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In light of the current coronavirus disease 2019 (COVID-19) vaccination programs being implemented worldwide, this study aimed to evaluate the COVID-19 vaccine acceptance survey in Indonesia conducted by the World Health Organization (WHO), the Ministry of Health of the Republic of Indonesia, the National Immunization Technical Advisory Group (NITAG), and the United Nations Children's Fund (UNICEF), published in November 2020. It was found that Sumatra Island having lower COVID-19 vaccine acceptance rates, with Aceh Province displaying the lowest level of vaccine acceptance. Thus, a cross-sectional study was conducted, and a logistic regression analysis was used to identify the factors affecting COVID-19 vaccine acceptance. Out of 368 respondents who participated in the survey, 143 (38.9%) accepted the vaccine, and 225 (61.1%) refused it. Vaccine safety concerns constituted the most reported reason for refusal (43.6%). This study also found that province of residence and basic immunization status were determinants of COVID-19 vaccine acceptance in Sumatra. Concerns regarding vaccine safety might be the reason for the low level of vaccination in Sumatra. Increased education and encouragement from healthcare professionals and regional authority figures can alleviate public concerns and improve vaccine acceptance. [ABSTRACT FROM AUTHOR]

Purpose: As coronavirus disease 2019 (COVID-19) continues to spread rapidly causing approximately 186 million confirmed cases around the world, the urgency to reach herd immunity through vaccination is increasing. However, vaccine safety is a top priority to limit the occurrence of adverse events. Henceforth, this study aims to recognize and perceive COVID-19 vaccine safety in Indonesia during the pandemic. Materials and Methods: This is a cross-sectional study and was conducted in Indonesia during the COVID-19 pandemic using an online survey of demographic information and a qualitative questionnaire. Responses were recorded and the association between demographic characteristics from survey questions was tested using chi-square with a risk estimate and 95% confidence interval. Results: A total of 311 participants from 33 out of 34 provinces in Indonesia participated in this study. Recorded responses showed multiple side effects of the COVID-19 vaccine both shortand long-term experienced by the participants. Significant associations were found between demographic factors and COVID-19 vaccine side effects such as female gender with shortterm puncture site (odds ratio [OR], 0.463; 95% confidence interval [CI], 0.263-0.816) and shortterm other reactions (OR, 0.463; 95% CI, 0.263-0.816), domicile outside Java island with longterm puncture site (OR, 4.219; 95% CI, 1.401-12.701) and immune reactions (OR, 3.375; 95% CI, 1.356-8.398), also between married marital status and long-term vagal reaction (OR, 4.655; 95% CI, 1.321-16.409). Conclusion: Gender, domicile and marital status factors were associated with COVID-19 vaccine side effects in Indonesian people. [ABSTRACT FROM AUTHOR]

• The role of COVID-19 survivor towards antibody titers post-Sinovac vaccination are unknown • The gender role towards antibody titers post-Sinovac vaccination are also unknown • COVID-19 survivorship was associated with higher antibody titers during first two months • Females had higher antibody titers than males in all 3 months after vaccination Male and female titers differed most in the 1 month and 3 months after vaccination Background: Sinovac was the first vaccine used in Indonesia against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data regarding the effects of certain variables such as clinical demographics on antibody levels in individuals vaccinated with Sinovac are scarce. This study aimed to investigate the impact of gender and previous SARS-CoV-2 infection status on neutralizing antibody titers 1, 2, and 3 months after administration of the Sinovac vaccine. Method: A cross-sectional study was conducted from February to May 2021. Data on neutralizing antibody levels, previous SARS-CoV-2 infection status, and gender were retrieved from the monthly quantitative serology evaluation database of Siloam Hospitals Lippo Village, Tangerang, Indonesia. The role of each variable was analyzed using the t -test or Mann-Whitney U test, depending on data distribution. Result: Data from 350 participants were collected for the study. Participants with a history of a positive SARS-CoV-2 RT-PCR test had significantly higher neutralizing antibody titers in the first (144 U/mL, p = 0.036) and second months (144 U/mL, p = 0.005) after vaccination compared with those without a history of positive RT-PCR test. Female participants also had significantly higher neutralizing antibody titers in the first, second, and third months (43 U/mL, 42 U/mL, and 39 U/mL, respectively; p = 0.001, p = 0.002, and p = 0.003, respectively) after vaccination compared to males. Conclusion: COVID-19 survivor status and the female gender were associated with higher neutralizing antibody titers after Sinovac vaccine administration. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome (IBS) is one of the health problems that bring great effects in education, productivity, and socioeconomic life in Indonesia. It accounts for approximately 10.5% of304 digestive problems in Jakarta, Indonesia. Particular characteristics are known to increase the risk of IBS in individuals, but the study of IBS in Indonesia is still limited in number. The objective of this study is to assess the prevalence and factors affectingIBS in medical students. Method: This study is a cross sectional study on medical students of Pelita Harapan University, Karawaci, Tangerang on January 2018 until March 2018. Data were obtained with the use of questionnaire of demographic data, ROME IV IBS Criteria, GAD DSM-IV, and PSQI as the instruments with random sampling technique, and statistically tested using Chi-square test. Results: A total of 210 samples consist of 54 subjects with IBS (25.7%) with 43 women (79.6%) and 11 men (20.4%). Findings ofbivariate analysis are sex (95% CI: 0.751 - 3.346), obesity (95% CI: 0.612 - 2.673), history of drug consumption (95% CI: 1.246 - 6.742), family history of IBS (95% CI: 1.246 - 6.742), anxiety (95% CI-.1.419 - 9.709), andsleep disorder (95% CI: 0.514 -1.785). Conclusion: The prevalence of IBS in medical students in our institution is 25.7% with history of drug consumptionffamily history ofIBS, and anxiety asfactors statistically significant in IBS. [ABSTRACT FROM AUTHOR]

To control the spread of COVID-19 transmission, Indonesia government has broadcasted information about the pandemic. The aim of this study is to evaluate the understanding of young people, about COVID-19 during the early outbreak in Indonesia. An online-based cross-sectional data collection was conducted from adolescents aged 10 to 25 years, based on 10 questions regarding general COVID-19 information. There were 355 subjects from 25 out of 34 Indonesian provinces who participated in the study, with mean age of 19.93 ± 2.91 years. Better understanding was found in the female and higher-income population. Largely, the subjects got the information from social media, instead of the official government site for COVID-19. Lack of understanding about crucial preventive measures was found, such as handwashing and physical distancing. In conclusion, the participants have an overall moderate-good initial understanding toward COVID-19 during the early outbreak in Indonesia. These results can be used as baseline data for development of awareness measurement tools. [ABSTRACT FROM AUTHOR]

Related Article This is a corrected version. See correction statement in: https://www.jmir.org/2021/4/e29790 Background: Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics. Objective: This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students. Methods: A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder. Results: Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P =.04). Conclusions: These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors. J Med Internet Res 2021;23(4):e25468 doi:10.2196/25468 [ABSTRACT FROM AUTHOR]

• Severe COVID-19 is associated with increased plasma concentrations of IL-6. • Tocilizumab, an interleukin-6 inhibitor, might alleviate the cytokine storm. • Tocilizumab treated group has better clinical outcome, laboratory results, and swab conversion. • The benefit from tocilizumab is more significant in severe COVID-19 patients. • Therefore, tocilizumab might be one of the promising therapies for severe COVID-19. COVID-19 is a public health emergency of international concern with millions confirmed cases globally including in Indonesia with more than two hundred thousand confirmed cases to date COVID-19. (1) COVID-19 has wide clinical manifestation ranging from asymptomatic, acute respiratory illness, respiratory failure that necessitates mechanical ventilation and support in an ICU, to MODS. (2) Several comorbidities have been demonstrated to be associated with the development of severe outcomes from COVID-19 infection, such as hypertension, diabetes, cardiovascular disease, dyslipidemia, thyroid disease, and pulmonary disease. (3)–(5) Severe COVID-19 is associated with increased plasma concentrations of IL-6, resulting in cytokine storm. (6) Tocilizumab, an interleukin-6 inhibitor, might alleviates the cytokine storm, prevents significant lungs and organs damage, thus improving clinical outcomes. (7) Therefore, tocilizumab, might be one of the promising therapies for severe COVID-19. (8) However there were limited studies regarding the efficacy in COVID-19 patients, especially with control group. We would like to report our experience in using tocilizumab as treatment in severe COVID-19 patients in Indonesia, which is the first in Indonesia to the best of our knowledge. [ABSTRACT FROM AUTHOR]

Background As of 2012¸ breast cancer accounts for 59% prevalence rate in Asia. The WHO identifies breast cancer as leading cancer in Indonesian women with 48.998 cases in 2014 with 48.9% incidence rate as well as 21.4% mortality rate out of 92.220 total deaths caused by cancers. Based on a research done in the UŞ initial diagnosis has evoked a state of shocķ fear and disbelief for the patients. Most women experience at least some psychosocial distress during the course of their breast cancer diagnosis. Even after appropriate treatments, 18% of women had posttraumatic stress symptomş many reported lymphedema (27%) and numbness (20%) as persistent problems. This contributed to significant psychosocial distress that can interfere with functioning which makes it necessary to assess the QoL within Indonesian femalés breast cancer patients. Objective The objective of this study was to test the reliability and validity of the Indonesian version of the EORTC QLQ-BR23 to assess the health-related quality of life of women with breast cancer in Indonesia. Methods The QLQ-BR23 questionnaire were distributed to 25 breast cancer patients in the Oncology Department of Siloam General Hospitaļ Karawaci¸ Tangerang. Data were collected using Microsoft Excel 2016 and was analyzed using SPSS 21.0 with descriptive statistic and pearson correlation statistics. Results Kolmogorov¯Smirnov test and Shapiro¯Wilk test for age showed results > 0.05 which indicates a normal distribution. Howeveŗ item statistics for Blr, SFr, Ser, FPr, STSEr, BSr, ASr and UHLr all showed a relatively low Cronbach's Alpha (<0.70) ranging from 0.378 to 0.56 which implies a low internal reliability. Conclusions In generaļ the findings of this study indicated that the Indonesian version of QLQ-BR23 validation that we did has not met the hypothesis and expected results. Further study is needed to achieve more reliable results. [ABSTRACT FROM AUTHOR]

