Abstract Background: Nasopharyngeal cancer (NPC) is a malignancy of the nasopharyngeal mucosal epithelium. Primary and secondary metastases in nasopharyngeal cancer are generally prevalent in the bones. Gene expression plays a critical role in regulating fundamental cellular processes in cancer cells, including metastasis. Methods: A total of 29 patients with non-metastatic NPC were included in the study. Results: The mean age of the participants was 48.45±9.98 years old. Most participants were male (75.9%). More than half of the participants had T4 and N2, 52.7% and 51.0% respectively). Secondary metastasis was observed in 9 of the 29 participants within two years. Patients with secondary metastases had a higher proportion of T4 (7/9) and N2 (4/9) disease. Bone was the first site of secondary metastasis (6/9 patients). The median time to secondary bone metastasis was 14.0 (6.8-21.2) months. Based on the differential expression gene (DEG) analysis, the MMP9 gene was upregulated 12.50 (4.18–37.40), adjusted p <0.01, and the ADNP gene was downregulated 0.141 (0.04–0.43), adjusted p 0.04, among patients with secondary bone metastasis. Conclusion: Bones are the first site of metastasis, with a time to metastasis of 14.0 (6.8-21,2) months. MMP9 was upregulated, and ANDP was downregulated in patients with bone metastasis compared to those without metastasis.
MMP-9 ; ADNP ; nasopharyngeal cancer ; secondary bone metastasis

Background: Mediastinal lymphadenopathy indicates an intrathoracic pathological process. Tuberculous mediastinal lymphadenopathy (TML) can be an early sign of tuberculosis infection, particularly in developing countries. Its incidence is often unclear due to underdiagnosis and limited access to diagnostic tools. Timely diagnosis is essential, as delayed treatment can result in severe complications. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a reliable method for obtaining samples and establishing a diagnosis, although its use is constrained by various factors. This study aims to clarify the role of EBUS features in assessing TML. Methods: This is a cross-sectional study that recruited ≥18 years old patients with suspected TML who underwent EBUS-TBNA. Mediastinal lymph nodes were systematically evaluated EBUS, with a focus on the largest nodes for further characteristic analysis. A TBNA was performed, and the retracted samples were assessed for pathology, acid-fast bacilli, Mycobacterium tuberculosis (MTB) culture, and Xpert Ultra examinations. Results: One hundred patients were recruited for the study. Fifty-three of these patients were ultimately diagnosed with TML. Significant associations were found between TML and several factors: short-axis size (p<0.001), oval-shaped lymph nodes (p=0.034), indistinct margins (p<0.001), central hilar presentation (p<0.001), internal echoes (p<0.049), thin layer echogenicity (p=0.033), and nodal matting (p<0.001). Among the diagnostic modalities, Xpert Ultra demonstrated the highest sensitivity for TML at 71.7%. Conclusion Endobronchial ultrasonographic features such as small size, round shape, indistinct margin, central hilar presentation, internal echo, thin layer echogenicity, and nodal matting are indicative of TML.

Multiple traumas require a fast and comprehensive treatment to overcome challenges that emerge from the patient’s condition. The right time for trauma team activation is necessary to treat these multiple trauma patients to improve patient outcomes. This integrative review identifies the criteria used to activate the trauma team, the activation process and the outcome of the activation. The search was conducted from January to March 2023 with two databases, namely MEDLINE and PubMed, and grey literature via Google Scholar. The search was limited to articles written in English, with abstracts and available in full text. There was no year limitation. The review found four criteria that were used for trauma team activation: physiological, anatomical, mechanism of injury and others. The process of trauma team activation begins in the pre-hospital setting. Outcomes used to evaluate the impact of trauma team activation included the level of satisfaction of patients and families, the level of complaints, response time, discharge status, and mortality. The findings of this review recommend that the criteria, process, and outcomes of trauma team activation are tailored, based on the needs and available resources of the institutions. Moreover, standardized trauma team activation may be necessary for future development.

