Journal of Epidemiology and Public Health
e-ISSN: 2549-0273 Publisher: Masters Program in Public Health, Sebelas Maret University Jl. Ir Sutami 36A, Surakarta 57126, Central Java, Indonesia Editor in Chief: Vitri Widyaningsih, dr., M.S., Ph.D Universitas Sebelas Maret, Solo, Indonesia Aim and Scope The Journal of Epidemiology and Public Health (JEPH) is an open-access, peer-reviewed international journal dedicated to advancing knowledge and research in the fields of epidemiology and public health. Established on June 2, 2015, JEPH publishes high-quality original research articles, systematic reviews, and meta-analyses on a quarterly basis. Our mission is to contribute to the global improvement of population health by disseminating rigorous scientific evidence that informs public health policy, practice, and education. The journal seeks to highlight innovative research that addresses contemporary health challenges, with a particular emphasis on health disparities, disease prevention, health promotion, and health systems strengthening. JEPH welcomes contributions from researchers around the world and is particularly committed to amplifying the voices of scholars from low- and middle-income countries (LMICs). We encourage submissions that tackle regionally relevant health issues, apply robust epidemiological methods, and propose evidence-based solutions to pressing public health problems. Key areas of interest include, but are not limited to: Epidemiological studies of communicable and non-communicable diseases Social determinants of health and health inequalities Health systems research and policy evaluation Public health interventions and health promotion Environmental and occupational health Global health and health equity Biostatistics and methodological advances in epidemiological research Pandemic preparedness and response JEPH is officially accredited by the Ministry of Research, Technology, and Higher Education, Government of Indonesia, under decree No. 10/C/C3/DT.05.00/2025. The journal holds SINTA 2 status, valid from July 16, 2022, to July 16, 2027. Through the publication of high-impact, policy-relevant research, JEPH aims to foster the exchange of knowledge across disciplines and regions and to support the development of evidence-based solutions to the world’s most pressing public health challenges.
Global Research Trends in Preeclampsia Screening and Early Diagnosis: A Bibliometric Analysis
Background: Preeclampsia remains a major cause of maternal and neonatal morbidity and mortality worldwide, while research on biomarkers, screening strategies, and early diagnostic approaches has increased substantially. However, a comprehensive understanding of global research trends and emerging hotspots in preeclampsia screening and early diagnosis remains limited, prompting this study to analyze these trends using bibliometric analysis. Subjects and Method: This was a descriptive bibliometric study conducted using the Scopus database. The target population consisted of publications related to preeclampsia screening and early diagnosis published between 2020 and 2026. Documents were identified using keywords related to preeclampsia, screening, prediction, and early diagnosis. Of 3,105 retrieved records, 882 English-language articles and reviews meeting the eligibility criteria were included in the analysis. The variables analyzed included annual scientific production, citation performance, source journals, authorship characteristics, institutional contributions, country productivity, keyword occurrence, and thematic evolution. Data were analyzed using R programming and VOSviewer. Results: Research on preeclampsia screening and early diagnosis increased substantially during the study period and reached its highest productivity in 2025. BMC Pregnancy and Childbirth was the most productive journal, while the 2021 ISSHP guideline on hypertension in pregnancy was the most globally cited document. The University of Oxford was the leading institutional contributor. Thematic and keyword analyses showed growing attention to biomarkers, placenta, prenatal diagnosis, and predictive models. Five major research clusters were identified, covering maternal risk factors, molecular biomarkers, screening and diagnostic methods, clinical and laboratory parameters, and predictive models. Bioinformatics and messenger RNA emerged as developing research themes. Conclusion: Research on preeclampsia screening has shifted toward biomarker-based prediction and molecular diagnostic approaches, reflecting the growing emphasis on early detection strategies. This bibliometric study provides a comprehensive overview of global research trends, emerging hotspots, and research gaps that may guide future investigations, strengthen biomarker based screening strategies, and foster international collaboration to improve maternal healthcare.
