Narra J (Journal)
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Preferences for a new vaccine against an emerging infectious disease: A discrete choice experiment among Millennials and Generation Z in Vietnam
Full text linkThe rising threat of emerging infectious diseases (EIDs) highlights the need to understand factors influencing vaccine adoption. The aim of this study was to explore the willingness to vaccinate and vaccine acceptance preferences among Millennials and Generation Z in Vietnam. Convenience sampling was conducted, after which a traditional discrete choice experiment was performed. Participants were tasked with selecting their preferred options from a set of eight vaccination choice tasks, each consisting of two alternatives distinguished by varying degrees of vaccine efficacy, side effects, influential endorsements, trusted sources, and disease susceptibility through literature reviews, expert interviews, and pilot tests. A minimum sample size of 375 participants was recruited via Internet-based and paper-based surveys. A latent class model was used to explore the heterogeneity in participant preferences, while a mixed logit model was employed to facilitate the computation of the predicted probabilities of vaccine acceptance. Among the 818 included participants, 494 (60.4%) were Millennials generation. The predicted probability of vaccine acceptance was 61.8%, with slight differences between Millennials (62.4%) and Generation Z (61.0%). Four latent classes with significant preference variations were identified. Class 1 (38%) was influenced by vaccine effectiveness, side effects, and health authority recommendations, showing lower opt-out rates. Class 2 (28%) prioritized vaccine effectiveness and authority recommendations but had higher opt-out rates and a stronger religious influence. Class 3 (23%) focused on vaccine effectiveness and side effects, with a tendency to opt-out. Class 4 (11%) valued high vaccine effectiveness and advice from family, with infection risks to family or local areas being significant motivators. Influential voices were more important in Classes 1 and 2, while side effects and effectiveness were prioritized in Classes 3 and 4. In conclusion, Vietnamese Millennials and Generation Z preferred vaccination when the vaccine had 90% efficacy, mild to moderate side effects, endorsements from the Ministry of Health, positive recommendations from family and social networks, and high exposure risks from family members
Biopsychosocial determinants of anxiety and depression among working mothers in China: A public mental health perspective
Full text linkWorking mothers often face dual demands from work and parenting, increasing their risk for anxiety and depression. However, the prevalence and contributing factors among Chinese working mothers remain underexplored. The aim of this study was to examine the prevalence and biopsychosocial determinants of anxiety and depression in this population. A cross-sectional survey was conducted between October 17 and November 21, 2024 through WeChat online among 330 working mothers aged 30–45 years old using validated instruments, including the Outcome Inventory-21 (OI-21), Parental Stress Scale (PSS), Experiences in Close Relationships-revised (ECR-R-10), Inner Strength-based Inventory (I-SBI), and the Multidimensional Scale of Perceived Social Support (MSPSS). Sociodemographic, socioeconomic and biological factors, including age, marital status, annual income, and physical disease, were also collected through a self-administered general information questionnaire. Data were analyzed using t-test, analysis of variance, Pearson’s correlation, and hierarchical linear regression. This study found the prevalence was 26.1% for anxiety symptoms and 38.2% for depression symptoms in this group based on the screening tools. Anxiety was significantly associated with both biological (e.g., hormonal changes, family psychiatric history) and psychological factors (e.g., attachment anxiety, parental stress). At the same time, depressive symptoms were primarily predicted by psychological and lifestyle-related factors (e.g., smoking, alcohol use). Notably, inner strength was a protective factor across both conditions. The findings highlight the importance of early detection and integrative care strategies for addressing mental health concerns in working mothers. Incorporating psychological screening, lifestyle assessment, and resilience-building interventions into workplace and community-based healthcare services may improve work-family balance outcomes in this population
Antimicrobial resistance and empirical antibiotic use in diabetic foot infections: A retrospective study from Indonesia
