Simulation of the COVID-19 handling policy in Indonesia.

Background: This study's background was inspired by the current COVID-19 handling policy, which focuses on the balance of public health and social economy. However, there is a knowledge gap on the dynamic complexity of balancing public health and social economy during the new normal period of COVID-19 handling policy. A system dynamics simulation of the COVID-19 handling policy could be used to understand that gap. Objective: This study aims to uncover the simulation of the COVID-19 handling policy in Indonesia. Methods: This study combined quantitative and qualitative modeling methods with a system dynamics tool. Results: This study revealed 3 elements in the dynamic balance of public health and social economy in the COVID handling policy system: i) COVID-19 and social-economic control; ii) COVID-19 escalation and de-escalation; iii) people's immunity enhancement. Such a mix of COVID-19-controlling policy instruments has maintained a dynamic equilibrium between easing economic suppression at the expense of worsening COVID-19 and tightening public health resolution at the expense of more economic suppression. Conclusions: The study conclusions are as follows: i) the COVID-19 handling policy worked as a leverage factor in balancing public health resolution and economic interest during the new normal period in Indonesia; ii) experiential creativity to respond to the newly serious public health problems triggered by COVID-19 implies adding public health knowledge; iii) the study's outcomes imply re-examining the strengths and deficiencies of the entire health system for a better health system.

Potential risks of heavy metals in green mussels (Perna viridis) harvested from Cilincing and Kamal Muara, Jakarta Bay, Indonesia to human health.

This study investigates Pb, Cd, and Cr in the suspended particulate matter (SPM), sediments, and green mussels from Cilincing and Kamal Muara, Jakarta Bay and estimates their potential human health risks. The results showed that the metal levels in SPM from Cilincing ranged from 0.81 to 1.69 mg/kg for Pb and 2.14 to 5.31 mg/kg for Cr, while in Kamal Muara ranged from 0.70 to 3.82 mg/kg for Pb and 1.88 to 4.78 mg/kg dry weight for Cr. The levels of Pb, Cd, and Cr in sediments from Cilincing ranged from 16.53 to 32.51 mg/kg, 0.91 to 2.52 mg/kg; and 0.62 to 1.0 mg/kg whereas in Kamal Muara ranged from 8.74 to 8.81 mg/kg; 0.51 to 1.79 mg/kg, and 0.27 to 0.31 mg/kg dry weight, respectively. The levels of Cd and Cr of green mussels in Cilincing ranged from 0.014 to 0.75 mg/kg and 0.003 to 0.11 mg/kg; while in Kamal Muara ranged from 0.015 to 0.073 mg/kg and 0.01 to 0.04 mg/kg wet weight, respectively. Pb was not detected in all samples of green mussels. The Pb, Cd, and Cr levels in the green mussels were still below the permissible limits set by international standards. However, the Target Hazard Quotient (THQ) for adult and children in several samples were higher than one indicating potential noncarcinogenic effects to consumers due to Cd accumulation. To reduce the detrimental effects of metals, we suggest maximum mussel consumption of 0.65 kg for adults and 0.19 kg for children in a week based on the highest level of metals.

Cohort study of the APACHE II score and mortality for different types of intensive care unit patients.

OBJECTIVES: Find the discriminant and calibration of APACHE II (Acute Physiology And Chronic Health Evaluation) score to predict mortality for different type of intensive care unit (ICU) patients. METHODS: This is a cohort retrospective study using secondary data of ICU patients admitted to Siloam Hospital of Lippo Village from 2014 to 2018 with minimum age ≥17 years. The analysis uses the receiver operating characteristic curve, student t-test and logistic regression to find significant variables needed to predict mortality. RESULTS: A total of 2181 ICU patients: men (55.52%) and women (44.48%) with an average age of 53.8 years old and length of stay 3.92 days were included in this study. Patients were admitted from medical emergency (30.5%), neurosurgical (52.1%) and surgical (17.4%) departments, with 10% of mortality proportion. Patients admitted from the medical emergency had the highest average APACHE score, 23.14±8.5, compared with patients admitted from neurosurgery 15.3±6.6 and surgical 15.8±6.8. The mortality rate of patients from medical emergency (24.5%) was higher than patients from neurosurgery (3.5%) or surgical (5.3%) departments. Area under curve of APACHE II score showed 0.8536 (95% CI 0.827 to 0.879). The goodness of fit Hosmer-Lemeshow show p=0.000 with all ICU patients' mortality; p=0.641 with medical emergency, p=0.0001 with neurosurgical and p=0.000 with surgical patients. CONCLUSION: APACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients.