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Research on sustainable marketing is mapped using bibliometric analysis, which offers a thorough picture of the field's current condition and future directions. By means of bibliometric analysis using VosViewer and the collection of 1.385 articles, the study indicates a noteworthy increase in publications and citations concerning the subject matter during the last ten years. Several important clusters actively studying Sustainable Marketing, including sustainable consumer behavior, sustainability orientation, consumption patterns, market segmentation, and stakeholder roles, were found through analysis of author collaboration patterns. "Sustainable marketing research" is the core research area, and the bibliometric network visualization displays the essential terms and relationships between concepts. Though less thoroughly, subjects including customer capital, sustainable management, sustainable business, and digital marketing were also covered. This article's bibliometric analysis reveals some intriguing mapping findings. Collaboration in research articles is revealed by the author's analysis. The report also presents the findings from studies on sustainable consumer behavior. The study method on consumer sustainability challenges, including customer capital, spending, and behavior, is outlined by the bibliometric analysis. Bibliometric analysis, thus, offers a mapping of sustainability research, particularly in terms of offering significant insights on specific sustainability challenges like consumer difficulties. [ABSTRACT FROM AUTHOR]

This study aims to determine the effect of the role of influencers, affiliate marketing, and online customer reviews at Shopee through TikTok content on Generation Z purchasing decisions. This research uses a quantitative approach by collecting data through an online survey of 199 respondents of the Management Study Program students class of 2020. The data were analyzed using multiple regression methods to evaluate the relationship between the independent variables of influencer roles, affiliate marketing, and online customer reviews and the dependent variable (purchasing decisions). The analysis results show that the role of influencers, affiliate marketing, and online customer reviews have a positive and significant influence on Generation Z's purchasing decisions. The findings emphasize the importance of integrating marketing strategies through influencers, affiliate marketing, and online customer reviews in influencing Generation Z's purchasing decisions. This provides guidance for businesses to utilize e-commerce platforms such as Shopee and TikTok content as an effective means of communication to reach and influence the Generation Z market. This research makes a new contribution to the understanding of how the role of influencers, affiliate marketing and online customer reviews on Shopee, particularly through TikTok content, can influence Generation Z's purchasing decisions. This research adds insight into effective marketing strategies to capture the attention and influence the consumption behavior of the younger generation in the context of e-commerce platforms. [ABSTRACT FROM AUTHOR]

Background: Crude extract of Streptomyces hygroscopicus has antimalarial effect in vivo and its active fractions showed Plasmodium inhibition in vitro. This study aims to analyze the antimalarial activity of fraction 41 and 44 of S.hygroscopicus in vivo and predict their antimalarial mechanism in silico. Material and methods: Secondary metabolite of S.hygroscopicus was identified using LC/MS. In silico analysis was done using PfA-M1, Falcipain 2 protease, and PfCRT as protein targets from PDB and active compound ligand from PubChem. The pharmacokinetic analysis was done using SwissADME. In vivo study was conducted using Plasmodium berghei infected mice that divided into 1 positive control group, 1 Artesunate group, and 8 treatment groups that administrated with fraction 41 and 44 each in dose 8,125 µg/kgBW, 32,5 µg/kgBW, 130 µg/kgBW, and 520 µg/kgBW. Result: Tryptanthrin was identified from S.hygroscopicus. Tryptanthrin has fulfilled drug-likeness criteria and stronger binding affinity to PfA-M1, Falcipain 2 protease, and PfCRT than control ligand. Fraction 41 showed a significant difference in parasite density between positive control group and 130µg/kgBW group (p=0.046) as well as 520µg/kgBW group (p=0.004). Fraction 44 showed a significant difference in parasite density between positive control group and 130µg/kgBW group (p=0.024) as well as 520µg/kgBW group (p=0.004). Correlation test of fraction 41 showed a strong negative relationship between doses and parasite density on day 3 (p=0.001; r=-0.607) and day 4 (p=0.000; r=-0.700) as well as fraction 44 on day 3 (p=0.044; r=-0.589). Conclusion: Active fractions of Streptomyces hygroscopicus subsp Hygroscopicus that contained Tryptanthrin has a potential antimalarial agent. [ABSTRACT FROM AUTHOR]

Malaria is one of the life-threatening diseases in the world. The spread of resistance to antimalarial drugs is a major challenge, and resistance to artemisinin has been reported in the Southeast Asian region. In the previous study, the active compound of Streptomyces hygroscopicus subsp. Hygroscopicus (S. hygroscopicus), eponemycin, has been shown to have antimalarial effects. To further analyze the effects of other active compounds on the Plasmodium parasite, identifying and analyzing the effectiveness of compounds contained in S. hygroscopicus through instrumentation of liquid chromatography/mass spectrometry (LC/MS) and in silico studies were very useful. This study aimed at identifying other derivative compounds from S. hygroscopicus and screening the antimalarial activity of the compound by assessing the binding affinity, pharmacokinetic profile, and bond interaction. The derivative compounds were identified using LC/MS. Protein targets for derivative compounds were found through literature studies, and the results of identification of compounds and protein targets were reconstructed into three-dimensional models. Prediction of pharmacokinetic profiles was carried out using Swiss ADME. Screening of protein targets for the derivative compound was carried out using the reverse molecular docking method. Analyzing bond interaction was done by LigPlot. One compound from S. hygroscopicus, i.e., 6,7-dinitro-2-[1, 2, 4]triazole-4-yl-benzo[de]isoquinoline-1,3-dione, was successfully identified using LC/MS. This compound was an isoquinoline derivative compound. Through literature studies with inclusion criteria, thirteen protein targets were obtained for reverse molecular docking. This isoquinoline derivative had the potential to bind to each protein target. The pharmacokinetic profile showed that this compound had the drug-likeness criteria. Conclusion. 6,7-Dinitro-2-[1, 2, 4]triazole-4-yl-benzo[de]isoquinoline-1,3-dione has antimalarial activity as shown by reverse molecular docking studies and pharmacokinetic profiles. The best inhibitory ability of compounds based on bond affinity is with adenylosuccinate synthetase. [ABSTRACT FROM AUTHOR]

Some marine current harnessing technology require a platform as the base of the marine current turbine. Several potential locations of marine current energy are in deep water and in a strait with limited width, so a floating platform is required for the system. The design of a floating platform should consider the motion caused by the environmental load such as wave, current, wind. The platform should provide a smooth motion response during the operation. This paper compares the motion response of several platform concepts and proposes a novel platform that accommodates several vertical axis turbines. The method of analysis used in this paper is by comparing the response amplitude operates (RAO). The compared platforms are semi-sub platform, catamaran platform PLAT-1. The proposed 44.93 tones platform will accommodate eight vertical axis turbines with total capacity 23kW and installed in 100-200 m water depth. The maximum ocean current is 2.4 m/s significant wave height 25 years return period is 2.4 m wind speed 4.5 - 6 m/s. The results show that the new platform has better translational motions such as surge, heave, sway, but has varied results on rotational motions such as roll, pitch, and yaw. [ABSTRACT FROM AUTHOR]

Introduction: High-risk pregnancies require special attention in maternal and child health services, given the high potential for complications that can affect maternal and fetal health. The continuity of care (COC) approach is expected to increase family independence and prevent pregnancy complications. This study aims to analyze the effectiveness of COC in improving the family independence of high-risk pregnant women in preventing pregnancy complications., Methods: This study used a quasi-experimental design with a pretest-posttest approach without a control group, involving 134 high-risk pregnant women, in the target area at the Wonoayu Community Health Centre, Sidoarjo, Indonesia from February to May 2024, who were selected through purposive sampling. Data were collected through structured questionnaires before and after the COC intervention, which included assessing knowledge and family roles in supporting pregnant women's health. The COC mentoring program was implemented for three months, with a focus on family education and involvement in maternal healthcare. A validated questionnaire measured family self-reliance before and after the intervention., Results: The study showed a significant increase in family self-reliance, with a p<0.001 in all aspects measured, including fulfilment of physiological and psychological needs, preparation for labor, the postpartum period, and preparation after the baby is born. This increase suggests that the COC intervention is effective in empowering families to support high-risk pregnant women. Before the intervention, the mean score for physiological and psychological needs fulfilment was 17.45, which increased to 36.42 after the intervention (p<0.001). In addition, labor preparation also showed a significant increase from 11.40 to 24.38, as well as postpartum preparation from 13.00 to 28.79, and preparation after the baby is born from 13.25 to 28.75 (all p<0.001)., Conclusions: The consistent improvement in all measured aspects, indicated that the COC intervention not only improved families' knowledge and skills, but also contributed to their preparedness in supporting pregnant women during and after pregnancy., Competing Interests: The authors have completed and submitted the ICMJE Form for disclosure of Potential Conflicts of Interest and none was reported., (© 2025 Sholikah S.M. et al.)

Some individuals, even when heavily exposed to an infectious tuberculosis patient, do not develop a specific T-cell response as measured by interferon-gamma release assay (IGRA). This could be explained by an IFN-γ-independent adaptive immune response, or an effective innate host response clearing Mycobacterium tuberculosis (Mtb) without adaptive immunity. In heavily exposed Indonesian tuberculosis household contacts (n = 1347), a persistently IGRA negative status was associated with presence of a BCG scar, and - especially among those with a BCG scar - with altered innate immune cells dynamics, higher heterologous (Escherichia coli-induced) proinflammatory cytokine production, and higher inflammatory proteins in the IGRA mitogen tube. Neither circulating concentrations of Mtb-specific antibodies nor functional antibody activity associated with IGRA status at baseline or follow-up. In a cohort of adults in a low tuberculosis incidence setting, BCG vaccination induced heterologous innate cytokine production, but only marginally affected Mtb-specific antibody profiles. Our findings suggest that a more efficient host innate immune response, rather than a humoral response, mediates early clearance of Mtb. The protective effect of BCG vaccination against Mtb infection may be linked to innate immune priming, also termed 'trained immunity'., Competing Interests: Competing interests: The authors declare no competing interests. Inclusion & ethics: All collaborators of this study have fulfilled the criteria for authorship required by Nature Portfolio journals and have been included as authors. The research included Indonesian researchers throughout the research process, as their participation was essential for the design and implementation of the study. Capacity-building plans for Indonesian researchers were discussed and have been implemented, with T.P.S. and L.A. exemplifying the success of these efforts within our longstanding collaboration. Roles and responsibilities were agreed among collaborators ahead of the research. This work includes findings that are locally relevant which have been determined in collaboration with local partners. This research was not severely restricted or prohibited in the setting of the researchers and does not result in stigmatization, incrimination, discrimination or personal risk to participants. The study has been approved by a local ethics review committee. Local and regional research relevant to our study was taken into account in citations. This research does not involve health, safety, security or other risk to researchers. Benefit-sharing measures have been discussed among all collaborators regarding biological materials transferred out of Indonesia., (© 2024. The Author(s).)

Background: Acral and mucosal melanomas, the most common sun-shielded site melanoma subtypes in Asia and Indonesia, often yield poor prognoses. The invasion depth reflects their progressivity, and the pathogenesis is influenced by vitamin D receptor (VDR) status and CD8+ T-Lymphocyte amount. This study aims to determine the association between the invasion depth of acral and mucosal melanomas with their VDR and CD8+ immunoexpression., Methods: A cross-sectional observational study was conducted on 60 formalin-fixed paraffin-embedded (FPPE) samples, with equal representation in acral and mucosal melanoma groups from 2017 to 2021. The samples were assessed for the invasion depth and immunoexpression of VDR and CD8+. A chi-square test with an alternative Exact-Fisher analysis was used to determine the association between the variables in both subtype groups., Results: An association between VDR and CD8+ immunoexpression and invasion depth in acral melanoma (p value = 0.0001 and 0.009, respectively) was observed, while only VDR immunoexpression was associated with the invasion depth in mucosal melanoma (p-value =0.004). Interestingly, no association was found between CD8+ immunoexpression and the invasion depth in mucosal melanoma (p = 0.640)., Conclusion: The role of VDR and CD8+ T-lymphocytes are inversely associated with melanoma depth in acral melanoma, while only VDR is associated with melanoma depth in mucosal melanoma., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Three Gram-stain-positive aerobic bacteria, characterized by branched mycelia with putative sporangia, were isolated from forest soil inside a decayed bamboo stem from a geothermal area in West Java, Indonesia. The strain S3.2.2.5 T grew at 15-37 °C (optimum 30 °C), at pH 5.0-7.0 (optimum 7.0) and in the presence of 0-1% NaCl (optimum 0%). Strain S3.2.2.5 T was able to hydrolyse cellulose, xylan, starch and skim milk. The cell-wall sugars were composed of xylose and mannose, and the peptidoglycan hydrolysates contained d-glutamic acid, glycine, d-alanine, l-alanine, β -alanine and l-ornithine. The major fatty acids (>10%) were anteiso-C 17:0 , iso-C 17:0 , C 16:1 2-OH and iso-C 16:1 . The major polar lipids were phosphatidylinositol, phosphatidylglycerol, diphosphatidylglycerol, unidentified glycolipids and unidentified phospholipids. The major menaquinone was MK-9 (H 2 ). The results of the analysis of the phylogenetic tree based on the 16S rRNA gene indicated that these three isolates belong to the genus Dictyobacter and they were most closely related to the type strain of species Dictyobacter aurantiacus S-27 T (97.41-98.00%). The strain S3.2.2.5 T exhibited a genome size of 9.41 Mbp, which was significantly larger than the known Dictyobacter species. The G+C content was 54.3 mol%. The average nucleotide identity (90.77%) and the digital DNA-DNA hybridization values (42.6%) between strain S3.2.2.5 T and D. aurantiacus S-27 T were below the threshold value for species delineation. Based on the phenotypic, chemotaxonomic and molecular characteristics of strain S3.2.2.5 T , a novel species of the genus Dictyobacter , for which the name Dictyobacter halimunensis sp. nov., is proposed. The type strain is S3.2.2.5 T (= UICC B-128 T = CGMCC 1.61913 T = KCTC 43728 T ).

Objectives:  The aim of this research was to analyze expression of vascular endothelial growth factor (VEGF), blood vessels, and fibroblast cell proliferation in direct pulp capping treatment of Rattus norvegicus using a combination of chitosan and hydroxyapatite paste., Materials and Methods:  The samples were male R. norvegicus strains of Wistar rats, weighing 200 to 250 g and aged between 8 and 16 weeks. The occlusal surface of the molars of R. norvegicus was prepared with class I cavity and then perforated with the tip of an explorer. Sixty male R. Norvegicus rats were divided into the following: control group (KA) in which the cavity was filled with glass ionomer cement; control group (KB), in which the cavity was filled with Ca(OH)2; PA group, in which the cavity was filled with chitosan (CH); PB group, in which the cavity was filled with hydroxyapatite (HA); and PC group, in which the cavity was filled with chitosan and hydroxyapatite (CH-HA). Each group was divided into 3-, 7-, and 14-day observation groups. The mandibular bone of the molar was cut and histopathological examination was performed to analyze the blood vessels and fibroblast cell proliferation. Immunohistochemistry examination was done to examine the expression of VEGF., Statistical Analysis: The data variation was analyzed with One Way Analysis of Variance (ANOVA) test and continued with multiple comparison Least Significant (LSD) test to determine the different pairs of group., Results:  Analysis of variance (ANOVA) showed a significant increase in the expression of VEGF, blood vessels, and fibroblast cell proliferations ( p ≤ 0.05;), especially in the PC group compared to the other four groups. The least significant test (LSD) test showed significant differences between the groups on the expression of VEGF, blood vessels, and fibroblast cell proliferations., Conclusion:  The combination of chitosan and hydroxyapatite could promote healing of direct pulp capping treatment by increasing the expression of VEGF, blood vessel, and fibroblast cell proliferation., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

The successful application of gradient boosting regression (GBR) in machine learning to forecast surface area, pore volume, and yield in biomass-derived activated carbon (AC) production underscores its potential for enhancing manufacturing processes. The GBR model, collecting 17 independent variables for two-step activation (2-SA) and 14 for one-step activation (1-SA), demonstrates effectiveness across three datasets-1-SA, 2-SA, and a combined dataset. Notably, in 1-SA, the GBR model yields R 2 values of 0.76, 0.90, and 0.83 for TPV, yield, and SSA respectively, and records R 2 of 0.90 and 0.91 for yield in 2-SA and combined datasets. The model highlights the significance of the soaking procedure alongside activation temperature in shaping AC properties with 1-SA or 2-SA, illustrating machine learning's potential in optimizing AC production processes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: None declared.

Naturally acquired immunity to the different types of malaria in humans occurs in areas of endemic transmission and results in asymptomatic infection of peripheral blood. The current study examined the possibility of naturally acquired immunity in Bornean orangutans, Pongo pygmaeus , exposed to endemic Plasmodium pitheci malaria. A total of 2140 peripheral blood samples were collected between January 2017 and December 2022 from a cohort of 135 orangutans housed at a natural forested Rescue and Rehabilitation Centre in West Kalimantan, Indonesia. Each individual was observed for an average of 4.3 years during the study period. Blood samples were examined by microscopy and polymerase chain reaction for the presence of plasmodial parasites. Infection rates and parasitaemia levels were measured among age groups and all 20 documented clinical malaria cases were reviewed to estimate the incidence of illness and risk ratios among age groups. A case group of all 17 individuals that had experienced clinical malaria and a control group of 34 individuals having an event of >2000 parasites μL −1 blood but with no outward or clinical sign of illness were studied. Immature orangutans had higher-grade and more frequent parasitaemia events, but mature individuals were more likely to suffer from clinical malaria than juveniles. The case orangutans having patent clinical malaria were 256 times more likely to have had no parasitaemia event in the prior year relative to asymptomatic control orangutans. The findings are consistent with rapidly acquired immunity to P. pitheci illness among orangutans that wanes without re-exposure to the pathogen.

Malaria eradication efforts prioritize safe and efficient vaccination strategies, although none with high-level efficacy against malaria infection are yet available. Among several vaccine candidates, Sanaria® PfSPZ Vaccine and Sanaria PfSPZ-CVac are, respectively, live radiation- and chemo-attenuated sporozoite vaccines designed to prevent infection with Plasmodium falciparum, the leading cause of malaria-related morbidity and mortality. We are conducting a randomized normal saline placebo-controlled trial called IDSPZV1 that will analyze the safety, tolerability, immunogenicity, and efficacy of PfSPZ Vaccine and PfSPZ-CVac administered pre-deployment to malaria-naive Indonesian soldiers assigned to temporary duties in a high malaria transmission area. We describe the manifold challenges of enrolling and immunizing 345 soldier participants at their home base in western Indonesia before their nearly 6,000-km voyage to eastern Indonesia, where they are being monitored for incident P. falciparum and Plasmodium vivax malaria cases during 9 months of exposure. The unique regulatory, ethical, and operational complexities of this trial demonstrate the importance of thorough planning, frequent communication, and close follow-up with stakeholders. Effective engagement with the military community and the ability to adapt to unanticipated events have proven key to the success of this trial.

Background: Microarrays are a well-established and widely adopted technology capable of interrogating hundreds of thousands of loci across the human genome. Combined with imputation to cover common variants not included in the chip design, they offer a cost-effective solution for large-scale genetic studies. Beyond research applications, this technology can be applied for testing pharmacogenomics, nutrigenetics, and complex disease risk prediction. However, establishing clinical reporting workflows requires a thorough evaluation of the assay's performance, which is achieved through validation studies. In this study, we performed pre-clinical validation of a genetic testing workflow based on the Illumina Global Screening Array for 25 pharmacogenomic-related genes. Methods: To evaluate the accuracy of our workflow, we conducted multiple pre-clinical validation studies. Here, we present the results of accuracy and precision assessments, involving a total of 73 cell lines. These assessments encompass reference materials from the Genome-In-A-Bottle (GIAB), the Genetic Testing Reference Material Coordination Program (GeT-RM) projects, as well as additional samples from the 1000 Genomes project (1KGP). We conducted an accuracy assessment of genotype calls for target loci in each indication against established truth sets. Results: In our per-sample analysis, we observed a mean analytical sensitivity of 99.39% and specificity 99.98%. We further assessed the accuracy of star-allele calls by relying on established diplotypes in the GeT-RM catalogue or calls made based on 1KGP genotyping. On average, we detected a diplotype concordance rate of 96.47% across 14 pharmacogenomic-related genes with star allele-calls. Lastly, we evaluated the reproducibility of our findings across replicates and observed 99.48% diplotype and 100% phenotype inter-run concordance. Conclusion: Our comprehensive validation study demonstrates the robustness and reliability of the developed workflow, supporting its readiness for further development for applied testing., Competing Interests: Authors PG, MH, MY, JH, LS, AI, KC, and MG-P were employed by Nalagenetics Pte Ltd. Authors HM, DW, SS, DO, FD, TA, TP, PA, RP, RH, MK, and AP were employed by Genomik Solidaritas Indonesia., (Copyright © 2024 Gan, Hajis, Yumna, Haruman, Matoha, Wahyudi, Silalahi, Oktariani, Dela, Annisa, Pitaloka, Adhiwijaya, Pauzi, Hertanto, Kumaheri, Sani, Irwanto, Pradipta, Chomchopbun and Gonzalez-Porta.)

Background: Limited data exist from southeast Asia on the impact of SARS-CoV-2 variants and inactivated vaccines on disease severity and death among patients hospitalised with COVID-19., Methods: A multicentre hospital-based prospective cohort was enrolled from September 2020 through January 2023, spanning pre-delta, delta, and omicron periods. The participant hospitals were conveniently sampled based on existing collaborations, site willingness and available study resources, and included six urban and two rural general hospitals from East Nusa Tenggara, Jakarta, and North Sumatra provinces. Factors associated with severe disease and day-28 mortality were examined using logistic and Cox regression., Findings: Among 822 participants, the age-adjusted percentage of severe disease was 26.8% (95% CI 22.7-30.9) for pre-delta, 50.1% (44.0-56.2) for delta, and 15.2% (9.7-20.7) for omicron. The odds of severe disease were 64% (18-84%) lower for omicron than delta (p < 0.001). One or more vaccine doses reduced the odds of severe disease by 89% (65-97%) for delta and 98% (91-100%) for omicron. Age-adjusted mortality was 11.9% (8.8-15.0) for pre-delta, 24.4% (18.8-29.9) for delta and 9.6% (5.2-14.0) for omicron. The day-28 cumulative incidence of death was lower for omicron (9.2% [5.6-13.9%]) than delta (28.6% [22.0-35.5%]) (p < 0.001). Severe disease on admission was the predominant prognostic factor for death (aHR34.0 [16.6-69.9] vs mild-or-moderate; p < 0.001). After controlling for disease severity on admission as an intermediate, the risk of death was 48% (32-60%) lower for omicron than delta (p < 0.001); and 51% (38-61%; p < 0.001) lower for vaccinated participants than unvaccinated participants overall, and 56% (37-69%; p < 0.001) for omicron, 46% (-5 to 73%; p = 0.070) for pre-delta (not estimable for delta)., Interpretation: Infections by omicron variant resulted in less severe and fatal outcomes than delta in hospitalised patients in Indonesia. However, older, and unvaccinated individuals remained at greater risk of adverse outcomes., Funding: University of Oxford and Wellcome Trust., Competing Interests: The studies included in this analysis received funding from the COVID-19 Research Response Fund of the University of Oxford (0009109 and 0009308); Wellcome Africa Asia Programme Vietnam (106680/Z/14/Z); Wellcome Trust (222574/Z/21/Z). JKB, AHS and RLH are supported by the Wellcome Africa Asia Programme Vietnam (106680/Z/14/Z). We declare no other competing interests., (© 2023 Published by Elsevier Ltd.)

The red dragon fruit (Hylocereus polyrhizus) extract (RDFE) is frequently used for a variety of therapeutic purposes (e.g., boosting the immune system, promoting a healthy gastrointestinal system, improving wound healing). We investigated the effects of a topical cream containing 7.5% RDFE on hydroxyproline and fibroblast growth factor 2 (FGF-2) levels and wound healing. On Day 0, we divided a total of 36 albino male Wistar rats into two equal groups. Using an 8-mm punch biopsy, we created a circular excision to fascial depth on the back of each rat. On Day 1, we treated the control group (n = 18) with 20 mg of base cream and the RDFE group (n = 18) with 20 mg of 7.5% RDFE cream. We measured hydroxyproline and FGF-2 levels in the wound tissue using an ELISA method on Days 3, 7, and 14. We found that on Day 3, hydroxyproline levels were significantly lower in the treatment group than in the control group (p = .031). We also found a significant correlation between FGF-2 levels in the treatment group and wound diameter (p = .02). On the basis of the results of this study, we concluded that using a topical cream containing 7.5% RDFE has the potential to accelerate wound healing by increasing levels of hydroxyproline and FGF-2 in the wound., Competing Interests: None of the authors have any conflicts of interest to disclose., (Copyright © 2023 International Society of Plastic and Aesthetic Nurses. All rights reserved.)

Baby food marketing poses a substantial barrier to breastfeeding, which adversely affects mothers' and children's health. Over the last decade, the baby food industry has utilised various marketing tactics in Indonesia, including direct marketing to mothers and promoting products in public spaces and within the healthcare system. This study examined the marketing of commercial milk formula (CMF) and other breast-milk substitute products during the COVID-19 pandemic in Indonesia. Using a local, community-based reporting platform, information on publicly reported violations of the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions (the Code) was collected. It was found that a total of 889 reported cases of unethical marketing of such products were recorded primarily through social media from May 20 through December 31, 2021. Our results suggest that the COVID-19 pandemic has provided more opportunities for the baby food industry in Indonesia to attempt to circumvent the Code aggressively through online marketing strategies. These aggressive marketing activities include online advertisements, maternal child health and nutrition webinars, Instagram sessions with experts, and heavy engagement of health professionals and social media influencers. Moreover, product donations and assistance with COVID-19 vaccination services were commonly used to create a positive image of the baby food industry in violation of the Code. Therefore, there is an urgent need to regulate the online marketing of milk formula and all food and beverage products for children under the age of 3., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The study aims to investigate the severity of raters toward examinees' performances and to analyze biases subject to genders and academic majors based on the rater-examinee interactions. Data were collected across a 13-week research seminar course in English. Six raters were selected to rate 33 examinees using 18-item criteria. The many-facet Rasch measurement was utilized to analyze rater-examinee interactions and bias factors. The results confirmed that the instrument is reliable and valid. This study depicted the interaction between raters and other facets using a variable map, where the raters exhibited different levels of severity/leniency in scoring students' performances in oral presentations at the research seminar course. The result based on the Rasch analysis also confirmed that gender and academic majors contaminated rater assessment. Bias interaction between raters and student gender was detected, and Rater 6 displayed bias based on gender due to the tendency to give higher scores to female than male participants with a target contrast of 2.05 logits. Bias interaction between rater academic majors and student academic majors was also identified among raters with linguistics and psychology majors., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Numerous analytical approaches have been developed to determine histamine levels in food samples due to its health consequences. Consuming histamine over the Food and Drug Administration (FDA)-regulated 50 mg kg -1 limit would result in chronic toxicity. Consequently, the present study discusses a novel electrochemical approach to evaluate histamine levels in fish products via a molecularly imprinted polymer (MIP) on an electrode surface. The film was produced with electropolymerized polyurethane (PU), which maintained the histamine compound. Fourier-transform infrared (FTIR) spectroscopy was applied to verify the MIP manufactured in this study. The capability of the polymer was measured by assessing its electron shifts with cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Differential pulse voltammetry (DPV) was also employed to validate the sensing method. The MIP/screen-printed electrode (SPE) and non-imprinted polymer (NIP)/SPE recorded a linear response ranging from 1 to 1000 nmol L -1 at the 1.765 and 709 nmol L -1 detection limits. The sensing technique was subsequently utilized to determine the histamine levels in selected samples at room temperature (25 °C). Generally, the sensor allowed the accurate and precise detection of histamine in the fish samples. Furthermore, the approach could be categorized as a simple technique that is low-cost and suitable for on-site detections., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

The China-Pakistan Economic Corridor (CPEC) is an ongoing mega-construction project in Pakistan that necessitates further exploration of new natural resources of aggregate to facilitate the extensive construction. Therefore, the Late Permian strata of Chhidru and Wargal Limestone for aggregates resources were envisaged to evaluate their optimal way of construction usage through detailed geotechnical, geochemical, and petrographic analyses. Geotechnical analysis was performed under BS and ASTM standards with the help of employing different laboratory tests. A simple regression analysis was employed to ascertain mutual correlations between physical parameters. Based on the petrographic analysis, the Wargal Limestone is classified into mudstones and wackestone, and Chhidru Formation is categorized into wackestone and floatstone microfacies, both containing primary constituents of calcite and bioclasts. The geochemical analysis revealed that the Wargal Limestone and Chhidru Formation encompass calcium oxide (CaO) as the dominant mineral content. These analyses also depicted that the Wargal Limestone aggregates bear no vulnerability to alkali-aggregate reactions (AAR), whereas the Chhidru Formation tends to be susceptible to AAR and deleterious. Moreover, the coefficient of determination and strength characteristics, for instance, unconfined compressive strength and point load test were found inversely associated with bioclast concentrations and directly linked to calcite contents. Based on the geotechnical, petrographic, and geochemical analyses, the Wargal Limestone proved to be a significant potential source for both small and large-scale construction projects, such as CPEC, but the Chhidru Formation aggregates should be used with extra caution due to high silica content., (© 2023. The Author(s).)

Background: Anti-angiogenic medications, one of cancer chemo preventive mechanism were permitted for different cancers. Nevertheless, major primary and secondary resistance obstruct efficacy in several tumor types. Moreover, the improvement of safe and effective NSAIDs for angiogenesis inhibition is complicated, because of their serious toxicity. So, we require improving clinically appropriate strategies to boost efficacy of anti-angiogenic drugs with low risk of toxicity., Objectives: The present study aimed to synthesize the (E)-3- (3-methoxyphenyl)propenoic acid (3MPCA), to determine the anti-angiogenic activity and predict its toxicity., Methods: 3MPCA was obtained by Knoevenagel reaction using microwave irradiation at 400 Watt. The anti-angiogenesis experimental was performed using chorioallantois membrane of embryonated chicken eggs induced by b-FGF. The potency of 3MPCA was verified at dosage 30 and 60 ng and compared with celecoxib 60 ng. Toxicity prediction of 3MPCA was performed by ProTox II online program., Results: The results showed that 3MPCA was achieved in good yield (89%). Anti angogenic activity was showed by endothelial cells growth in neovascular capillaries of new blood vessel of chorioallantois membrane of embryonated chicken eggs. The endothelial cells growth decreased until 41.7-83%. The prediction LD50 was 1772mg/kg., Conclusion: (E)-3-(3-methoxyphenyl)propenoic acid can be obtained through Knovenagel reaction using microwave irradiation and it has potential as anti-angiogenesis inhibitor with low toxicity., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest. Funding: LPPM Airlangga University supported financially our research through PUF-2019 Grand No. 1143/UN3.1.5/LT/2019., (©Copyright: the Author(s).)