Full text linkDiabetic foot infection (DFI) represents a major complication of diabetes mellitus with significant morbidity, frequently leading to amputation if not optimally managed. The aim of this study was to analyze clinical, microbiological, and antibiotic susceptibility data from patients with type 2 diabetes who presented with foot infections in Indonesia. The retrospective study, conducted at St. Elisabeth Hospital in North Sumatra, Indonesia, predominantly comprised male farmers with a mean diabetes duration of 8.6 years, most of whom exhibited advanced ulcer severity (64.5% at Wagner grade III). Surgical debridement was performed in 79.0% cases, and amputation in 21.0% of cases. Laboratory investigations revealed poor glycemic control (mean HbA1c 10.12%) and biochemical markers indicative of systemic inflammation and renal impairment. Microbial cultures identified a predominance of Gram-negative bacteria (58.1%), primarily Klebsiella pneumoniae, Proteus mirabilis, and Escherichia coli, whereas Gram-positive isolates (41.9%) were dominated by Staphylococcus aureus, including methicillin-resistant strains. Empirical outpatient and inpatient antibiotic regimens commonly included amoxicillin, ciprofloxacin, metronidazole, and ceftriaxone; however, in vitro susceptibility testing demonstrated limited efficacy of β-lactams such as ampicillin and amoxicillin (<10% sensitivity). In contrast, linezolid, amikacin, vancomycin, carbapenems, and fosfomycin exhibited superior activity against the isolated pathogens. These findings emphasize the critical need for empirical antibiotic guidelines tailored to local microbial ecology and resistance profiles, integrated with early surgical management, stringent glycemic control, and multidisciplinary care. This comprehensive approach is essential to reduce the risk of amputation and improve clinical outcomes in tropical, resource-limited settings
Cortisol and pregnancy-related anxiety in relation to preeclampsia among third-trimester pregnant women: A case–control study from Aceh, Indonesia
Full text linkDespite extensive research, the interplay between hormonal stress markers and pregnancy-specific anxiety in the pathogenesis of preeclampsia remains insufficiently understood. This study aimed to analyze the simultaneous relationships between serum cortisol levels, pregnancy-related anxiety, and the occurrence of preeclampsia among third-trimester pregnant women. A case–control study was conducted at three hospitals in Banda Aceh, Indonesia, involving third-trimester pregnant women. Serum cortisol concentrations were measured using an immunoassay, and anxiety levels were assessed with the validated Pregnancy Related Anxiety Questionnaire (PRAQ). Preeclampsia diagnosis followed standard clinical and laboratory criteria. Associations between cortisol levels (categorized into high and normal) and PRAQ scores (classified as high and low–moderate) with preeclampsia were evaluated using the Chi-squared test, and crude odds ratios (OR) with 95% confidence intervals (95%CI). The Spearman’s correlation was used to determine the correlation between cortisol levels and PRAG scores. A total of 66 pregnant women were included in the final analysis (33 with preeclampsia and 33 with normal pregnancy). Women with high serum cortisol levels had a markedly greater likelihood of developing preeclampsia compared with those with normal cortisol levels (odds ratio (OR)=34.00; 95% confidence interval (95%CI): 4.93–234.46). Similarly, women with high pregnancy-related anxiety exhibited a significantly elevated risk of preeclampsia (OR=16.71; 95%CI: 4.95–56.39). No significant correlation was observed between cortisol levels and PRAQ scores in both groups (preeclampsia: r=-0.041, p=0.821; normal pregnancy: r=0.278, p=0.117). In conclusion, elevated serum cortisol and high pregnancy-related anxiety are independently associated with preeclampsia, although not directly correlated with each other. These findings highlight the potential of dual screening for cortisol and pregnancy-specific anxiety as an innovative approach for early identification of women at high risk of preeclampsia
Effectiveness of digital health in improving pregnancy quality among preconception women: A systematic review
Full text linkImproving nutrition in women prior to conception represents an alternative approach to enhancing the quality of pregnancy. Increased knowledge and self-efficacy among preconception women positively impact changes in health behavior. The rapid development of technology provides an opportunity to implement innovative interventions, including digital health. The aim of this study was to systematically review the efficacy of digital health interventions in modifying the behavior of preconception women. The data were obtained by searching relevant articles published from 2015 to 2023 in electronic databases, including Google Scholar, Science Direct, Web of Science (WoS), Biomed Central, and PubMed. The following keywords were used: "digital health" OR "mobile health" OR "e-health" AND "preconception women" OR "pre-marriage women." Of the 266 studies identified in the search phase, only those that met the inclusion criteria were included in the review. These criteria included 10 articles that assessed the effectiveness of digital health interventions on the behavior change of preconception women. The articles included in this study originated from diverse countries and addressed various digital health interventions. The findings of the review indicated that ten articles reported an increase in pregnant women's knowledge, nine articles demonstrated an enhancement in self-efficacy, and nine articles documented behavioral changes. The behavioral changes observed included the initiation of folic acid consumption before pregnancy, an increase in vegetable and fruit consumption, and a reduction in unhealthy dietary behaviors, such as maintaining a normal weight, smoking cessation, and reduced alcohol consumption. In conclusion, digital health literacy interventions, delivered via web-based platforms or mobile applications, demonstrate effectiveness in promoting positive preconception health behaviors among women, ultimately contributing to improved pregnancy outcomes
