Indonesian Journal of Global Health Research
Indonesian Journal of Global Health Research (p-ISSN 2714-9749; e-ISSN 2715-1972) is a open access, peer reviewed and refereed international journal. IJGHR aim to publish original research paper devoted to various area of all health sciences. IJGHR provides a forum for sharing timely and up-to-date publication of scientific research, health care and promoting the development of nursing, public health, community, environmental and occupational health. The journal publishes original research papers of health sciences. High priority will be given to articles on public, nursing, adolescent, community, environmental and occupational health, pharmaceutical technology, social pharmacy, traditional medicine, pharmacology, and so on. The topics related to this journal include but are not limited to: public health, health promotion, environmental health, occupational health, clinical aspects related to health, healthcare services, health policy and management, school health, food health, remote health, rural health, community health, mental health, adolescent health, industrial health, circumpolar health, drug health, equity in health, reproductive health care, urban health, health geographics, women's health, paediatrics and child health.
The Effectiveness of Self-Management Approaches on Improving Self-Efficacy and Quality of Life in Stroke Patients Undergoing Rehabilitation Programs: A Systematic Review
Stroke is a major global health problem and one of the leading causes of long-term disability and death worldwide. Post-stroke patients often experience decreased physical function and independence, while adherence to rehabilitation programs remains suboptimal due to low motivation, insufficient knowledge, and limited family support. The self-management approach has been introduced to encourage patients' active participation in their recovery process by improving self-efficacy and overall quality of life This study aims to evaluate the effectiveness of the self-management approach in improving self-efficacy and quality of life among post-stroke patients, and to critically appraise the quality of existing scientific evidence. This study applied a systematic review design following the PRISMA 2020 guidelines. Literature searches were conducted in PubMed, Scopus, Web of Science, Google Scholar, and Registers for studies published between 2020 and 2025. Of the 1,383 articles identified, 10 studies met the inclusion criteria and were analyzed. All ten studies consistently demonstrated that self-management interventions effectively improved self-efficacy , adherence to rehabilitation, and quality of life in post-stroke patients. The interventions also promoted independence in daily living activities ( Activities of Daily Living/ADL ) and strengthened patients' confidence and motivation in managing their health. Additionally, family involvement and healthcare support were identified as key factors contributing to the success of self-management programs. The self-management approach is proven to be an effective strategy for enhancing self-efficacy and quality of life among stroke survivors. It empowers patients to actively engage in their physical, psychological, and social recovery. Therefore, self-management programs should be integrated into post-stroke rehabilitation as a sustainable and patient-centered intervention model in both clinical and community settings.
Copyright (c) 2025 Indonesian Journal of Global Health Research https://creativecommons.org/licenses/by-sa/4.0
Digital Technologies for Emergency Response in Outdoor and Mountain Settings: A Systematic Review using SWiM
Digital technologies such as wearable devices, unmanned aerial vehicles (UAVs), and e-learning platforms are increasingly applied to enhance safety and emergency response in outdoor and mountain environments. However, evidence regarding their effectiveness, feasibility, and implementation remains limited and scattered across disciplines. This systematic review aimed to synthesize current findings on digital technologies supporting emergency preparedness and response in outdoor activities. Following the PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed/MEDLINE, Scopus dan sciencedirect, including grey literature, for studies published up to October 30, 2025. Eligible studies examined (a) wearable or mobile-based fall detection systems, (b) UAV-based search-and-rescue (SAR) applications, or (c) e-learning interventions for rescue personnel. Two reviewers independently performed study selection and data extraction. Risk of bias was appraised using appropriate tools according to study design (QUADAS-2, JBI, and MMAT). Due to heterogeneity and the small number of studies, a narrative synthesis approach following the SWiM framework was applied. Out of 161 records identified, three studies met the inclusion criteria. One simulation-based study on wearable fall detection reported 97.9% sensitivity and 99.9% specificity in recognizing fall events with real-time location tracking. A feasibility study demonstrated the operational potential of UAVs in avalanche search-and-rescue scenarios but lacked standardized performance indicators. An e-learning intervention among rescuers showed significant improvement in knowledge retention, especially among professionals compared to volunteers after 12 months. Overall, the methodological quality of included studies was moderate to low. Digital technologies show promising potential to improve emergency preparedness and response in outdoor and mountain settings. Nonetheless, the evidence remains preliminary due to limited sample sizes, heterogeneous designs, and simulation-based validation.
Evaluation of the Impact of Primary Care Service Implementation on Service Quality
Patient satisfaction is a critical indicator in assessing the quality of healthcare services, as it influences patient loyalty and the sustainability of service utilization. This study aimed to evaluate the impact of the implementation of Integrated Primary Care (ILP) on the quality of healthcare services at Pilolodaa Primary Health Center. This study employed a qualitative research design with a case study approach. This qualitative study included nine purposively selected informants. Data were obtained through in-depth interviews and analyzed using thematic analysis with triangulation. Data were collected through in-depth interviews, direct observation, and document review. The data were then analyzed thematically using the Input–Process–Output–Impact (IPO-D) evaluation. The findings indicate that the implementation of ILP had a positive impact on service quality, as evidenced by improved cross-program coordination, enhanced service workflows, increased ease of access to healthcare services, and higher levels of patient satisfaction. However, several challenges remained, including limitations in human resources, increased digital administrative workload, and disparities in infrastructure and facilities. The implementation of ILP contributes positively to improving healthcare service quality and patient satisfaction at the primary care level. Nevertheless, addressing human resource constraints, administrative burdens, and infrastructural inequalities is essential to ensure the sustainability and optimal effectiveness of ILP implementation.
The Role of Educators in the Formation of the Professional Character of Nursing Students: A Phenomenological Study
This research focuses on the importance of the role of educators in shaping the professional character of nursing students, especially since this character is the basis for their readiness to face the demands of clinical practice. The purpose of this study is to explore students' experiences regarding how supervisors and lecturers affect the process of internalizing professional values. The study employed a phenomenological approach, involving ten students who underwent in-depth interviews to gain a more comprehensive understanding of their 10 experiences. The data analysis yielded five main themes: educator exemplars, mentoring in clinical simulations and practices, communication and team dynamics, affirmation of ethical values and professionalism, and challenges in applying professional character in real-life situations. The study's results indicate that the development of a professional character occurs through observation, direct guidance, intense interaction, and the inculcation of moral values by educators. In conclusion, educators play a crucial role in shaping students' professional identities, so that an exemplary and reflection-based learning approach needs to be strengthened in nursing education.
The Effect of Using VIRASAT Media (Virtual Reality–Based Sexual Education) on Adolescent Behaviors Leading Toward Free Sex
Currently, it is estimated that there are 39.9 million people living with HIV worldwide. In the Asia-Pacific region, there are approximately 6.7 million people living with HIV. In Indonesia, it is estimated that there are around 564,000 people living with HIV. Data from the National Commission for Child Protection shows that 93.7% of adolescents in Indonesia have engaged in kissing, petting, and oral sex. Adolescents' knowledge regarding sexuality is still relatively low. Sexual education is a way to reduce the spread of sexually transmitted diseases. This study aims to determine the influence of VIRASAT (Virtual Reality Sexual Education) media on adolescent behavior leading to free sex. This study used a pre-experimental one-group pretest–posttest design involving 80 students from SMAN 14 Ambon selected through stratified random sampling. Data on knowledge, attitudes, and behaviors related to free sex were collected using a structured questionnaire administered before and after a virtual reality–based sexual education (VIRASAT) intervention under researcher supervision. The effect of the intervention was analyzed using a paired t-test. The results showed that after the intervention, the majority of respondents had high knowledge (63.8%) with a p-value of 0.013. After the intervention, the majority of respondents had a positive attitude (67.5%) with a p-value of 0.005. After the intervention, the majority of respondents exhibited non-risky behavior (68.8%) with a p-value of 0.004. Thus, it can be interpreted that there is a significant influence between the use of VIRASAT (virtual reality sexual education) media on adolescent behavior leading to free sex at SMAN 14 Ambon. The use of VIRASAT (Virtual Reality Sexual Education) media had a significant effect on adolescents’ knowledge, attitudes, and behaviors related to free sex at SMAN 14 Ambon. After the intervention, most respondents demonstrated high knowledge, positive attitudes, and non-risky sexual behaviors, indicating that VIRASAT is an effective educational medium for preventing risky sexual behavior among adolescents.
The Effect of Nira Beverage Consumption on Blood Glucose Levels and Glycemic Index in Patients with Diabetes Mellitus: An Experimental Study
Diabetes mellitus (DM) is a major public health problem with a continuously increasing prevalence. Dietary regulation is a key pillar in glycemic control for DM management. Palm sap (nira aren) is a traditional beverage reported to have a low glycemic index; however, public concerns regarding its potential alcohol content have raised controversy about its consumption among individuals with DM. This study aimed to determine the effect of nira beverage consumption on blood glucose levels and glycemic index in patients with diabetes mellitus. This study employed a quasi-experimental pretest–posttest control group design involving 28 patients with diabetes mellitus. Data were collected through direct measurement of blood glucose levels using a glucometer before and after the intervention, while glycemic index was calculated based on standardized glycemic response procedures. Statistical analysis was performed using the paired t-test. The findings showed a statistically significant difference in blood glucose levels before and after nira beverage consumption in the intervention group (p = 0.000). In addition, glycemic index analysis demonstrated a significant difference (p = 0.001). Nira beverage consumption has a significant effect on blood glucose levels and glycemic index among patients with diabetes mellitus.
Analysis of Dental Caries Risk Factors Based on the DEF-T Index in Children Aged 6-7 Years
Dental caries is a chronic disease characterized by the destruction of hard dental tissues, including enamel, dentin, and cementum, resulting from bacterial activity within dental plaque that produces acids from food residues, particularly sugars and carbohydrates, adhering to tooth surfaces. These acids cause enamel demineralization, which, if it progresses, leads to the formation of cavities. This study aimed to analyze the risk factors associated with dental caries occurrence based on the def-t index among children aged 6–7 years in Tolinggula District, North Gorontalo Regency. This cross-sectional study involved 74 children aged 6–7 years selected using purposive sampling. Data were collected through structured questionnaires and clinical examinations, including def-t index assessment and salivary pH measurement. The questionnaire had undergone expert content validation and demonstrated acceptable reliability (Cronbach’s alpha > 0.70). Data were analyzed using the chi-square test and multiple linear regression. The findings revealed significant associations between dental caries occurrence based on the def-t index and the consumption behavior of cariogenic foods and beverages (p = 0.000), toothbrushing frequency (p = 0.000), and salivary pH (p = 0.000). Among these variables, salivary pH was identified as the most dominant factor associated with dental caries occurrence (p = 0.000). Several risk factors were found to be significantly associated with dental caries occurrence based on the def-t index among children aged 6–7 years in Tolinggula District, North Gorontalo Regency, with salivary pH being the strongest contributing factor.
The Effectiveness of Communication Training and the Application of Structured Communication Methods on Handover Quality, Patient Safety, and Nurse Performance in Hospitals: A Systematic Review
Effective communication is a critical component of the nursing handover process and directly contributes to patient safety. This systematic review aims to identify, evaluate, and synthesize scientific evidence regarding the effectiveness of communication training and the implementation of structured communication methods on handover quality, patient safety, and nurse performance in hospitals.A literature search was conducted in PubMed, Scopus, and CINAHL databases for studies published between 2010 and 2025. Studies that met the inclusion criteria included randomized controlled trials (RCTs) and quasi-experimental studies that provided interventions such as communication training or the implementation of structured communication methods for hospital nurses. Study selection followed the PRISMA 2020 guidelines, while methodological quality assessment was conducted using the Joanna Briggs Institute (JBI) instrument. From 678 articles, we found total of 10 eligible studies were synthesized narratively due to the heterogeneity of interventions and outcomes. The synthesis showed that communication training and structured communication methods consistently improved the completeness, clarity, and accuracy of handovers; strengthened team coordination; and reduced the risk of communication errors that impact patient safety. RCTs demonstrated significant improvements in nurses' communication competency and clinical performance, while quasi-experimental studies confirmed the practical effectiveness of SBAR/ISBAR implementation in various hospital units. Contextual factors such as workload, organizational culture, and leadership support also influenced implementation success. Communication training and structured communication methods have proven effective in improving handover quality, patient safety, and nurse performance.
The Effectiveness of Breast Care in Increasing Breast Milk Production in Postpartum Mothers
The postpartum period is a crucial phase for the success of exclusive breastfeeding, marked by various physiological and psychological changes in the mother. One common issue during this period is the difficulty in expressing breast milk, which can affect the baby's growth and overall health. Contributing factors include stress, fatigue, poor nutritional intake, and a lack of knowledge about proper breastfeeding techniques. Breast care is a non-pharmacological intervention that has been scientifically proven to stimulate the hormones prolactin and oxytocin, thereby enhancing milk production and expression. This study aims to evaluate the effectiveness of the breast care technique in improving breast milk production and expression in postpartum mothers. It also seeks to describe the characteristics of the respondents and compare their condition before and after the intervention. This research used a descriptive qualitative approach with a case study design involving five postpartum mothers. Respondents were selected based on specific criteria using purposive sampling. Data were collected through direct observation during a four-day breast care intervention. Before the intervention, all respondents experienced difficulties in milk expression, with scores categorized as “very low” to “low.” After four days of intervention, a significant improvement was observed. All respondents achieved the maximum score (10/10) based on maternal indicators and a good score (5/6) based on infant indicators. Breast care proved effective in enhancing milk flow through hormonal stimulation and its relaxing effect.
The Effect of Implementing Pre-Conference and Post-Conference on the Completeness of Nursing Care Documentation: A Systematic Review
Completeness of nursing care documentation is an important indicator of service quality and patient safety because it supports continuity of care, communication between shifts, and professional accountability. However, in clinical practice, documentation is often incomplete due to workload, time constraints, varying adherence to SOPs, and minimal feedback. Pre- and post-conferences, as a forum for structured briefings and evaluations, are seen as capable of organizing team communication flows and strengthening process discipline, thus potentially improving documentation completeness. To synthesize scientific evidence regarding the application of pre-conference and post-conference in nursing practice and their impact on the completeness of nursing care documentation. The study design was a systematic review with narrative synthesis. A literature search was conducted on Google Scholar, Scopus, and PubMed for articles published between 2011 and 2025, in Indonesian or English. Included studies were original research that evaluated the implementation of pre- and/or post-conferences for nurses or nursing teams in clinical settings and reported outcomes related to completeness of documentation or relevant process quality indicators. Selection was conducted through title/abstract screening and full-text assessment. Data were then standardized and synthesized descriptively due to heterogeneity in design, context, and measurement indicators. Eight studies met the inclusion criteria with varying designs, including case studies, descriptive studies, PDSA-based pilot studies, quasi-experimental, pre-experimental, and cross-sectional correlational studies. Thematic synthesis showed that pre-conferences play a role in establishing shared clinical perceptions, establishing priorities, and aligning care plans, resulting in more focused recording. While post-conferences serve to close the work cycle by evaluating and verifying completeness before the shift change. Studies that directly assessed documentation reported improved completeness after the implementation of pre- and post-conferences, while others demonstrated improved compliance with the handover/conference process and nurse performance as supporting mechanisms for documentation quality. Effective implementation appeared to be influenced by team leader leadership, clarity of SOPs and formats, practice-based training (e.g., role-play/simulation), and tiered supervision. Workload and time constraints, particularly at the end of the shift, were key barriers. Implementing pre- and post-conferences has the potential to improve the completeness of nursing care documentation by improving team communication processes, standardizing clinical priorities, and strengthening accountability before handover. A more consistent impact is likely to emerge when conferences are integrated into a quality control system that includes clear standard operating procedures (SOPs), training, supervision, and periodic documentation audits and feedback.
Effectiveness of Experiential Learning–Based Clinical Education on Nurses' Clinical Decision-Making: A Systematic Review
Clinical decision-making is a core competency for nurses that directly impacts patient safety. However, the development of this skill is often not automatic and faces barriers such as service complexity and lack of confidence. Experiential learning through a cycle of concrete experiences and reflection offers an approach to bridge this competency gap. This study aims to synthesize scientific evidence regarding the types of experiential learning interventions in clinical education and assess their impact on nurses' clinical decision-making or judgment. The study design was a systematic review following the PRISMA 2020 guidelines. A literature search was conducted in PubMed/MEDLINE, Scopus, and CINAHL databases for articles published between 2011 and 2025. Inclusion criteria included RCTs or quasi-experimental studies involving nurses or nursing students in clinical settings with experience-based interventions. Nine studies met the inclusion criteria and were analyzed narratively. Data synthesis identified two main themes. First, intervention modalities included realistic clinical simulations, in-situ simulations in the ICU, scenario-based triage training, interactive cognitive techniques (such as critical thinking cards), and structured reflection methods such as Debriefing for Meaningful Learning (DML). Second, these interventions consistently improved clinical decision accuracy, reasoning, knowledge, and service time efficiency. The use of DML was shown to be more effective in improving clinical reasoning than traditional debriefing. However, some studies have shown a decline in retention of the effect after three months, emphasizing the need for ongoing training. Experiential learning-based clinical education is effective in improving the quality of nurses' clinical decisions. The success of this intervention depends heavily on the integration of structured exposure to clinical experiences with systematic reflection mechanisms. Hospital management is advised to implement regular scenario-based training and strengthen the capacity of facilitators in conducting debriefings to ensure patient safety and the quality of nursing care.
The Relationship Between the Quality of Pharmaceutical Services and Patient Safety
Pharmaceutical services are a critical component of healthcare delivery in ensuring patient safety, particularly at Community Health Centers (Puskesmas). Suboptimal pharmaceutical service quality may increase the risk of medication errors and adverse drug events, thereby compromising patient safety. However, empirical evidence regarding the contribution of pharmaceutical service quality to patient safety in primary healthcare settings remains limited. A quantitative cross-sectional study was conducted at the Sipatana Community Health Center, Gorontalo City, Indonesia, in November 2025. The study population comprised patients receiving pharmaceutical services, with 295 respondents selected through purposive sampling. Data were collected using a structured questionnaire based on national pharmaceutical service standards. The instrument demonstrated acceptable validity and reliability, with item–total correlations above the critical value and Cronbach’s alpha coefficients exceeding 0.60. Data were analyzed using the Chi-square test and stepwise logistic regression at a significance level of p < 0.05. The results showed that all dimensions of pharmaceutical service quality were significantly associated with patient safety. Management of pharmaceutical supplies and consumable medical materials, prescription review, prescription services, drug information services, prevention of medication errors, prevention of adverse drug events, and patient medication adherence were significantly associated with patient safety (p = 0.000). Monitoring of adverse drug reactions also showed a significant association (p = 0.004). Simultaneously, pharmaceutical service quality had a significant effect on patient safety (F = 23.171; p = 0.000) with an R-square value of 0.326. Stepwise regression analysis indicated that management of pharmaceutical supplies and consumable medical materials was the strongest predictor of patient safety (B = 0.284; β = 0.278). The quality of pharmaceutical services plays a significant role in ensuring patient safety at the Sipatana Community Health Center. Management of pharmaceutical supplies and consumable medical materials emerged as the primary predictor of patient safety. Strengthening pharmaceutical supply management, improving the competence of pharmaceutical personnel, and optimizing strategies for preventing medication errors and adverse drug events are essential to enhance patient safety in primary healthcare settings.
