Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey.

BACKGROUND: It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS: We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS: The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (ß1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS: The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Preparation and Challenges in Developing a Big Data Analysis Framework in Occupational Medicine in Indonesia.

This mini review explores the transformative potential of big data analysis and artificial intelligence (AI) in reforming occupational medicine in Indonesia. Emphasizing the preconditions, case studies, and benefits, it underscores the role of big data in enhancing worker well-being. The review highlights the importance of informative health big data, especially in high-risk industries, with examples of case studies of AI implementation in occupational medicine during the COVID-19 pandemic and other relevant scenarios. While acknowledging the challenges of AI implementation, the essay identifies the role of academic and professional organizations as pioneers in big data utilization. Six potential benefits that are identified, including improved patient care and efficient resource allocation, demonstrate the transformative impact of big data analysis. The proposed pathway of preparation underscores the need for awareness, skill enhancement, and collaboration, addressing challenges in data management and stakeholder engagement. The conclusion emphasizes continuous assessment, feasibility studies, and commitment as essential steps in advancing occupational medicine through big data analysis.

Physician's hesitancy in treating COVID-19 patients and its associated occupational risk factors in Indonesia: an online cross-sectional survey.

This cross-sectional survey aims to investigate physician hesitancy in treating COVID-19 patients in Indonesia, particularly among those who have already contracted the disease, along with associated occupational risk factors. The study involved distributing a questionnaire to physicians across the country, using contact information from the Indonesian Physician Association database. The results show that out of the 383 participants, 25.6% experienced moderate symptoms of COVID-19, and 2.9% required critical care. The study found that 20.3% of physicians demonstrated hesitancy to treat suspected, probable, or confirmed COVID-19 patients. Interestingly, older physicians and those with less experience in treating COVID-19 patients were found to have a higher hesitancy rate, while specialist trainees and those working in public hospitals demonstrated the lowest hesitancy. These findings highlight the significant hesitancy among physicians who have suffered from COVID-19 and underline the need for management and policymakers to take further action to address this issue. Understanding the effects and benefits of physician hesitancy in treating COVID-19 patients is crucial for ensuring the effective delivery of healthcare services during pandemics like COVID-19.

Validity and reliability test of the brief symptom rating scale 5 (BSRS-5) questionnaire in Indonesian version as an assessment tool for psychological disorders in Indonesia.

BACKGROUND: Psychological disorders in workers is associated with physical health problems and decreased work productivity costing the impact of workplace accidents. We can minimize these problems by introducing screening programs with a simple screening tool for psychological disorders. One of the questionnaires used in several countries to assess psychological disorders is the Brief Symptom Rating Scale - 5 (BSRS-5). Thus, this study aimed to assess the validity and reliability of the Brief Symptom Rating Scale - 5 (BSRS-5) in the Indonesian version. METHODS: The BSRS-5 was translated into a local language (Bahasa), and experts judgment in the forward and backward translation process. What collected BSRS-5 data in a primary health care setting on 64 respondents. Internal reliability was tested using Cronbach's alpha. Factorial validity was done using exploratory factor analysis to investigate whether BSRS-5 items properly measure the underlying dimensions of psychological disorders. External (criterion) validity was analysed by looking at the relationship between BSRS-5 and Depression, Anxiety and Stress Scale - 21 (DASS-21), using the coefficient correlation. RESULTS: The BSRS-5 questionnaire was produced from transcultural validation using the ISPOR method. The results of the construct validity test for all questions between (0.634-0.781) with a significance level < 0.05. The factor analysis values for all statements > 0.3 were all items having Eigenvalues > 1 yielded into one factor. The instrument performed well in detecting common psychological disorders. The BSRS-5 had good internal reliability (α = 0.770). The external validity test results with DASS-21 showed that BSRS-5 correlated with the DASS-21 dimensions of depression and stress with correlation values of 0.397 and 0.399. In opposition to correlated BSRS-5 with the dimension of anxiety in DASS-21 showed no correlation with a correlation value of 0.237. Therefore, another gold standard questionnaire is required to evaluate psychological distress based on each item in BSRS-5. CONCLUSION: The BSRS-5 is a satisfactory screening tool for identifying common psychological disorders such as Insomnia, Anxiety, Depression, Hostility, and Inferiority in the community. The absence of correlation with anxiety in this assessment tool needs another gold standard questionnaire, or professional assistance is required for further evaluation to follow up on psychological disorders.

Cultivating patient-centered care competence through a telemedicine-based course: An explorative study of undergraduate medical students' self-reflective writing.