Evaluation of an E. coli-expressed spike protein-based in-house ELISA system for assessment of antibody responses after COVID-19 infection and vaccination
Full text linkEvaluating long-term immunity after COVID-19 infection and vaccination is critical for managing potential outbreaks. The aim of this study was to develop a cost-effective in-house enzyme-linked immunosorbent assay (ELISA) based on Escherichia coli-expressed SARS-CoV-2 spike protein (E-S1) for antibody detection and to evaluate its performance. The system was validated by comparing the in-house ELISA results with those obtained using a commercial ELISA with HEK293-expressed spike protein (H-S1). Recombinant SARS-CoV-2 spike protein was produced in E. coli, purified, and validated for antigenicity via ELISA. Indirect ELISAs with both E-S1 and H-S1 antigens were performed on 386 serum samples from COVID-19 survivors, vaccinated individuals, and pre-pandemic controls collected at different time points. The E-S1 ELISA showed a statistically significant but weak correlation with H-S1 ELISA across all samples (r=0.205; p=0.0001). Stronger correlations were observed among vaccinated individuals with prior infection on day 90 (r=0.6017; p<0.001) and in naïve vaccine recipients on day 30 (r=0.5361; p=0.0003). Pre-pandemic sera from a rural population in Sumba Island exhibited high background reactivity in E-S1 ELISA, likely due to anti-E. coli antibodies, while urban pre-pandemic sera from Jakarta showed a stronger correlation with H-S1 ELISA. This suggests potential regional or immune background differences influencing assay performance. Although E-S1 retained antigenic properties, its diagnostic utility is limited by non-specific reactivity and reduced sensitivity compared to H-S1. In conclusion, E. coli expression systems may not be ideal for producing spike protein-based ELISA antigens specific to SARS-CoV-2. Alternative expression systems, such as human or baculovirus, could enhance diagnostic accuracy and specificity for COVID-19 antibody detection
Effect of hemp seed oil on accelerating wound healing: Evaluation of wound size reduction, epithelialization, granulation tissue formation, and vascularization in murine models
Full text linkEssential oils have gained interest in wound management, with prior studies exploring combinations of hemp seed oil (Cannabis sativa) and other oils. However, single-oil strategies may offer simpler formulation, reducing the risk of interactions while preserving therapeutic benefits. The aim of this study was to explore the effect of hemp seed oil on accelerating wound healing, focusing on wound size reduction, epithelialization, granulation tissue formation, and vascularization in murine models. An in vivo with a post-test-only control group was conducted using 36 male Mus musculus mice (3−4 months, 150–250 grams) which were divided into three groups: negative control (NC), positive control (PC, treated with chloramphenicol ointment twice daily), and treatment group (TG, treated with hemp seed oil 400,000 mg/mL twice daily). Mice were euthanized on day 3, 7, 14, and 21 for wound healing assessment, including macroscopic evaluation (visual observation, wound size, and wound healing rate) and microscopic evaluation (epithelialization, granulation tissue formation, and vascularization). The present study found that the TG group demonstrated smaller wound sizes on day 14 (p<0.001) and day 21 (p<0.001). This group also enhanced wound healing rates observed on day 14 (p<0.001) and day 21 (p=0.001) compared to PC and NC groups. Epithelialization was significantly higher in the TG group compared to PC and NC groups on day 14 (p=0.007), while granulation tissue formation showed significant improvement on day 3 (p=0.045), day 14 (p=0.028), and day 21 (p=0.003). Additionally, TG group showed significantly greater new blood vessel formation on day 21 (p=0.001) compared to the PC and NC groups. In conclusion, hemp seed oil demonstrated significant potential in accelerating wound healing processes suggesting a superior effect compared to chloramphenicol ointment. Therefore, hemp seed oil may serve as a promising natural and cost-effective adjunct for wound management
Adherence to mass drug administration and environmental factors related to lymphatic filariasis incidence: A case-control study in endemic area, Papua, Indonesia
Full text linkPapua has the highest number of lymphatic filariasis cases in Indonesia. Despite the implementation of mass drug administration (MDA), adherence to MDA remains low in this region. The aim of this study was to evaluate the influence of adherence to MDA and environmental factors on the incidence of lymphatic filariasis. The study was conducted in 11 areas in Sarmi Regency, Papua, in 2024. This case-control study included 135 respondents (45 cases and 90 controls) selected through a proportional random sampling method. Data were collected via structured interviews, observations, and medical record reviews. Data analysis was performed using logistic regression with the backward likelihood ratio method to identify risk factors. The study revealed that male (aOR: 4.88; 95%CI: 1.39–17.06; p=0.013), age ≥40 years (aOR: 4.65; 95%CI: 2.26–7.00; p=0.002), low