Background: Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease that can be triggered by various precipitating factors, including colonization by Staphylococcus aureus ( S. aureus ). The toll-like receptor (TLR), which belongs to the family of pattern recognition receptors (PRR), can recognize components of S. aureus , such as staphylococcal enterotoxin B (SEB). This receptor is known to be expressed on monocytes. However, the understanding of the role of SEB in the pathogenesis of AD through the TLR pathway, especially TLR2 and TLR6, is not widely known., Purpose: To investigate the expression of TLR2 and TLR6 on peripheral blood monocytes induced by SEB during AD exacerbations., Patients and Methods: Twenty AD patients and 20 healthy subjects as a control group were selected. A 5 mL blood sample from each subject was taken for monocyte culture, which was induced by SEB for three days, and the outcomes were assessed by flow cytometry to evaluate TLR2 and TLR6 expression., Results: The expression of TLR2 on peripheral blood monocytes in AD patients was increased compared to healthy controls ( p = 0.000), but not for the expression of TLR6 ( p = 0.304). In the AD group, TLR2 and TLR6 expression on peripheral blood monocytes after being induced by SEB was significantly increased compared to before induction ( p = 0.025 and p = 0.023, respectively), but not in the control group ( p = 0.737 and p = 0.100, respectively)., Conclusion: There is significantly increased expression of TLR2 and TLR6 on peripheral blood monocytes induced by SEB during exacerbation in AD patients., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Salim et al.)

Background: Plasmodial species naturally infecting orang-utans, Plasmodium pitheci and Plasmodium silvaticum, have been rarely described and reportedly cause relatively benign infections. Orang-utans at Rescue Rehabilitation Centres (RRC) across the orang-utan natural range suffer from malaria illness. However, the species involved and clinical pathology of this illness have not been described in a systematic manner. The objective of the present study was to identify the Plasmodium species infecting orang-utans under our care, define the frequency and character of malaria illness among the infected, and establish criteria for successful diagnosis and treatment., Methods: During the period 2017-2021, prospective active surveillance of malaria among 131 orang-utans resident in a forested RRC in West Kalimantan (Indonesia) was conducted. A total of 1783 blood samples were analysed by microscopy and 219 by nucleic acid based (PCR) diagnostic testing. Medical records of inpatient orang-utans at the centre from 2010 to 2016 were also retrospectively analysed for instances of symptomatic malaria., Results: Active surveillance revealed 89 of 131 orang-utans were positive for malaria at least once between 2017 and 2021 (period prevalence = 68%). During that period, 14 cases (affecting 13 orang-utans) developed clinical malaria (0.027 attacks/orang-utan-year). Three other cases were found to have occurred from 2010-2016. Sick individuals presented predominantly with fever, anaemia, thrombocytopenia, and leukopenia. All had parasitaemias in excess of 4000/μL and as high as 105,000/μL, with severity of illness correlating with parasitaemia. Illness and parasitaemia quickly resolved following administration of artemisinin-combined therapies. High levels of parasitaemia also sometimes occurred in asymptomatic cases, in which case, parasitaemia cleared spontaneously., Conclusions: This study demonstrated that P. pitheci very often infected orang-utans at this RRC. In about 14% of infected orang-utans, malaria illness occurred and ranged from moderate to severe in nature. The successful clinical management of acute pitheci malaria is described. Concerns are raised about this infection potentially posing a threat to this endangered species in the wild., (© 2022. The Author(s).)

During Ramadan fasting, people are likely to consume water and beverages lower than recommended intake due to the limited time. However, it is necessary to achieve the recommended daily water intake to maintain the hydration status, as well as productivity during fasting. Unfortunately, there is a lack of data on drinking patterns during Ramadan. This study aims to investigate water and beverage intake and drinking patterns to help achieve water requirements during Ramadan among Indonesian adults. This is a cross-sectional study conducted during the Ramadan period from April to May 2021 (Ramadan 1442 Hijri). We used a self-administered questionnaire on drinking habits during Ramadan and utilized a 7-day fluid record (Liq.In 7) to assess water and beverage intake among participants who were managed through online procedure. There were 380 participants from five universities across Indonesia who completed the questionnaire accordingly and then analyzed it. The result shows that total water and beverage intake during Ramadan among participants was below the recommendation [1,670 (1,326-2,034) ml/day]. Among the type of beverages, water is the highest level of consumption [1,262 (983-1,666) ml/day] then followed by sugar-sweetened beverages [200 (91-350) ml/day]. We found a significant difference in water and beverages consumption between time of iftar [474 (375-590) ml/day], nighttime [574 (414-810) ml/day], and suhoor [560 (423-711) ml/day]. From this study, we found that during Ramadan the most common drinking pattern is 2-4-2, but a drinking pattern of 4-2-2 glasses (sequence of four glasses at iftar, two glasses at nighttime, two glasses at suhoor) had a significantly higher chance to adhere with the recommendation of fluid intake compared to other patterns. Therefore, based on this research on water and beverage intake, it is necessary and important to make improvements among Indonesian adults during Ramadan, and the drinking pattern of 4-2-2 glasses may help to achieve the recommended daily water consumption., Competing Interests: DS, DC, BM, DF, NM, WL, and PI were a part of the Indonesian Hydration Working Group. The Indonesian Hydration Working Group is a collaboration project between the Faculty of Medicine Universitas Indonesia and PT Tirta Investama (Danone). However, PT Tirta Investama (Danone) did not participate nor was involved in the proposal writing, process of data collection, analyzing, interpretation, as well as manuscript writing. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sunardi, Chandra, Medise, Friska, Manikam, Lestari, Insani, Ayusari, Mayasari, Saftarina, Sari and Ulvie.)