Background: The COVID-19 pandemic has encouraged adaptations of learning methods in clinical clerkship. There have been limited reports on the merits of involving medical students in telemedicine. This study, therefore, aims to investigate students' reflection on what they learned and identify the challenges and benefits of doctor-patient interaction through their experience in a telemedicine-based course. Methods: A 4 week telemedicine-based course for medical students to participate in telemonitoring of COVID-19 patients undergoing self-isolation was conducted. This is a qualitative study using an interpretive phenomenology design to investigate students' self-reflection on their experiences in monitoring COVID-19 patients. Students were asked to reflect on their experience upon completion of the course through 750-1,000 words essays. A thematic analysis which considers units of meaning based on students' experiences was completed. Results: Our study identified four main themes gathered from students' experiences related to the telemedicine-based course: communication and education, professionalism and professional identity formation, system-based practice, and patient-centered care. Conclusion: The course was part of an integrative effort involving multiple parties to tackle the burden on the nation's healthcare system during the pandemic. Telemedicine is part of future medical practice which supports the medical curriculum adaptability along with attempts to develop future-proof medical doctors through various clinical learning experiences.

Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study.

Workers with tuberculosis (TB) are often stigmatized, negatively impacting their socioeconomic position, mental health, and TB treatment outcomes. There is a dearth of validated tools to assess stigma in the worker population. This study aimed to develop and validate a novel, culturally adapted tool to measure TB-related stigma among workers in Indonesia. We translated, adapted, applied, and internally validated Van Rie's TB-Stigma Scale to the worker population in varying sizes businesses (formal and informal business sectors) in Indonesia. Psychometric evaluation using exploratory and confirmatory factor analyses (EFA and CFA) was performed to check the tool's internal consistency and reliability. The translation and cultural adaptation phases resulted in a final 11-item tool. From 172 participant responses, the EFA found two loading factors relating to responses on isolation and exclusion from the workplace. The CFA confirmed that the developed model had moderate fit with R2 values for each item ranging from 0.37 to 0.84. The tool was reliable (Cronbach's alpha 0.869). This validated, consistent and reliable adapted tool is ready to use in larger scale evaluations of TB-related stigma amongst workers in formal and informal business sectors of Indonesia to develop strategies to eliminate TB-related stigma from the workplace.

A COVID-19 self-isolation monitoring module for FMUI undergraduate medical students: Linking learning and service needs during the pandemic surge in Indonesia.

To ensure that students continued receiving adequate yet safe clinical exposure during the COVID-19 pandemic, the Faculty of Medicine at Universitas Indonesia (FMUI) created the Module of COVID-19 Self-Isolation Monitoring which aims to equip students with the knowledge and skill to monitor confirmed and close contact cases of COVID-19. Module development, divided into four phases: preparation, orientation, implementation, and evaluation phase, started as soon as the delta wave of COVID-19 cases forced medical students to halt their offline clinical rotations. A quantitative secondary data were obtained from student and patient satisfaction questionnaires and on students' performance and reflection. We analyzed the distribution of module evaluation, the student's discussion score during the module, the students' interest in participating as Covid-19 volunteers before and after the module's deployment, and the correlation between learning outcomes and satisfaction. A total of 372 patients were monitored by 208 students during the 4-week module. The response rates were above 80%, with the majority agreeing that students found this module well-organized and fulfilled their expectations. There was a significant increase in discussion scores from weeks 1 to 4, a significant difference in the proportion of students interested in COVID-19 volunteering before and after the module completion as well as a significant low correlation between the patient's monitoring score sheet and the reflection essay towards the patient's satisfaction. We should still improve tutors' time management, tutors' provision of triggering questions for critical thinking skills, and tutors' feedback for students. The module met patient expectations and is expected to assist tutors in providing feedback and examples of doctor-patient communication, thus accelerating students' competence in patient interaction. Further evaluation is needed regarding knowledge transfer, the impact on community health, and the faculty development program, especially regarding how tutors fulfill their roles as medical educators.

The effect of plastic tape seal to reduce face seal leak in respirator N-95 type 1860.

The risk of face seal leak while using N-95 respirators is experienced by health workers and thus failing fit test are quite common. Finding solutions to overcome face seal leaks is crucial; one of which is by sealing the N-95 respirator. The seal used in this research was Tegaderm® a transparent film dressing or a plastic tape which is known to have the advantages of strong adhesion, high level of pore density and standardized medical grade. This study tries to determine the effectiveness of plastic tape adhesive on the N-95 type 1860 respirator in overcoming face seal leak qualitative fit test using Bitrex immediately after being worn and after 4 h of using it. The study used a quantitative approach with an incidence study design conducted pre and post experimental without comparison to see the effectiveness of plastic tape sealing. The subjects for the research were 81 health workers in the CMH environment who were at risk of being exposed to COVID-19. The study found a significant difference in the Bitrex fit test immediately after sealing the N-95 type 1860 respirator with plastic tape; 100% passed the fit test immediately after sealing, and 64.2% passed the fit test after 4 h of working. The effectiveness of sealing using plastic tape is considered to be quite good to overcome face seal leak on the N-95 type 1860 respirator. Health care workers need to be more vigilance to ensure better face seal.

The Impact of Air Pollution on Gut Microbiota and Children's Health: An Expert Consensus.