Background and Objective: Hypertension is a major health issue worldwide, with primary schoolteachers possessing several lifestyle risks of the disease. There have not been any health promotion programs yet for primary schoolteachers in Indonesia, especially for blood pressure control. A school-based model of workplace wellness program for teachers was developed. It focused on using screening as feedback in controlling blood pressure by eating a healthy diet, doing physical activity, and having regular checks. This study aimed to assess its clinical and behavioral effects. Methods: This trial was a one group pre- and post-test study design without control. It was implemented purposively in three public primary school locations in Jakarta to 44 eligible teachers for approximately three months from January to March 2022. The workplace wellness program included on-site screening (blood pressure, body mass index/BMI, spot urine sodium-creatinine ratio), knowledge, motivation, and ongoing health behavior (physical activity and the dietary approach to stop hypertension/DASH), online education/training, consultation/counseling sessions with a family doctor, and self-monitoring. All screening measurements were repeated at the end of the program. A paired t-test or Wilcoxon analysis was performed using SPSS 20.0. Results: Both systolic and diastolic blood pressure decreased by 5.05 mmHg (p = 0.018) and 6.41 mmHg (p < 0.001), respectively. The spot urine sodium-creatinine ratio and BMI decreased slightly but not significant (p = 0.707; p = 0.761). Knowledge and motivation increased slightly but not significant (p = 0.529; p = 0.175). The DASH behavior significantly increased by 25% (p < 0.001). Though the overall physical activity did not change, the walking activity increased twofold significantly (p = 0.006). This study also showed that the outcome would be achieved when the participant followed the recommendations obediently. Conclusion This school-based workplace wellness program was found to have a potential effect on controlling blood pressure by changing health behaviors. A randomized controlled trial is recommended to provide stronger evidence on its effectiveness before doing a large-scale implementation in primary schools in Indonesia.
Health Promotion ; Hypertension ; Exercise ; DASH diet ; Dietary Approaches To Stop Hypertension

Objectives: Recovery from drug addiction often poses challenges for the recovering person. The coping mechanisms employed by these individuals to resist temptations and manage stress play a key role in the healing process. This study was conducted to explore the coping strategies or techniques that individuals with addiction use to handle stress and temptation while undergoing treatment. Methods: A qualitative meta-synthesis approach was utilized to critically evaluate relevant qualitative research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used for article selection, with these standards applied to 4 academic databases: Scopus, PubMed, ProQuest, and CINAHL. The present review included studies published between 2014 and 2023, selected based on pre-established inclusion criteria. The quality of the studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024497789. Results: The analysis of 13 qualifying qualitative articles revealed 5 major themes illustrating the coping mechanisms employed in the pursuit of recovery by individuals who use drugs. These themes include seeking social support, as well as psychological coping strategies, spiritual experiences, professional interventions, and the enhancement of awareness. Conclusions Among individuals with drug addiction, coping mechanisms are crucial for resisting stress and temptations throughout the recovery process. Healthcare professionals, as medical specialists, can establish more thorough and effective plans to support these patients on their path to recovery.

Objectives: One of the most widely used pesticides today is chlorpyrifos (CPF). Cytochrome P450 (CYP)2B6, the most prominent catalyst in CPF bioactivation, is highly polymorphic. The objective of our study was to evaluate the role of CYP2B6*6, which contains both 516G>T and 785A>G polymorphisms, in CPF toxicity, as represented by the concentration of 3,5,6-trichloro-2-pyridinol (TCPy), among vegetable farmers in Central Java, Indonesia, where CPF has been commonly used. Methods: A cross-sectional study was conducted among 132 vegetable farmers. Individual socio-demographic and occupational characteristics, as determinants of TCPy levels, were obtained using a structured interviewer-administered questionnaire and subsequently used to estimate the cumulative exposure level (CEL). TCPy levels were detected with liquid chromatography-mass spectrometry. CYP2B6*6 gene polymorphisms were analyzed using a TaqMan® SNP Genotyping Assay and Sanger sequencing. Linear regression analysis was performed to analyze the association between TCPy, as a biomarker of CPF exposure, and its determinants. Results: The prevalence of CYP2B6*6 polymorphisms was 31% for *1/*1, 51% for *1/*6, and 18% for *6/*6. TCPy concentrations were higher among participants with CYP2B6*1/*1 than among those with *1/*6 or *6/*6 genotypes. CYP2B6*6 gene polymorphisms, smoking, CEL, body mass index, and spraying time were retained in the final linear regression model as determinants of TCPy. Conclusions The results suggest that CYP2B6*6 gene polymorphisms may play an important role in influencing susceptibility to CPF exposure. CYP2B6*6 gene polymorphisms together with CEL, smoking habits, body mass index, and spraying time were the determinants of urinary TCPy concentrations, as a biomarker of CPF toxicity.