Factor Analysis of Determinants Influencing the Use of Implant Contraception among Women of Reproductive Age
Implant contraceptives are long-acting reversible methods intended to prevent pregnancy and are considered highly effective and non-permanent. Implants can provide protection for three to five years with a failure rate of only 0.05 per 100 users, achieving effectiveness of up to 99%. However, the utilization of implant contraception remains influenced by various factors. This study aimed to analyze the factors influencing the use of contraceptive implants among couples of reproductive age in the working area of the Kabila Community Health Center. This study employed an analytical observational design with a cross-sectional approach. The research was conducted in the working area of the Kabila Community Health Center, Bone Bolango Regency, from April to May 2025. A total of 173 respondents were selected using a simple random sampling technique. Data were collected using a structured questionnaire that had been validated through expert judgment and item–total correlation analysis and demonstrated good reliability with a Cronbach’s alpha value greater than 0.70. The data were analyzed using the chi-square test. The results showed that visits by family planning officers (ρ = 0.000), availability of contraceptives (ρ = 0.029), and contraceptive service costs (ρ = 0.000) were significantly associated with the use of contraceptive implants. This study concludes that family planning officer visits, contraceptive availability, and service costs are significant factors influencing the use of contraceptive implants among couples of reproductive age in the working area of the Kabila Community Health Center, Bone Bolango Regency.
Maternal and Fetal Determinants of Caesarean Section Delivery
Maternal, infant, and toddler mortality rates remain a serious public health problem in Indonesia. One effort to reduce these rates is by ensuring safe delivery services, both vaginally and through cesarean sections (CS). Although normal delivery is preferred, the trend of cesarean sections has continued to increase in recent decades. Sultan Iskandar Muda Regional Hospital, as a type C hospital in Nagan Raya Regency, Aceh, records an increase in childbirth cases every year. This study aims to analyze the determinants that influence cesarean section procedures at the hospital. This study uses an explanatory sequential design. This type of quantitative research with a cross-sectional design was conducted using patient medical records. The population is all data on mothers who gave birth by cesarean section at Sultan Iskandar Muda Regional Hospital, taken within a 3-month period, namely October - December 2024, a total of 324 mothers giving birth by cesarean section. The sampling method used the total population with a sample size of 324 respondents. While qualitative research with a phenomenological approach, conducted by interview using interview guidelines, the method of collecting informants using purposive sampling with a total of 7 informants. The results of quantitative research show that the most dominant relationship between cesarean section is prolonged labor (OR: 701.40; 95%CI: 98.02-5019.20; p value: 0.0001), the occurrence of PEB (OR=446.33; 95%CI=21.62-9214.06; p=0.0001) and term birth (OR=35.76; 95%CI=0.29-4446.35; p=0.146) at Sultan Iskandar Muda Regional Hospital, Nagan Raya Regency. The results of qualitative research show that non-medical factors that play a role in cesarean section are fear of pain and complications during normal delivery. Prolonged labor is the most dominant factor with cesarean section. Therefore, health workers at community health centers are expected to provide positive support in the form of positive affirmations to pregnant women, such as deep breathing and relaxation exercises to reduce pain. Strengthen education programs and routine pregnancy check-ups at primary health care facilities to detect risk factors early and prevent childbirth complications.
Optimization of Tiered Nursing Competency Supervision in the Central Surgical Installation of the Hospital
Supervision of nurse competency in the operating room is an important component in ensuring compliance with standard operating procedures and patient safety. However, in some hospitals, supervision is still not optimal, often unscheduled, using manual forms, and lacking proper documentation. This residency project aims to improve the effectiveness of tiered nurse competency supervision to enhance patient safety in the hospital's central surgical installation. This case study uses Kurt Lewin's planned change approach consisting of three stages unfreezing, moving, and refreezing combined with management functions: planning, organizing, staffing, actuating, and controlling. Data collection was conducted through interviews, observations, and questionnaires. Planned change began with problem identification, followed by Fishbone analysis to determine root causes. Several improvement strategies were developed, including forming a supervision team, creating a routine supervision schedule through Google Sheets, and developing five digital supervision instruments using Google Forms. A trial implementation was carried out. Data were analyzed using descriptive statistics to summarize respondent characteristics and key variables, while inferential analysis was used to examine variable relationships and support achievement of the research objectives. The implementation of digital-based tiered nurse competency supervision increased the effectiveness of supervision and supported more structured competency development. The formation of a supervision team, scheduled supervision activities, and digitized instruments improved supervision quality. Trial results indicated competent performance aligned with SOPs based on observation checklists. Digital supervision forms proved efficient and practical, facilitating implementation, simplifying documentation, and accelerating evaluation of supervision outcomes.
Global Bibliometric Analysis of Postoperative Cognitive Dysfunction (POCD) in Anesthesia: Mapping Risk Factors and Research Trends
Postoperative Cognitive Dysfunction (POCD) is a post surgical cognitive disorder and is at risk of worsening quality of life and triggering dementia. This study aimed to conduct a bibliometric analysis of scientific publications on postoperative cognitive dysfunction (POCD) published between 2014 and 2024. The analysis examined annual publication trends, the distribution of contributing countries and institutions, types of documents, publishers, and the most frequently occurring keywords, including “postoperative cognitive dysfunction,” “anesthesia,” “risk factors,” and “POCD,” based on data retrieved from the Scopus database. This study was conducted using data from the Scopus database, analysed with the help of the Publish or Perish, PRISMA flowchart, and VOS viewer tools to visually map patterns and relationships between keywords. A total of 254 articles were identified, of which 182 articles were included in the analysis. Publication trends showed a consistent increase, peaking in 2024 with 28 papers. China (53.3%) and the United States (15.3%) were the leading contributors, followed by Japan, Germany, and the United Kingdom. Most publications were original research articles (73.1%), indicating a dominance of empirical investigations. The most active journals included Frontiers in Aging Neuroscience, BMC Anesthesiology, and Neuroscience. Keyword mapping revealed five major clusters: (1) anesthesia and surgery type, (2) neuroinflammation mechanisms, (3) aging and cognitive impairment, (4) biomarkers and pharmacological interventions, and (5) postoperative care. Recent trends (2021–2024) show a shift from descriptive to mechanistic and evidence-based studies. However, research gaps persist in the areas of digital biomarkers, psychosocial factors, long-term outcomes, and younger populations. Based on data, POCD research trends have been consistently developing and showing maturity in terms of clinical and methodological approaches.
Copyright (c) 2026 Indonesian Journal of Global Health Research https://creativecommons.org/licenses/by-sa/4.0
The Mediating Role of Purchase Intention between Product Display, Price Perception, and Purchasing Decisions in Retail Pharmacies
The transformation of retail pharmacies into modern retail environments has intensified competition, making marketing strategies such as product display and pricing increasingly important in influencing consumer purchasing behavior. Objective: This study aims to analyze the effect of product display and price perception on purchasing decisions through purchase intention in modern retail pharmacies. This quantitative study employed a cross-sectional design involving 180 respondents from a modern retail pharmacy (Apotek A) in Kendari City. Data were collected using structured questionnaires selected using purposive sampling from a modern retail pharmacy (Apotek A) in Kendari City. Data were collected through structured questionnaires and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). Measurement model (outer model) and structural model (inner model) evaluations were conducted to assess validity, reliability, and hypothesis testing. The results indicate that product display and price perception have significant positive effects on purchase intention. Purchase intention, in turn, significantly influences purchasing decisions and mediates the relationship between product display, price perception, and purchasing decisions. All constructs demonstrated adequate validity and reliability. Effective product display and favorable price perception enhance consumers’ purchase intentions, leading to higher purchasing decisions in retail pharmacies. These findings highlight the strategic importance of retail-oriented management practices in modern pharmacies.
Oral Care Protocol and the Prevention of Ventilator-Associated Pneumonia in ICU Patients: A Literature Review
Patients undergoing mechanical ventilation are at high risk of developing infectious complications, particularly Ventilator-Associated Pneumonia (VAP). Structured oral care through the implementation of an oral care protocol plays a critical role in preventing such infections. This study employed a Systematic Literature Review design guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Relevant articles were identified from databases including Google Scholar, Elsevier, ScienceDirect, and ResearchGate. The review focused on articles published within 2020-2025 and relevant to oral care in mechanically ventilated patients. The keywords used in the article search were Ventilator-Associated Pneumonia, Oral Care Protocol, and Mechanical Ventilation. The findings indicate that structured oral care protocols significantly reduce the incidence of VAP. Effective strategies include the use of additional topical agents such as honey, disposable oral care kits, and individualized care approaches based on appropriate assessment tools. Regular training and ICU nursing certification are also key factors in optimizing the implementation of oral care. Moreover, attention to nurse-to-patient ratios contributes to improved care quality. Oral care for ventilated patients should be integrated into hospital Standard Operating Procedures (SOPs) using an evidence-based approach. Institutional support through training, resource provision, and policy development is essential to enhance intervention effectiveness and reduce complications such as VAP.
The Relationship between Family Income and Maronutrient Intake with the Incidence of Chronic Energy Deficiency in Pregnant Women
Chronic Energy Deficiency (CED) in pregnant women remains a major public health problem in developing countries, including indonesian. Socioeconomic factors such as family income and inadequate macronutrient intake play an important role in the occurrence of CED. This study aimed to analyse the relationship betwen family income and macronutrient intake with the incident of chronic enegry deficiency in pregnant women. This study employed an observational analytic design with cross-sectional apporach. The study population consisted of pregnant women who attended antenatal care service at primary health centres. Family income data were collected using structured questionnaires, while amcronutrient intake (enegry, protein, fat and carbohydrate) was assessed using a 24-hour dietary recall. The incidence of CED was determined based on MUAC measurement. Data were analysed using appopriate statistical test with a significance level of 0.05. The result showed the signicant relationship between family income and the incidence of chronic energy deficiency in pregnant women (p<0.05). in addition, inadequate macronutrient intake, particularly enegry and protein intake, was significantly associated with the incident of CED (p<0.05). family income and macronutrient intake are significantly associated with the incident of chronic energy deficiency in pregnant women. Effort to impove household economic conditions and maternal mutritional intake are essential to prevent CED during pregnancy.
Factors Influencing Nurses' Performance in Hospital Settings: A Systematic Review
Nurse performance is a key indicator of healthcare quality in hospitals because it directly relates to patient safety, nursing care effectiveness, and organizational performance. Therefore, a comprehensive synthesis of scientific evidence is needed to understand the determinants of nurse performance in hospital settings. To identify and synthesize scientific evidence related to factors that influence nurse performance in hospitals. This systematic review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A literature search was conducted in PubMed/MEDLINE, Scopus, and CINAHL databases for English-language articles published between 2021 and 2025. A total of 378 articles were identified initially. After removing duplicates and screening titles, abstracts, and full texts based on the PICOS criteria, seven cross-sectional studies met all inclusion criteria. Data were systematically extracted and analyzed using a narrative synthesis approach. The synthesis identified three main categories of factors influencing nurse performance. First, psychological factors and personal capacities, such as self-efficacy, grit, work engagement, and secondary traumatic stress, showed a significant relationship with nurse performance. Second, organizational and practice environment factors, including a supportive work environment, social support, leadership, workload, and reward systems, played a significant role in enhancing or degrading performance. Third, demographic characteristics and physical conditions, such as length of service, education level, health status, and overtime work habits, also influenced nurses' work effectiveness in hospitals. Nurse performance in hospitals is the result of a complex interaction between individual, psychological, and organizational factors. These findings underscore the importance of a holistic approach to nursing management, focusing not only on nurses' clinical competence but also on creating a supportive work environment and organizational policies that are responsive to the needs of the nursing workforce.
Factors Associated with Mental Health Status of Pregnant Women
Mental health of pregnant women is an important aspect of efforts to improve the health status of mothers and children. South Lampung Regency still faces low achievement in mental health screening of pregnant women (22.27%). This study aims to determine the factors associated with the mental health status of pregnant women in South Lampung Regency in 2025. This study employed a quantitative approach with a cross-sectional analytical design. The study population consisted of all pregnant women attending nine selected community health centers in South Lampung Regency, with a total sample of 415 respondents selected using proportional random sampling. The dependent variable, namely the mental health status of pregnant women, was measured using the Edinburgh Postnatal Depression Scale (EPDS), which has been validated in the Indonesian population and demonstrated good reliability, with Cronbach’s alpha ranging from 0.78 to 0.85, indicating satisfactory internal consistency. A cut-off score of ≥10 was applied to classify pregnant women as being at risk of depression, as this threshold is considered sensitive for community-based screening in primary health care settings. The independent variables maternal age, gestational age, residence, spousal support, frequency of antenatal care (ANC) visits, and history of mental disorders were measured using a structured questionnaire. Data analysis was conducted using univariate, bivariate (Chi-Square test), and multivariate (multiple logistic regression) analyses. The results of the chi-square test showed a significant relationship between the age of the pregnant woman (p=0.000; OR=2.755), gestational age (p=0.014; OR=1.684), place of residence (p=0.004; OR=0.544), spousal support (p=0.000; OR=0.462), frequency of ANC visits (p=0.026; OR=0.625), and history of mental disorders (p=0.000; OR=3.595) with the mental health status of pregnant women. Multiple logistic regression analysis showed that the dominant factor associated with the mental health status of pregnant women was a history of mental disorders in the family (OR=4.453). In conclusion, there is a relationship between the age of pregnant women, gestational age, place of residence, spousal support, frequency of ANC visits, and history of mental disorders with the mental health status of pregnant women. The dominant influencing variable is a family history of mental disorders.
The Relationship of Service Quality, Pricing, and Digital Marketing with Customer Revisit Intention
Patient revisit intention is an important indicator for evaluating hospital service performance, as it reflects patient satisfaction and loyalty. This study aims to analyze the effect of service quality, tariffs, and digital marketing on patient revisit intentions at Bhayangkara Kediri Hospital in 2025, both partially and simultaneously. This research employs a quantitative approach with an observational analytic design and a cross-sectional method. The study population included all outpatient patients who revisited the hospital from June to August 2024, totaling 18,317 patients, and a sample of 110 respondents was selected using purposive sampling based on inclusion criteria, calculated with Slovin’s formula and supported by a power test. Data were collected using structured questionnaires that had been tested for validity and reliability, and subsequently analyzed using multiple linear regression. The results indicate that, partially, service quality (X₁) has a positive and significant effect on patient revisit intention (β = 0.147; t = 3.297; p = 0.001), as do tariffs (X₂) (β = 0.173; t = 2.453; p = 0.016) and digital marketing (X₃) (β = 0.299; t = 4.158; p < 0.001). Simultaneously, all three independent variables significantly affect patient revisit intention (F = 38.336; p < 0.001), with a coefficient of determination (R²) of 0.520, indicating that 52% of the variation in revisit intention is explained by the study variables, while 48% is influenced by other factors. These findings emphasize that improving service quality and optimizing digital marketing are the main factors in strengthening patient loyalty, while tariffs act as a supporting variable in patients’ decision to revisit.
Effectiveness of Providing High-Protein Snacks from Tempe on Weight Gain in Malnourished Children: A Literature Review
Malnutrition can lead to growth retardation. Untreated malnutrition can trigger weight faltering, which can lead to a 15-20 point decrease in IQ scores and impact a child's learning ability and cognitive function. Malnutrition in children is caused by diets that do not meet nutritional needs, particularly low-protein diets. This deficiency can potentially lead to an imbalance in the gut microbiota and interfere with optimal nutrient absorption. Therefore, innovations are needed in the form of practical, protein-rich snacks from tempe. This study aims to review the effectiveness of providing high-protein snacks from tempe on weight gain in malnourished children based on recent research findings. This study employed a literature review method by searching relevant articles online through Google Scholar, ScienceDirect, and PubMed databases. The inclusion criteria were full-text articles, involving Children aged 1 to 12 years, published within the last five years (2020–2025), written in English or Indonesian, and relevant to the research topic. The literature search was conducted through several scientific databases using relevant keywords, resulting in 434 articles in the initial identification stage and five eligible articles were reviewed and analyzed to evaluate the impact of providing high-protein snacks from tempe on weight gain in malnourished children. Providing high-protein tempeh snacks has a significant effect on weight gain in malnourished children, with weight gain ranging from 0.2 kg to 0.5 kg. Providing high-protein snacks can increase the weight of children with malnutrition.
Effectiveness of Cognitive Exercise on Anxiety Levels in the Elderly
Anxiety is a common psychological problem experienced by older adults and can impact quality of life and cognitive function. Various non-pharmacological interventions have been used to reduce anxiety in older adults, but most studies still focus on physical activity and relaxation. Empirical evidence regarding the effectiveness of cognitive training on anxiety in older adults is limited and shows varying results. Therefore, this study was conducted to assess the effectiveness of cognitive training in reducing anxiety levels in older adults. Objective to determine the effectiveness of cognitive gymnastics on anxiety levels in the elderly at the Tresna Werdha 3 Social Home. This study used a quantitative approach with a pre-test and post-test design in one group. A sample of 45 elderly individuals was selected using the Slovin formula. Data collection was conducted through interviews and the Hamilton Anxiety Rating Scale (HARS) questionnaire. The HARS questionnaire was valid (0.30 – 0.80) and reliable (Cronbach’s Alpha 0.93). Data analysis was performed using univariate and bivariate methods using paired sample t-tests. Before the intervention, most elderly individuals experienced mild (46.8%) to moderate (31.9%) anxiety. After the intervention, the proportion of elderly with mild anxiety increased to 60%, and 8.9% experienced no anxiety. Paired Sample t-test results showed a significant decrease in anxiety scores (p < 0.001). Cognitive gymnastics is effective in significantly reducing anxiety levels in elderly individuals and can be used as a non-pharmacological intervention to improve the psychological well-being of elderly individuals.
Qualitative Study: Ethical Standards and Patient Rights
In the era of health transformation following the enactment of Law Number 17 of 2023, hospitals are faced with the significant challenge of integrating ethical standards and patient rights protection into real-world service practices. As a referral hospital with high patient dynamics, Al-Fatah Ambon General Hospital requires an internal evaluation mechanism to ensure that administrative policies are aligned with implementation in the field. This study aims to analyse the effectiveness of the implementation of ethical standards and patient rights through a self-assessment method. This study uses a descriptive qualitative approach with a thematic analysis design. Data were collected through semi-structured interviews with five key informants: the Head of Personnel, personnel staff, HRD, Head of Training, and the Secretariat. Data collection used a semi-structured interview technique. Data were collected using a self-assessment instrument. The data analysis technique employed was thematic analysis, then compared and synchronised with the latest national regulations, particularly Law No. 17 of 2023. The study findings reveal a high level of compliance, with an average score exceeding 85%. Al-Fatah General Hospital achieved a perfect score (100%) in the aspects of complaint handling and understanding of managerial ethics. This success was driven by the transparency of its no-down-payment emergency financing policy and ethical leadership that prioritises patient safety over administrative procedures. Al-Fatah General Hospital Ambon has successfully internalised ethical standards and patient rights in accordance with the latest national regulations. A strong internal oversight system and a responsive complaint handling mechanism are key to maintaining service quality and public trust.
Analysis of Risk Factors Associated with Type 2 Diabetes Mellitus among Regional Government Organizations Employees
Type 2 diabetes mellitus was a major non communicable disease with an increasing prevalence among the productive-age population. Multiple risk factors, including sociodemographic characteristics, lifestyle behaviors, clinical conditions, and family history, were known to contribute to its development. Employees of Regional Government Organizations (RGO) represented a productive age group with a potentially high risk of type 2 diabetes mellitus. This study aimed to analyze risk factors associated with type 2 diabetes mellitus. A quantitative cross sectional study was conducted from January to February 2023 involving 3,313 RGO employees. A total of 1,955 respondents were selected using accidental sampling based on the Lemeshow formula. Data were collected through questionnaire, physical examinations, and random blood glucose measurements. The questionnaire was not subjected to validity and reliability testing, as the data were derived from direct measurements and interview findings. Statistical analyses were performed using chi-square tests and multiple logistic regression. The results showed that body mass index, sex, family history of diabetes mellitus, blood pressure, and history of heart disease were significantly associated with type 2 diabetes mellitus (p<0.05). In contrast, smoking behavior, physical activity, fruit and vegetable consumption, and history of stroke were not significantly associated. Multivariate analysis indicated that family history of diabetes mellitus was the most dominant risk factor (OR = 4.882). It was concluded that family history of diabetes mellitus was the strongest determinant of type 2 diabetes mellitus among RGO employees, emphasizing the importance of early screening and risk factor management in the productive age population.