Copyright (c) 2026 Journal of Epidemiology and Public Health
Meta-Analysis of the Effect of Oyster Mushrooms (Pleurotus ostreatus) Contaminated by Heavy Metals on Potential Health Risks
Background: Oyster mushrooms (Pleurotus ostreatus) are widely cultivated and consumed in Indonesia, but heavy metal contamination poses severe human health risks, such as digestive and neurological disorders. Despite numerous individual studies on heavy metal exposure, a comprehensive quantitative synthesis of their relative health risks remains lacking. This meta-analysis aimed to evaluate the health risk potential of arsenic, lead, mercury, and cadmium contamination in oyster mushrooms and assess their pooled effect sizes. Subjects and Method: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar using PRISMA guidelines and PICO criteria to identify eligible studies on heavy metal contamination in Pleurotus ostreatus. A total of 10 articles met the inclusion and exclusion criteria and were synthesized using RevMan 5.4 software. Pooled effect sizes (Standardized Mean Differences) were calculated using a random-effects model to account for study variability, and heterogeneity was evaluated using the I2 statistic along with funnel plot symmetry for publication bias. Results: The meta-analysis of 10 studies revealed that lead exposure had the strongest correlation with health risk (Effect Size = 2.37;95% CI: 1.85-3.04), representing a significantly higher risk compared to mercury (Effect Size = 1.53;95% CI: [-1.01, 4.08]), respectively. Moderate heterogeneity was observed across studies (I2= 93%-97%, p < 0.05), while a symmetrical funnel plot indicated minimal publication bias. Conclusion: This meta-analysis quantitatively confirms that lead, arsenic, and cadmium present the highest health risks among heavy metal contaminants in cultivated Pleurotus ostreatus, with lead demonstrating the strongest overall risk association. These quantified risk magnitudes highlight an urgent need for targeted, mandatory monitoring of lead, arsenic, and cadmium levels in mushroom cultivation to safeguard public health.
Determinants of Type 2 Diabetes Mellitus among Adults in Urban and Rural Areas of Sragen Regency, Central Java, Indonesia
Background: Type 2 diabetes mellitus (T2DM) is a non-communicable disease with increasing prevalence in both urban and rural areas. Differences in sociodemographic characteristics and health behaviors between urban and rural populations are suspected to influence the clinical profile and demographic characteristics of T2DM patients. This study aims to analyze differences in T2DM patient characteristics in adults in urban and rural areas of Sragen Regency, Indonesia, and identify the most dominant factors differentiating these two groups. Subjects and Method: This was a comparative observational analytical study with a cross-sectional design conducted in six health centers in Sragen Regency representing urban and rural areas. Research subjects were adult patients with T2DM who met inclusion criteria. Variables examined included age, sex, educational level, income, occupation, and physical activity. Data were collected using structured questionnaires and medical records. Bivariate analysis was performed using the Chi-square test, while multivariate analysis used binary logistic regression. Results: Significant differences were found between T2DM patients in urban and rural areas based on age (p=0.035), educational level (p=0.007), income (p=0.011), occupation (p=0.016), and physical activity (p=0.005). No significant difference was found in sex distribution between the two areas (p=0.078). Binary logistic regression analysis showed that physical activity was the most dominant factor differentiating T2DM patient characteristics in urban and rural areas (OR=2.326; p=0.007). Patients with low physical activity had 2.326 times higher odds of residing in urban areas compared to those with moderate or high physical activity. Conclusion: Physical activity is the most dominant factor differentiating T2DM patient characteristics between urban and rural areas. Area-specific T2DM prevention and control stra­tegies should prioritize physical activity improvement with approaches tailored to local community characteristics.
Health Belief Model Predictors of Tertiary Preventive Behavior and HbA1c Levels among Patients with Type 2 Diabetes Mellitus
Background: Type 2 diabetes mellitus (T2DM) remains a major public health challenge worldwide. This study applied the Health Belief Model (HBM) to examine its association with tertiary preventive behavior and HbA1c levels among patients with T2DM. The study aimed to analyze the effects of HBM constructs on tertiary preventive behavior and their impact on HbA1c levels in patients with T2DM. Subjects and Method: A quantitative study with a cross-sectional design was conducted among 210 patients with T2DM receiving outpatient care at UNS Hospital. Data were collected between September and October 2025. The independent variables included perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and cues to action. The dependent variables were tertiary preventive behavior and HbA1c levels. Data were analyzed using univariate analysis, bivariate analysis with simple logistic regression, and multivariate analysis using path analysis in STATA 13. Results: Self-efficacy (b = 0.190; 95% CI = 0.029 to 0.350; p = 0.020), perceived benefits (b = 0.162; 95% CI = 0.021 to 0.301; p = 0.023), and cues to action (b = 0.294; 95% CI = 0.122 to 0.465; p = 0.001) had direct and significant effects on tertiary preventive behavior. Tertiary preventive behavior (b = −0.183; 95% CI = −0.307 to −0.085; p = 0.004), age (b = 0.134; 95% CI = 0.005 to 0.263; p = 0.041), duration of diabetes (b = 0.164; 95% CI = 0.035 to 0.295; p = 0.014), and family history of diabetes (b = 0.228; 95% CI = 0.104 to 0.351; p < 0.001) had direct and significant effects on HbA1c levels. Sex had direct but non-significant effects on both tertiary preventive behavior and HbA1c levels. Perceived susceptibility and perceived severity exerted indirect but significant effects on tertiary preventive behavior through perceived benefits. Conclusion: Self-efficacy, perceived benefits, cues to action, and sex directly influenced tertiary preventive behavior, whereas perceived susceptibility and perceived severity exerted indirect effects through perceived benefits. Furthermore, tertiary preventive behavior, duration of diabetes, age, family history of diabetes, and sex directly affected HbA1c levels.