Air pollution is an unseen threat to children's health because it may increase the risk of respiratory infection, atopy, and asthma, and also alter gut microbiota compositions. The impact of air pollution on children's health has not been firmly established. A literature review followed by a series of discussions among experts were performed to develop a theoretical framework on how air pollution could affect various bodily organs and functions in children. We invited experts from different backgrounds, such as paediatricians, nutritionists, environmental health experts, and occupational health experts, to provide their views on this matter. This report summarizes the discussion of multidisciplinary experts on the impact of air pollution on children's health. The report begins with a review of air pollution's impact on allergy and immunology, neurodevelopment, and cardiometabolic risks, and ends with the conceptualization of a theoretical framework. While the allergic and immunological pathway is one of the most significant pathways for air pollution affecting children's health in which microbiotas also play a role, several pathways have been proposed regarding the ability to affect neurodevelopment and cardiometabolic risk. Further research is required to confirm the link between air pollution and the gut microbiota pathway.

Total Flight Hours and Other Factors Associated with Hyperuricemia in Civilian Pilots.

BACKGROUND: In the aviation world, hyperuricemia can endanger flight safety through the risk of incapacitation, either associated with gout disease or associated with an increased risk of cardiovascular disease. This study aims to determine the prevalence of hyperuricemia in civil pilots in Indonesia and the identification of risk factors for hyperuricemia in civil pilots in Indonesia.METHODS: The study used a cross-sectional method from the medical records of civil pilots at the Aviation Medical Center, Jakarta, who were examined on 1 November 2019 through 30 April 2020. Data collected from medical records included: laboratory data of uric acid, age, total flight hours, Body Mass Index (BMI), and alcohol consumption. Hyperuricemia is a plasma urate concentration > 420 µmol · L-1(7 mg · dl-1).RESULTS: The research sample amounted to 5202 pilots; 18.4% had hyperuricemia. Pilots who have total flight hours ≥5000 have a reduced risk of hyperuricemia by 24% compared to pilots with total flight hours <5000. Obese and overweight pilots had a 2.98 times and 1.36 times, respectively, greater risk of hyperuricemia than pilots who had a normal BMI. Based on BMI criteria classification of WHO Asia Pacific, obese is ≥25 and overweight is 23-24.9. Furthermore, compared to pilots who did not consume alcohol, pilots who consumed alcohol had a 14.68 times greater risk of developing hyperuricemia.CONCLUSION: The prevalence of hyperuricemia in civil pilots in Indonesia is 18.4%. Obesity, overweight, and alcohol consumption increase the risk of hyperuricemia in civil pilots in Indonesia.Tisera SC, Agustina A, Soemarko DS. Total flight hours and other factors associated with hyperuricemia in civilian pilots. Aerosp Med Hum Perform. 2022; 93(1):22-25.

The formula for calculating the predicted value of cardiorespiratory endurance using a foot rest-based cardiorespiratory exercise device.

This study developed a formula for calculating the predicted VO2 max value using a prototype model of foot-based cardiorespiratory exercise. Forty sedentary workers (20 men and 20 women) were enrolled via consecutive sampling. They underwent direct measurement of VO2 max using spiroergometry as the gold standard; the predicted VO2 max value was calculated using a prototype model of foot-based cardiorespiratory exercise, which was performed on consecutive days. Multivariate linear regression analysis was used to formulate the equation for the predicted VO2 max value by including potential contributing variables: gender, body height, body weight and heart rate. Bland-Altman test was used for assessing the agreement level for the predicted VO2 max value. The equation for the predicted VO2 max value was formulated as 3.2 + 0.15 optimal exercise heart rate -5.5 sexes (0 for men, 1 for women). The agreement level for the formula was acceptable in all measurement result ranges. The formula developed in this study can be used to measure the predicted VO2 max value with an acceptable agreement level.

[The System and Human Resources for Occupational Health in Republic Of Indonesia for Japanese Enterprises to Manage Proper Occupational Health Activities at Overseas Workplaces].

OBJECTIVES: To consider the appropriate occupational health system for Japanese enterprises in Indonesia with information on the regulations and development of the specialists. METHODS: In this study, we used the information-gathering checklist developed by Kajiki et al. Along with literature and internet surveys, we surveyed local corporations owned and operated by Indonesians, central government agencies in charge of medical and health issues, a Japanese independent administrative agency supporting subsidiaries of overseas Japanese enterprises, and an educational institution formulating specialized occupational physician training curricula. RESULTS: In Indonesia, the Ministry of Manpower and the Ministry of Health administer occupational health matters. The act No. 1 on safety serves as the fundamental regulation. We confirmed at least 40 respective regulations in pertinent areas, such as the placement of medical and health professionals, health examinations, occupational disease, and occupational health service agencies. There are some regulations that indicate only an outline of activities but not details. Occupational physicians and safety officers are the two professional roles responsible for occupational health activities. A new medical insurance system was started in 2014, and a workers' compensation system was also established in 2017 in Indonesia according to the National Social Security System Act. DISCUSSION: Although safety and health laws and regulations exist in Indonesia, their details are unclear and the quality of expert human resources needed varies. To conduct high-quality occupational health activities from the standpoint of Japanese companies' headquarters, the active promotion of employing highly specialized professionals and cooperation with educational institutions is recommended.