The Relationship between High Heel Size Variation and Long Standing Duration on the Risk of Plantar Fasciitis
a Plantar fasciitis is one of the most common musculoskeletal complaints, especially in working women who often wear high heels and stand for long periods of time, such as Sales Promotion Girl (SPG). Biomechanical stress due to unnatural foot position when wearing high heels and standing static for long periods of time can increase the risk of plantar fasciitis. This study aimed to determine the relationship between the variation in the size of high heels and the length of standing duration on the risk of plantar fasciitis in female Sales Promotion Girl (SPG) workers. A cross-sectional study was conducted in one of the shopping centers in Surabaya in June 2025 - September 2025. A total of 66 Sales Promotion Girls were selected by simple random sampling. The dependent variable is plantar fasciitis. Independent variables were variations in heel size, high heel, and length of standing. Data was collected using questionnaire that had been tested for validity and reliability. The data was analyzed by the Spearman Correlation Test. The results showed that 68.6% of respondents used ≥5 cm heels and 57.1% stood >8 hours per day. Of all respondents, 51.4% experienced no pain, 32.9% mild pain, and 15.7% moderate pain. Spearman's correlation analysis found a moderately positive association between high heel shoe height and standing duration with the risk of plantar fasciitis (p<0.001). The variation in the size of high heels and long standing duration had a significant relationship with the risk of plantar fasciitis, with a positive relationship, namely the higher the heel and the longer the duration of standing, the higher the risk of SPG women experiencing plantar fasciitis.
The Effect of Empowering Health Cadres Through Whatsapp on the Knowledge and Skills of Health Cadres in Hypertension Management
Hypertension remains one of the leading causes of global mortality, affecting approximately 1.28 billion adults worldwide, yet only 21% successfully manage to control their blood pressure. This highlights the urgent need for community-based strategies, particularly through the empowerment of health cadres. Digital health education interventions—such as those utilizing WhatsApp—are considered promising for enhancing cadres’ competencies in hypertension management. The aim of this study was to determine the effect of empowering health cadres through Whatsapp on the knowledge and skills of cadres in hypertension management. This study employed a quasi-experimental design with a pretest-posttest control group approach. The first phase involved the development of a training module informed by a literature review, field study, and expert consultation. Data collection was done using purposive sampling with inclusion and exclusion criteria, a total of 60 respondents, 30 intervention and control groups each. In the second phase, an intervention was conducted involving 60 health cadres (30 in the intervention group and 30 in the control group) within the jurisdiction of Tateli public health care, delivered via WhatsApp. Data were analyzed using the Wilcoxon Signed Rank Test and the Mann-Whitney U Test, with a significance level set at p < 0.05. The findings revealed a statistically significant improvement in both knowledge and skills among cadres in the intervention group. Knowledge increased from moderate (90%) to good (73.3%), and skills from moderate (90%) to good (93.3%), with p < 0.001. No significant changes were observed in the control group. WhatsApp-based educational interventions are effective in improving health cadres' knowledge and skills in hypertension management. Given its accessibility, affordability, and practicality, WhatsApp serves as a strategic and sustainable tool for ongoing cadre training in the prevention and control of non-communicable diseases at the community level.
Phenomenological Study of Patient Experiences with Metabolic Syndrome
Metabolic syndrome is a cluster of interrelated metabolic risk factors that have the potential to cause chronic complications such as type 2 diabetes mellitus and cardiovascular disease. This condition affects not only physical aspects but also the psychological and social dimensions of patients. This study aimed to explore the experiences of patients with metabolic syndrome in their daily lives after being diagnosed. A qualitative approach with a phenomenological method was employed to explore and understand the lived experiences of patients with metabolic syndrome. Data were collected through Focus Group Discussion (FGD) and observations involving eight patients aged 56-60 years diagnosed with metabolic syndrome (seven women and one man), each presenting at least three diagnostic components. Data were analyzed using the Miles and Huberman Model, which includes data reduction, data display, and conclusion drawing/verification. Five main themes were identified: (1) initial post-diagnosis experiences, including denial and anxiety; (2) the impact of metabolic syndrome on physical and psychological conditions; (3) family support in emotional, functional, and acceptance forms; (4) adaptation and coping, consisting of self-initiated efforts, treatment adherence, and following healthcare professionals’ recommendations; and (5) life changes after diagnosis, including lifestyle modification, spiritual strengthening, challenges, and the formation of new habits. Patients with metabolic syndrome undergo complex emotional and adaptive processes. Family and healthcare professional support play important roles in helping patients adjust to this chronic condition. These findings contribute to the development of nursing practice based on a holistic bio-psycho-socio-spiritual approach.
Literature Review: Factors Associated with the Incidence of Chronic Energy Deficiency in Pregnant Women
Chronic Energy Deficiency in pregnant women is a serious health problem because it increases the risk of complications during pregnancy, childbirth, and fetal growth. Various studies have shown that the prevalence of chronic energy deficiency remains high and is influenced by multidimensional factors such as nutritional status, socioeconomic status, knowledge, and access to health services. The purpose of this study was to conduct a literature review to identify factors of chronic energy deficiency to strengthen evidence-based prevention strategies, specifically dietary patterns, maternal knowledge, and husband or family support. The study used a literature review by searching articles in PubMed, ScienceDirect, and Google Scholar. The inclusion criteria were articles published between 2021 and 2025, cross-sectional design, full papers, and discussing variables related to chronic energy deficiency in pregnant women. The MeSH (Medical Subject Heading)-based keywords were "Chronic Energy Deficiency" AND "Pregnant Women" AND "Food Consumption Patterns" OR "Husband/Family Support" OR "Mother's Knowledge". A total of 21 articles met the criteria and were analyzed. Most studies found a significant association between maternal knowledge and the incidence of chronic energy deficiency. Consumption patterns were also associated with the incidence of chronic energy deficiency, especially in mothers with low energy and protein intake. Husband or family support has been shown to be a reinforcing factor that helps mothers meet nutritional needs through emotional, informational, and financial support. Prevention of chronic energy deficiency requires a multidimensional approach that focuses on increasing nutritional knowledge, improving eating habits, and strengthening family support.
The Relationship between Physical Activity and Blood Pressure Status in Hypertensive Patients
Hypertension is a major global health problem with an increasing prevalence and a high risk of serious complications. Insufficient physical activity is recognized as a significant modifiable risk factor for elevated blood pressure. This study aims to identify the relationship between physical activity and blood pressure status in hypertensive patients in the working area of the Nguter Community Health Center, Sukoharjo Regency. This quantitative study employed a descriptive correlational design with a retrospective longitudinal approach. Sampling was conducted using purposive sampling based on specific criteria, resulting in 207 hypertensive respondents. Physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ), which has been tested for validity and reliability. Blood pressure was measured using a sphymomanometer that had been calibrated by the Agency for the Security of Medical Devices and Facilities (BPAFK) in Surakarta. Data analysis involved univariate examination, bivariate testing with Spearman rank test, and odds ratio calculation. The majority of respondents had light physical activity (61.4%) and stage 2 hypertension (69.9%). The analysis showed a significant negative correlation between physical activity and blood pressure status in hypertensive patients (p < 0.001; r = -0.337). Respondents with light physical activity were 4.5 times more likely to have stage 2 hypertension than those with moderate and heavy physical activity (OR = 0.221; 95% CI: 0.118-0.415). In conclusion, respondents with light physical activity had a higher risk of developing stage 2 hypertension. Regular physical activity plays a crucial role in the prevention and control of hypertension. Education from health professionals and community motivation are necessary to enhance awareness of the benefits of regular physical activity.
The Relationship Between Chronic Kidney Disease and Sarcopenia: A Systematic Review
Chronic kidney disease (CKD) is a growing global health problem and is associated with multiple systemic complications. One important but often underrecognized complication is sarcopenia, characterized by progressive loss of muscle mass, strength, and physical performance. Sarcopenia is highly prevalent in patients with advanced CKD and those undergoing hemodialysis and is associated with poor clinical outcomes, including increased hospitalization, functional decline, and mortality. This literature review aimed to synthesize recent evidence on the relationship between CKD and sarcopenia, including prevalence, contributing factors, pathophysiological mechanisms, and clinical implications. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Semantic Scholar for English-language articles published between 2020 and 2025. Study selection was guided by the PICOS framework. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. A total of 15 studies meeting the inclusion criteria were included in the final synthesis. The included studies reported a high prevalence of sarcopenia among CKD patients, ranging from 15.9% to 64.1%, with higher rates observed in advanced CKD stages and hemodialysis populations. Sarcopenia was consistently associated with older age, malnutrition, protein–energy wasting, chronic inflammation, reduced physical activity, and metabolic disturbances. Clinically, sarcopenia was linked to increased mortality, hospitalization, reduced physical function, and poorer quality of life. Sarcopenia is a prevalent and clinically significant complication of CKD. Early detection and integrated interventions combining nutritional optimization, resistance exercise, and metabolic management are essential to improve patient outcomes. Further longitudinal studies are needed to strengthen preventive and therapeutic strategies.
The Relationship between Parenting Style and Nutritional Intake with Children's Language Development
Language development is a fundamental aspect of early childhood's golden period, influenced by environmental factors, namely parenting patterns and biological foundations through nutritional intake. This literature review aims to analyze the relationship between parenting patterns and nutritional intake and children's language development. The data used are secondary data in the form of articles from PubMed, Science Direct, and Google Scholar. Researchers used 21 national and international research articles published between 2020 and 2025. The inclusion criteria for this study were: 1) primary research articles published between 2020 and 2025; 2) article topics aligned with the research objectives; and 3) articles from accredited national full access journals and reputable international journals. The synthesis of results indicates that parenting patterns that provide positive verbal stimulation and interaction, as well as regulating gadget use, can improve children's receptive and expressive language skills. Conversely, excessive gadget use without parental supervision can increase the risk of language delay. From a nutritional perspective, stunting and micronutrient deficiencies (especially iron and zinc) contribute to impaired cognitive function and attention, which impact children's language acquisition. In conclusion, children's language development is influenced by a combination of parenting patterns and nutritional intake, with good parenting patterns and balanced nutritional intake being key components in supporting optimal language development.
The Effectiveness of Poundfit Exercise as High-Intensity Interval (HIIT) Training on Stress and Anxiety Levels among Young Adults with A Sedentary Lifestyle
Stress and anxiety are common mental health problems among young adults, particularly those with a sedentary lifestyle. Regular physical activity, especially high-intensity interval training (HIIT), has been suggested as a non-pharmacological approach to improve mental health outcomes. Poundfit is a music-based HIIT exercise that combines rhythmic movements and high-intensity activity, which may provide psychological benefits. This study aimed to examine the effectiveness of Poundfit exercise as a HIIT program on stress and anxiety levels among young adults with a sedentary lifestyle. A quasi-experimental study with a pretest–posttest control group design was conducted involving 40 young adults with high sedentary behavior, divided into an intervention group (n = 20) and a control group (n = 20). The intervention group participated in a Poundfit exercise program for four weeks (12 sessions), conducted three times per week with a duration of 45 minutes per session and led by a certified instructor. Stress and anxiety levels were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using paired samples t-tests and independent samples t-tests. The results showed a significant reduction in stress and anxiety levels in the intervention group compared to baseline, while no significant changes were observed in the control group. Posttest comparisons indicated significantly lower stress and anxiety levels in the intervention group than in the control group. Poundfit exercise may be considered an effective and enjoyable physical activity to support mental health among sedentary young adults.
Effect of Stunting on Cognitive Development of Children: A Systematic Literature Review
Stunting is a critical global health issue, with Indonesia ranking third in Southeast Asia for prevalence. This study examines the impact of stunting on cognitive development, its determinants, and interventions in Low- and Middle-Income Countries (LMICs). A systematic review was conducted across ProQuest, Ebsco, PubMed, and SpringerLink for English peer-reviewed articles (2009–2019). Using the PICOS framework, the review focused on stunted children (0–16 years) in LMICs. After screening 157 records and performing quality appraisals, 13 high-quality studies (scores >8/12) were selected for qualitative synthesis. Findings across Africa, Asia, and South America show stunting prevalence between 15.6% and 41.4%. Stunting typically manifests in the first three years due to chronic malnutrition and infectious diseases. Key risk factors include low socioeconomic status and parental education. Stunted children scored significantly lower in memory, spatial ability, and attention compared to non-stunted peers. While some children achieving catch-up growth showed improved results, those who recovered often still lagged behind children who were never stunted. Evidence confirms a strong correlation between stunting and impaired cognitive development. Despite global data, there remains a significant research gap regarding this specific correlation in Indonesia over the last decade.
Effectiveness of Ice Pack Application on Pain During Intravenous Insertion Procedures in Preschool-Aged Children
Introduction: Intravenous (IV) cannulation in preschool-aged children often causes pain, which can affect their comfort and overall experience in hospital. Various pain reduction techniques, such as deep-breathing and distraction, are commonly used but are not always effective in directly minimising pain. One non-pharmacological method to reduce pain is the application of ice packs or cold compresses. Aim: This article review aims to evaluate the effect of ice pack application on pain in preschool-aged children undergoing IV cannulation. Methods: This literature review utilised five databases: Google Scholaa Intravenous (IV) cannulation in preschool-aged children often causes pain, which can affect their comfort and overall experience in hospital. Various pain reduction techniques, such as deep-breathing and distraction, are commonly used but are not always effective in directly minimising pain. One non-pharmacological method to reduce pain is the application of ice packs or cold compresses. This article review aims to evaluate the effect of ice pack application on pain in preschool-aged children undergoing IV cannulation. This literature review utilised five databases: Google Scholar, ScienceDirect, ResearchGate, PubMed, and Portal Garuda. The keywords used included “use of ice pack in preschool children”, “effectiveness of ice compress”, and “IV cannulation”. Of the 138 articles published between 2015 and 2025 prospective articles identified, only 13 met the inclusion criteria. The quality of the articles was assessed using the 2020 CASP instrument. Based on data extraction, the authors found that the use of ice packs is effective as a non-invasive intervention and can reduce pain during IV insertion. Conclusion: Paediatric nurses are advised to consider the use of ice packs as part of atraumatic care in order to minimise procedural pain in children. r, ScienceDirect, ResearchGate, PubMed, and Portal Garuda. The keywords used included “use of ice pack in preschool children”, “effectiveness of ice compress”, and “IV cannulation”. Of the 138 prospective articles identified, only 13 met the inclusion criteria. The quality of the articles was assessed using the 2020 CASP instrument. Results: Based on data extraction, the authors found that the use of ice packs is effective as a non-invasive intervention and can reduce pain during IV insertion. Conclusion: Paediatric nurses are advised to consider the use of ice packs as part of atraumatic care in order to minimise procedural pain in children.
Stress Levels and Blood Sugar Control in Patients with Type 2 Diabetes Mellitus
The prevalence of type 2 diabetes mellitus (T2DM), a chronic condition, is on the rise around the world. Glycemic regulation, which includes unexpected blood glucose levels, is impacted by both biological and psychological influences, including stress. Specifically, studies examining the impact of stress on unforeseen glucose regulation have been under-researched in Indonesia. This research aims to fill a gap in our understanding of how stress influences individuals' ability to deliberately regulate their blood sugar levels. Those taking part in the study were monitored using a cross-sectional method. Two hundred patients with type 2 diabetes mellitus were selected from the patient registry of the Baki Community Health Center based on a list of predefined inclusion and exclusion criteria. We measured the amount of stress and then categorized it as low, medium, or high using the Perceived Stress Scale (PSS). Stress levels were measured using the Indonesian version of the Perceived Stress Scale-10 (PSS-10), which had been previously validated and demonstrated good reliability (Cronbach’s Alpha α = 0.84). During data collection, a single RBG test was performed to evaluate the impact of random modulation on blood glucose levels. In both the univariate and bivariate data analyses, Pearson's Chi-Square test was employed with a significance level of p < 0.05 to determine if the variables were related. We utilized Cramer's V to determine the reliability of the association. This study was authorized by the Health Research Ethics Committee of the Faculty of Medicine at Muhammadiyah University Surakarta. The study comprised 200 participants, the average age of whom was 41.82 ± 6.50 years. Women comprised 67.5% of that group. On average, 244.07 ± 84.46 mg/dL was recorded by 60% of those whose levels were uncontrolled and 51.5% of those who indicated moderate stress. The results of the bivariate analysis showed a significant relationship (χ² = 81.919; p < 0.001) between the levels of stress and the random control of blood glucose. Their bond was strong. People with type 2 diabetes mellitus find it more difficult to regulate their blood glucose levels when they are under a lot of stress. A substantial and statistically significant relationship exists here. The results show that mental stress needs to be taken into account while managing blood sugar levels thoroughly.
Adolescent Emotion Regulation Based on Emotional Intelligence and Self-Compassion
Adolescence is a developmental stage characterized by social pressure, emotional turbulence, and identity exploration. Emotion regulation is a crucial skill that enables adolescents to adapt to social and academic demands. This study aimed to examine the role of emotional intelligence (EI) and self-compassion (SC) as predictors of emotion regulation among adolescents in Manado City. An explanatory quantitative design was employed, involving 300 high school students aged 15–19 years selected through stratified random sampling. Data were collected using the Schutte Emotional Intelligence Scale, the Self-Compassion Scale, and the Difficulties in Emotion Regulation Scale (DERS). Prior to the main study, all instruments were subjected to validity and reliability testing on a pilot sample of 30 adolescents with characteristics comparable to the study population. Item validity was assessed using item–total correlation, while reliability was evaluated using Cronbach’s alpha coefficient. Data were analyzed using descriptive statistics and multiple linear regression after meeting classical assumption tests. Indicated that the regression model was statistically significant (F = 412.245; p < 0.001), with a coefficient of determination (R²) of 0.727, indicating that EI and SC jointly explained 72.7% of the variance in emotion regulation. Partial analyses revealed that EI had a positive and significant effect on emotion regulation (B = 0.321; p < 0.001), whereas SC showed no significant effect (B = −0.009; p = 0.750). These findings indicate that emotional intelligence is the dominant factor in enhancing adolescents’ emotion regulation. Therefore, school-based mental health interventions should prioritize strengthening emotional intelligence, while fostering self-compassion may serve as a complementary long-term strategy.
Effectiveness of High-Intensity Physical Exercise (HIIT) through Poundfit Exercise on Cognitive Function in Young Adults with A Sedentary Lifestyle
Technological developments and lifestyle changes following the COVID-19 pandemic have increased the prevalence of sedentary behavior in young adults, potentially negatively impacting cognitive function. Physical activity interventions, particularly High-Intensity Interval Training (HIIT), are known to have benefits for brain health. Pound Fit is a form of HIIT that combines high-intensity exercise, rhythmic music, and motor coordination, but empirical evidence regarding its effects on cognitive function in sedentary young adults is still limited. This study aims to analyze the effectiveness of HIIT through Pound Fit on cognitive function in young adults with a sedentary lifestyle. This study used a Randomized Controlled Trial (RCT) design with a quantitative approach. The MoCA-Ina has been reported to have good construct validity and high reliability with a Cronbach's Alpha value >0.70, making it considered reliable for measuring cognitive function in the Indonesian population. A total of 40 female Nursing students with a sedentary lifestyle were recruited and randomly divided into an intervention group (n=20) and a control group (n=20). The intervention group participated in a HIIT-based Pound Fit exercise program for four weeks (3 times/week, ±45 minutes/session), while the control group carried out their usual activities. Cognitive function was measured using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina) before and after the intervention. Data analysis was performed using a Paired Samples t-test and an Independent Samples t-test . The results of the paired samples t-test showed a significant increase in cognitive function in the intervention group after Pound Fit exercise (p < 0.001). The independent samples t-test also showed a significant difference in cognitive function scores between the intervention group and the control group in the posttest measurement (p < 0.001). All data met the assumptions of normality and homogeneity. HIIT training through Pound Fit exercise has been proven effective in improving cognitive function in young adults with a sedentary lifestyle. This intervention has the potential to be an applicable promotive and preventive strategy in nursing and public health practice to support the cognitive health of young adults.