Objective:  This study aimed to analyze interaction between glycosaminoglycan-acemannan as a scaffold material and toll-like receptor-2 (TLR-2) receptor, which predicted the osteogenesis potency on alveolar bone healing ( in silico analysis)., Materials and Methods:  Docking interaction between glycosaminoglycan-acemannan and TLR-2 receptor using the Molegro Virtual Docker (MVD) program. The compounds of glycosaminoglycan-acemannan and TLR-2 receptor with the structure in the form of two- and three-dimensional images were analyzed, as well as the most stable structure. It was observed the interaction of the ligand on the cavity of the TLR-2 receptor structure. The energy required for the ligand and receptor interaction (Moldock score) was calculated with MPD program., Results:  The chemical structure shows that glycosaminoglycan-acemannan is capable binding to the TLR-2 receptor with hydrogen bonds and strong steric interaction. The docking results were detected for five cavities where the compound binds to the TLR-2 receptor. The Moldock score of the ligand on the CAS-LYS-LEU-ARG-LYS-ILE-MSE[A] ligand was -95,58 Kcal/mol, that of acemannan was -91,96 Kcal/mol, and for glycosaminoglycan -61,14 Kcal/mol., Conclusion:  The compound of glycosaminoglycan-acemannan as a scaffold material is able to bind with a TLR-2 target receptor, which predicted osteogenesis activity on alveolar bone healing supported by in silico analysis., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Background: Automated wearable cameras present a new opportunity to accurately assess human behavior. However, this technology is seldom used in the study of adolescent's screen exposure, and the field is reliant on poor-quality self-report data., Objective: This study aimed to examine adolescents' screen exposure by categorizing the type and context of behaviors using automated wearable cameras., Methods: Adolescents (mean age 15.4 years, SD 1.6 years; n=10) wore a camera for 3 school evenings and 1 weekend day. The camera captured an image every 10 seconds. Fieldwork was completed between February and March 2020, and data were analyzed in August 2020. Images were date and time stamped, and coded for screen type, content, and context., Results: Data representing 71,396 images were analyzed. Overall, 74.0% (52,842/71,396) of images contained screens and 16.8% (11,976/71,396) of images contained multiple screens. Most screen exposures involved television sets (25,950/71,396, 36.3%), smartphones (20,851/71,396, 29.2%), and laptop computers (15,309/71,396, 21.4%). The context of screen use differed by device type, although most screen exposures occurred at home (62,455/64,856, 96.3%) and with solitary engagement (54,430/64,856, 83.9%). The immediate after-school period saw high laptop computer use (4785/15,950, 30.0%), while smartphone use (2059/5320, 38.7%) peaked during prebedtime hours. Weekend screen exposure was high, with smartphone use (1070/1927, 55.5%) peaking in the early morning period and fluctuating throughout the day., Conclusions: There was evidence for high screen use during the after-school and weekend period, mostly through solitary engagement, and within the home environment. The findings may inform the basis of larger studies aimed at examining screen exposure in free-living conditions., (©George Thomas, Jason A Bennie, Katrien De Cocker, Fitria Dwi Andriyani, Bridget Booker, Stuart J H Biddle. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 21.03.2022.)

Bioaccumulation studies of Zn and 137 Cs by the horse mussel (Modiolus micropterus) were conducted in a laboratory that used radiotracer. The study has been carried out on the effect of cesium and zinc concentrations and the effect of sea seawater salinity on the ability of M. micropterus to accumulate these two contaminants. The uptake of Zn and Cs according to the one-compartment model and the experiment was carried out until the steady-state conditions were reached. The concentration factor at steady-state Zn is 31.94-45.54 mL. g -1 and 23.22-33.26 mL. g -1 which are influenced by the concentration and salinity of seawater, respectively. The concentration factor of 137 Cs at steady-state conditions due to changes in concentration and salinity is 3.34-7.55 mL. g -1 and 4.23-9.66 mL. g -1 , respectively. The release rates of Zn were 30-47 % and 39-49 % at various concentrations and salinity. The depuration rate from concentration reaching 60 % and salinity at ranges 43-52 % was observed within 10 days after exposure. On the other hand, the release rates of 137 Cs were 60 % and 43-52 % at various changes in the concentration and salinity of seawater., (Copyright © 2021. Published by Elsevier B.V.)

Background: Although there is no licensed vaccine for monkeypox, smallpox vaccine has been shown to be 85% effective in preventing the monkeypox. This study was conducted to assess the willingness of frontline healthcare providers to be vaccinated with smallpox vaccine to prevent monkeypox., Methods: A cross-sectional study was conducted in Indonesia. The willingness was assessed under two scenarios: fully subsidized and non-subsidized vaccine. Explanatory variables such as sociodemographic profile, workplace and professional characteristics, and knowledge of monkeypox were collected. A logistic regression assessed the influence of these explanatory variables on participants' willingness., Results: Out of 510 received participants' responses, 407 (79.8%) were analyzed. With a fully subsidized vaccine scenario, 381 (93.6%) of the participants were willing to be vaccinated and in an unadjusted analysis, gender, education, monthly income, and type of workplace were associated with willingness. With a non-subsidized vaccine (i.e. the vaccine price was US$ 17.9), the proportion who were willing to be vaccinated decreased to 71.9%. In adjusted analyses for both scenarios, gender was the only independent predictor for willingness; men were less willing to be vaccinated than women, adjusted odds ratio (aOR): 0.37; 95% confidence interval (CI): 0.16, 0.87 and aOR: 0.42; 95%CI: 0.27, 0.67, respectively for subsidized and non-subsidized scenario., Conclusion: Vaccine price and gender are important factors for physicians' willingness to be vaccinated for smallpox vaccine prevent monkeypox in Indonesia. These findings indicate that achieving high vaccine converge may require partially or fully subsidized vaccines, along with a clear guideline and recommendation from authorities., Competing Interests: The authors declare that they have no competing interests., (© 2020 INDIACLEN. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Background: IDH1 mutation shows diagnostic, prognostic, and predictive value in gliomas. Direct Sanger sequencing is considered the gold standard to detect IDH1 mutation. However, this technology is not available in most neuropathological centers in developing countries such as Indonesia. Immunohistochemistry (IHC) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) have also been used to detect IDH1 mutation. This study aimed to compare DNA sequencing, IHC, and PCR-RFLP in detecting IDH1 mutations in gliomas., Methods: Research subjects were recruited from Dr. Sardjito Hospital. Genomic DNA was extracted from fresh or formalin-fixed paraffin-embedded samples of tumor tissue. DNA sequencing, PCR-RFLP and IHC were performed to detect IDH1 mutation. Sensitivity, specificity, and accuracy of PCR-RFLP and IHC were calculated by comparing them to DNA sequencing as the gold standard., Results: Among 61 recruited patients, 13 (21.3%) of them carried a mutation in codon 132 of the IDH1 gene, as shown by DNA sequencing. PCR-RFLP and DNA sequencing have a concordance value of 100%. Meanwhile, the concordance value between IDH1 R132H IHC and DNA sequencing was 96.7%. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy for PCR-RFLP were all 100%. On the other hand, the sensitivity, specificity, and accuracy of IHC were 92.3%, 97.9%, and 96.7%, respectively., Conclusion: This study showed that both PCR-RFLP and IHC have high accuracy in detecting IDH1 mutation. We recommend a combination of PCR-RFLP and IHC to detect IDH1 mutation in resource-limited settings., .