education level (aOR: 0.24; 95%CI: 0.07–0.84; p=0.025), and income below the regional minimum wage (aOR: 15.66; 95%CI: 1.84–30.26; p=0.012) were significant risk factors for lymphatic filariasis incidence. Non-consumption of complete antifilarial drugs (aOR: 3.24; 95%CI: 1.00–10.50; p=0.050), not taking antifilarial drugs at the recommended time (aOR: 7.36; 95%CI: 1.99–27.23; p=0.003), and delayed consumption of antifilarial drugs (aOR: 3.73; 95%CI: 1.09–12.73; p=0.036) were adherence-related factors associated with an increased risk. Furthermore, not wearing long-sleeved clothing at night (aOR: 6.73; 95%CI: 1.81–24.94; p=0.004) was significantly associated with lymphatic filariasis incidence. The dimensions of MDA medication adherence, including the consumption of preventive antifilarial drugs, night-time dosing, and immediate consumption of antifilarial drugs after distribution, were associated with lymphatic filariasis incidence in Papua. This study suggests that MDA programs against filariasis in endemic areas need to be supported by adherence-focused interventions to enhance the effectiveness of prevention efforts
Impact of lumbar support on pain reduction in low back pain patients: A systematic review and meta-analysis of randomized control trials
Full text linkLow back pain (LBP) is a global health concern, affecting millions and contributing significantly to disability and economic burden. Various non-pharmacological interventions, including lumbar support, have been explored for LBP management. However, its efficacy remains debated due to inconsistent findings. The aim of this study was to evaluate the impact of lumbar support on pain reduction in individuals with LBP and compare its effectiveness to alternative interventions. A systematic search was conducted across multiple databases (PubMed, ScienceDirect, Scopus, SpringerLink, Google Scholar, and ProQuest) for studies published up to 2023. Data from six search engines were searched using inclusion criteria based on the PICO framework. Search terms included low back pain, lumbar support, lumbar orthose and randomized controlled trial, combined using Boolean operators. Sixteen randomized controlled trials (RCTs) were included in the systematic review, with eight studies analyzed in the meta-analysis. Eligible studies focused on adults with non-specific LBP, assessing pain levels using the Visual Analog Scale (VAS). The meta-analysis was assessed using the standardized mean difference (SMD) in the Visual Analog Scale (VAS). The meta-analysis revealed a statistically significant pain reduction with lumbar support compared to other interventions (SMD: 1.33; 95%CI: -2.09–(-0.57)); p=0.0006), though with high heterogeneity (I²=97%). The findings indicated that lumbar support effectively reduces pain and improves health-related quality of life, particularly in physically demanding occupations or among individuals with severe pain. While efficacy may depend on specific conditions, lumbar support represents a viable non-pharmacological option for LBP management
Customized feeding plate for nutritional and respiratory support in an infant with Pierre Robin sequence and cleft palate complicated by severe respiratory infections: A case report
Full text linkPierre Robin sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction, often accompanied by cleft palate. Feeding difficulties and respiratory compromise pose significant challenges in early management. While feeding plates are commonly used to improve feeding and airway stability, their application in infants with severe respiratory infections remains underreported. The aim of this study was to describe the challenges of impression-taking and feeding plate fabrication in an infant with PRS complicated by multiple congenital anomalies and severe respiratory complications, including bilateral pneumonia. A 23-day-old male infant was referred to the pediatric dentistry department of Pandega General Hospital, Pangandaran, Indonesia, with the chief complaints of feeding difficulties, recurrent choking episodes, and respiratory distress. The patient was diagnosed with PRS with a cleft palate, complicated by congenital tuberculosis and bilateral pneumonia, exacerbating respiratory compromise. Given the patient's fragile condition, impression-taking was performed with strict airway precautions, including lateral positioning, continuous oxygen monitoring, and suction readiness. High-viscosity alginate and a perforated stock tray were used to minimize aspiration risk. Two clinicians ensured airway security throughout the procedure. A customized acrylic feeding plate was fabricated with a palatal extension to prevent nasal regurgitation and a contoured surface to aid tongue positioning. The plate was polished for comfort, adjusted for retention, and fitted to accommodate maxillary growth, ensuring safe and effective feeding support. Within one month, the infant’s weight increased from 2,200 g to 3,100 g, choking episodes significantly decreased, and a transition from orogastric tube to bottle feeding was achieved. In conclusion, this case highlights the feasibility and benefits of feeding plate adaptation in PRS management, even in the presence of severe respiratory infections. A non-invasive approach using a feeding plate can serve as an initial intervention before surgical correction, particularly in fragile neonates