Dermatomyositis is a systemic autoimmune disorder that is an inflammatory disease of the skin, muscles, and blood vessels with characteristic skin eruptions accompanied by proximal limb muscle weakness or atrophy. This condition can affect children and adults. The pathognomonic lesions are the heliotrope sign, Gottron's papule, and Gottron's sign Malignancy can occur in 10%- 20%, with nasopharyngeal cancer being the most common. Etiology and pathogenesis are autoimmune; other triggers include drugs, infection, sun exposure, and malignancy. The latest diagnosis criteria by EULAR/ACR 2017 and Sontheimer et al. can be used as a reference for diagnosis. Comprehensive management of dermatomyositis aims to decrease symptoms, increase quality of life, and early detection of malignancy. Topical therapy options for dermatomyositis are topical calcineurin inhibitors and corticosteroids. In addition, systemic therapy consists of steroid- sparing agents, antimalarials, and corticosteroids. The current treatment of dermatomyositis is the administration of intravenous Immunoglobulin (IVIG) and rituximab.
Analysis of Placental Profile in Pregnancy with Hypertension and Its Relationship with the Condition of the Newborn
Hypertension in pregnancy (HDK) is one of the main complications that contribute to maternal and infant morbidity and mortality. This study aims to analyze the placental profile in pregnancies with hypertension and its relationship with the condition of the newborn. This study used an observational analytical design with a case-control approach. The sample consisted of 60 respondents consisting of 30 mothers with HDK (case group) and 30 mothers without hypertension (control group), selected using consecutive sampling technique. Data analysis was performed using t-test, Chi-square, and logistic regression with a significance level of p < 0.05. There were significant differences in placental profiles between the case and control groups, where the HDK group had lower weight (420 ± 55 vs 510 ± 60 grams; p = 0.001), diameter (16.5 ± 1.8 vs 18.2 ± 1.5 cm; p = 0.002), and thickness (2.1 ± 0.4 vs 2.8 ± 0.5 cm; p = 0.001). The incidence of infarction (60.0 % vs 20.0%; p = 0.002) and calcification (66.7% vs 26.7%; p = 0.001) was higher in the HDK group. The condition of newborns in the HDK group showed a higher incidence of LBW ( 50.0 % vs. 20.0%; p = 0.015), APGAR <7 (40.0% vs. 16.7%; p = 0.032), and asphyxia (43.3% vs. 16.7%; p = 0.021). Analysis showed that low placental weight (OR=3.8 ; p = 0.008), infarction (OR=4.5; p = 0.004), and calcification (OR=3.9; p = 0.006) were significantly associated with the condition of newborns. Placental profiles in hypertensive pregnancies experienced significant changes and were closely associated with the condition of newborns.
The Role of Knowledge and Attitude as Determinants of Adolescent Girls’ Compliance with Iron Tablet Consumption
Anemia remains one of the most significant global nutritional problems, particularly affecting adolescent girls. In Indonesia, the government has implemented a preventive strategy through the Weekly Iron and Folic Acid Supplementation (WIFAS) program, commonly known as tablet tambah darah (TTD). However, the success of this program relies heavily on adolescents’ adherence to regular consumption. Knowledge and attitude are recognized as key psychological determinants influencing compliance with iron supplementation. This study aimed to examine the correlation between knowledge and attitude with compliance in iron tablet consumption among adolescent girls at SMA Negeri 2 Sukoharjo. A descriptive correlational design with a quantitative approach was employed, involving 100 female students from grade XI selected using purposive sampling. Data were collected through a structured questionnaire measuring knowledge, attitude, and compliance variables. The instrument demonstrated good validity with Pearson Product Moment correlation coefficients ranging from 0.54 to 0.88 and acceptable reliability with a Cronbach’s Alpha value of 0.79. Statistical analysis was performed using the Chi-Square test at a significance level of p < 0.05. The majority of respondents had good knowledge (59%), positive attitudes (73%), and high compliance (44%) toward TTD consumption. The Chi-Square test showed a significant association between knowledge and compliance (p = 0.010), as well as between attitude and compliance (p = 0.010). The study concludes that knowledge acts as a primary cognitive factor influencing adolescents’ compliance with iron tablet intake, while attitude serves as a reinforcing element that strengthens behavioral intention and consistency.
Effectiveness Hydrogel Plaster of Kirinyuh and Palm Empty Fruit Bunches as An Anti-Inflammatory Cut Wound
Urgency of this research is that the use of non-steroidal drugs often causes gastrointestinal irritation, while non-steroidal drugs often cause side effects that disrupt growth and the immune system. long-term use of these medications has potential to cause side effects. Important to find alternative treatments that can prevent these side effects. Reiducing inflammation and speieiding up wound heialing reiquireis appropriatei heialing meithods, onei of which is using a wound dreissing containing anti-inflammatory propeirtieis. Deiveilopmeint of a hydrogeil wound dreissing from palm eimpty fruit buncheis wastei as a substitutei for hydrophilic hydrogeil cheimicals. This reiseiarch not only teisteid thei eiffeictiveineiss of thei hydrogeil wound dreissing but also reiduceid thei probleim of palm eimpty fruit buncheis wastei eixpeirieinceid by thei community, particularly in North Sumateira speicifically Asahan. Thei aim of this reiseiarch was to deiteirminei thei eiffeictiveineiss of kirinyuh leiaf eixtract and to utilizei thei ceillulosei conteint of palm eimpty fruit bunch wastei as a hydrogeil plasteir as an anti-inflammatory for cuts. Thei reiseiarch meithod useid was eixpeirimeintal meithod, which includeis sampling, preiparation of kirinyuh leiaf steim eixtract with conceintrations of 4,6%, 5,6% and 6,6%, Preiparation of ceillulosei eixtract 10%, phytocheimical screieining, hydrogeil plasteir eivalution teist and anti-inflammatory teist of hydrogeil plasteir on malei rats (Rattus norveigicus) groupeid in to 5 groups. Statistical analysis includeis onei-way ANOVA to seiei theirei is a significant diffeireincei beitweiein conceintrations in thei heialing of incisional wounds in malei rats. Thei reiseiarch showeid that F1 (4.6% conceintration) heialeid rat cuts on day 12, F2 (5.6% conceintration) heialeid rat cuts on day 10, F3 (6.6% conceintration) heialeid rat cuts on day 8, and thei positivei control (Deirmafix T Plasteir) heialeid rat cuts on day 6. Hydrogeil plasteir of kirinyuh leiaf eixtract and palm eimpty fruit buncheis arei eiffeictivei as anti-inflammatory ageints for cuts in whitei rats (Rattus norveigicus).
Exploration of Occupational Accident Risk Factors Causing Worker Disability in the Coconut Flour Industry
Occupational accidents in the coconut flour industry in Gorontalo Regency remain a serious threat to workers, with an increasing incidence rate and a high risk of causing permanent disability. This study aims to analyze the risk factors for work-related accidents leading to disability among workers in the coconut flour industry of Gorontalo Regency. This research is a qualitative study utilizing a case study approach. Data collection was conducted through in-depth interviews, field observations, and documentation. The informants consisted of workers with disabilities resulting from occupational accidents, the person in charge of the Occupational Health and Safety Management System (OHSMS), and OHS practitioners. Data analysis was performed using the Miles and Huberman model. The results indicate that accidents leading to disability are dominated by the sheller unit. These incidents are triggered by the interaction between unsafe actions and unsafe conditions. Behavioral factors include low OHS knowledge, rushed work attitudes to meet production targets, and non-compliance with the use of standardized Personal Protective Equipment (PPE). These conditions are exacerbated by substandard physical work environments, characterized by high room temperatures (32.3°C–33.7°C) and dim lighting (132–176 Lux), which significantly reduce worker concentration. Furthermore, the suboptimal implementation of OHSMS policies and management supervision increases the risk of fatalities.
Analysis of Causal Factors and Malaria Vector Breeding Sites among Mining Workers
Malaria remains a major public health problem in mining areas due to environmental conditions that favor mosquito breeding and sustained human–vector contact. Mining workers are particularly vulnerable because of prolonged exposure to high-risk environments. This study aimed to analyze the factors associated with malaria incidence and the presence of vector breeding sites among mining workers in Hulawa Village, Buntulia Subdistrict, Pohuwato Regency. This observational analytic study employed a cross-sectional design involving 125 mining workers. Data were collected through structured interviews using a standardized questionnaire and environmental observations. The questionnaire was developed based on previous empirical studies and underwent validity and reliability testing prior to data collection; item validity was assessed using item–total correlation analysis, while internal consistency was confirmed with Cronbach’s alpha coefficients ≥0.70. Malaria incidence was determined using a Rapid Diagnostic Test (RDT). The independent variables included knowledge, nighttime outdoor activities, history of malaria, risk perception, self-efficacy, length of residence, presence of potential breeding sites, and presence of malaria vectors. Bivariate associations were examined using the chi-square test, and multivariate analysis was conducted using logistic regression. The results showed that several factors were significantly associated with malaria incidence. Knowledge (p = 0.000; OR = 0.018) and history of malaria (p = 0.014; OR = 0.068) acted as protective factors, whereas length of residence in the mining area (p = 0.001; OR = 31.179) and the presence of malaria vectors (p = 0.020; OR = 55.195) significantly increased the risk of malaria. In contrast, self-efficacy and the presence of breeding sites were not significantly associated with malaria incidence. The most dominant factor influencing malaria incidence was the presence of malaria vectors. Malaria incidence among mining workers in Hulawa Village is influenced by a combination of individual and environmental factors, with vector presence and prolonged exposure in mining areas playing a dominant role. These findings highlight the critical importance of prioritizing vector control and environmental management in mining areas as key strategies to reduce malaria incidence.
Monitoring Tuberculosis Patient: the Effectiveness of Directly Observed Therapy (DOT) or PMO
Although global incidence and mortality rates of tuberculosis (TB) have declined, TB remains the second leading cause of death worldwide after HIV/AIDS. To improve treatment adherence, the World Health Organization (WHO) recommends the Directly Observed Treatment, (DOT) strategy, known in Indonesian as the Pengawas Minum Obat (PMO). PMOs are expected to support, remind, and motivate patients to complete their treatment regimen effectively. This study aimed to determine the prevalence of PMO use, identify PMO characteristics, assess medication adherence among active TB patients, and evaluate the relationship between PMO presence and adherence. A descriptive–analytic study with a cross-sectional design using total sampling of all TB patients who were actively undergoing treatment at the Sigerongan Primary Health Care. Data were collected through structured interviews and analyzed using the chi-square statistical test. The study found no significant difference in medication adherence between patients with a PMO and those without (p = 1.000; p > 0.05). Interestingly, 21.7% of patients with a PMO were still non-adherent to their treatment. The study found no significant difference in medication adherence between patients with a PMO and those without. This may be influenced by the small sample size and suboptimal role execution of PMOs.
Palliative Care in Patients with Kidney Failure: Bibliometric Analysis
Palliative care for patients with kidney failure is increasingly recognized as an important approach to improving quality of life through symptom control, psychosocial and spiritual support, and strengthening shared decision-making, yet the global knowledge landscape remains fragmented and incompletely mapped. Mapping publication performance, geographic distribution of country contributions, and the dynamics of research themes related to palliative care in kidney failure patients through bibliometric analysis. A bibliometric study was conducted using the Scopus database spanning the last 10 years. The search strategy combined the keywords palliative care and kidney failure. From 4,730 initial findings, a gradual narrowing was performed to obtain 2,397 documents meeting the criteria, consisting of 1,974 research articles and 423 review articles. Descriptive analysis was used for annual publication trends and country contributions, while VOSviewer version 1.6.18 was used to map keyword co-occurrence, overlay maps, and density maps. Keyword mapping places demographic and clinical terms as central nodes, with primary clusters reflecting acute conditions and severity indicators including acute kidney injury and respiratory infectious complications, chronic kidney disease and dialysis therapy clusters linked to themes of palliative care, terminal care, quality of life, psychology, and conservative care, and geriatric clusters and service outcomes such as hospitalization, comorbidities, risk factors, length of stay, and mortality. The overlay map demonstrates a shift in themes from patient support and quality of life to a stronger focus on clinical outcomes, comorbidities, and infectious and respiratory contexts in the more recent period, while the density map highlights the largest hotspots in the elderly population and the kidney disorder theme networked with hospitalization outcomes.Palliative care research in patients with kidney failure is dominated by clinical themes and service outcomes, while patient-centered themes such as quality of life, psychology, and terminal and conservative care emerge as important but relatively less prominent. Strengthening studies measuring meaningful outcomes for patients and caregivers, standardizing terminology and reporting, and multicenter collaboration across countries are needed to reduce contextual bias and enhance global relevance.
The Effect of Educational Videos on Knowledge and Attitudes of Healthy Eating Patterns to Prevent Anemia in Adolescent Females
Anemia is a common health problem among adolescent girls and has a significant impact on learning concentration and productivity. One of the main contributing factors is an unhealthy dietary pattern. Educational videos are considered an effective medium to improve adolescents’ knowledge and attitudes regarding anemia prevention. To determine the effect of educational videos on knowledge and attitudes related to healthy eating patterns for anemia prevention among adolescent girls at SMP N 1 Cepogo. This study employed a quasi-experimental design with a pretest–posttest control group. A total of 100 female students were selected using proportionate stratified random sampling and divided into intervention and control groups. Data were collected using structured knowledge and attitude questionnaires. Instrument validity was tested using Pearson correlation, showing all items had correlation coefficients greater than the r-table value (r > 0.209; p < 0.05). Reliability testing demonstrated excellent internal consistency, with Cronbach’s alpha values of 0.961 for the knowledge questionnaire and 0.945 for the attitude questionnaire. Data analysis was conducted using the Wilcoxon Signed-Rank test. The control group showed no significant changes in knowledge (p = 0.472) or attitude (p = 0.239). In contrast, the intervention group showed significant improvements in both knowledge (p = 0.05) and attitude (p = 0.00). The mean knowledge score increased from 5.33 to 10.44, while the mean attitude score increased from 35.56 to 50.93. Educational videos are effective in significantly improving knowledge and attitudes toward healthy dietary patterns for anemia prevention among adolescent girls.
Bibliometric Analysis of Global Trends in Cardiac Rehabilitation for Patients with Acute Coronary Syndrome
Cardiac Rehabilitation (CR) is a structured, multidisciplinary program for managing cardiovascular disease that includes education, physical exercise, risk factor modification, and psychosocial support for heart patients, including those who have experienced Acute Coronary Syndrome (ACS). This study aims to analyze global research trends and examine cardiac rehabilitation from 1964 to 2025. A bibliometric analysis was conducted on publications in the Scopus database, The search strategy: in this review was based on the following terms: ‘Cardiac Rehabilitation’ and its alternative keywords (‘Acute Coronary syndrome*’, "Cardiac Rehabilitation. These terms were combined using the Boolean operator ‘AND’ to generate a broad range of results. using visualization, co-occurrence, and trend analysis through VOSviewer software (version 1.6.20). The United States made the largest contribution. The most frequently used keywords were "cardiac rehabilitation," "rehabilitation," and "secondary prevention." The most significant publication increases in 2025 (102 publications), 2021 (101 publications), and 2024 (94 publications). The results show fluctuations in research activity, with a significant increase from 2021 to 2025. Further research should focus on developing technology-based rehabilitation models that are accessible from home and affordable, particularly in low-income countries. As telemedicine, which is still seldom discussed and published.
Pneumonia among Children with Congenital Heart Disease: Patterns by Shunt Type in A Tertiary Hospital in Indonesia
Congenital Heart Disease (CHD) in children is frequently associated with lower respiratory tract infections, particularly pneumonia. Pneumonia risk in CHD is influenced by shunt type, defect size, nutritional status, yet local data regarding these associations remains limited. To determine the incidence of pneumonia in children with CHD and to analyze its association with shunt type and defect size. This retrospective cross-sectional study consecutively extracted demographic and clinical data—including CHD shunt type and defect size, nutritional status, and pneumonia diagnosis—from 134 echocardiography-confirmed medical records of hospitalized and outpatient pediatric CHD treated at Adam Malik General Hospital, Medan, from January 2022 to December 2024. Data associations were analyzed using Chi-square or Fisher’s exact tests, and prevalence ratios (PR) were calculated. Pneumonia occurred in 32.8% (44/134) of children with CHD. A higher proportion of pneumonia was observed in acyanotic CHD compared with cyanotic CHD (40.3% vs. 25.4%; PR 1.57; p = 0.066). Among acyanotic CHD, pneumonia was more frequent in children with large defects than in those with moderate to small defects (47.0% vs. 38.0%; PR 1.24; p = 0.511). Pneumonia is a frequent complication in children with CHD. Acyanotic CHD and larger defect size show a tendency toward increased pneumonia risk, although no statistically significant associations were identified.
Quality of Life in Palliative Care for Patients with Renal Failure: A Bibliometric Analysis
Quality of life is a key outcome in palliative care for patients with chronic kidney disease (CKD), especially in advanced stages and patients undergoing dialysis. Although publications on QoL in palliative care for CKD continue to increase, the global knowledge landscape remains scattered and has not been comprehensively mapped through a bibliometric approach. Objective to map publication performance, the geographical distribution of country contributions, and the dynamics of research themes related to QoL in palliative care for CKD through bibliometric analysis. A bibliometric study was conducted using the Scopus database (Elsevier) with the range 10 years . The search strategy combined the keywords palliative care/support, CKD/ESRD/dialysis, and QoL/health-related QoL. The initial search yielded 1,077 documents, which were then narrowed down to 681 publications (last 10 years), 654 publications (Medicine and Nursing fields), and finally 561 documents (article and review types) for analysis. Descriptive analysis was used for annual publication trends (2016–2026) and country contributions, while keyword co-occurrence mapping, overlay maps, and density maps were performed using VOSviewer version 1.6.18. Publication production showed an increasing trend from 37 documents (2016) to a peak of 69 documents (2025), with 2026 recording 1 document that was likely temporary. Country contributions were dominated by the United States (198 documents), followed by the United Kingdom (92), Australia (74), and Canada (45). The co-occurrence map places the terms population and service context as central nodes (human/humans, male, aged, article) and shows major clusters reflecting (1) CKD themes and management related to dialysis/hemodialysis as well as palliative and conservative care, (2) comorbidities, symptoms, and clinical indicators related to disease burden (e.g., fatigue, pruritus, anemia, hypertension, sepsis, depression, creatinine, acute kidney failure), and (3) hospital service context and study design (hospitalization, observational/retrospective study). The overlay map indicates a strengthening of the themes of service outcomes and follow-up (follow-up, clinical outcome, hospitalization) as well as an increased focus on patient-centered approaches and psychosocial support (patient-centered care, nurse, interpersonal communication, qualitative research). The density map confirms the largest hotspots in the terms of population (male, aged) and kidney service/therapy themes (palliative care, dialysis/hemodialysis, CKD) that are interconnected with comorbidities and service outcomes. QoL research in CKD palliative care is growing consistently and is dominated by countries with established research ecosystems, with the main themes still strongly centered on the clinical and service context (dialysis/hemodialysis, CKD, comorbidities, inpatient outcomes). However, there are indications of a strengthening research direction towards patient-centered approaches, communication, caregivers, and qualitative methods. Future studies need to strengthen the measurement of QoL outcomes that are meaningful to patients and families, expand the geographical context, and evaluate palliative-nephrology integration models that can tangibly improve QoL.
