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.

Fatal drowning in Indonesia: understanding knowledge gaps through a scoping review.

Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the epidemiology and risk factors of unintentional drowning in Indonesia and explore existing health promotion and drowning prevention approaches in Indonesia within a socio-ecological health promotion framework. A scoping review, guided by PRISMA-ScR, was conducted to locate peer-reviewed studies and government reports/policy documents published until May 2023, in English or Indonesian language, using MEDLINE (Ovid), CINAHL, Informit, PsycINFO (ProQuest), Scopus, SafetyLit, BioMed Central and Google Scholar, Indonesian journal databases (Sinta, Garuda) and government agencies websites around the terms: drown, swim, flood, hurricane, cyclone, disaster, water rescue and maritime/boat safety. This review identified 32 papers. However, a paucity of information on unintentional drowning rates, risk factors and prevention in Indonesia was noted. The unavailability of a coordinated national drowning data collection system in Indonesia, from which national and subnational subcategory data can be collected, underlines the possibility of under-representation of drowning mortality. The association between various exposures and drowning incidents has not been fully investigated. An over-reliance on individual-focused, behaviour-based, preventive measures was observed. These findings highlight the need for improving drowning surveillance to ensure the availability and reliability of drowning data; and strengthening research to understand the risk factors for drowning and delivery of drowning prevention programs. Further policy development and research focusing on health promotion approaches that reflect a socio-ecological approach to drowning prevention in Indonesia is imperative.

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.

Hematological Parameters in Individuals with Beta Thalassemia Trait in South Sumatra, Indonesia.

Background: ß-Thalassemia has a very wide clinical variation, depending on the severity of the patient's condition. Individuals with ß-thalassemia traits are usually asymptomatic; however, laboratory examination will show mild anemia with microcytic hypochromic erythrocytes morphology with wide variation depending on the genotype. This study was conducted to determine the reference value of hematological parameters and hemoglobin (Hb) analysis based on the phenotype of ß-thalassemia (ß 0 and ß +) and determine the differences of hematological characteristics between the two phenotypes. Methods: This cross-sectional study was conducted by evaluating the hematological parameters and Hb analysis of the ß-thalassemia trait in the family of thalassemia patient population. The subjects were divided into ß 0 and ß +. The subject with normal Hb analysis with or without iron deficiency was excluded. Results: A total of 203 subjects with thalassemia traits were included from the families of thalassemia patients, consisting of 101 subjects with ß 0-thalassemia, 82 subjects with ß +-thalassemia, and the mutation had not been found in 20 subjects. There was a relationship in the mean/median of hematological parameters, HbA2 and HbF, between ß 0-thalassemia and ß +-thalassemia (P < 0.05). ROC for each hematological parameter, HbA2 and HbF, showed that the highest diagnostic value based on the area under the curve was mean corpuscular hemoglobin (MCH) (0.900) and mean corpuscular volume (MCV) (0.898). The cutoff point of MCH for ß 0-thalassemia trait was ≤20.5 pg (sensitivity 85%, specificity 90%) and MCV was ≤66.8 fL (sensitivity 87%, specificity 87%). Conclusion: MCH values can be used as a screening tool for predicting ß 0-thalassemia in the relatives of thalassemia patients in the South Sumatra population.

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.