Journal of Preventive Medicine and Public Health

Brief Report

Towards Mental Health Equity: Task Shifting Strategy to Overcome Barriers in Primary Healthcare Services in India: Suganya Panneerselvam, Senthilkumar Ramasamy, Sanjana Agrawal; Received February 18, 2025 Accepted April 11, 2025 Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.144 [Accepted]

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Abstract PDF: Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100,000 population, yet the current ratio is only 0.7 per 100,000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups—particularly residents of rural and remote areas, women, and older adults—are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India’s National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.; Summary

Original Articles

Experience of Medical Personnel Dispatched to Isolated Psychiatric Institution in South Korea During COVID-19: Content Analysis: Youngjoo Kim, Jung Hee Hyun, Jacob Lee, Yoonyoung Nam, Eunshil Yim, Kyounga Lee, Baegju Na; Received November 11, 2024 Accepted March 28, 2025 Published online June 18, 2025; DOI: https://doi.org/10.3961/jpmph.24.680 [Accepted]

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Abstract PDF: Objectives
This study investigates problems related to medical response, and the support system among medical personnel dispatched to the psychiatric hospital when the first cluster of infections occurred in a psychiatric hospital in South Korea.
Methods
Contents analysis was conducted for the responses of the medical personnel who responded to the interview. Training about basic quarantine rules, and safety management is not provided in the early dispatch stages.
Results
No guidance is available regarding the human rights protection of medical staff. Additionally, no on-site situation-control tower is available. Participants reported that temporary quarantine measures implemented at Hospital D to restrict the movement of patients and medical staff from the external world are problematic. The most significant problem is the insufficient governmental systemic support and consideration for protecting Both the human rights of psychiatric patients and the human rights of the medical staff who care for them.
Conclusions
Future responses to new infectious diseases should include the establishment of a continuous support system in the community by changing the collective and closed-room environments as well as isolation-centered mental healthcare systems to protect the human rights of patients with mental disorders. Additionally, response drills for people with mental illness in closed environments should be practiced in response to emerging infectious diseases at ordinary times. Finally, training and emergency measures for medical staff dispatched to these facilities and a manual for the protection of the human rights of medical staff should be prepared.; Summary

COVID-19 Vaccine Acceptance and Hesitancy: Perceptions in Kerala, the Indian State With the Highest Literacy: DHANYA MURALIDHARAN, Arun Paul, Suhaila Panangadanakath, Sreelakshmi Nandakumar, Shana Poothotill, Rahila MoiduKunhi, Zainul Ameen; Received February 15, 2025 Accepted May 14, 2025 Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.137 [Accepted]

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Abstract PDF: Objectives
Public acceptance of a vaccine determines whether pandemic control is successful. Most studies assessing COVID-19 vaccine acceptance were conducted before the vaccine became publicly available, whereas the actual intent to be vaccinated often differs once the vaccine is accessible. Therefore, this study investigated COVID-19 vaccine acceptance, hesitancy, and associated determinants among the general population of Kerala, India, after the vaccine became available.
Methods
A cross-sectional descriptive online survey was conducted using a structured and validated questionnaire in both English and Malayalam. It collected information on contextual influences, individual perceptions, group influences, COVID-19 vaccine-specific factors, and attitudes toward COVID-19 vaccination.
Results
Of the 1078 participants, 85% (n=916) accepted the COVID-19 vaccine, while 15% (n=162) were hesitant. Factors predicting vaccine hesitancy included male gender, younger age, lower educational attainment (school level), lower income, being unmarried, and not having children. Key determinants of vaccine hesitancy identified were concerns regarding vaccine safety and effectiveness, lack of trust in the government, insufficient information provided through the vaccination program, disbelief in vaccination’s protective role against COVID-19, and perception of the vaccination process as complicated and inconvenient.
Conclusions
Vaccine-hesitant individuals do not perceive COVID-19 vaccination as a social responsibility to their community. Digitization of the vaccination process may not be suitable for all segments of society, indicating that additional support for persons from lower socioeconomic statuses may be necessary to enhance acceptance. The newly identified areas of concern can guide government and healthcare workers, both nationally and globally, in effectively addressing and mitigating vaccine hesitancy.; Summary

Knowledge, Attitudes, Barriers and Uptake Rate of Influenza Virus Vaccine among Physicians in Jordan: A Multicentric Cross-Sectional Study: Munir Abu-Helalah, Tarek Gharibeh, Mohammad Al-Hanaktah, Hussam Alshraideh, Raghad Darweesh, Maria Alshurman, Lekaa Al mughrabi F, Yaqeen Al mughrabi F, Neveen Ghanem; Received December 20, 2024 Accepted April 10, 2025 Published online June 3, 2025; DOI: https://doi.org/10.3961/jpmph.24.776 [Accepted]

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Abstract PDF: Objectives
Seasonal influenza (SI) poses significant global health challenges, with healthcare professionals (HCPs) particularly vulnerable due to frequent exposure to infected patients. Influenza vaccination is a proven method to reduce morbidity and mortality. Despite recommendations by health authorities, vaccination uptake among HCPs remains suboptimal globally and within Jordan. This study aimed to assess knowledge, attitudes, barriers, and influenza vaccine uptake among physicians in Jordan.
Methods
A cross-sectional study was conducted from March to June 2023 involving 389 physicians from Ministry of Health facilities across Jordan. A structured and validated questionnaire was used to collect demographic data, vaccination history, and insights guided by the health belief model. Multivariate logistic regression analyses were performed to identify predictors of vaccine uptake and patient vaccination practices.
Results
The influenza vaccination rate during the 2022–2023 season was 47%. Vaccination uptake was associated with factors such as age, geographic location, professional designation, and training. Vaccinated physicians demonstrated better knowledge and more favorable attitudes toward vaccination. Common barriers included misconceptions about personal risk, concerns over vaccine efficacy, and forgetting to vaccinate. Physicians who received training were more likely to recommend vaccination to patients.
Conclusions
The low vaccination rate among Jordanian physicians highlights the need for targeted educational interventions and policies to address misconceptions and barriers. Improving influenza vaccination uptake among HCPs is critical to enhancing patient confidence, reducing transmission, and improving public health outcomes.; Summary

Relationship Between Social Isolation, Seclusion, and Suicidal Ideation Among Young Adults: An Analysis of Data From the 2022 Survey on the Lives of Young People in South Korea: Jiwon Shin, Hyun Yang, Muwon Lee, Haeyean Park, Suyeong Bae; Received December 30, 2024 Accepted April 11, 2025 Published online May 8, 2025; DOI: https://doi.org/10.3961/jpmph.24.792 [Accepted]

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Abstract PDF: Objectives
This study aimed to investigate the current status of social isolation and seclusion among young adults in South Korea and to analyze their association with suicide risk.
Methods
We utilized data from 14,966 young adults aged 19–34 years from the 2022 Survey on the Lives of Young People. Social isolation and seclusion were defined as independent variables, and suicidal ideation within the past year was set as the dependent variable. Propensity score matching (PSM) was employed to reduce the risk of selection bias, and logistic regression analysis was conducted to examine the associations between social isolation, seclusion, and suicidal ideation.
Results
Of the participants, 266 individuals (1.78%) were socially isolated, and 67 individuals (0.45%) were secluded. The prevalence of suicidal ideation was 10.53% among socially isolated young adults and 14.93% among secluded young adults. Associations were observed between social isolation and suicidal ideation (population-weighted adjusted model: odds ratio [OR]=2.429, p=0.003; population-weighted PSM model: OR=2.030, p=0.037), as well as between seclusion and suicidal ideation (population-weighted adjusted model: OR=4.148, p=0.004; population-weighted PSM model: OR=3.873, p=0.010) across all models.
Conclusions
Being socially isolated or secluded is associated with an increased risk of suicidal ideation among young adults aged 19–34 years. Preventive policies and tailored support systems are urgently needed to address these risks. This study contributes to the development of specific policies for mitigating social isolation and supporting the reintegration of young adults aged 19–34 years into society.; Summary

Population-attributable Fractions of Lifestyle Factors for Prediabetes in Korea: A Regression-based Analysis of National Survey Data: Yeon Woo Oh, Chung Mo Nam, Eun-Cheol Park; Received January 11, 2025 Accepted March 31, 2025 Published online May 7, 2025; DOI: https://doi.org/10.3961/jpmph.25.030 [Accepted]

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Abstract PDF: Objectives
Although lifestyle modification programs are widely implemented for diabetes prevention, the contributions of individual lifestyle factors remain unclear. This study investigated lifestyle risk factors for prediabetes and employed a regression-based approach for estimating their population-attributable fractions (PAFs) using nationally representative data.
Methods
We analyzed data from 3,104 adults aged ≥30 years without diabetes from the 2022 Korea National Health and Nutrition Examination Survey. Seven lifestyle factors were assessed: body weight, alcohol consumption, smoking, physical activity, sleep duration, vegetable intake, and breakfast consumption. Prediabetes was defined as fasting blood glucose of 100-125 mg/dL or HbA1c levels of 5.7-6.4%. Complex survey-adjusted logistic regression was used to identify significant lifestyle risk factors, and their PAFs were estimated using a regression-based sequential method.
Results
Five lifestyle factors were significantly associated with prediabetes: abnormal body weight (OR: 2.046; 95% CI, 1.676-2.498), excessive alcohol consumption (OR: 1.274; 95% CI, 1.000-1.623), smoking (OR: 1.354; 95% CI, 1.073-1.709), insufficient exercise (OR: 1.259; 95% CI, 1.049-1.512), and irregular breakfast consumption (OR: 1.309; 95% CI, 1.078-1.590). In sequential PAF estimation, abnormal body weight had the largest contribution (22.2%; 95% CI, 16.2-28.2%), followed by smoking (6.4%; 95% CI, 1.1-11.6%), insufficient exercise (5.8%; 95% CI, 1.2-10.5%), irregular breakfast consumption (4.9%; 95% CI, 0.5-9.2%), and excessive alcohol consumption (3.6%; 95% CI, 0.1-7.4%). These results remained consistent in sensitivity analyses including undiagnosed diabetes cases.
Conclusions
Abnormal body weight emerged as the largest contributor to prediabetes (PAF>20%). Diabetes prevention programs in South Korea should prioritize weight management within a comprehensive approach to lifestyle modification.; Summary

Mental Disorders Mediate the Relationship between Adverse Childhood Experiences and Suicidal Behavior in a High-Risk Population: A Counterfactual Analysis From Jeju Island: Yeon Woo Oh, Dongkyu Lee, Young-Eun Jung, Sun Jae Jung; Received February 11, 2025 Accepted April 11, 2025 Published online May 7, 2025; DOI: https://doi.org/10.3961/jpmph.25.120 [Accepted]

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Abstract PDF: Objectives
Jeju Island, Korea, is characterized by a significantly higher prevalence of adverse childhood experiences (ACE, 32.4%), elevated rates of mental disorders (34.6% vs. 22.9%), and lifetime suicidal thoughts (20.6% vs. 10.7%) compared to national averages. We investigated the mediating role of mental disorders in the pathway from ACE to suicidal behavior in Jeju.
Methods
Data from the Jeju Special Self-Governing Province Mental Health Survey 2023 (n = 703) were analyzed. Exposure was defined as experiencing at least one ACE from the 10-item Adverse Childhood Experience International Questionnaire (ACE-IQ-10). Depressive disorder, anxiety disorder, and alcohol use disorder were diagnosed using the Korean-Composite International Diagnostic Interview (K-CIDI). Suicidal behavior was defined as experiencing suicidal ideation, planning, or attempts. A counterfactual mediation model was used to evaluate the natural direct effect and natural indirect effect (NIE) of mental disorders.
Results
The total effect of ACE on suicidal behavior showed a risk difference of 0.353. When considering all three mental disorders simultaneously, the NIE was 0.276, accounting for 78.1% of the total effect. Stratification analyses revealed stronger total effects in women and older adults, while the proportion mediated was higher in women and younger adults.
Conclusions
In this ACE-prevalent population, mental disorders collectively mediated approximately three-quarters of the pathway from ACE to suicidal behavior. These findings, derived through robust counterfactual analysis, suggest that strengthening screening and management protocols for mental disorders among adults with a history of ACE may effectively prevent suicide in populations with high ACE prevalence.; Summary

Mobile App-based Care Management Training to Improve Family Caregiver Competence in Caring for Children With HIV: A Quasi-experimental Study: Nyimas Heny Purwati, Syamikar Baridwan Syamsir, Mutmainah Mutmainah, Dhea Natashia, Amelia Hartika Rani, Dwi Budiyati, Agus Setiawan; Received December 31, 2024 Accepted April 15, 2025 Published online May 7, 2025; DOI: https://doi.org/10.3961/jpmph.24.789 [Accepted]

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Abstract PDF: Objectives
Family caregivers play a crucial role in the care of children with HIV; however, they frequently face limitations in knowledge, attitudes, and skills. Mobile application (app)-based training may offer an effective solution to enhance caregiver competence. This study aimed to assess the effectiveness of mobile app-based care management training in improving the knowledge, attitudes, and skills of family caregivers caring for children with HIV.
Methods
A quasi-experimental design, including pretest, posttest, and follow-up assessments, was conducted at a national referral hospital for infectious diseases in Jakarta, Indonesia. The study involved 44 respondents, divided equally into intervention and control groups (22 per group). The intervention group received mobile app-based training, while the control group received conventional caregiver education. Questionnaires assessing caregivers\' knowledge, attitudes, and skills in managing children with HIV were utilized. Data were analyzed using Independent Sample T-tests and Repeated Measures ANOVA.
Results
Repeated Measures ANOVA revealed that the intervention group experienced significant improvements in knowledge, attitudes, and skills from pretest to posttest, which were maintained at the 1-month follow-up (p<0.001). In contrast, the control group did not exhibit significant changes in any of these variables (knowledge, attitudes, and skills) throughout the study period (p>0.05).
Conclusions
Mobile app-based care management training significantly enhances caregiving competencies among family caregivers of children with HIV. These findings underscore the potential of digital technology as an innovative and sustainable approach for caregiver training in various healthcare settings, supporting the long-term effectiveness of educational interventions.; Summary

Enhancing TNM Stage Completeness Using the SEER Summary Stage: Chang Kyun Choi, Mina Suh, Kyu-Won Jung, E Hwa Yun; Received February 6, 2025 Accepted March 27, 2025 Published online April 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.099 [Accepted]

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Abstract PDF: Objectives
Accurate and complete cancer staging is essential for effective prognosis and treatment planning. This study investigated the feasibility of enhancing the completeness of tumor‐node‐metastasis (TNM) staging by integrating Surveillance, Epidemiology, and End Results (SEER) Summary Stage data.
Methods
We analyzed data from 5 cancer types (stomach, colorectum, liver, lung, and breast) in South Korea (2012–2017). The study assessed the impact of supplementing missing TNM information with SEER Summary Stage data on both staging completeness and 5‐year relative survival rates.
Results
The study included 173,061 stomach cancer, 159,199 colorectal cancer, 89,639 liver cancer, 137,103 lung cancer, and 110,286 breast cancer patients. The percentage of missing TNM stage data varied by cancer type, ranging from 65.1% (breast cancer) to 93.0% (liver cancer). Supplementation significantly reduced missing values—most notably in stomach cancer, where missing data dropped by 50.6 percentage points, followed by liver (21.5 percentage points) and breast cancers (13.6 percentage points). For stomach cancer, supplementation led to a 3.6 percentage point decrease in stage I survival rates, whereas liver cancer exhibited the most pronounced changes, with stage IV survival rates declining from 17.7% to 7.9%.
Conclusions
Integrating SEER Summary Stage data enhances TNM staging completeness. However, further evaluation incorporating treatment information is essential.; Summary

Longitudinal Effects of Life Satisfaction on Smoking Status of South Korean Adult Men: Baksun Sung; Received November 4, 2024 Accepted February 26, 2025 Published online April 21, 2025; DOI: https://doi.org/10.3961/jpmph.24.664 [Accepted]

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Abstract PDF: Objectives
The prevalence of smoking among adult men remains high in South Korea. Additionally, life satisfaction can influence health behaviors. Therefore, the objective of this study was to examine the longitudinal effects of life satisfaction on smoking status among South Korean men.
Methods
This study utilized panel data from wave 1 (2005) to wave 12 (2016) of the Korea Welfare Panel Study. Life satisfaction was measured using 8variables, representing satisfaction with leisure, social relations, family relations, health, job, family income, residential environment, and overall life. A Cox proportional hazards model was employed to assess the causal relationship between life satisfaction and smoking status.
Results
Over the 11-year follow-up period, improved leisure satisfaction was associated with a decreased hazard of smoking (hazard ratio [HR], 0.831; p<0.01). In contrast, greater satisfaction with social relations was linked to an increased hazard (HR, 1.230; p<0.05). Improved satisfaction with family relations was associated with a decreased hazardof smoking (HR, 0.842; p<0.05).
Conclusions
Certain life satisfaction variables appear to influence the incidence of smoking among male South Korean adults.; Summary

Sleep Disturbances in Early Pregnancy and the Risk of Preeclampsia: Qazvin Maternal and Neonatal Metabolic Outcomes Study (QMNMS): Sima Hashemipour, Fatemeh Lalooha, Milad Badri, Leila Modarresnia, Amirabbas Ghasemi, Sara Esmaeili Kelishomi, Sarah Mirzaeei Chopani, Seyyed Hamidreza Ghafelehbashi, Mahnaz Abbasi, Sepideh Kolaji; Received November 17, 2024 Accepted March 27, 2025 Published online April 21, 2025; DOI: https://doi.org/10.3961/jpmph.24.698 [Accepted]

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Abstract PDF: Objectives
The association between sleep disturbances and hypertension has been reported in numerous studies. However, prospective cohort data on the role of sleep disturbances in the development of preeclampsia remain limited.
Methods
This prospective cohort study was conducted on pregnant women with a in Iran. Sleep quality was assessed at the first prenatal visit (gestational age ≤14 weeks) using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Multivariate logistic regression was run to investigate the independent role of sleep abnormalities in the development of preeclampsia.
Results
The final analysis was performed on 576 participants, of whom 3.5% developed preeclampsia. In the univariate analysis, short sleep duration (< 6 hours) and prolonged sleep latency was associated with a 5.5-time and 3.5-times higher risk of developing preeclampsia (95% CI: 1.5-20.9, P=0.011, and 95% CI:1.2-10.1, P=0.019, respectively). Considering the total PSQI score, fairly bad or very bad sleep quality was a risk factor for developing preeclampsia, with a relative risk of 4.9 in the univariate analysis (95% CI: 1.4-17.8, P=0.014). In the fully adjusted model, short sleep duration and prolonged sleep latency were associated with 7.2 and 4.5 times higher risk of preeclampsia, respectivey (95% CI: 1.6-33.1, P=0.011 and 95% CI:1.4-14.6, P=0.012, respectively). In this model, pregnant women with fairly bad or very bad sleep quality had 5.9 times higher risk of preeclampsia development ( 95% CI: 1.5-22.8, P=0.011).
Conclusions
This cohort study demonstrated the role of short sleep duration and prolonged sleep latency as the main components of poor sleep quality in the development of preeclampsia.; Summary

Are Nonstandard Work Schedules Related to Sleep Difficulty and Health-related Quality of Life? An Examination of Gender Differences: Seowoo Park, Ji Sun Park, Moo Hyuk Lee, Young Kyung Do; Received July 17, 2024 Accepted March 11, 2025 Published online April 15, 2025; DOI: https://doi.org/10.3961/jpmph.24.378 [Accepted]

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Abstract PDF: Objectives
The rise of flexible and diverse work schedules has become increasingly common in modern society. This study aims to investigate whether nonstandard work schedules are related to sleep difficulty and other aspects of health-related quality of life (HRQOL) in South Korea, with special attention to gender differences.
Methods
Data from the 2019 and 2021 National Health and Nutrition Examination Survey (Phase 8) were used, with a final sample consisting of 6,735 participants. Ordinal logistic regression analysis was performed on sleep difficulty and the other seven items of the Health-related Quality of Life Instrument with 8 items (HINT-8) to examine associations with work schedules. Linear regression analysis was also conducted using the HINT-8 index as a composite measure.
Results
Nonstandard work schedules were associated with a higher likelihood of sleep disturbances compared to the standard daytime work schedule. In particular, the negative impact of the night work schedule on sleep was greater for female workers than for male workers. Females working under the night work schedule were 12.2 percentage points more likely to report severe sleep difficulty than females under the day work schedule (9.6%). Additionally, the working, happiness, and vitality items of the HINT-8 were negatively associated with the night work schedule, whereas the other HINT-8 items and the HINT-8 index did not exhibit similar results.
Conclusions
Nonstandard work schedules are associated with increased sleep difficulty, particularly among women, and negatively affect several aspects of HRQOL, including vitality, happiness, and work performance. Given their rising prevalence and adverse impact on workers’ sleep, health, well-being, as well as workplace safety and performance, nonstandard work schedules should be recognized as a significant public health concern.; Summary

Prognostic Scoring Model for the Transition from Acute to Chronic Non-specific Low Back Pain in Primary Health Care Units: Djoko Kuswanto, Riva Satya Radiansyah, Dwinka Syafira Eljatin, Muhammad Nazhif Haykal, Rumman Karimah, Ratri Dwi Indriani, Zain Budi Syulthoni, Erna Furaidah, Andiva Satrio Rinaldi, Hafira Nushifa Putri, Jessica Felina Adi, Anak Agung Bagus Wirayuda; Received October 7, 2024 Accepted March 28, 2025 Published online April 12, 2025; DOI: https://doi.org/10.3961/jpmph.24.581 [Accepted]

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Abstract PDF: Objectives
Non-specific low back pain (NSLBP) is a prevalent health issue that can progress from acute to chronic, resulting in prolonged disability and diminished quality of life. This study aimed to develop a prognostic scoring model to predict the transition from acute to chronic NSLBP in primary care settings.
Methods
This prospective cohort study enrolled 112 adults with acute NSLBP from primary health care units in Indonesia. Participants were assessed at baseline and at a 3-month follow-up visit. Bivariate and multivariable analyses were conducted to identify significant predictors of chronicity. A scoring system was then developed based on the final logistic regression model.
Results
Three factors were found to be significant predictors of the transition to chronic NSLBP: age above 30 years, low education level, and moderate to severe pain intensity. The prognostic scoring model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.705, 70.8% sensitivity, and 62.5% specificity at the optimal cut-off score of 2.5.
Conclusions
This simple prognostic scoring model can help clinicians identify patients at high risk of developing chronic NSLBP. Early identification of at-risk patients could guide targeted interventions to prevent chronicity. Further validation in diverse populations is necessary to confirm the broader applicability of this model.; Summary

Exposure of Volunteer Traffic Assistants to PM2.5 From Transportation: An Environmental Health Risk Analysis: Iwan Suryadi, Juherah Juherah, Siti Rachmawati, Nurlaila Fitriani, Muhammad Kahfi, Syahrul Basri; Received January 1, 2025 Accepted February 11, 2025 Published online February 25, 2025; DOI: https://doi.org/10.3961/jpmph.25.004 [Accepted]

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Abstract PDF: Objectives
PM2.5 from motor vehicle emissions has increased air pollution, negatively affecting both the environment and human health. This study aims to evaluate the concentration of fine particulate matter, assess associated health risks, and simulate the spatial distribution of PM2.5.
Methods
PM2.5 samples were collected from 36 key congestion points along the main roads of Makassar City. Measurements were taken for one hour during the morning, afternoon, and evening sessions. The hazard quotient (HQ) was calculated to estimate non-carcinogenic health risks. A total of 175 volunteer traffic assistants participated in the study. Spatial analysis was performed using the kriging method.
Results
The highest recorded PM2.5 concentration was 65 µg/m³ on Hertasning Street, while the lowest was 2 µg/m³ on AP Pettarani Street. The average concentration across all locations was 23.20 µg/m³. Although PM2.5 levels remained below Indonesia's regulatory limit of 65 µg/m³, they exceeded the WHO guideline of 15 µg/m³. The highest HQ value was 12.94, and the lowest was 0.221. The spatial analysis showed a direct correlation between higher pollutant concentrations and congested areas.
Conclusions
The findings indicate that the HQ for PM2.5 exceeds the acceptable standard (HQ > 1), signifying a health risk that increases with frequent exposure. Effective air quality management strategies—including the use of masks, promotion of green transportation, and expansion of green open spaces—are essential to reduce pollutants and minimize health risks, especially for individuals with regular exposure.; Summary

Rapid Antiretroviral Therapy Initiation Reduces Mortality Among People Living With HIV,: A Retrospective Observational Study: Ifael Yerosias Mauleti, Krishna Adi Wibisana, Djati Prasetio Syamsuridzal, Sri Mulyati, Vivi Lisdawati, Harimat Hendarwan, Ika Saptarini; Received October 20, 2024 Accepted January 24, 2025 Published online February 22, 2025; DOI: https://doi.org/10.3961/jpmph.24.622 [Accepted]

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Abstract PDF: Objectives
Current recommendations for managing human immunodeficiency virus (HIV) propose that initiating antiretroviral therapy (ART) promptly after diagnosis, regardless of CD4 cell count, may decrease illness and mortality risk. This study aimed to investigate factors associated with reduced mortality, including the time to ART initiation after diagnosis with HIV.
Methods
We conducted a retrospective cohort study using the medical records of 326 people living with HIV (PLHIV) aged 18 years or older who initiated ART at a tertiary hospital between January 2018 and December 2022. We employed Cox regression models to estimate survival and identify mortality predictors, considering variables with p-values less than 0.05 as statistically significant.
Results
From 2018 to 2022, 19.9% of PLHIV initiated ART within 7 days of diagnosis, and 57 participants died. The final multivariable Cox proportional hazards model indicated that earlier ART initiation significantly reduced mortality risk compared with starting ART more than 60 days after diagnosis, with adjusted hazard ratios of 0.36 for initiation within 7 days and 0.42 for initiation between 8 and 60 days. Additional characteristics associated with reduced mortality risk included a CD4 count above 200 cells/mm3 before ART initiation, a lower World Health Organization clinical stage, and tuberculosis post-exposure prophylaxis.
Conclusions
Earlier ART initiation significantly lowered mortality rates. Furthermore, a pre-ART CD4 count above 200 cells/mm3, a lower clinical stage, and tuberculosis preventive therapy were associated with reduced mortality risk among PLHIV. Future studies should investigate additional predictors of mortality within a prospective cohort study framework.; Summary

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