Objective: The objective of our study was to determine the genotype frequencies of CYP2C19*2 and *3 gene polymorphisms among Javanese farmers exposed to chlorpyrifos (CPF) in Central Java, Indonesia. Methods: This cross-sectional study was conducted from July to October 2020 in Central Java, Indonesia, involving 151 vegetable farmers aged 18-65 years who used CPF for at least one year. CYP2C19*2 and *3 gene polymorphisms were analyzed using PCR-RFLP. Direct calculations were applied to calculate allele and genotype frequencies. The difference in genotype frequencies among the sex and cumulative exposure level (CEL) group was performed using the Chi-square test. In contrast, the proportion difference of allele frequencies was analyzed using Z-test. Results: The frequency of CYP2C19 genotypes *1/*1, *1/*3, *1/*2, and *2/*2 were 64 %, 7 %, 23 % and 6 %. We observed no significant difference in the genotype distribution according to sex group and CEL group. Conclusion In summary, the prevalence of toxicologically relevant CYP2C19 polymorphisms was determined in the Javanese agricultural population. The CYP2C19 genotype may be helpful as an essential biomarker of genetic susceptibility towards CPF exposure. Nevertheless, further studies to confirm the role of CYP2C19 in this context are still needed.
Cytochrome P-450 CYP2C19 ; Pesticides

Occupational health and nutrition are closely related. Nutrition in the workplace plays an essential role in supporting workers' health through a balanced nutrition approach. Reciprocally Occupational health is an approach to solving nutritional problems in workers, which in turn impacts the nutrition and health of families and communities. The workplace-based nutrition promotion is one of the pillars of the occupational health approach to solving health problems among workers. The workers' health related to nutrition is still a big challenge; on the other hand, the workplace is a potential setting for solving workers' and community health and nutrition problems. Currently, the Southeast Asian Region has been facing multiple burdens of the workers/productive age nutrition problem. The problem of nutritional deficiency, especially iron and other nutrients deficiency anemia dominate in women workers, especially pregnant women. The prevalence of anemia in working women is high in some Asian countries such as Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, and Timor Leste. The prevalence of anemia in women of productive age in these countries ranges from 22.7% to more than 50%.1 Meanwhile, other nutritional deficiencies such as folic acid and zinc also add to the magnitude of the calorie and protein deficiency problem in this population. Along with the problem of nutritional deficiency, Southeast Asian countries are also facing obesity and the risk of non-communicable diseases related to diets, such as hypertension and cardiovascular disease. It was noted that the prevalence of obesity in workers reached 49.8% among males and 50.2% among females.2 Work and work environment are significant risk factors for obesity among workers. Social stressors, psychosocial work factors, working hours, sleep and night shift work, and sedentary behavior are associated with obesity among workers.3 In addition, food contamination due to the environment, including work environment, increases health risks in the workplace.4 This situation is certainly threatening because it is also a determinant variable of presenteeism and reduces productivity. Many programs have been carried out to prevent and control these health and nutrition problems, including health and nutrition promotion, supplementation of iron tablets, and food fortification. The program's success will undoubtedly be improved by making the workplace a setting for activities towards a healthy workplace. World Health Organization5 defined "a healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace". The principles of approach to workplace health promotion are addressed at the underlying causes of ill health, combining diverse methods of interventions. Workplace health promotion is aimed at effective worker participation and is not partially based on medical activities but should be part of the work organization and working conditions. These approaches are in line and build a synergy with the goals of the occupational health services that are devoted to the prevention and management of occupational and environmental injury, illness and disability, and the promotion of health and productivity of workers, their families, and communities. In practice, the goals of the occupational health service are to protect the workers against any occupational hazard, to contribute towards harmonious human-machine relationships and to establish and maintain the workers' physical and mental well-being.6 The bottom line of workplace-based health and nutrition intervention is the worker's healthy behavior and balanced nutrition practices. Workplace health promotion should be done by implementing health promotion strategies focusing on the individual and their lifestyle behavior change and creating healthy work organizations and environments. In the case of nutritional deficiencies, improving diets may be more appropriate, and workplaces are an excellent setting to improve the nutritional quality of diets. Nutrition promotion is the basis of the strategic approach to address nutrient deficiency anemia. Workplaces appear as the main entry point: workers are generally healthy and productive, and nutrition activities may also reach the workers' families. Mansyur7 proposed integrating nutrition education, factory canteen and health services improvements. Workplace-based nutrition education effectively improves female workers' knowledge and practices of balanced nutrition and healthy habits. The service of the company canteen plays an important role in providing nourishing meals and compensating for family food shortages due to financial constraints and cultural barriers. In addition, factory health services strengthen their activities with health promotion and preventive approach via workplace hazard prevention and control, and minimizing the risk of occupational and environmental food contaminants.