The Effect of Audiovisual Educational Media About Gentle Birth on Pregnancy Readiness for Delivery in the Thirty Trimester of Pregnant Women
Childbirth preparedness is a critical factor influencing maternal and infant outcomes. However, many pregnant women in their third trimester still experience low levels of preparedness due to a lack of knowledge and high levels of anxiety. Therefore, innovative educational methods such as audiovisual media based on the concept of gentle birth are needed to improve childbirth readiness. This study aims to analyze the effect of audiovisual educational media about gentle birth on childbirth readiness in third-trimester pregnant women at the AHBS Sentani Clinic. This study used a quasi-experimental design with a pretest-posttest approach with a control group design. The study sample consisted of 60 respondents selected using a purposive sampling technique and divided into intervention and control groups of 30 people each. The intervention group was given education using audiovisual media about gentle birth, while the control group was given conventional education. Data dikumpulkan menggunakan kuesioner kesiapan persalinan yang telah diuji validitas dan reliabilitasnya. Analisis data menggunakan uji paired t-test dan independent t-test dengan tingkat signifikansi p < 0 ,05. The results of the study showed a significant increase in childbirth readiness in the intervention group after the intervention (the mean score increased from 1.73 ± 0.70 to 2.47 ± 0.63; p = 0.001). Meanwhile, in the control group there was no significant increase (p = 0.084). There was also a significant difference between the intervention and control groups after the intervention (p = 0.002). Audiovisual educational media about gentle birth has a significant effect on increasing childbirth readiness in pregnant women in the third trimester.
Spiritual Support and Parental Communication on Perceptions of HIV Prevention in Adolescents
Adolescents are a group vulnurable to HIV transmission due to limited knowledge and strong social influences. Adolescents’ perceptions of HIV prevention are greatly influenced by internal and external factors, including spiritual support and communication with parents. Spiritual support can strengthen moral values and self-responsibility, while parental communication plays a role in providing accurate information and guidance. This study aims to spiritual support and parental communication on adolescents’ perception of HIV prevention. This study used a cross-sectional design with a total sampling of 31 adolescent respondent. Data collection was conducted using a Likerts scale questionnaire to assess spiritual support, parental communication, and perceptions of HIV prevention. Data analysis was perfomed using multiple linear regression tests with a significance level of <0.05. The analysis results showed that spiritual support had no significant effect on perceptions of HIV prevention (p = 0.969), not did parental communication (p = 0.469). Simultaneous testing showed that both variables together did not significantly influence perceptions of HIV prevention. Spiritual support and parental communication did not significantly influence adolescents' perceptions of HIV prevention. HIV prevention efforts need to consider a spiritual approach and strengthen family communication to shape healthy perceptions and behaviors in adolescents.
The Influence of Hospital Marketing Mix and Consumer Personal Factors on the Selection of Referral Hospitals by Patients
The selection of referral hospitals is not solely determined by the administrative mechanism of the National Health Insurance (JKN) referral system but is also influenced by hospital marketing strategies and patient characteristics. This study aimed to examine the effects of the hospital marketing mix (7Ps) and personal patient factors on referral hospital selection at Segiri Primary Health Center, Samarinda. A quantitative cross-sectional design was employed involving 348 respondents selected through simple random sampling from 1,758 referred patients. Data were collected using a structured questionnaire that had been tested and confirmed to be valid and reliable. Statistical analyses included Chi-square and Fisher’s exact tests for categorical variables, as well as Kruskal-Wallis and Mann-Whitney tests for non-parametric comparisons. The results indicated that most personal characteristics, including age, gender, education, occupation, income, and JKN ownership, were not significantly associated with referral hospital selection (p>0.05), except for domicile (p<0.05). Clinical factors, represented by the destination polyclinic, showed a strong association with hospital choice (p<0.001). Among the marketing mix components, Product (p=0.026), Process (p=0.018), and Physical Evidence (p<0.0001) significantly influenced referral hospital selection, while Price, Place, Promotion, and People showed no significant effects (p>0.05). In conclusion, referral hospital selection was primarily influenced by service needs and the quality of patient experience rather than personal characteristics. Prioritizing improvements in physical facilities and optimizing service processes are essential to enhance the effectiveness of the referral system.
Analysis of Medical Equipment Control Through Handover Tools in the Inpatient Ward of Hospital
Medical equipment control is a crucial aspect in supporting the continuity and effectiveness of nursing services in inpatient wards. This study aimed to evaluate internal and external factors influencing the effectiveness of medical equipment control and to formulate the need for developing a structured, documentation-based handover tool. This preliminary study was conducted in hospital inpatient wards involving Nurse Unit Managers (NUMs) and staff nurses. Data were collected through in-depth interviews, field observations, and questionnaires. Medical equipment control processes were examined using the POSAC management framework. Questionnaire data were analyzed descriptively, while overall data were analyzed using POSAC and SWOT analyses, followed by IFE and EFE matrices to formulate improvement strategies. Data validity was ensured through source and method triangulation. The findings indicated that medical equipment control had not been optimally implemented due to the absence of standard operating procedures, inconsistent documentation, unequal distribution of equipment, and the lack of routine evaluation. Analysis of external factors revealed significant opportunities, including government regulations, accreditation requirements, technological advances, and increasing public expectations for fast and accurate services. A standardized, user-friendly, and integrated medical equipment handover system is required to improve efficiency, accuracy, and the overall quality of nursing services.
Clinical Evidence of Probiotics for Acne
Genital health is a fundamental component of reproductive health and significantly influences physical, psychological, and social well-being. However, the relationship between knowledge, attitudes, and behaviors toward genital health remains underexplored, particularly among male populations. The aim of the study was to examine the simultaneous relationship of knowledge and attitudes with behaviors in maintaining genital health among male. This cross-sectional analytical study involved 608 male respondents selected through purposive sampling. Data were collected using a structured questionnaire assessing knowledge, attitudes, and behaviors related to genital health. Descriptive statistics were used to summarize respondent characteristics, and associations between variables were analyzed using the Chi-square test with a significance level of p < 0.05. Most respondents demonstrated good knowledge (73.8%) and positive attitudes (88.8%) toward genital health. However, behavioral practice was divided between moderate (51.3%) and good (48.5%) categories. A significant association was observed between knowledge and behavior (p = 0.007) and between attitude and behavior (p = 0.001), indicating that higher knowledge and more positive attitudes were strongly associated with better genital health practices. Knowledge and attitudes are key determinants of genital health behavior. Interventions aimed at improving male genital health should integrate educational strategies that enhance knowledge while simultaneously fostering positive attitudes to achieve sustainable behavioral change.
Effects of Back Massage and Music Relaxation on Blood Pressure among Patients with Hypertension: A Literature Review
Hypertension is a leading contributor to cardiovascular morbidity and mortality. Non-pharmacological strategies such as back massage and music relaxation have been proposed to attenuate sympathetic activation and stabilize blood pressure. Grounded in relaxation theory and stress physiology, this review synthesizes current evidence on the effectiveness of these interventions in patients with hypertension. A systematic review was conducted in accordance with PRISMA guidelines across national and international databases (2020–2025). The research question was structured using the PICO framework. Quasi-experimental and randomized controlled trials involving hypertensive patients and reporting pre–post or between-group changes in blood pressure were eligible. Of 312 records identified, 97 duplicates were removed. After title–abstract screening of 215 records and full-text assessment of 69 articles, 15 studies met the inclusion criteria and were narratively synthesized. Most studies demonstrated statistically significant reductions in systolic and diastolic blood pressure following back massage, music therapy, or combined relaxation approaches. However, notable heterogeneity was observed in intervention protocols, duration, comparators, and control for confounding factors. Back massage and music relaxation appear to be safe, complementary interventions with promising potential to reduce blood pressure among individuals with hypertension. Nonetheless, rigorously designed randomized controlled trials with standardized protocols and longer follow-up are warranted to strengthen the evidence base.
Analysis of the Implementation of the Digitalization of Non-Communicable Disease Screening Reporting Policy Through the ASIK Aplication
Aplikasi Sehat IndonesiaKu (ASIK) is a digital-based healthcare service recording and reporting application aimed at replacing manual recording and simplifying the reporting process for various health programs. Field experience shows that there is still a gap between the reporting results in the application and manual recording, resulting in serious consequences for the validity of health data. This study aims to evaluate the implementation of the digitalization policy for reporting non-communicable disease screening through the ASIK application in North Lampung Regency in 2025. The evaluation was conducted by examining four main factors, namely the technical aspects of the application, human resources, organizational support, and health accessibility. This research uses a qualitative approach with a case study design using triangulation methods in the form of in-depth interviews, observation, and documentation. Data were collected through in-depth interviews, document review, and field observations at primary health facilities, and analyzed thematically using triangulation of sources and methods. Barriers to ASIK reporting are a multidimensional problem that causes a gap between policy design and field readiness. The research results show four main factors causing low reporting, namely technical application factors, limited human resources, weak organizational support, and regional accessibility constraints. This study recommends integration and strengthening of the ASIK system, improved infrastructure support and reporting management in the regions, and further quantitative studies to assess its impact on the quality of NCD screening data.
The Effect of Modified Lunch Animal Side Dishes on Leftovers in Patients On A Regular Rice Diet
Food waste is an important indicator of the quality of hospital nutrition services and influences the adequacy of patient intake. Data from Dr. H. Andi Abdurrahman Noor Regional General Hospital (RSUD) in 2025 showed that animal side dishes at lunch had the highest waste, particularly omelettes and fried catfish. This study aimed to assess the effect of modified animal side dishes on animal side dish waste in hospitalized patients on a regular rice diet. The study used a quasi-experimental design with a control and intervention group. A total of 72 patients were selected purposively, consisting of 36 patients who received standard side dishes and 36 patients who received modified side dishes (fried egg balado, sweet and sour catfish, and crispy catfish). Food waste was measured using the Comstock method, while sensory assessments were obtained through a questionnaire with validity test results showed that all sensory assessment questionnaire items had a calculated r value > r table (0.30), thus being declared valid. The reliability test results for the sensory assessment questionnaire showed a Cronbach's Alpha value of 0.82, indicating a reliable instrument. The statistical test used was the independent mean difference test (T-independent test). The results showed that standard side dishes had a very high percentage of food waste. After modification, the average food waste decreased significantly (p = 0.001). Consumption of modified side dishes increased, with the "good" category reaching 63.9% for fried egg balado, 69.44% for sweet and sour patin, and 59.4% for crispy patin. This study concluded that modifying animal side dishes effectively reduced food waste and increased patient sensory acceptance.
An Exploration of Osing Youth Mental Health in Suicide Mitigation Efforts
Mental stability refers to a condition of psychological stability that allows people to handle life's challenges, reach their full potential, acquire knowledge effectively, work productively, and make positive contributions to their communities. The Osing tribe has a unique tradition of integrating biological, psychological, social, and spiritual aspects holistically, which is believed to play a role in maintaining health. This research seeks to investigate the mental health of Osing tribe adolescents in achieving mental wellbeing as a suicide prevention strategy. The study explores the efforts and strategies of Osing tribe adolescents in achieving mental wellbeing. The framework of this research employs a qualitative methodology utilizing a phenomenological perspective. The individuals involved in this research were six Osing tribe adolescents from Kemiren Village. This research employed a semi-structured interview guide as the research instrument. The collected data were transcribed and then validated by the participants. The sampling technique used in this study was purposive sampling. There were six participants in this study, all of whom were Osing teenagers aged between 10 and 21 years old. The Colaizzi method was employed to analyze the data transcripts. The analysis of data coding was performed with the help of Nvivo 12 software. Three themes and eight subthemes were identified. The identified themes are Stress, Osing Youth Activities, and Social Support. Osing ethnic group youth demonstrated that they are like other youth in general, who also experience stress. Osing ethnic group adolescents demonstrated stress resolution processes through coping mechanisms applied with various strategies, including physical strategies (traditional dancing, playing gamelan musical), cognitive strategies by managing time, emotional strategies by sharing concerns, apologizing, and reminding each other, and behavioral strategies by resting when there are no activities. Osing tribe teenagers also receive good emotional and social support. Osing tribe adolescents possess adaptive coping resources for stress through their daily routine of artistic activities. Osing tribe adolescents have four domains that contribute to mental well-being: family, community, school, and village government.
Analysis of Factors Associated with the Incidence of Dengue Fever
Dengue Hemorrhagic Fever (DHF) remained a public health problem in Bontang City. From January to December 2023, a total of 457 DHF cases were reported among 188,101 residents, with an incidence rate of 242.95 per 100,000 population and two deaths (Case Fatality Rate = 0.44%). This study aimed to identify factors associated with the occurrence of Dengue Hemorrhagic Fever in the working area of Bontang Barat Public Health Center. An analytic observational study with a retrospective case control design was conducted. The study population consisted of all DHF cases reported from January to December 2023, totaling 128 cases. Using simple random sampling, 192 respondents were selected, comprising 96 cases and 96 controls. Cases were patients with dengue hemorrhagic fever (DHF) confirmed by healthcare professionals, while the control group consisted of neighbors of the cases who agreed to participate and were matched by sex and residential area (±100 m). Data were collected from DHF surveillance records, interviews, observations, and measurements of housing density. Data were analyzed using the Chi-square test. The results showed a significant association between 3M Plus practices, the presence of mosquito larvae (p < 0.001), and the frequency of cleaning water storage containers (p = 0.001) with the occurrence of DHF. In contrast, housing density (p = 0.721) and the habit of hanging worn clothes (p = 0.771) were not associated with DHF incidence. Conclusion the occurrence of DHF was mainly influenced by behavioral and environmental factors therefore, strengthening community based 3M Plus prevention practices was identified as a key strategy for DHF control.
The Effectiviness of Turmeric and Tamarind Herbal Medicine in Reducing Menstrual Pain Intensity
Menstrual cramps are pain that occurs during a woman's period, typically felt in the lower abdomen during the menstrual cycle. Effective non-pharmacological management includes administering turmeric and tamarind to reduce menstrual pain. Turmeric and tamarind contain curcumin and anthocyanins, which inhibit cyclooxygenase, thereby reducing inflammation and inhibiting uterine contractions. Interviews revealed that the menstrual pain was very bothersome. The aim of this study was to determine the effect of giving turmeric and tamarind herbal medicine on reducing the intensity of menstrual pain in nursing students at STIKES Advaita Medika Tabanan. The study employed a quantitative approach with a pre-experimental, one-group pretest-posttest design. Respondents were selected through purposive sampling of 16 people using a Numerical Rating Scale (NRS) pain assessment observation questionnaire. The Wilcoxon Signed Rank test was used for analysis. The decrease in menstrual pain scale after the intervention was given in the no pain category for 2 respondents (12.5%), mild pain for 11 respondents (68.8%), and moderate pain for 3 respondents (18.8%). The Wilcoxon Signed Rank test results showed a p-value of 0.001 (<0.05) and a Z-value of -3.286. The conclusion of this study is that there is an effect of giving turmeric and tamarind herbal medicine on reducing the intensity of menstrual pain in nursing students at STIKES Advaita Medika Tabanan.
Analysis of Factors Related to Nutritional Status of Toddlers Aged 12-59 Months
The nutritional status of toddlers is influenced by factors such as immunization history, exclusive breastfeeding history, maternal knowledge, socioeconomic status, and parenting patterns. This study aims to identify risk factors associated with the nutritional status of toddlers aged 12-59 months in the working area of the Padang Pasir Community Health Center. This is an observational analytical study with a cross-sectional design. This study aims to determine the relationship between the history of exclusive breastfeeding, maternal knowledge, socioeconomic status, and parenting patterns with nutritional status in toddlers in the Padang Pasir Community Health Center work area. The sample consisted of 351 mothers with toddlers aged 12-59 months, selected using proportional sampling. Data collection used a questionnaire. Data were analyzed using chi-square analysis, logistic regression multinomial. The results of the quantitative research using chi-square test showed a relationship between exclusive breastfeeding (p=0.032), maternal knowledge (p=0.010), parental income (p=0.003), feeding parenting patterns (p=0.008) with the nutritional status of toddlers aged 12-59 months. The most dominant factor was feeding parenting patterns (OR=1.302). The study concluded that parenting and feeding patterns were the most closely related factor to the nutritional status of toddlers aged 12-59 months. Community health centers are expected to improve parenting through routine counseling, information media, and direct information on the importance and negative impacts of inadequate parenting and feeding patterns on children's nutritional status.
The Effectiveness of the Ma'baca Baca Tradition as An Educational Medium on Pregnancy Danger Signs to Prevent Stunting”
Stunting remains a serious public health problem, with inadequate maternal knowledge of pregnancy danger signs being one of its major risk factors. Health education efforts are often less effective due to the lack of culturally appropriate approaches. The Ma’baca-Baca tradition, which is deeply rooted in the Luwu indigenous community, has strong potential as a culturally acceptable medium for health education. Therefore, integrating education on pregnancy danger signs and stunting prevention into the Ma’baca-Baca tradition, supported by a pocketbook as a sustainable source of information, is important to examine in order to improve the effectiveness of culturally based maternal health education. To determine the effectiveness of the Ma'baca Baca tradition as an educational medium on pregnancy danger signs for stunting prevention in the Luwu indigenous community. This study employed a quasi-experimental design using a pre-test and post-test with a control group. The participants were women from religious study groups selected through accidental sampling, namely those who attended the Ma’baca-Baca activity. The respondents consisted of 25 participants in the intervention group who received education through a pocketbook and 25 participants in the control group. Data were collected through pre-tests and post-tests and analyzed using the Mann–Whitney test. A normality test was conducted, and the results showed that the data were not normally distributed. Data analysis was performed using the Mann-Whitney test, which revealed a p-value of 0.001 (< 0.05), indicating a statistically highly significant difference between the intervention group and the control group after the intervention was administered. These results demonstrate that the intervention was effective in improving pregnant women’s knowledge of pregnancy danger signs. In other words, the treatment applied to the intervention group was proven to have a significantly positive impact compared to the control group.
Analysis of Risk Factors for Hypertension among the Productive Age Population
Hypertension is a growing public health issue, particularly affecting individuals in productive age groups. The high incidence of hypertension in the North Sangatta Health Centre area highlights the need to identify contributing risk factors. This study aims to analyse determinants associated with hypertension among productive-age residents within the working area of the North Sangatta Health Centre. The method used in this study was an analytical observational approach with a case–control design. Data were collected using demographic questionnaires and blood pressure observation sheets. The research instruments were not subjected to validity and reliability testing because a digital sphygmomanometer that had been calibrated by the hospital and was used in accordance with standard operating procedures was utilized. The variables examined included demographic factors (age, sex, education, occupation), smoking habits, and medical history (familial hypertension and diabetes). The sampling technique used was non-random sampling, specifically purposive sampling, with a total of 136 respondents (68 cases and 68 controls). Data were analyzed using chi-square tests and logistic regression tests. Result: The findings indicated significant associations between hypertension and age (P < 0.000), diabetes (P < 0.001), and family history of hypertension (P = 0.009). No significant associations were found for gender (P = 0.859), occupation (P = 0.360), education (P = 0.069), or smoking habits (P = 0.170). Conclusion: It is concluded that age and specific medical and occupational factors play important roles in hypertension incidence in this population.
Application of Acupressure Therapy to Reduce Blood Pressure in Hypertension Patients
Hypertension is a condition of increased systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, which has the potential to cause various cardiovascular complications if not optimally managed. Hypertension can be managed through pharmacological and non-pharmacological therapies. One non-pharmacological method that can be used is acupressure therapy, a stimulation technique in the form of pressure on certain points on the body that aims to increase relaxation and improve blood circulation. This study aims to determine the effectiveness of applying acupressure therapy in reducing blood pressure in hypertension patients. The research method used is qualitative research with a descriptive case study approach. The study subjects consisted of four respondents with hypertension. Data collection was carried out through interviews, observations, physical examinations, and blood pressure measurements before and after the intervention according to standard operating procedures. The acupressure therapy intervention was carried out for two weeks with a total of six meetings. Data was analyzed using thematic analysis. The results showed that before the intervention, the respondents' blood pressure was in the range of 150–170 mmHg for systolic and 90–110 mmHg for diastolic. After acupressure therapy, all respondents experienced a decrease in blood pressure, with systolic blood pressure ranging from 8–14 mmHg and diastolic blood pressure between 10–14 mmHg. These results indicate that acupressure therapy is effective in lowering blood pressure in patients with hypertension. Acupressure therapy can be considered a complementary non-pharmacological intervention in the management of hypertension.
Hospital Length of Stay and Family Needs of Critically Ill Patients
The needs of families of patients treated in intensive care units with unstable conditions and uncertain lengths of stay often cause anxiety and increase the need for proximity, service assurance, support, information, dan comfort. The purpose of this study was to determine the relationship between hospital length of stay and family needs during intensive care. The method used was quantitative with a cross-sectional approach and purposive sampling technique. The study population consisted of family members of critically ill patients at Dr. Moewardi General Hospital in Surakarta, with 100 participants. The tool used was the Indonesian version of the Critical Care Family Needs Inventory (CCFNI) questionnaire with a Cronbach's alpha score of 0.97. Data analysis was performed using Spearman's rank correlation test to examine the relationship between hospital length of stay and family needs. The results showed a significant relationship between hospital length of stay and family needs in the dimensions of proximity (p = 0.003), service assurance (p = 0.029), and total family needs score (p = 0.035). No significant relationship was found between hospital length of stay and family needs in the dimensions of family support (p = 0.171), information (p = 0.131), and comfort (p = 0.401).
Continuity of Care for Post-Coronary Artery Bypass Grafting (CABG) Patients: A Literature Review
Post-CABG period is often characterized by medical complications, functional limitations, psychosocial problems, and a high risk of readmission. This review aims to examine the scientific evidence related to continuity of care in post-CABG patients, including the effectiveness of nursing interventions and cardiac rehabilitation in influencing patient outcomes. The method used was a literature review with a narrative approach, through searches of articles in PubMed, Scopus, ScienceDirect, and Google Scholar (2019–2025). Of the 1,863 articles initially identified, 9 met the inclusion criteria and were analyzed thematically. The results show that systematic nursing interventions such as discharge planning significantly reduce readmissions and medical complications, as well as improve quality of life. Home-based, outpatient, and telerehabilitation cardiac rehabilitation programs are effective in improving functional capacity, patient adherence, and productivity. Biopsychosocial support, integration of psychological rehabilitation, and patient participation through shared decision-making enhance coping, satisfaction, and patient engagement. Contextual factors such as geographical location and access to health services also influence outcomes. In conclusion, continuity of care after CABG requires an integrated, multidimensional intervention approach that encompasses physical, psychosocial, and socioeconomic aspects, in order to enhance clinical effectiveness, accelerate recovery, and support patients’ social reintegration.
The Relationship between Sleep Quality and Fasting Blood Sugar Levels in Diabetes Mellitus Patients
Diabetes mellitus is a major health problem with increasing prevalence and complication rates. Blood sugar control is influenced by various factors, one of which is sleep quality, which plays a role in regulating glucose metabolism. This study aims to determine the relationship between sleep quality and fasting blood sugar levels in diabetes mellitus patients. This study is a quantitative study with a correlational design and a cross-sectional approach conducted on 114 type 2 diabetes mellitus patients at the Internal Medicine Polyclinic of Dr. Moewardi Regional General Hospital, Surakarta. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, while fasting blood sugar levels were obtained from patient medical records. Data analysis was carried out descriptively and inferentially using the Chi-Square test. The PSQI questionnaire has been tested for validity and reliability by Fatmawati (2013) using the Pearson product moment correlation coefficient , with a correlation coefficient value (r count) ranging from 0.487–0.778 (r table > 0.444) and a Cronbach's alpha value of 0.63. Most respondents had poor sleep quality (79.8%) and high fasting blood sugar levels (> 126 mg/dL) (82.5%). The chi-square test results showed a significant association between sleep quality and fasting blood sugar levels (p = 0.001). Poor sleep quality was significantly associated with increased fasting blood sugar levels in patients with diabetes mellitus. These findings suggest that sleep quality plays a crucial role in glycemic control, and efforts to improve sleep quality should be considered as part of a comprehensive approach to diabetes mellitus management.
Wound healing is a crucial aspect in orthopedics. Channa striata (snakehead fish) contains albumin and other bioactive compounds thought to accelerate wound healing To assess the effectiveness of Channa striata extract gel on wound healing in Wistar rats based on clinical (wound area) and histopathological (HEALS-A score) parameters. Laboratory experimental research with post-test only control group design using 27 male Wistar rats, divided into three groups: negative control (no treatment), positive control (Bioplacenton), and treatment (Vipalbumin gel). Evaluation of wound area was performed on days 0, 3, 7, and 14 using ImageJ. Histopathological examination was conducted using HE staining and HEALS-A scoring. Data were analyzed using ANOVA and Chi-Square tests. On day 14, the mean wound area of the treatment group (7.1±2.8 mm²) was equivalent to the positive control (6.7±2.5 mm²), both significantly smaller than the negative control (54.2±32.5 mm²; p<0.001). HEALS-A scores showed significant differences between groups on days 3, 7, and 14 (p<0.001; p=0.001; p=0.001). Channa striata extract gel effectively accelerates wound healing clinically and histologically, with effectiveness equivalent to Bioplacenton.
Analysis of Factors in Early Childhood Stunting Mitigation in Disaster-Prone Areas of Sukabumi Regency
Sukabumi Regency is a disaster-prone area. Throughout 2024, Sukabumi Regency experienced 787 landslides, 396 floods, and 49 earthquakes. In the health sector, Sukabumi Regency also faces a fairly serious stunting problem. The 2023 Indonesian Health Survey (SKI) found that stunting prevalence reached 27%, making it one of the top five districts with the highest stunting prevalence in West Java Province. The purpose of this study is to examine the risk variables that contribute to stunting mitigation. stunting in early childhood in disaster-prone areas of Sukabumi Regency. The study population consisted of all mothers with children aged 0–59 months residing in the study area. The sample size was calculated using the Lemeshow formula based on a stunting prevalence of 27% in Sukabumi Regency, resulting in a total of 303 respondents. A two-stage probability sampling method was applied, with sample allocation across locations determined using proportional random sampling, followed by respondent selection through cluster random sampling within each area. This study employed a correlational design with a cross-sectional approach. Data were collected through structured interviews using a standardized questionnaire. Univariate analysis was performed using frequency distributions, bivariate analysis employed the chi-square test, and multivariate analysis was conducted using multiple logistic regression. 41.9% of respondents had mitigation. stunting is less, 57.4% socioeconomic is less, 22.1% said access to health services is difficult to reach, 47.5% family food security is less and 61.7% family sanitation is less good, the results of the bivariate analysis showed that there is a relationship between food security, socioeconomic, access to health services, family sanitation towards mitigation stunting with p value (0.000-0.015)<0.05, multivariate analysis found that food security is the dominant factor influencing stunting stunting where , families with less food security are 10.6 times more likely to experience mitigation Lack of stunting . Conclusion: Mitigation Stunting in early childhood in disaster-prone districts in Sukabumi Regency is influenced by family sanitation, food security, socioeconomic factors, and accessibility to health services. Food security is a dominant factor influencing mitigation stunting.
Relationship between High Sensitivity C-Reactive Protein Levels and the Severity of Vulgaris Psoriasis
Psoriasis vulgaris is a chronic immune-mediated inflammatory skin disease increasingly recognized as a systemic inflammatory condition. High-sensitivity C-reactive protein (hs-CRP) is a sensitive marker of systemic inflammation, but its relationship with psoriasis severity remains inconsistent. This research evaluate the association between serum hs-CRP levels and disease severity in patients with psoriasis vulgaris. To evaluate the association between serum hs-CRP levels and disease severity in patients with psoriasis vulgaris. A cross-sectional analytical study was conducted involving 30 patients with psoriasis vulgaris and 30 control subjects at a tertiary hospital in Indonesia. Samples were obtained using non-probability sampling with a consecutive sampling technique, in which subjects who met the inclusion criteria were recruited sequentially until the minimum required sample size was achieved. Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI). Serum hs-CRP levels were measured using enzyme-linked immunosorbent assay. Correlations between hs-CRP levels and PASI scores were analyzed using Spearman’s rank test. Most psoriasis patients had mild disease (56.7%). The mean serum hs-CRP level in the psoriasis group was 1.23 mg/L. No significant correlation was found between hs-CRP levels and PASI scores (r = 0.128, p = 0.499) or categorical disease severity. Although hs-CRP levels were higher in psoriasis patients than controls, the difference was not statistically significant. Serum hs-CRP levels were not associated with clinical severity of psoriasis vulgaris, suggesting that hs-CRP reflects systemic inflammation rather than cutaneous disease severity alone.
The Effectiveness of Patient Safety In Reducing Patient Safety Incidents
Patient safety incidents (PSIs) continue to pose serious challenges to healthcare quality and public trust. The persistence of adverse events, near misses, and medical errors indicates that patient safety implementation remains inadequate, often due to weak reporting cultures, limited healthcare worker competence, and insufficient risk management systems. This study aimed to synthesize evidence on the effect of patient safety implementation in reducing patient safety incidents in healthcare services. A literature review was conducted on studies published between 2020 and 2025 using PubMed, Google Scholar, Semantic Scholar, and ScienceDirect. From 1,833 identified articles, duplicates were removed, titles and abstracts were screened, and methodological quality was assessed using the JBI Critical Appraisal Checklist. Seven eligible articles were included and analyzed through narrative synthesis. The findings show that effective patient safety implementation reduces patient safety incidents through four main components: incident reporting systems, strengthening safety culture, improving healthcare worker competence through education, and utilizing information technology for reporting and rapid response. These strategies enhance risk identification, procedural compliance, and prevention of recurrent incidents. Patient safety implementation significantly reduces patient safety incidents and improves healthcare service quality. Comprehensive strategies, managerial support, and continuous non-punitive reporting systems are essential for sustainable patient safety improvement.
The Effect of Exercise on Cardiovascular Parameters in Postmenopausal Women: A Systematic Review
Menopause is characterized by a decline in estrogen levels that leads to physiological changes increasing cardiovascular risk, including hypertension, dyslipidemia, reduced cardiorespiratory fitness, and vascular dysfunction. Consequently, cardiovascular disease remains a major public health concern among postmenopausal women. This study aimed to systematically review evidence on the effects of exercise on cardiovascular parameters in postmenopausal women and to identify the most effective exercise modalities for cardiovascular health improvement. A literature review was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between 2020 and 2025. Study selection followed predefined inclusion and exclusion criteria based on the PICOS framework. Methodological quality was assessed using the JBI Critical Appraisal Checklist. Fifteen studies met the eligibility criteria and were included in the synthesis. The findings consistently demonstrated that exercise significantly improves cardiovascular outcomes in postmenopausal women. Moderate-intensity aerobic exercise was most frequently associated with reductions in systolic and diastolic blood pressure and improvements in VO₂max. Resistance training improved body composition and cardiometabolic biomarkers, while combined aerobic–resistance programs provided broader cardiovascular benefits. High-intensity interval training yielded marked improvements in cardiorespiratory fitness but requires appropriate supervision. Mind–body exercises were associated with improved autonomic regulation and reduced inflammation. Exercise is a safe and effective strategy for improving cardiovascular health in postmenopausal women. A combination of aerobic, resistance, and complementary exercise modalities is recommended to optimize cardiovascular outcomes and support evidence-based menopausal health management.
Abdominal Stretching Exercise as A Complementary Therapy for Dysmenorrhea Pain in Adolescent Girls
Dysmenorrhoea is a reproductive health problem commonly experienced by adolescent girls and women of reproductive age, with a high prevalence and significant impact on daily activities, emotional well-being, and quality of life. Physical exercise, particularly abdominal stretching exercises, has the potential to be a non-pharmacological intervention in attenuating the pain scale of dysmenorrhea through increased comfort and muscle relaxation. This study was conducted to determine the effect of abdominal stretching exercises on attenuating the pain scale of dysmenorrhea at SMA Negeri 2 Sukoharjo. This study used a quantitative method with a one-group pretest–posttest quasi-experimental design. The study was conducted in September 2025 on 87 female students in grade XI at SMA N 2 Sukoharjo who were selected using purposive sampling according to the inclusion criteria. The intervention given was abdominal stretching exercises. The severity level of dysmenorrhea pain was assessed pre- and post-intervention employing the Numeric Rating Scale (NRS). Data analysis included univariate and bivariate analyses. Normality was tested using Kolmogorov–Smirnov and showed that the data were not normally distributed, so bivariate analysis used the Wilcoxon signed rank test with a confidence level of 95% and α = 0.05. The results showed that the majority of respondents were 16 years old with a dominant age of menarche of 12 years and had a normal menstrual cycle and duration. Before the intervention, most respondents experienced moderate dysmenorrhea pain (scale 5). After being given abdominal stretching exercises, there was a decrease in the intensity of dysmenorrhea pain, with the majority of respondents experiencing low pain (scale 2). Bivariate analysis using the Wilcoxon signed rank test showed a significant difference between the pain scale before and after the intervention (p ≤ 0.05), indicating that abdominal stretching exercises are effective in reducing the scale of dysmenorrhea pain. This study shows that abdominal stretching exercises are effective in reducing the pain scale of dysmenorrhoea in adolescent girls.
Early Mobilization for Cardiovascular Function Recovery In Post-CABG Patients with Cardiopulmonary Bypass: A Systematic Literature Review
Coronary artery bypass grafting (CABG) surgery is often performed with cardiopulmonary bypass (CPB) to maintain systemic perfusion during the procedure. While improving procedural safety, CPB can trigger a systemic inflammatory response and hemodynamic fluctuations that can potentially delay early recovery. Early mobilization is a crucial component of the postoperative recovery approach because it can prevent deconditioning, improve activity tolerance, and support cardiorespiratory stability. However, evidence regarding the form of early mobilization protocols and their impact on cardiovascular function recovery in post-CABG patients with CPB is scattered and heterogeneous. To synthesize scientific evidence regarding early mobilization in post-CABG patients with CPB. A systematic literature review was conducted following the PRISMA 2020 guidelines. A literature search was conducted in PubMed/MEDLINE, Scopus, and CINAHL databases for articles in English or Indonesian published between 2010 and 2025. A total of 518 articles were identified. After removal of duplicates, title and abstract screening, followed by full-text review, were performed. Eight studies with randomized controlled trial or quasi-experimental designs met the inclusion criteria and were analyzed using a narrative synthesis approach. The synthesis of these findings suggests that progressive early mobilization, including position changes, range-of-motion exercises, sitting, standing, and early ambulation, tends to provide better outcomes than conventional care or less structured mobilization. The most consistent positive impact is seen in increased functional capacity, particularly walking parameters such as the six-minute walk test prior to discharge. Several studies also report improved oxygenation and reduced pulmonary complications, decreased pain intensity, and some protocols, starting very early after extubation, are associated with shorter ICU and hospital stays. In addition to protocol factors, patient characteristics such as smoking status and self-efficacy-based educational support also influence recovery outcomes. Evidence from eight studies suggests that early mobilization after CABG with CPB is generally associated with better recovery outcomes, particularly in functional capacity, oxygenation, pulmonary complications, pain, and length of stay in some studies. These findings underscore the importance of implementing structured, progressive, and safety-based early mobilization, tailored to the patient's clinical condition, to optimize postoperative recovery.
Vaginal and Labial Graft Urethroplasty in Female Urethral Stricture: A Systematic Review
Female urethral stricture is considered a relatively uncommon clinical condition, and urethral dilatation has traditionally been the preferred treatment. In recent years, various reconstructive surgical techniques have emerged to provide more definitive management for this challenging group of patients, including the use of grafts in urethroplasty. This study aimed to review the use of vaginal and labial grafts in urethroplasty for female urethral stricture. A systematic review was conducted using PubMed and related databases to identify studies published between 2014 and April 2025. The results were classified according to surgical technique and type of graft used in augmentation urethroplasty. A total of seven studies involving 119 patients were included. The mean follow-up period was 13.55 months for labial grafts and 17.23 months for vaginal wall grafts. Labial grafts demonstrated slightly higher success rates (84%) compared to vaginal grafts (81.73%). In the vaginal graft group, incontinence and recurrence were reported in 17.5% of cases, while failed calibration occurred in 3.8% of patients in the labial graft group. No major donor-site complications were reported. Overall, both graft types provide feasible and safe options for managing female urethral stricture, with labial grafts showing slightly better outcomes.
The Effect of Quality Sexuality Health Education Using the Strategy Method on Knowledge of the Dangers of Pre-Marital Sex in Adolescent Students
Adolescent sexual behavior in Indonesia shows an increasingly worrying trend, as evidenced by the rise in premarital sex, unwanted pregnancies, abortions, and early marriages. This phenomenon reflects the vulnerability of adolescents in facing biological, psychological, and social changes that are not balanced with adequate knowledge and attitudes. The influence of social environments, media exposure, and weak internalization of moral values also increase the risk of unhealthy sexual behavior. These conditions indicate that existing prevention efforts have not been able to comprehensively address the needs of adolescents. Therefore, this research is important to gain a deeper understanding of the factors that influence adolescent sexual behavior and to serve as a basis for formulating more effective, sustainable, and culturally appropriate educational and intervention strategies. This study aimed to determine the effect of health education using the stratagem method on students' knowledge of the dangers of premarital sex at SMPN 3 Bontomarannu. This was done by assessing their knowledge levels before and after the intervention. The results showed an increase in adolescents' understanding after the intervention, indicating that the stratagem method was effective in increasing their knowledge. This study applied a quantitative approach with an experimental design aimed at determining the causal relationship between variables through manipulation of independent variables. The study population included individuals who met the predetermined inclusion criteria and were relevant to the study objectives. There were 44 respondents in this study, divided into 22 respondents in the intervention group and 22 respondents in the control group. This study demonstrates that sexuality education using the staging method effectively improves students' understanding of the risks of premarital sex. Involving 44 respondents through simple random sampling, pre- and post-test results showed a significant increase in the intervention group compared to the control group. The results of the study showed that before the intervention there was no difference in knowledge between the two groups, but after being given counseling on the stratagem method, the intervention group experienced a significant increase, while the control group did not show any significant changes.
The Effect of Closed Suction System Use on the Incidence of Ventilator-Associated Pneumonia (VAP) in Patients Receiving Mechanical Ventilation: A Systematic Literature Review
Ventilator-associated pneumonia (VAP) is one of the most common and serious infections in patients who use mechanical ventilation. It has an incidence of 5–50% and contributes to increased morbidity and mortality. One of the efforts to prevent Ventilator-associated pneumonia (VAP) is the endotracheal suctioning procedure. Currently, there are closed suction systems and open suction systems. However, scientific evidence regarding the effectiveness of closed suction systems in reducing the incidence of ventilator-associated pneumonia (VAP) remains variable. This study aimed to evaluate the effectiveness of closed versus open suction systems in preventing ventilator-associated pneumonia (VAP) in mechanically ventilated adult patients, This study is a systematic review of 13 articles published between 2020 until 2025, which were selected through the PRISMA-2020 process using databases such as Google Scholar, ScienceDirect, and Semantic Scholar. The inclusion studies involved adult patients who were mechanically ventilated for more than 48 hours and reported the incidence of ventilator–associated pneumonia (VAP) as the primary outcome. The review showed that most studies reported no significant difference between closed and open suction systems in reducing ventilator-associated pneumonia (VAP) (p < 0.05). However, several studies have shown additional clinical benefits of closed suction systems, including improved oxygenation, reduced hypoxia, delayed onset of VAP, and reduced end expiratory pressure (PEEP). One study reported a significant reduction in VAP when closed suction was combined with chlorhexidine flushing. The close suction system has not been conclusively proven to reduce the incidence of ventilator-associated pneumonia (VAP), however, it provides valuable clinical and safety benefits.
Effectiveness of Ivermectin as A Treatment Modality for Cutaneous Larva Migrans: A Case Series
Cutaneous larva migrans (CLM) is a parasitic skin infection caused by the penetration of nematode larvae into the epidermis, typically following direct contact with contaminated soil or sand. The disease presents with characteristic serpiginous erythematous papules accompanied by intense pruritus and is commonly found in tropical regions with warm and humid climates. Although hookworm infection affects an estimated 740 million people globally, and Indonesia has a reported prevalence of 30–50%, ivermectin had not been used as a therapeutic option for CLM in Indonesia prior to the COVID-19 pandemic due to limited availability. The purpose of this report is to describe the clinical response of CLM patients treated with oral ivermectin as an alternative therapy that has only recently become accessible in Indonesia. This study was conducted as a descriptive case series. The respondents were three patients attending the dermatology outpatient clinic who were clinically diagnosed with cutaneous larva migrans. Data were obtained through patient interviews, dermatological examinations, dermoscopic evaluation, eosinophil counts, and clinical documentation before and after treatment. All patients received a single oral dose of 12 mg ivermectin. Three patients—two aged 67 years (one male and one female) and one 40-year-old female—presented with serpiginous erythematous papules accompanied by pruritus for 3 to 4 weeks. Two of them had previously shown no improvement with mebendazole and topical betamethasone. All patients demonstrated complete resolution of lesions after receiving a single 12 mg dose of ivermectin without any adverse effects. The results showed a 100% clinical cure rate across all cases, with no reported side effects following treatment. This case series highlights the effectiveness and safety of single-dose oral ivermectin for CLM and suggests that ivermectin may be considered a viable therapeutic option for the management of CLM in Indonesia.
Literature Study: Evaluation of Community-Based Stunting Prevention Policies
Stunting in children under five remains a significant public health problem in Indonesia and has long-term implications for human capital development. Community based stunting prevention policies play a crucial role in addressing this issue, particularly at the local level. This study aimed to evaluate the implementation and effectiveness of community-based stunting prevention programs in the Palembang region using a literature review approach. Relevant articles were obtained from national and international databases, including Google Scholar, PubMed, Science Direct, and the Garuda Portal, limited to publications from 2019 to 2024. Selected articles were analyzed qualitatively using thematic analysis to identify key aspects of program implementation, supporting factors, and barriers. The findings indicate that community-based stunting prevention programs in Palembang have generally been implemented in accordance with national policies and have contributed positively to improving child nutritional status. Program effectiveness was strongly supported by the active involvement of health workers and community health cadres, locally adapted intervention innovations, and cross-sectoral collaboration. However, several challenges remain, including logistical constraints, inconsistent monitoring systems, limited family participation, and suboptimal communication strategies. In conclusion, strengthening community engagement, enhancing program sustainability, and improving monitoring and evaluation mechanisms are essential to optimize the impact of community-based stunting prevention programs and ensure sustainable stunting reduction at the local level.
Global Trends in Spiritual and Palliative Intervention in Cancer Patients: Bibliometric Analysis
Advanced cancer patients often experience multidimensional suffering known as "Total Pain," which includes physical, psychological, social, and spiritual distress. While spiritual interventions are recognized as core components of holistic palliative care, a comprehensive global mapping of research trends over the last five decades remains limited. This study aims to explore global publication trends, identify influential countries and authors, and map key thematic clusters in spiritual intervention research for cancer patients from 1973 to 2025. A quantitative bibliometric design was used. Bibliographic data of 1,121 documents were extracted from the Scopus database following PRISMA 2020 protocols. Data analysis evaluated publication performance and geographic distribution. VOSviewer software was used for keyword co-occurrence and network visualization. Publication growth showed three phases: initiation, acceleration, and maturity (post-2011). The United States dominates global publications (42.5%), followed by Canada (7.4%) and the UK (6.4%). A significant rise in research from Iran and China indicates a shift toward de-westernization in spiritual care. The most influential study by Zimmermann et al. (2014) emphasized early palliative care. Four main thematic clusters were identified: spiritual well-being, quality of life, structured interventions (eg, Dignity Therapy), and death anxiety mitigation. Spiritual intervention research has evolved into a high-level health science. Integrating structured spiritual protocols into early palliative care is essential to address existential distress in terminal cancer patients.
The Impact of Nursing Rounds and Pre–Post Conferences on Nursing Care Quality: A Literature Review
The quality of nursing services is a critical determinant of patient safety, care effectiveness, and overall patient satisfaction. Nursing rounds and pre–post conferences are widely implemented strategies to enhance team coordination, clarify care plans, and improve the quality of nursing care delivery. This study aimed to systematically review the impact of nursing rounds and pre–post conferences on nursing care quality outcomes. A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. Electronic searches were performed in PubMed, ScienceDirect, Scopus, ProQuest, and Google Scholar for studies published between 2020 and 2025 using relevant MeSH terms and keywords related to nursing rounds, pre–post conferences, and nursing care quality. The review process involved identification, screening, eligibility assessment, and inclusion of studies. Original studies and systematic reviews conducted in nursing settings that reported quality-related outcomes were included. Case reports, editorials, conference abstracts without full text, and studies without a clear description of the intervention were excluded. Of the 312 records identified, 12 studies met the inclusion criteria. The findings indicate that nursing rounds and pre–post conferences were associated with improvements in patient satisfaction, quality of nursing documentation, patient safety outcomes, and work efficiency, although the magnitude of effects varied across settings and study designs. Nursing rounds and pre–post conferences have a positive impact on multiple dimensions of nursing care quality and represent effective strategies for enhancing nursing service delivery.
The Relationship between Body Image and Self-Confidence among Health Sciences Students
University students are individuals who are in a transitional phase from late adolescence to early adulthood, characterized by various physical, psychological, and social changes. Body image is one psychological aspect related to how individuals perceive and evaluate their bodies. Body image can play a role in the development of self-confidence, which is needed to engage in academic and social activities. Self-confidence is a positive attitude that reflects an individual’s belief in their abilities, objective self-assessment, and the ability to act rationally and responsibly. Adequate self-confidence plays an important role in supporting learning processes, environmental adaptation, and students’ psychological well-being. Therefore, understanding the relationship between body image and self-confidence among university students is important. This study aimed to determine the relationship between body image and self-confidence among students of the Faculty of Health Sciences at Universitas Muhammadiyah Surakarta. This study employed a quantitative correlational design with a sample of 96 students selected using purposive sampling. Data were collected using body image and self-confidence questionnaires that had been tested for validity and reliability. Data analysis was conducted using Spearman correlation analysis. The results showed that most respondents had a moderate level of body image (74%) and a moderate level of self-confidence (54.2%). Spearman correlation analysis showed a p-value of 0.001 (p < 0.05) with a correlation coefficient of r = 0.557, indicating a positive relationship with moderate strength between body image and self-confidence. It can be concluded that there is a significant and positive relationship between body image and self-confidence among students of the Faculty of Health Sciences at Universitas Muhammadiyah Surakarta. The more positive an individual’s perception of their body, the higher their level of self-confidence.
Overview of Quality of Life in Children with Meningitis Post-Treatment
The research, conducted from August 2020 to January 2021, was motivated by an indication of the quality of life problems of children with meningitis with prolonged treatment at dr. M. Djamil Padang related to the identification of complex neuropsychological sequelae in children. On the other hand, there has been an increasing trend in the number of pediatric meningitis patients hospitalized in these hospitals in recent years, especially the 2017–2019 period. The main objective of the study was to identify quality of life of children with meningitis post-treatment at dr. M. Djamil Padang in 2017–2019. The research method used was quantitative descriptive with a cross-sectional approach. Sampling in this study used purposive sampling, which found 34 respondents. The results showed that more than half (52.9%) of the sample of children with post-treatment meningitis had a poor quality of life, 29.4% had a poor quality of life with physical dimensions, 58.8% had a poor quality of life, respectively for the emotional and social dimensions, and 41.7% had a poor quality of life in the environmental/school dimension. In terms of age groups, poor quality of life was identified in 57.1% of children aged 2–4 years, 66.7% of children aged 5–7 years, and 40% of children aged 8–12 years.
The Relationship Between the Level of Knowledge and Attitudes of the Community Regarding the Use of Family Medicinal Plants (TOGA) as An Optimization of Community Health
Family medicinal plants (TOGA) are a form of traditional medicine that has long been used by Indonesians to maintain health, but the level of knowledge and attitudes of the community towards their use still varies. This study aims to determine the relationship between the level of knowledge and attitudes of the community regarding the use of TOGA as an effort to optimize public health in Catur Boyolali Village. This study used a correlative descriptive design with a cross-sectional approach. The study population consisted of 40 members of the Catur Village germas group, selected using total sampling technique. Data were collected through knowledge and attitude questionnaires, then analyzed using Spearman Rank correlation test. The research instruments demonstrated content validity based on validation conducted in previous studies. The questionnaires met reliability criteria and showed good measurement consistency based on previous studies. Most respondents had a good level of knowledge (60%) and a good attitude (52.5%). The Spearman Rank test results showed a p-value of 0.901 (>0.05), which means that there is no significant relationship between the level of knowledge and attitude of the community towards the use of TOGA. There was no relationship between the level of knowledge and attitude of the community in the use of TOGA. The attitude of the community was influenced by other factors such as culture, experience, beliefs, and social support. Culture-based education and sustainable health promotion are needed to optimize the use of TOGA.
Analysis of Hypertension Risk Factors among Donorers in the PMI Blood Donor
Hypertension remains a global non-communicable disease problem and is a major risk factor for cardiovascular morbidity and mortality. Regular blood donation has been suggested as one strategy that may help reduce blood pressure. The Indonesian Red Cross (PMI) Blood Donor Unit in Banda Aceh City is one of the largest blood donation centers in Aceh Province, serving approximately 2,500 donors per month. This study aimed to determine the association between lifestyle, metabolic, and donation-related risk factors and the incidence of hypertension among blood donors at the PMI Blood Donor Unit in Banda Aceh City. This study employed a quantitative approach with a case–control design. Data were collected from 156 blood donors aged over 41 years who visited the PMI Blood Donor Unit in Banda Aceh City during January 12–17, 2024, consisting of 52 hypertensive donors (cases) and 104 non-hypertensive donors (controls). Participants were selected using accidental sampling. Data were obtained through donor register records and structured interviews, which included demographic characteristics, lifestyle factors, medical history, and donation frequency. Data analysis was performed using univariate analysis to describe respondent characteristics, bivariate analysis using logistic regression to assess associations between risk factors and hypertension, and multivariate logistic regression to identify the most dominant factors associated with hypertension. The results showed that employment status (OR 0.32; 95% CI; p = 0.013), poor diet (OR 11.32; 95% CI; p < 0.001), smoking status (OR 2.31; 95% CI; p = 0.018), moderate physical activity (OR 0.12; 95% CI; p < 0.001), diabetes mellitus (OR 4.11; 95% CI; p = 0.001), hypercholesterolemia (OR 4.11; 95% CI; p < 0.001), donation frequency (OR 0.71; 95% CI; p = 0.009), and body mass index (OR 1.22; 95% CI; p < 0.001) were significantly associated with the incidence of hypertension among blood donors at the PMI Blood Donor Unit in Banda Aceh City.
Reducing Postoperative Pain Following Turp in Patients with Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is common in men and worsens with age. Transurethral Resection of the Prostate (TURP) is a common treatment but may cause post-operative pain. Non-pharmacological interventions such as warm and cold compresses are often used to reduce pain. Data from KHZ Musthafa Regional Hospital, Tasikmalaya Regency, recorded 302 BPH cases between April and June. This study aimed to compare the effectiveness of warm and cold compresses in reducing post-operative pain in TURP patients. A quasi-experimental pretest-posttest control group design was used. The population consisted of 101 TURP patients over three months. Purposive sampling selected 60 participants, divided into Group 1 (warm compress, n = 30) and Group 2 (cold compress, n = 30). Warm compresses were applied using a hot water bottle, and cold compresses using ice water; temperatures were monitored with a thermometer. Pain was measured using the Numerical Rating Scale (NRS) before and after intervention. Data were analyzed using central tendency, paired t-tests, and independent sample t-tests. Participants were aged 61–70 years, mostly with junior or senior high school education, and worked in private sectors or as employees. Warm compresses reduced pain from 5.53 (moderate) to 3.07 (mild), and cold compresses from 5.63 to 3.90. Both interventions significantly reduced pain (p = 0.000), with warm compresses more effective than cold (p = 0.003). Warm compresses are more effective than cold compresses in reducing post-TURP pain, though both significantly decrease pain levels.
Nurse Management and Leadership Practices in Hospitals: A Systematic Review
Nurse management and leadership play a critical role in shaping nurses’ work environments, patient safety, and organizational performance in hospital settings. In recent years, there has been a growing shift from traditional hierarchical management toward more relational and clinically oriented leadership practices. However, empirical evidence regarding dominant leadership styles, associated outcomes, and remaining research gaps remains dispersed across the literature. This systematic review aimed to synthesize existing evidence on nurse management and leadership practices in hospital settings, with a focus on dominant leadership styles, reported outcomes, and identified research gaps. A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed in PubMed/MEDLINE, Scopus, and CINAHL databases. A total of 524 articles were initially identified. After removal of duplicates and screening of titles and abstracts, 45 articles were assessed for full-text eligibility. Ten studies met all inclusion criteria and were included in the final synthesis. Data were analyzed using a narrative thematic approach. The synthesis revealed three main themes. First, transformational leadership emerged as the most frequently examined leadership style in nurse management, with increasing attention to clinical leadership among bedside nurses. Second, leadership practices were associated with nurse-related outcomes (work engagement, reduced burnout, and job performance), patient-related outcomes (quality of care, patient safety, and satisfaction), and organizational outcomes (innovative work behavior and reduced counterproductive behaviors). Third, several research gaps were identified, including the predominance of cross-sectional designs, reliance on self-reported measures, limited multicultural perspectives, and insufficient evidence on the long-term impact of leadership during and after healthcare crises such as the COVID-19 pandemic. Evidence from this systematic review indicates that relational and transformational leadership practices are consistently associated with positive outcomes for nurses, patients, and healthcare organizations in hospital settings. Strengthening leadership development and advancing longitudinal and intervention-based research are essential to better understand causal mechanisms and support sustainable improvements in nursing management and leadership.
Maternal Knowledge and Behavior in Relation to Compliance with Complete Basic Immunization among Children Under Five: A Literature Review
Compliance with complete basic immunization among children under five remains a public health concern, with maternal knowledge and behavior identified as important influencing factors. This literature review aimed to synthesize quantitative evidence on the association between maternal knowledge and behavior and compliance with complete basic immunization among under-five children. A systematic literature review was conducted following PRISMA guidelines. Searches were performed in PubMed, ScienceDirect, and Google Scholar for open-access articles published between 2020 and 2025. A total of 1,012 articles were identified; after removing 300 duplicates, 712 articles were screened by title and abstract. Of these, 521 articles were excluded, and 191 were assessed for full-text eligibility, with 171 articles unavailable in full text. Twenty articles underwent full assessment, and 16 cross-sectional studies met the inclusion criteria based on study design, participant characteristics, and data completeness. Methodological quality was evaluated using the JBI Critical Appraisal Checklist, and data were synthesized using a quantitative narrative approach. The majority of studies reported a significant association between maternal knowledge and behavior and compliance with complete basic immunization, although adjustment for confounding variables was limited. Maternal knowledge and behavior are closely associated with immunization compliance. Further longitudinal and intervention-based studies are recommended to strengthen causal evidence.
Literature Review: Analysis of Potential Human Error Factors in the Industrial Sector Using the Heart Method
Occupational Health and Safety (OHS) is a fundamental aspect of the industrial world, playing a crucial role in protecting workers and ensuring operational continuity. Various reports indicate that the majority of workplace accidents in industrial sectors, such as mining, construction, and manufacturing, are still dominated by human error. Therefore, a comprehensive evaluation of the probability of human error is necessary to reduce the number of workplace accidents and improve safety performance. Objective to analyze and integrate research findings related to the implementation of the Systematic Human Error Reduction and Prediction Approach (SHERPA) and Human Error Assessment and Reduction Technique (HEART) methods in identifying, measuring, and reducing the risk of human error in various industrial sectors. This study is a systematic literature review compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched through Google Scholar and PubMed databases using the keywords "Human Error," "Occupational Health and Safety (OHS)," "HEART," "Human Reliability Analysis," and "occupational accident." Inclusion criteria included articles published between 2021 and 2025, with full text, and discussing human error analysis using the HEART method in the industrial sector. Of the 313 identified articles, nine met the criteria and were analyzed qualitatively. The HEART method produced varying Human Error Probability values, with the highest values for manual work in underground mining (0.89), manual valve operation in oil tank facilities (0.95), and cutting machine operation in the furniture industry (0.888). The dominant factors triggering errors included work fatigue, unclear instructions, time pressure, and lack of training. The HEART method is effective in providing a quantitative and holistic picture of human error risk.
Evaluation of the Pattern of Prescribing Antimalaria Drugs
Malaria is caused by infection with the plasmodium virus that comes from the Anopheles mosquito. This disease often occurs in the rainy season and can cause morbidity and even death for humans. Based on data from the Ministry of Health, there were 304,607 cases of 247 malaria in Indonesia throughout 2021, this figure increased by 19.9% compared to the previous year of 254,050 cases, Papua is the province with the most cases. The highest number of malaria cases in Indonesia in 2021 was recorded at 275 cases. Objective: determine the pattern of prescribing anti-malaria drugs at the Sentani Health Center (period October-December 2023). Method: quantitative descriptive type. it is an evaluation of the pattern of prescribing antimalarial drugs at the Sentani Health Center for the period October-December 2023 with a sample of 33 prescriptions carried out in October-December 2023 using a technique, namely purposive sampling the Data was obtained using Excel and the processing was analyzed. Result: evaluation of the pattern of prescribing antimalarial drugs at the Sentani Health Center for the period October-December 2023. The highest prevalence of antimalarial drug use in Sentani Health Center in Jayapura regency is DHP (Dihydroartemisinin-Piperaquine) with a percentage of 100%.
Assessing the Relationship Between Public Acceptance and Access to Primary Health Services
Primary healthcare serves as the foundation of an effective health system, and its utilization is strongly influenced not only by service availability but also by community acceptance. In urban areas with an increasing number of primary healthcare facilities, understanding how public acceptance affects access to services is essential for improving service utilization and equity.This study aims to determine the relationship between public acceptance with access to service health primary in Clinic Mitra Gustiana, Samarinda City. This research is a quantitative research with approach cross-sectional. Sample in study This as much as Ninety-six respondents were selected using stratified random sampling. Data were collected through a closed-ended questionnaire that had been tested for validity and reliability. Data analysis was performed using the Spearman Rank test to determine the relationship between the two variables. variables. Results research obtained p-value = 0.001 (p < 0.05) Which show existence connection Which A significant correlation was found between community acceptance and access to primary healthcare services. The Spearman correlation coefficient showed a value of 0.340, indicating a positive correlation with moderate strength. The results of this study are expected to serve as evaluation material for primary healthcare providers, particularly the Mitra Gustiana Clinic, in improving service quality based on community acceptance to expand access to services equitably and sustainably.