Background: A clinical trial is ongoing to evaluate the safety and efficacy of a monkeypox vaccine among healthcare workers (HCWs). The critical question that needs to be addressed is whether HCWs are willing to accept and purchase this vaccine. The objective of this study was to evaluate the acceptance and willingness to pay (WTP) for the vaccine among HCWs., Methods: From May to July 2019, a cross-sectional study was conducted among registered general practitioners (GPs) in Indonesia. A contingent valuation method was employed to evaluate the WTP. Besides acceptance and WTP, various explanatory variables were also collected and assessed. A logistic regression and a multivariable linear regression were used to explore the explanatory variables influencing acceptance and WTP, respectively., Results: Among 407 respondents, 391 (96.0%) expressed acceptance of a free vaccination. The mean and median WTP was US$ 37.0(95%CI:US$ 32.76-US$ 41.23) and US$ 17.90(95%CI:US$ 17.90-US$ 17.90), respectively. In an unadjusted analysis, those 30 years old or younger had 2.94 times greater odds of vaccine acceptance compared to those who were older (95%CI: 1.07-8.08). Location of alma mater, type of workplace, length of individual medical experience, and monthly income of GPs were all significantly associated with WTP., Conclusion: Although the vast majority of GPs would accept a freely provided vaccine, they were also somewhat price sensitive. This finding indicates that partial subsidy maybe required to achieve high vaccine coverage, particularly among GPs at community health centres or those with a shorter duration of medical practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Families, especially parents, play an important role in identifying their children's talents and directing their educational journey. The role of parents in their children career applies both to collectivist and to noncollectivist culture., Aim: To examine the correlation between parental influences on medical students' self-efficacy and career exploration in collectivist culture., Methods: This research was a quantitative study. The study involved 1017 medical students of medical faculties in four faculties of medicine in Indonesia. All data were collected online in August 2018. The study was conducted using an online survey questionnaire and analyzed to finally form a model that displays the determinants of career exploration behavior. The data were analyzed using the maximum likelihood estimation in IBM AMOS 24., Results: The results found a model that has various routes toward career exploration in collectivist culture. Path analysis revealed both direct and direct effect toward the variable studied. Parents' expectations had influence on self-efficacy., Conclusion: The findings show the important role between the influence of parents expectations for self-efficacy and career exploration in children., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Purpose: Highly active systemic lupus erythematosus (SLE) causes a high risk of tuberculosis (TB) infection in SLE patients in Indonesia, a country in which the disease, especially extrapulmonary TB, is endemic. Interferon (IFN)-γ releasing assay (IGRA) can detect latent or previous TB infection. This study sought to determine latent TB infection and levels of IFN-γ, a key player in various inflammation and autoimmune disease, in patients with SLE and relate findings to disease activity., Patients and Methods: This experimental study included 79 female subjects distributed into three groups of active SLE, quiescent SLE and healthy controls. We used SLE Disease Activity Index-2000 (SLEDAI-2K) scores to stratify the subjects. Each group underwent IGRA testing using the QuantiFERON-TB Gold Plus kit., Results: We recruited 59 female patients with SLE. The patients had a median age and disease duration 30 and 5 years, respectively. Statistical analysis using the Kruskal-Wallis test showed that active condition, high SLEDAI-2K score and immunosuppressive therapies affect IGRA results. Specifically, healthy controls (n=20) were most likely to have negative IGRA results (67.09%), whilst 27.27% of active cases (n=33) and 3.85% of quiescent cases (n=26) had indeterminate results (p=0.02). The number of immunosuppressant therapies was significantly negatively correlated with IFN-γ (p=0.004). No difference in IFN-γ concentration was detected amongst the active and other groups (p>0.05)., Conclusion: High-activity SLE and immunosuppressive therapies cause dysregulation of the immune response, which, in turn, influences IGRA results. Thus, additional testing is necessary to detect TB infection in patients with SLE., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Maharani et al.)

The current re-emergence of human monkeypox (HMPX) is a global concern for endemic and non-endemic countries, but healthcare workers in some regions, like Asia, have less experience with identifying and treating HMPX cases. This study aimed to assess the confidence and its predictors in HMPX case management among general practitioners (GPs), the frontline doctors in Indonesia, and to explore their perspectives on HMPX. Between May and July 2019, GPs in Indonesia completed an online-based survey. The questionnaire collected information on GPs' confidence, perspective, sociodemographic, workplace and professional characteristics, exposure to HMPX information and knowledge on HMPX. A logistic regression analysis was employed to explore the explanatory variables influencing the confidence and the perspective. We included 395 GPs in our analysis (77.4% out of 510 responses received) of which 10.1% and 34.9% were classified having good confidence using an 80% and 70% cut-off for confidence score, respectively. In the adjusted analysis, receiving information about HMPX during medical training was the only variable significantly associated with good confidence (adjusted odds ratio 2.74, 95% confidence interval 1.57 to 4.78 and p < 0.001). Approximately 73.6% and 77.9% of GPs agreed that HMPX is an important infectious disease and it has potential to detrimentally impact the Indonesian economy, respectively. In addition, 88.8% of GPs suggested that the disease should be incorporated into the National Medical Curriculum of Indonesia. In conclusion, in case of HMPX outbreak, majority of the GPs in Indonesia seem to be less confident in diagnosing and treating cases, using their current knowledge, skills and their workplace facilities. Therefore, a systematic strategy to improve their confidence in managing HMPX is required., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)