INTRODUCTION: Offshore and onshore workers have a higher risk of psychological stress related to their job. Stress reactions vary depending on the type of stressor, the duration or severity of the stressor, their genetics, their coping styles, and their nutrition. Tryptophan is an essential amino acid precursor of serotonin and melatonin, which have an antidepressant effect and roles in stress perception and management. This study assessed the correlation of daily tryptophan intake and occupational factors with stress outcome scores based on the Indonesian Short Version New Brief Job Stress Questionnaire (SV-NBJSQ) among offshore and onshore workers. METHODS: A cross-sectional study was conducted on 14 offshore workers and 20 onshore workers. Interviews and questionnaires were conducted to obtain demographic data, dietary intake, occupational factors, and stress outcome scores. Tryptophan daily intake was measured through a single 24-hour dietary recall and a one-day-weighted food record. Data of average daily intake for two days were analyzed using the NutriSurvey software based on the food composition table from The United States Department of Agriculture National Nutrient Database for calculating tryptophan intake. RESULTS: The median (min-max) tryptophan daily intake of offshore workers was 5.5 (1.9–9.9) mg/kg, and 4.5 (1.4–7.5) mg/kg among onshore workers. There was no difference in tryptophan daily intake between offshore and onshore workers (p = 0.064). There was no significant difference between occupational factors except for the shorter tenure of offshore workers (12.5 vs 3, p < 0.001). There was no significant correlation between tryptophan daily intake and each of the stress outcome scores. There was a significant correlation between occupational factors and stress outcome scores among offshore and onshore workers, specifically between workload and fatigue (r = 0.35, p =0.04), workload and depression (r = 0.4, p = 0.02), interpersonal conflict and anxiety (r = 0.47, p = 0.005), role conflict and anxiety (r = 0.47, p = 0.005), as well as between tenure and physical reaction stress (r = -0.42, p = 0.02). CONCLUSION Adequate tryptophan daily intake and high stress outcome scores among offshore and onshore oil and gas workers are observed in this study, and no correlation was found between the two. Similar food sources, homogeneous occupational stressors, the selection bias of the “healthy worker effect” or other factors that were not studied may influence the findings. There is a correlation between occupational factors and stress outcome scores, namely workload and fatigue, workload and depression, interpersonal conflict and anxiety, role conflict and anxiety, and tenure and stress physical reactions.

Objectives: Shift work results in changing worker’s behavior, food, and sleep patterns, which can cause circadian rhythm disturbance, which is a cardiovascular risk. Until now, a biomarker of early prediction of cardiovascular risk on shift workers is still not developed. This study aimed to assess the cardiovascular risk of shift worker nurses by detecting endothelial microparticles (EMPs). Methods: This longitudinal study compared six shift nurses and five non-shift nurses by measuring the EMPs using antigen CD31+ flow cytometry. All met the inclusion criteria consisting of 28 blood samples followed in one week shift. Results: EMPs among non-shift nurses were below 200 μL. However, shift nurses’ EMPs increased above 200 μL with Man-Whitney U p = 0.000 on days 4 and 7 following a one shift per week schedule. Conclusion There was an increase in shift workers’ endothelial microparticles (EMP) which was a sign of cardio-vascular risk.
Heart Disease Risk Factors ; Nurses