Background Breast cancer is the most prevalent type of cancer in Indonesian women. To overcome psychosocial concerns due to treatment, breast cancer patients rely on coping mechanisms and social support. Thus, the aim of this study is to assess the association of social support and coping strategies in breast cancer patients receiving chemotherapy. Methods A cross-sectional study is conducted at our general Hospital in Tangerang from October 2018-February 2019. The data sample is breast cancer patients who underwent mastectomy and adjuvant chemotherapy. Data were collected using the Multidimensional Scale of Perceived Social Support questionnaire which assessed social support. Cancer Coping Questionnaire (CCQ-21) is used to classify coping mechanisms. The data were presented using descriptive statistics and analyzed with Chi-square test using SPSS version 24.0 Result This study enrolled 36 breast cancer patients with a mean age of 49.93 (29-73) ±11.473 years old. Among them, 41.4% received moderate support while 58.6% received high social support from family members. Meanwhile, 68.9% received moderate support and 31.1% received high support from friends. From other forms of social support, 44.8% received moderate support while 55.1% received high support. The total social Result makes of 62.1% moderate social support and 37.9% high social support. For coping mechanisms, 65.5% had adaptive coping mechanisms and 34.5% had maladaptive coping mechanisms. 9 of the patients received moderate support but maladaptive, while 11 others had adaptive coping mechanism. The rest received high social support with 2 maladaptive and 14 adaptive coping. (p -value=0.039) Conclusion Social support in breast cancer patients in Indonesia is moderate and most of it comes from family members. With most patients used adaptive coping paired with high social support. A deeper study is required to confirm the Results. [ABSTRACT FROM AUTHOR]

Background Chemotherapy, which still is the first line for Breast Cancer treatment, plays a significant role in the undesirable side effects including Gastrointestinal Chemotherapy Toxicity, such as Nausea, Vomiting. Even though there are a lot of studies which show adequate Quality of Life (QoL), minimum data is reported in Indonesia on breast cancer patients. The purpose of this study is to assess the QoL in the breast cancer patient in Indonesia influenced by GI chemotherapy toxicity. Method A cross-sectional study was done at the general hospital in Tangerang, Indonesia from October 2018- February 2019. The breast cancer patient who has underwent adjuvant chemotherapy is included in this study and assessed using BR23 questionnaire which assess the functional and symptoms scale of the patient, ranged from 0% (worst function and most symptoms) to 100% (the best function and no symptoms) and National Cancer Institute Common Toxicity Criteria (> 1 consider as toxic). Association between both variables are analysed with Spearmańs correlation using SPSS version 24.0 Result The data was collected from 32 patients with mean age of 47.72 ±9.095. It is found that functional scale mean is 55.47% ± 8.53 and toxicity scale mean is 85.89% ±11.61. 30 patients has experienced no chemotherapy toxicity. The association between Functional QoL and Gastrointestinal Chemotherapy Toxicity is defined as 0.254 with the p -value of 0.161, while the association between Symptoms QoL and Gastrointestinal Chemotherapy Toxicity is defined as - 0.308 with the p -value of 0.08. Conclusion Majority of the patients shows adequate Quality of Life and no experienced any chemotherapy toxicity. the association between QoL and Gastrointestinal Chemotherapy Toxicity is low. Thus, further investigation with greater number of sample is needed to confirm the result. [ABSTRACT FROM AUTHOR]

We are reporting a male, 46 years old came to emergency unit with a chief complaint of abdominal tenderness since 1 day prior to admission. No history of abdominal trauma. He often felt abdominal discomfort for the last 5 years. Physical examination revealed decreased consciousness, shock, pale conjungtiva, distended abdomen, with tenderness of the whole abdomen on palpation, and no bowel movement. Laboratory examination found anemia, leucocytosis, normal amilase and lipase. FAST (focus assissted Sonography on trauma) found massive ascites. Patient underwent cito laparotomic exploration that found blood on abdominal cavity, nodular liver, and actively bleeding tumour of liver. During hospitalization, patient recovered and discharged. In the case of acute abdomen, spontaneous ruptured hepatocellular carcinoma (HCC) is one of differential diagnosis, considering high incidence of HCC in South East Asia, especially Indonesia. Confirming diagnosis of generalized peritonitis requires abdominal CT scan and ultrasonography, to rule out ruptured HCC.