Fear of Childbirth: A Bibliometric Analysis
Background: Fear of childbirth (FOC) is an increasingly recognized maternal health issue that affects women's physical, psychological, and overall well-being and is associated with adverse outcomes, including increased obstetric interventions and perinatal mental health problems. This study aimed to analyze global research trends, collaboration patterns, and thematic developments in FOC research over the past decade using a bibliometric approach. Subjects and Method: This was a bibliometric study using the Scopus database. A literature search was performed from database inception January 27, 2026 using the search query: TITLE-ABS-KEY (“fear of childbirth” OR “tokophobia” OR “anxiety childbirth”). The search was english-language, open-access, and final published articles were included. A total of 1,022 publications met the eligibility criteria. Annual scientific production, institutional productivity, author productivity, and publication trends by source and country were descriptively analyzed, while thematic analysis was conducted using VOSviewer. Results: A total of 1.022 publications, demonstrating a consistent increase in scientific product­ion, with the highest output recorded in 2025 (n=184). Iran contributed the largest number of publications (n=137), while the United Kingdom showed the strongest international collaboration network with the highest total link strength (TLS=135), followed by the United States (TLS=112). Citation analysis revealed that the most cited article received 472 citations. Keyword co-occurrence analysis identified four major research themes: social and healthcare system factors, clinical and physiological aspects of childbirth, perinatal mental health, and methodological and psychological measurement approaches. Conclusion: Research on fear of childbirth has expanded substantially, reflecting a multi­dimensional field encompassing psychological, clinical, social, and healthcare perspectives. Key research gaps, particularly regarding family involvement and healthcare system factors, highlight priorities for future research and the development of comprehensive, woman centered maternal healthcare strategies.
Factors Associated with Pulmonary Tuberculosis in Yogyakarta, Indonesia: A Matched Case-Control Study
Background: Tuberculosis (TB) remains a public health problem in Indonesia, including in the city of Yogyakarta. The incidence of TB is influenced by various socioeconomic factors, individual characteristics, behavior, and the physical conditions of the home environment. Given these influences, this study aims to analyze the determinants of pulmonary tuberculosis incidence in Yogyakarta, Indonesia. Subjects and Method: This was a matched case-control study. Cases were patients with pulmo­nary tuberculosis, matched 1:2 by age, sex, and health center area to non-TB controls. Among 168 respondents (56 cases and 112 controls). The study involved 18 community health centers in Yogyakarta, Indonesia, from April to May 2026. Variables included family income, knowledge, attitudes, nutritional status, smoking history, diabetes mellitus, household and close contact history, and housing characteristics. Data were analyzed using bivariate tests and multivariate conditional logistic regression. Results: Family income below the Yogyakarta regional minimum wage (aOR= 0.30; 95% CI= 0.10–0.93), poor tuberculosis knowledge (aOR = 0.27; 95% CI= 0.08–0.95), history of diabetes mellitus (aOR= 0.07; 95% CI= 0.01–0.82), and a confirmed history of close contact with a tuberculosis patient (aOR= 5.12; 95% CI= 1.00–26.09) were independently associated with pulmo­nary tuber­culosis. Respondents who were unaware of their close contact history also had higher odds of tuber­culosis (aOR= 3.67; 95% CI= 0.82–16.30), although this association did not reach statistical significance. Conclusion: The incidence of pulmonary tuberculosis in Yogyakarta is significantly associated with family income, tuberculosis-related knowledge, history of diabetes mellitus, and close contact with TB patients. These findings highlight the importance of strengthening active TB case finding through systematic contact investigation not only among household contacts but also in workplaces and industrial settings to facilitate early detection and reduce the risk of tuberculosis transmission
Association Between Education Level and Level of Knowledge of Skin Cancer among Basal Cell Carcinoma Patients at the Dr. Moewardi Hospital, Surakarta, Indonesia
Background: Basal cell carcinoma (BCC) is a non-melanoma skin cancer from basal cells. Limited knowledge of risk factors and prevention contributes to BCC. This study examined the relationship between knowledge of skin cancer and education level in BCC patients at the Dermatology and Venereology Outpatient Clinic, Dr. Moewardi General Hospital. Subjects and Method: A cross-sectional study was conducted on 64 BCC patients diagnosed clinically and histopathologically from January 2022 to December 2024. The study was conducted at the Dermatology and Venereology Outpatient Clinic of Dr. Moewardi General Hospital, Sura­karta, Central Java, Indonesia. Sample were recruited using a consecutive sampling. The depen­dent variable was the level of skin cancer knowledge. The independent variable was education level. Data were analyzed using a multiple logistic regression. Results: Education level was significantly associated with skin cancer knowledge after adjustment for age (OR= 7.26; 95% CI= 3.45–86.45; p<0.001). Conclusion: Education level is significantly associated with skin cancer knowledge. Strengthening skin cancer education for low-education, high-exposure groups may support earlier detection and prevention.
Household Drinking Water Source, Treatment, Storage, and Weather Conditions in Relation to Drinking Water Quality in Klaten District, Indonesia
Background: Safe drinking water remains a major public health challenge in Indonesia, where contamination continues to contribute to diarrheal disease burden. Household drinking water quality surveillance coverage in Klaten District remains far below the national target. This study analyzed the association between water source protection, household water treatment, water storage conditions, and climatic factors with household drinking water quality in Klaten District. Subjects and Methods: A cross-sectional study was conducted among 390 households from 26 subdistricts in Klaten District, selected via equal-allocation subsampling from the 2025 National Household Drinking Water Quality Surveillance Program (SKAMRT) using two-stage cluster sampling (15 households/subdistrict). Drinking water quality was classified as safe or unsafe based on five parameters (E. coli, Total Dissolved Solids, pH, nitrate, nitrite) per Ministry of Health Regulation No. 2/2023. Associations were assessed using Chi-square and Fisher's exact tests, followed by multiple logistic regression with backward stepwise elimination (α = 0.05). Results: Of 390 households, 202 (51.8%) had unsafe drinking water. Unprotected water sources were the only significant determinant of unsafe water quality (Adjusted OR = 1.61; 95% CI: 1.05–2.47; p = 0.029). Water treatment, storage type, and weather conditions showed no statistically significant association. Spatial analysis identified five subdistricts with very high risk (>80% non-compliant): Polanharjo (93.3%), Wonosari (86.7%), Bayat, Tulung, and Klaten Tengah (80.0% each). Model calibration was adequate (Hosmer-Lemeshow p = 0.741). Conclusion: Unprotected water sources represent an independent determinant of unsafe household drinking water quality in Klaten District. Interventions should prioritize water source protection, household water safety education, and expansion of SKAMRT surveillance coverage to support SDGs 6.1 achievement by 2030.
Association between Systemic Immune-Inflammation Index and Self-Harm Behavior: A Scoping Review
Background: Emerging evidence suggests that systemic inflammation may contribute to the pathophysiology of depression and self-harm. This study aims to map the scientific evidence regarding the relationship between Systemic Immune-Inflammation Index (SII) as a readily available biomarker and self-harm behavior across various populations and clinical contexts, while identifying patterns of findings, methodological variations, and existing research gaps. Subjects and Method: This research employs a scoping review methodology based on the Arksey and O’Malley framework and reported in accordance with the PRISMA Extension for Scoping Review. Literature was sourced from databases such as PubMed and ScienceDirect. Seven studies were included in the final synthesis and the critical appraisal of the selected papers followed the Joanna Briggs Institute (JBI) guidelines. Results: Higher SII levels were consistently associated with increased suicide risk, particularly in treatment-naïve and first-episode Major Depressive Disorder (MDD) populations. Adolescents with co-occurring NSSI and SA demonstrated the most pronounced inflammatory profiles, whereas findings were less consistent in isolated NSSI or SA groups. Conclusion: Current evidence suggests that SII may have potential utility as an adjunctive biomarker for self-harm risk stratification and its clinical utility remains limited by moderate predictive accuracy and methodological heterogeneity.
Multilevel Analysis of District- and City-Level Contextual Factors Influencing Hypertension Risk Among Adults: An Analysis of Indonesian Health Survey Year 2023
Background: Hypertension remains a major public health challenge in Indonesia, with prevalence continuing to rise across different population groups. The burden of hypertension varies across settings, including urban and rural areas, socioeconomic levels, and regional contexts. This study aimed to examine how district- and city-level contextual factors influence the risk of hypertension among adults in Indonesia. Subjects and Method: A cross-sectional study included a sample of 48,878 adults who participated in the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia). The data were analyzed using multilevel multiple linear regression. Results: Multilevel analysis showed that the risk of hypertension increased among individuals aged ≥60 years (b= 4.12; 95% CI= 3.76 to 4.48; p < 0.001), compared with those aged <20 years. Senior high school or higher education (b= –0.40; 95% CI= –0.48 to –0.31; p <0.001) was associated with a lower risk of hypertension compared with individuals with no formal education. Higher BMI was associated with an increased risk of hypertension among individuals with BMI 18.5–25 kg/m² (b= 0.19; 95% CI= 0.09 to 0.30; p < 0.001) and BMI ≥25 kg/m² (b= 0.92; 95% CI= 0.82 to 1.03; p < 0.001). Female sex (b= 0.21; p < 0.001), urban residence (b= 0.06; p= 0.021), and high Gini Ratio (b = 0.17; p < 0.001) increased the risk of hypertension, whereas high physical activity and higher provincial minimum wage reduced the risk. The ICC of 0.37% indicated low variation across districts/cities. Conclusion: Hypertension risk among Indonesian adults is mainly driven by individual factors, while income inequality is the only contextual factor with a significant effect. These results emphasize the need for interventions targeting both personal health behaviors and socioeconomic disparities.
Determinants of Tuberculosis Incidence Among Children Under Five in Karanganyar, Central Java, Indonesia
Background: Tuberculosis (TB) remains a major infectious disease and a leading cause of mortality worldwide, with 10.8 million cases and 1.25 million deaths reported in 2023. Indonesia is classified as a high-burden TB country, with 78,566 cases reported among children under five years of age. Young children are particularly vulnerable due to their immature immune systems. In Karanganyar Regency, Central Java, Indonesia, 137 cases of TB among under-five children were recorded in 2023. This study aimed to analyze the risk factors associated with TB incidence among children under five in Karanganyar Regency. Subjects and Method: This study employed an analytic observational design using a case-control approach. A total of 200 children under five were randomly selected, comprising 50 TB cases and 150 non-TB controls. Data were analyzed using simple logistic regression and path analysis to examine direct and indirect relationships among variables. Results: The incidence of TB among children under five increased with a history of contact with TB patients (b = 0.18; 95% CI = 0.10–0.26; p < 0.001) and living in homes with high humidity (b = 0.09; 95% CI = 0.01–0.17; p = 0.019). Conversely, TB incidence decreased with good lighting (b = -0.11; 95% CI = -0.19 to -0.03; p = 0.005), presence of bedroom windows (b = -0.41; 95% CI = -0.51 to -0.31; p < 0.001), living room windows (b = -0.31; 95% CI = -0.41 to -0.22; p < 0.001), and residence in highland areas (b = -0.13; 95% CI = -0.21 to -0.06; p < 0.001). Nutritional status was negatively affected by TB (b = -0.30; 95% CI = -0.43 to -0.15; p < 0.001) and positively influenced by family income (b = 0.17; 95% CI = 0.03–0.31; p = 0.016), with income exerting both direct and indirect effects through TB. The path analysis model demonstrated good fit (Chi-square p = 0.068; RMSEA = 0.052; CFI = 0.981; TLI = 0.960). Conclusion: The risk of TB among children under five increases with exposure to adult TB cases and living in humid housing conditions. Conversely, TB incidence decreases in children residing in well-lit homes with bedroom and living room windows and in highland areas. Nutritional status is influenced by both TB and family income, with income affecting TB directly and indirectly.
Pathways to Depression: A Multidimensional Composite Analysis of Socioeconomic Inequalities in a Population-Based Study
Background: Socioeconomic factors are recognized as key contributors to the risk of depression among adults and older populations. However, socioeconomic status (SES) is often measured using single indicators, which may not capture its multidimensional nature. Moreover, the mechanisms through which socioeconomic conditions influence depression remain insufficiently explored. This study aimed to examine the pathways linking socioeconomic inequalities to depression using a multidimensional composite measure of SES. Subjects and Method: A cross-sectional analysis was conducted using data from the 2023 Indonesian Health Survey, a nationally representative population-based survey. SES was constructed using principal component analysis (PCA) based on wealth index, education level, employment status, participation in government social protection programs, and provincial-level income inequality (Gini index). Path analysis was performed to assess direct and indirect relationships between SES, physical activity, comorbidity, and depression. All analyses were conducted using STATA 17. Results: Higher SES was associated with a lower risk of depression. Significant pathways were observed from SES to depression both directly (β= -0.06; 95% CI= -0.07 to -0.06; p <0.001) and indirectly through comorbidity (β= -0.03; 95% CI= -0.03 to 0.02; p <0.001). Conclusion: Socioeconomic inequalities play a critical role in shaping depression risk through multiple pathways.
Association Between Screen Time Duration and Attention- Deficit/Hyperactivity Disorder Symptoms Among Children Aged 4–6 Years
Background: The rapid increase in screen time among children has raised urgent public health concerns due to its potential link with Attention- Deficit/ Hyperactivity Disorder (ADHD)-related symptoms. Emerging evidence suggests that excessive and early exposure to digital media may contribute to inattention, impulsivity, and behavioral dysregulation. This study aimed to examine the association between the duration of gadget use and ADHD symptoms in children aged 4–6 years. Subjects and Method: A cross-sectional study was conducted at four early childhood education institutions in Kartasura, Central Java, Indonesia. A total of 87 children aged 4–6 years were included. Screen time duration was assessed using a 7-day parent-reported observation sheet. ADHD symptoms were measured using the ADHD Rating Scale-5 (ADHDRS-5). The association between screen time duration and ADHD symptoms was analyzed using Pearson’s correlation test. Results: There was a statistically significant positive correlation between screen time duration and ADHD symptoms (r = 0.35; p = 0.001). Conclusion: Longer screen time duration is associated with higher levels of ADHD symptoms among children aged 4–6 years.
attention deficit hyperactivity disorder
Scalable Forecasting Geoanalytics for Epidemic Dengue Risk in East Java
Background: Current methods for managing Dengue Hemorrhagic Fever (DHF) in East Java often separate temporal and spatial analyses, hindering proactive public health interventions. To address this limitation, this study develops an integrated spatio-temporal framework that combines multi-model forecasting and geospatial analysis to create localized dengue projections and risk maps. Subjects and Method: An ecological spatio-temporal design was conducted across 38 districts/ cities in East Java using secondary data from 2013–2023. The dependent variable was annual dengue incidence, while independent variables comprised natural factors (e.g., rainfall, humidity) and social factors (e.g., population density, poverty). Data were analyzed using Geographically Weighted Regression (GWR) for spatial modeling. Time series forecasting for the 2024–2028 period was conducted using Trigonometric seasonality, Box-Cox transformation (TBATS), Auto­regressive Integrated Moving Average (ARIMA), Prophet, and Neural NETwork AutoRegression (NNETAR) models, evaluated by Root Mean Square Error (RMSE). Results: Rainfall demonstrated the strongest natural association (R²=0.49; p=0.022), followed by humidity (R²=0.26; p<0.001). Epidemiologically, population density emerged as the key social determinant (R²=0.50; p=0.005). TBATS achieved the highest forecasting accuracy with the lowest RMSE (47.657), outperforming ARIMA (202.980), Prophet (172.809), and NNETAR (157.653). Spatial risk mapping revealed that high-risk social clusters are heavily concentrated in the eastern 'Tapal Kuda' region and northern coastal metropolitan corridors. Conclusion: Dengue incidence in East Java is significantly driven by climatic factors and spatially varying social vulnerabilities. The integration of TBATS forecasting and GWR spatial modeling provides a robust framework for anticipating future case burdens and identifying priority inter­vention areas, thereby supporting highly targeted public health planning.
Determinants of Acceptance of Tuberculosis Preventive Therapy among Household Contacts of Tuberculosis Patients: A Systematic Review
Background: Tuberculosis Preventive Therapy (TPT) constitutes a central pillar in global TB elimination efforts; however, its implementation remains substantially below international targets. Data from the World Health Organization Regional Office for South-East Asia indicate that between 2018 and 2020, only 1.2 million household contacts aged <5 years (29% of the target) and 320,000 contacts aged ≥5 years (1.6% of the target) initiated TPT. This study aimed to identify the determinants influencing acceptance of TPT among household contacts of tuberculosis patients. Subjects and Method: This systematic review followed PRISMA 2020 guidelines and the PICOS framework. It included analytical observational studies on household contacts of tuberculosis patients reporting determinants of TPT acceptance (acceptance, uptake, or initiation) with measures of association. Literature searches were conducted in PubMed, Scopus, Embase, or Web of Science, and Google Scholar for studies published between 2015 and 2026. Study selection involved screening of titles, abstracts, and full texts. Risk of bias was assessed using a modified Critical Appraisal Checklist for quantitative observational studies. Results: A total of 14 studies were included, comprising 45,076 household contacts of tuberculosis patients. TPT acceptance ranged from 17% to 95% across studies. The most influential determinants of higher acceptance included active contact investigation and counseling, prior TB screening, shorter treatment regimens, and strong health system support. Key barriers were low perceived benefit, concerns about adverse effects, stigma, and limited access to healthcare services. Conclusion: TPT acceptance among household contacts is primarily influenced by active contact investigation and counseling, prior TB screening, use of shorter treatment regimens, and strong health system support. In contrast, low perceived benefit, concerns about adverse effects, stigma, and limited healthcare access remain key barriers. Addressing these determinants through targeted, patient-centered interventions is essential to improve TPT uptake.
Clinical Indicators of Robotic Assisted versus Conventional Spine Surgery: A Systematic Review
Background: Spine surgery has technological breakthrough of robotic assistance systems. The objective of this review is to explore clinical outcome indicators employed for comparison of out-comes of robotic assisted surgery to conventional spine surgery under the framework of evidence-based practice. Subjects and Method: Based on guidelines issued by PRISMA, we systematically searched multi-ple sources, including PubMed, Scopus, and Science Direct databases. Studies comparing robotic assisted and conventional spine surgery were screened and analysed. Clinical indicators were collected and categorized according to surgical, functional, and safety concerns. Results: The 24 review papers reviewed were all published during 2017 – 2025. The study design studies included three RCTs, nineteen RC studies, one prospective controlled study and one PSMC study pointing to the recent incorporation of robotic technologies in spinal surgery. This has revealed five categories of clinical indicators: accuracy benchmarks, operative parameters, safety and complications, functional outcomes, recovery and hospitalization. The most often reported indicator was the precision of the placement of the pedicle screw, followed by time of operation and intraoperative blood loss. Radiation exposure is a very important measure of occupational health and safety. The goal of this comprehensive clinical framework is to identify a method whereby an evidence-based clinical practice framework for efficient application of technological adoption becomes possible which is in favour of sustainable use can help to guide fiscally responsible adoption. Conclusion: The current review establishes a composite framework of clinical indicators of clinical considerations towards robotic versus conventional spine surgery across robotic versus conventional spine surgery, a comprehensive evaluation paradigm. This framework provides a foundation upon which future studies can proceed.
Implementation of Theory of Planned Behavior on Behavior Change and Outcomes in Type 2 Diabetes Mellitus Patients in Surakarta, Central Java, Indonesia
Background: The Theory of Planned Behavior (TPB) can serve as a conceptual framework for improving healthy behaviors among patients with type 2 diabetes mellitus (T2DM). The application of TPB is essential for predicting both behavioral patterns and health outcomes in individuals with T2DM. This study aimed to assess the implementation of TPB on behavioral change and outcomes in T2DM patients Subjects and Method: This cross-sectional study was conducted in Surakarta, Indonesia. There was 200 type 2 DM patients selected by purposive sampling. The dependent variables were HbA1c and behavior. The independent variables were behavioral belief, outcome evaluation, normative belief, motivation, control belief, control power, attitude, subjective norm, perceived behavioral control, and intention. Data were collected using a set of questionnaires and analyzed using path analysis. Results: HbA1c ≥6.5% was directly reduced by strong behavior, but it was statistically non signi­ficant (b= -0.22; 95%CI= -0.15 to 1.08; p= 0.745). Behavior was directly and significantly increased by strong intention (b= 1.66; 95% CI= 1.03 to 2.30; p<0.001) and high perceived behavior control (b= 0.87; 95% CI= 0.23 to 1.50; p= 0.007). Conclusion: The Theory of Planned Behavior can be used to predict healthy behavior among patients with type 2 DM.
Analysis of Risk Factors Associated with Rabies Cases in South Timor Tengah Regency, East Nusa Tenggara, Indonesia
Background: Rabies is a zoonotic infectious disease that can be directly transmitted to humans and is fatal, leading to death in South Timor Tengah Regency. Rabies has been officially declared an outbreak in this region. This study aimed to analyze the effects of selected risk factors on rabies cases in South Timor Tengah Regency, East Nusa Tenggara Province, Indonesia. Subjects and Method: This study used primary data and employed an analytic observational design with a case–control approach. A total of 200 participants were included, consisting of 100 rabies cases and 100 controls, drawn from a population of 4,749 cases and controls using random sampling across 32 subdistricts in South Timor Tengah Regency. The dependent variable was rabies case status. The independent variables included community knowledge, history of contact with dogs, vaccination status of pet dogs, age, sex, stray dog bites, and stray dog population density. Data were collected using a questionnaire that had been tested for validity and reliability. Path analysis was conducted using STATA version 13. Results: The study found significant associations between rabies cases and community knowledge (OR= 0.06; 95% CI= 0.03–0.16; p < 0.001), stray dog population density (OR= 2.72; 95% CI= 1.30–5.70; p= 0.008), stray dog bites (OR = 4.59; 95% CI= 1.97–10.69; p < 0.001), age (OR= 0.97; 95% CI= 0.95–0.99; p= 0.008), and sex (OR= 0.33; 95% CI= 0.16–0.71; p = 0.005). In contrast, history of contact with dogs (OR= 1.30; 95% CI= 0.62–2.71; p= 0.487), vaccination of pet dogs (OR= 0.89; 95% CI= 0.37–2.13; p = 0.796), and educational level (OR = 1.31; 95% CI= 0.54–3.15; p= 0.553) were not statistically significant. Conclusion: High stray dog population density and stray dog bites increase the risk of rabies, while higher community knowledge, female sex, and age ≥35 years serve as protective factors against rabies in the population of South Timor Tengah Regency.
The Influence of Social Trust, Income Inequality, and Employment Status on the Risk of Depression
Background: Depressive disorders are among the most common and complex mental health problems worldwide, including in Indonesia. The determinants of depression are closely linked to social and economic factors. This study aimed to estimate the effects of social trust, income inequality, and employment status on the risk of depression. Subjects and Method: An observational study with a cross-sectional design utilized the fifth wave of the Indonesia Family Life Survey (IFLS5). The dataset includes more than 29,716 individuals across 13 provinces. The sample was selected using a purposive sampling method. Results: The risk of depression increased significantly among individuals who were unmarried (b = 0.97; 95% CI: 0.84 to 1.07; p < 0.001), female (b = 0.16; 95% CI: 0.06 to 0.26; p = 0.002), unemployed (b = 0.25; 95% CI: 0.14 to 0.35; p < 0.001), and living in provinces with higher income inequality (b = 0.32; 95% CI: 0.21 to 0.42; p < 0.001). Conversely, the risk of depression decreased significantly with higher social trust (b = -0.18; 95% CI: -0.29 to -0.08; p < 0.001), good sleep quality (b = -0.20; 95% CI: -0.21 to -0.19; p < 0.001), older age (b= -0.81; 95% CI: -0.99 to -0.63; p < 0.001), and higher education level (≥senior high school) (b= -0.36; 95% CI: -0.46 to -0.25; p < 0.001). Conclusion: The risk of depression increases with unmarried, female, unemployed, and living in provinces with higher income inequality. The risk of depression decreases with higher social trust, good sleep quality, older age, and education ≥senior high school.
The Influence of Gender, Body Mass Index, Work Fatigue and Noise Exposure on Blood Pressure among Manufacturing Industry Workers
Background: Noise in the work environment can exceed a set threshold and have an impact on workers' health, including increased blood pressure. In addition to noise, other factors such as work fatigue, body mass index, and gender also contribute to the risk of hypertension. Preliminary studies show that exposure to high noise and manual work activities is at risk of causing fatigue, so it requires further analysis of the influence of these factors on the blood pressure of industrial workers. Subjects and Method: The study design was a cross-sectional study. The study was conducted in Karanganyar Regency, Central Java in February-April 2025. Sampling in this study was conducted using the Fixed Exposure Sampling method, involving 200 worker samples from a herbal medicine factory and a fireworks factory in Karanganyar Regency, Central Java. The method used to collect data in this study was analytical observations with a cross-sectional approach. The analysis used in this study was path analysis. The dependent variable was blood pressure. The independent variables were noise exposure, fatigue, body mass index, and gender. Results: Blood pressure increased with high fatigue (b= 0.15; 95% CI <0.01 to 0.29; p= 0.038), noise exposure (b= 0.15; 95% CI= 0.02 to 0.28; p= 0.020). Blood pressure in female workers was lower than in men (b= -0.14; 95% CI= -0.28 to -0.01; p= 0.034). Blood pressure was indirectly affected by body mass index. Conclusion: This study shows that noise exposure and work fatigue have a direct effect on increasing blood pressure; women have lower blood pressure than men, while body mass index has an indirect effect on increasing the blood pressure of workers.