmed COVID-19 corpses. Rejection of the COVID-19 corpse protocol occurred eight times. The most rejection reason is that the deceased families do not believe the deceased died because of COVID-19. CONCLUSIONS: The decline in the COVID-19 corpse protocol rejection has occurred after applying RMT and providing a negative pressure mortuary room. This decline proves that religious conservative groups can accept this innovation to reduce rejection on religious grounds.

Exercise adaptations and TGF-ß1 levels in recreational cyclists.

BACKGROUND: Cycling is a physical exercise that is widely performed to improve physical fitness. Regular physical exercise will lead to adaptations to exercise. This adaptation is useful in suppressing the production of reactive oxygen stress (ROS) generated in response to cellular metabolism that uses oxygen. Transforming growth factor beta-1 (TGF-ß1) plays a role in increasing the production of ROS, thus, when the concentration is low, it would lead to an improvement in physical fitness. This study aims to compare levels of TGF-ß1 between recreational cyclists and sedentary groups. In addition, this research also compares several other parameters, which are fasting blood sugar levels and lipid profiles (triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol) between cyclists and sedentaries. METHODS: This was an observational analytical study with a cross-sectional design. The research subjects consisted of 2 groups, each consisting of 21 participants, namely the recreational cyclist and the sedentary group. Anthropometric examinations were carried out, including body weight, height, body mass index, waist circumference, and body fat percentage. Fasting blood glucose concentration and lipid profile (Triglyceride - TG, Total Cholesterol - Total C, HDL Cholesterol - HDL-C, and LDL Cholesterol - LDL-C) were determined by the enzymatic colorimetric methods, and TGF-ß1 levels were determined using the fluorescence of specific antibodies for TGF-ß1 (pg/ml) using ELISA method. Statistical analysis was performed using IBM SPSS v. 25. RESULTS: The anthropometric variables, other than body height, did not differ significantly between the two groups, so did the fasting blood glucose concentration. Nevertheless, the lipid profile (TG, Total C, HDL-C and LDL-C) were found to be significantly better in the cyclist group (p < 0.05).The mean level of TGF-ß1 in recreational cyclists was 8, 908.48 pg/ml, lower than the control group, 10, 229.28 pg/ml. The results of the unpaired t-test showed significant mean differences between the two groups, (p = 0.001; p < 0.05). CONCLUSION: The levels of TGF-ß1 in the recreational cyclist group were lower than the sedentary group. Regular physical exercise will trigger exercise adaptations that can suppress latent TGF-ß1 activation.

Urgent need to strengthen school health in Asia and the Pacific islands.

In Asia and the Pacific island region, strengthening of school health activities and measures is urgently recommended to deal with the impact of the increasing risk of potential school closures due to continuation of the coronavirus disease 2019 (COVID-19) pandemic in 2021. As the incidence of COVID-19 in 2020 was relatively low in these regions, many of the countries were able to avoid prolonged school closures. However, even if vaccination is expanded in the future and the pandemic tends to come to an end, the risk of SARS-CoV-2 variants spreading among children will also increase, and the possibility of having to close schools again will also increase.

Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines.

INTRODUCTION: Japan's health policies to address the most advanced-aged society have been the target of focus in Asia, but no studies have investigated this issue using tools for cross-country comparisons. THEORY AND METHODS: A cross-country study design was used to compare healthcare reform policies with a framework in Japan, Korea, Thailand, China, Indonesia, and the Philippines. Data were collected via document reviews and key informant interviews. RESULTS: Three distinctions were identified. First, all countries except for the Philippines have policy decisions regarding reforms for the existing service delivery systems for healthcare, long-term care and welfare. Second, the most extensive service delivery reform is currently being implemented in Japan, whose system is shifting to primary health care. Third, the direction of the transformation of service delivery system is different between Thailand and China despite a similar level of ageing society. China has made progress on facility-based care integration between health and social care, whereas Thailand is focusing on home-based care. CONCLUSIONS AND DISCUSSION: Doctor and hospital-based healthcare delivery system requires more drastic reform for an aged society. This fact implies that strengthening primary health care is not only useful for current health issues but also an investment for the aged society near future in low- and middle-income countries.

COVID-19 infection in the palatine tonsil tissue and detritus: the detection of the virus compartment with RT-PCR.

Two patients suffering from chronic recurrent tonsillitis were reported. The first patient was confirmed infected with COVID-19, 3 weeks prior to tonsillectomy. The detritus and tonsil specimen were further analysed through real-time PCR (RT-PCR) and revealed amplification of the fragment N and ORF1ab genes of SARS-CoV-2. The second patient had a negative IgM and positive IgG antibody for COVID-19; however, the nasopharyngeal swab indicated negative for SARS-CoV-2. Tonsillectomy was performed 2 weeks after the swab; the tonsil specimen was analysed through RT-PCR and revealed amplification of the N2 and RdRp gene of SARS-CoV-2. According to both results, the presence of the SARS-CoV-2 gene remains to be detected in tonsil and/or detritus after 2-3 weeks after recovery. Hence, it is suggested that it is necessary to use adequate protection when performing tonsillectomy on early recovered patients with COVID-19. Furthermore, tonsillectomy would be more advisable to be performed after the fourth week after recovery from COVID-19.

School-based education to prevent bullying in high schools in Indonesia.

BACKGROUND: The Global School-based Health Survey showed that 20.6% of Indonesian students aged 13-17 years old were bullied. The proportion was lower than those reported from Southeast Asian countries (28.3-51.0%). School education was reported to contribute to the reduction of bullying, but no similar study has been done in Indonesia. This study aimed to explore the role of school-based education in preventing bullying in high schools in Indonesia. METHODS: In-depth interviews with principals and focus group discussions with teachers from five schools in Mataram City were conducted in 2018. Data were transcribed and analyzed using thematic analysis. Participant observations and document reviews were conducted to verify the data. RESULTS: Seven themes emerged: (i) Bullying as a problem; (ii) Causes of bullying; (iii) Effects of bullying; (iv) Curricular interventions; (v) Cultural interventions; (vi) Institutional interventions; and (vii) Challenges and recommendations regarding current interventions. Curricular interventions include Pancasila (state ideology or principles of the state's philosophy) and civic education, and religious education, while cultural interventions include cultural practices and extracurricular activities. The schools provide an enabling environment by maintaining a good physical environment and implementing policies to prevent bullying. These activities promote the prevention of school bullying. CONCLUSIONS: This study demonstrated that moral education in curriculum and cultural activities are avenues for the prevention of school bullying. The implementation of both religious education and civic education encouraged the creation of values among students. In Indonesia, current interventions should be continued and must be modified to respond with societal changes.

Subcutaneous hemangioma on nasal dorsum: a case report.

INTRODUCTION: Hemangioma is a benign tumor made up of blood vessels and typically occurs as a slightly elevated purplish or reddish area of skin. Hemangioma is mostly found superficially; subcutaneous hemangioma in the nasal dorsum is rare. CASE PRESENTATION: In West Nusa Tenggara Regional Hospital, the authors found two cases of subcutaneous hemangioma in patients of very different ages. The first patient was a 2-year-old Sasak girl, and the other was a 40-year-old Sasak man. The pediatric patient was treated with an elliptical approach, whereas the adult patient was treated with lateral rhinotomy extended by an elliptical approach to remove the hemangioma and ligate the feeding arteries. After surgery, the adult patient was followed up for 5 months, whereas the pediatric patient was followed up for 3 months. The results for both patients were good, with minimal scar formation. CONCLUSION: Despite the limitations of technology and human resources in a remote area of Indonesia, the surgical approach used in these cases produced good outcomes for both patients.