The Effect of the Information Motivation Behavioral Skills (IMB) Model on Fluid Adherence of Hemodialysis Patients
Patients undergoing hemodialysis therapy often experience problems with excessive Interdialytic Weight Gain (IDWG) increase. The Information–Motivation–Behavioral Skills (IMB) model has been widely used in health behavior modification, but its application to fluid management of hemodialysis patients is still limited. Therefore, IMB-based interventions are needed to improve fluid adherence. This study aims to determine the influence of the IMB model on fluid adherence (IDWG) of hemodialysis patients. This study uses a quasi-experiment design with a two-group pretest-posttest approach, namely the intervention group and the control group. A total of 70 hemodialysis patients were divided into two groups, each of which was given different treatment. The intervention group received IMB-based education for 4 weeks, including information improvement, personal and social motivation, and behavioral skills. Data were collected from haemodialysis patients who met the inclusion criteria through observation sheets. Interdialytic weight gain (IDWG) was assessed by calculating the difference between post-dialysis and pre-dialysis body weight. Statistical analysis using Wilcoxon and Mann–Whitney tests. There was a significant effect on IDWG in the intervention group with p = 0.000, while the control group showed no significant change (p = 0.165). There was a significant difference between the two groups in IDWG after intervention with p = 0.003. The application of the Information Motivation Behavioral Skills (IMB) Model education has proven to be effective in improving fluid adherence of patients undergoing hemodialysis therapy. The application of the Information Motivation Behavioral Skills (IMB) model education is recommended as part of standard practice in fluid management of hemodialysis patients.
THE The Effect of Telehealth-Based Self Management Interventions for Irritable Bowel Syndrome: A Systematic
An Irritable Bowel Syndrome (IBS) is a dysfunctional bowel disorder characterized by such gastrointestinal symptoms as abdominal pain, defecation, constipation, and bloating. Consequently, the condition may worsen over time. A systematic evaluation of the effectiveness, mechanisms, and implementation aspects of telemedicine-based self-management strategies in adults with irritable bowel syndrome (IBS). This study used a quantitative method with a systematic review approach following the PRISMA 2020 guidelines. The search was conducted in various databases such as PubMed, Scopus, Web Of Science (WOS), Sciencedirect, and Proquest with a publication year range from 2020 to 2025. The Boolean search strategy was: “self-management” OR “self-care” “telehealth” AND ‘telemedicine’ “Irritable Bowel Syndrome OR intestinal disorder.” From the 1,074 articles found, after screening using inclusion and exclusion criteria, 20 articles were selected for further analysis using the JBI Critical Appraisal checklist. 20 articles that met the study criteria showed that the use of telehealth can improve self-management skills and reduce the number of inpatient cases. The highest level of effectiveness was achieved through collaboration between telehealth and interprofessional health services in food map management. Digital self-management through telehealth is effective and feasible as an adjunct to IBS management, with consistent evidence for CBT-based, nutritional, relaxation, and multimodal interventions despite methodological variations.
The Interplay Between Food Allergy and Atopic Dermatitis: Mechanism, Diagnosis, and Management
Atopic dermatitis (AD) and food allergy (FA) are two conditions that frequently coexist and present significant challenges in both diagnosis and management. This review aims to describe the link between atopic dermatitis and food allergy, as well as their diagnosis, management, and prevention, especially in the Asian context. The findings indicate that impairment of the skin barrier and exposure to food allergens through the skin (epicutaneous sensitization) play central roles in the development of FA among individuals with AD. From a diagnostic perspective, it is essential to distinguish between food sensitization and clinically significant food allergy in order to avoid unnecessary elimination diets. Management strategies encompass comprehensive care for AD, including skin-barrier maintenance and anti-inflammatory therapy, alongside evaluation for FA when clinically indicated, and avoidance of confirmed trigger foods. Preventive efforts, particularly in high-risk infants, show promise through early skin-barrier care and controlled introduction of food allergens. In the Indonesian and broader Asian contexts, adaptation of these strategies should consider local dietary patterns and the availability of allergy and dermatology services.
The Relationship between Risk Factors and Characteristics of People with Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma (KNF) is a malignant cancer that originates from the nasopharyngeal epithelium and is one of the leading causes of cancer death in Indonesia. This disease is related to various environmental and genetic risk factors such as salted fish consumption, smoking habits, exposure to wood burning smoke, alcohol consumption, and genetic factors. Exposure to wood burning smoke contains carcinogenic compounds that can cause chronic irritation and DNA mutations in nasopharyngeal epithelial cells. This study aims to determine the relationship between salted fish consumption patterns, smoking habits, exposure to wood burning smoke, alcohol consumption, and genetic factors with the incidence of nasopharyngeal carcinoma at RSPAL dr. Ramelan Surabaya for the period March 2020 to March 2025. Cross-sectional research was carried out at RSPAL dr. Ramelan Surabaya. A total of 49 consisting of 36 patients with nasopharyngeal carcinoma and 13 non-nasopharyngeal carcinoma patients were selected by total sampling. The dependent variable is nasopharyngeal carcinoma. Independent variables were salted fish consumption patterns, exposure to wood burning smoke, smoking habits, alcohol consumption and genetics. Data was collected using questionnaires that had been tested for validity and reliability, and medical records. The data was analyzed by Chi-square test. There was a significant association between exposure to wood burning smoke and the incidence of nasopharyngeal carcinoma (p = 0.036). Meanwhile, salted fish consumption patterns (p = 0.165), smoking habits (p = 0.586), alcohol consumption (p = 0.288), and genetic factors (p = 0.609) showed no meaningful relationship. This shows that exposure to wood burning smoke is the most influential environmental factor on the incidence of KNF at the research site. There was a significant association between exposure to wood burning smoke and the incidence of nasopharyngeal carcinoma, while salted fish consumption patterns, smoking habits, alcohol consumption, and genetic factors did not show a significant relationship.
Health Belief Model–Based Health Education and Maternal Health Behaviors During Pregnancy: A Literature Review
Maternal health behaviors are a critical determinant of successful maternal healthcare outcomes; however, adherence to recommended health behaviors during pregnancy remains a significant challenge. Health education based on the Health Belief Model (HBM) has been recognized as an effective approach for modifying health behaviors by addressing individual perceptions and motivational factors. This literature review aimed to synthesize empirical evidence on the effectiveness of Health Belief Model–based health education in improving maternal health behaviors during pregnancy. This study employed a systematic literature review in accordance with the PRISMA 2020 guidelines. Articles were retrieved from PubMed, ScienceDirect, Google Scholar, and national journal databases, covering publications from 2020 to 2025. A comprehensive literature search was conducted using predefined keywords, including Health Belief Model, Health Behaviors During Pregnancy, Health Education, and Pregnant Women. A total of 312 articles were identified, of which 72 duplicates were removed. The remaining 240 articles were screened based on titles and abstracts, resulting in the exclusion of 205 articles. Subsequently, 35 full-text articles were assessed for eligibility. Based on predefined inclusion and exclusion criteria, 10 open-access studies involving pregnant women, applying the Health Belief Model, and reporting maternal health behavior outcomes were included in the qualitative synthesis. Health Belief Model–based health education was found to significantly improve maternal health behaviors, including adherence to antenatal care (ANC) visits, nutritional practices, compliance with iron–folic acid supplementation, physical activity, and disease prevention behaviors. Health education grounded in the Health Belief Model is an effective and relevant approach for enhancing maternal health behaviors during pregnancy and warrants integration into evidence-based maternal healthcare services.
The Effect of Combining Astaxanthin and Vitamin E on IL-1, IL-6, And CRP Levels
Carrageenan-induced inflammation binds to TLR-4, activating the NF-kβ pathway, which attracts macrophages to release proinflammatory cytokines, Interleukin-1 and Interleukin-6, leading to the production of CRP. Astaxanthin and vitamin E have anti-inflammatory effects, but their combined effects are poorly studied. This study examines whether astaxanthin combined with vitamin E reduces IL-6, IL-1, and CRP levels in male Wistar rats induced by carrageenan. This experiment used a post-test-only control-group design with groups: KN (standard feed), KS (1% carrageenan induction), and KP (combination of 0.72 mg/kgBW astaxanthin and 24.1 mg/kgBW vitamin E). ELISA was performed 24 hours after carrageenan induction. Parametric data analysis was performed, followed by a post hoc test. The results showed that IL-1 levels were highest in KS (1.61 pg/mL), followed by KP (0.42 pg/mL) and KN (0.28 pg/mL). Statistical analysis (one-way ANOVA and post hoc tests) identified significant differences among all groups (p<0.05). IL-6 levels decreased in KP (58.67 pg/mL) compared to KS (98.83 pg/mL). CRP levels were highest in KS (2.35 ng/mL), followed by KP (1.01 ng/mL) and KN (0.75 ng/mL), with KS showing a significant increase compared to KN (p<0.05). From these results, it can be concluded that the combination of astaxanthin and vitamin E has an anti-inflammatory effect on IL-6, IL-1, and CRP levels in male Wistar rats induced by carrageenan.
The Effectiveness of Bathing and Massage Methods on Stress Levels and Physiological Parameters in Premature Infants in the NICU: A Systematic Review
Premature infants are at high risk of physiological and neurological disturbances due to organ immaturity. Although bathing is often considered a calming routine, it may act as a significant sensory stressor for premature infants in the neonatal intensive care unit (NICU). This study aimed to evaluate the effectiveness of various bathing methods and complementary interventions in reducing stress levels and maintaining physiological stability in premature infants. A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed across five electronic databases PubMed, Scopus, ScienceDirect, ProQuest, and Sage Journals as well as additional website sources, covering publications from 2016 to 2025. The search used combinations of keywords including premature infant, preterm infant, bathing, stress, physiological stability, and NICU. A total of 634 records were identified, with 50 duplicates removed. After title and abstract screening, 70 full-text articles were assessed for eligibility. Seven randomized controlled trials involving 523 premature infants met the inclusion criteria and were included in the final review. Data were analyzed using narrative synthesis. Swaddled bathing was consistently more effective than conventional bathing methods in maintaining physiological stability and reducing acute stress responses. Complementary interventions, such as aromatherapy massage and mother-led multisensory stimulation, were beneficial as post-bathing strategies to enhance recovery and relaxation. Swaddled bathing is an effective and recommended bathing method for premature infants in the NICU to reduce stress and support physiological stability.
Digitizing Tiered Nursing Supervision in the Icu: Prototype Development and Usability Testing A Case Study
Tiered nursing supervision in the Intensive Care Unit (ICU) has been routinely conducted; however, its impact on competency development and performance monitoring remains suboptimal due to the absence of a structured schedule, incomplete instruments and documentation, limited reflective practice and self-assessment, high workload, and supervisors’ time constraints. This case study aimed to initiate the development of a digital, tiered supervision prototype integrated with the hospital Electronic Medical Record (EMR). The change process was guided by Kotter’s eight-step model and aligned with nursing management functions (POSAC). Root causes were identified using an Ishikawa (fishbone) analysis based on the 5M framework. The study population consisted of ICU nursing personnel, with key informants (the ICU head nurse and nursing manager) selected through purposive sampling, and 36 ICU nurses meeting the inclusion criteria (≥2 years of experience and minimum PK-1 level) participating as survey respondents. Data were collected from May to June 2025 through semi-structured interviews, direct observations, and structured questionnaires distributed via Google Forms, with informed consent obtained from all participants. Data were analyzed descriptively and analytically using an Ishikawa (fishbone) diagram based on the 5M framework to identify root causes, followed by problem prioritization to inform the development and evaluation of a digital, tiered nursing supervision prototype. The innovation produced a supervision prototype comprising scheduling, standardized checklists, and evaluation outputs to support structured monitoring and feedback. A preliminary usability assessment using the System Usability Scale (SUS) yielded a score of 72/100, indicating acceptable usability. Further work is recommended to finalize integration with the existing EMR, conduct broader-scale testing, provide supervisor training, and strengthen a reflective and structured evaluation culture to comprehensively assess the system’s effectiveness.
The Relationship Between Hopelessness and Suicide Idea in Adolescents
Suicide is the third leading cause of death in the 15-29 age group. Adolescents with dynamic psychosocial development are highly vulnerable to pressures that can trigger hopelessness and suicidal ideation. Hopelessness is a pessimistic condition about the future, which is related to the emergence of thoughts of ending one's life. This study aims to analyze the relationship between hopelessness and suicidal ideation in adolescents. This quantitative correlational study involved 98 adolescents from SMA Negeri 2 Sukoharjo who were selected through simple random sampling. Data were collected using the Beck Hopelessness Scale (BHS) and Revised–Suicide Ideation Scale (R-SIS) questionnaires, each of which showed high to very high reliability (BHS α = 0.92; R-SIS α = 0.943) and adequate item and construct validity, then analyzed univariately and bivariately using the Spearman correlation test. Results: Most respondents experienced low hopelessness (52%) and low suicidal ideation (78.6%). The Spearman correlation test results showed a correlation coefficient (r) of 0.227 and a p-value of 0.024 (p<0.05). There is a significant but weak positive relationship between hopelessness and suicidal ideation in adolescents. The higher the level of hopelessness, the higher the likelihood of suicidal ideation.
Research Trends on Time Management and Workload in Nursing: A Bibliometric Analysis
Time and workload management are crucial issues in nursing practice because they directly relate to time pressure, workflow efficiency, and nurses' psychological well-being. However, the rapid growth of publications has not been accompanied by a comprehensive scientific mapping to understand the global knowledge landscape on this topic. Mapping publication performance, distribution of country contributions, and dynamics of research themes related to time management and workload in nursing through bibliometric analysis. A bibliometric study was conducted using the Scopus database (Elsevier) covering the last 10 years. The search strategy combined keywords related to time management/time pressure/workflow management, workload/work demands/work intensity, and nursing/nurse. The initial search yielded 562 documents, which were then narrowed down to 199 publications (in the last 10 years), 173 publications (in the fields of Medicine and Nursing), and finally 164 documents (articles and reviews) for analysis. Descriptive analysis was used for annual publication trends (2016–2026) and country contributions, while keyword co-occurrence mapping, overlay maps, and density maps were performed using VOSviewer version 1.6.18. Co-occurrence mapping placed population/indexation terms (e.g., human/humans, adult, male, aged, article) as the central node, with prominent substantive themes on workload and nurse. Key clusters were identified that reflect: (1) work stress and mental health (e.g., stress/job stress, mental health/mental stress, burnout, job satisfaction), (2) management/operations and work processes (e.g., organization and management, workflow, task performance, time management/time pressure), and (3) qualitative approaches and capacity building (e.g., qualitative research, interview, content analysis, nursing education, skills, leadership). The overlay map indicates a strengthening of newer themes on time pressure, time management, procedures, and qualitative approaches, while the density map highlights hotspots on the relationship between nurse workload and stress/burnout and organizational factors. Research on time management and workload in nursing shows increasing scientific attention and is still dominated by contributions from countries with established research ecosystems. Key themes center on the relationship between nurse workload and stress/burnout, as well as organizational factors and work processes, with recent signs of increased focus on time pressure and qualitative approaches to understanding work dynamics. Future research should strengthen the standardization of workload definitions and measurements, expand geographic coverage, and evaluate organization-based interventions that can reduce workload and improve nurse well-being and service quality.
Histopathological Test of Placental Tissue to Measure the Effectiveness of Mahkota Dewa Fruit (Phaleria Macrocarpa) in Overcoming Placental Inflammation in Case of Preeclampsia
Preeclampsia is disturbance pregnancy - related hypertension​ close with inflammation placenta, stress oxidative, and damage structure network placenta that has an impact bad to health mother and fetus. Available therapies​ moment This Still focus on control symptoms and not yet in a way specific target mechanism base in the form of inflammation placenta. Fruit The Crown of God (Phaleria macrocarpa) is plant drug original Indonesian containing compound bioactive potential anti-inflammatory, but proof scientific about its effectiveness to inflammation placenta in preeclampsia Still limited. Research objectives This For test effectiveness extract fruit Crown of the Gods in lower inflammation placenta based on description histopathology network placenta in preeclampsia model. Research methods This use design true experimental post-test only control group in mice white female induced pregnancy (Rattus norvegicus) preeclampsia using monosodium glutamate. Subject study shared become six group, namely normal control, control preeclampsia, control nifedipine comparator, as well as three group treatment extract ethanol fruit Crown of the Gods with doses of 180, 360, and 720 mg/ kgBW. Tissue placenta taken after delivery and examination in a way histopathology use coloring hematoxylin -eosin with infiltration parameters cell inflammation, edema, necrosis, degeneration trophoblast, and cell structure. Data were analyzed using one ANOVA test direction and Tukey's further test. The results of the study show that induction preeclampsia cause improvement inflammation real placenta, whereas​ giving extract fruit Crown of the Gods in a way significant lower degrees inflammation placenta. Dose 360 mg/ kgBW show effectiveness best with description histopathology that approaches normal conditions. It was concluded that fruit The Crown of God is proven effective lower degrees damage histopathological placenta in a way significant in the preeclampsia model.
The Effect of Therapy Intervention of Group Activity Socialization (Taks) on the Social Interaction Abilities of Children and Adolescents
Mental disorders are conditions that affect a person's thoughts, feelings, and behavior, thus disrupting social functioning, work, and family relationships. One of the surgical interventions used to treat clients with similar problems is Group Activity Therapy (GAT). Its forms include socialization GAT, which is a therapy that aims to improve social skills through structured group activities and facilitated by health professionals. This therapy focuses on improving communication skills, empathy, and cooperation between individuals. This study aims to determine the effect of the socialization GAT intervention on the social interaction skills of children and adolescents with social isolation. The research method used a quasi-experimental design with a one-group pre-test and post-test. A total of 30 respondents aged 9–19 years diagnosed with social isolation were selected using a total sampling technique. The intervention was carried out for seven sessions, and social interaction skills were measured before and after the intervention using an observation sheet. Data analysis used the Kolmogorov-Smirnov normality test and Paired Sample t-Test. The results showed that before the intervention, 86.7% of respondents were in the "sufficient" category, while after the intervention, this increased to 50% "good" and 50% "very good". Statistical testing showed a p-value of 0.001 (p < 0.05), indicating a significant effect of TAK socialization on improving social interaction skills. In conclusion, TAK socialization is effective in improving social interaction in children and adolescents with social isolation and is suitable for continued implementation in psychiatric care.
Determinants of Nutritional Status, Weight Gain, and Utilization of Health Services in Toddlers: A Literatur Review
Nutritional problems in toddlers, such as stunting and underweight , as well as non-compliance in growth and development monitoring remain major public health challenges. Participation in health services such as Posyandu and other determinants that influence nutritional status need to be identified more deeply to determine appropriate interventions. This study aims to synthesize current research on the determinants of nutritional status, successful weight gain, and factors that influence the utilization of toddler health services. The method used is a literature review by searching for articles online through the Google Scholar database (13,430 articles), ScienceDirect (6,674 articles), and PubMed (499 articles). The article search used the keywords "weight gain in toddler," "toddler nutritional status , " and "Health Service Utilization in Toddlers" articles published within the last five years (2020–2025). The data analysis process went through the process of organizing , synthesizing , identifying , and further analyzing until 10 selected research articles were obtained. The research design analyzed mostly used a cross-sectional and descriptive analytical approach, with study locations covering various regions in Indonesia and one international comparative study. The results of the study show that low maternal education is the dominant determinant factor in the incidence of underweight And stunting . Key biological risk factors include a history of low birth weight (LBW), incomplete immunization status, and a history of infectious diseases such as tuberculosis and diarrhea . In terms of services, the frequency of visits to integrated health posts (Posyandu) and nutritional counseling are significantly associated with normal nutritional status. Furthermore, the effectiveness of utilizing health data for prevention is crucial. stunting influenced by the level of education and time allocation of Posyandu cadres. The nutritional status of toddlers is influenced by a complex array of factors , including parental characteristics (especially maternal education), the child's health history (immunizations and infections), and active participation in Posyandu (Integrated Health Posts). Nutrition improvement interventions must integrate maternal education, infectious disease prevention, and capacity building for health workers.
The Relationship between Knowledge, Attitudes, and Behaviors Toward Genital Health
Acne vulgaris is a common inflammatory skin disorder influenced by microbial imbalance, immune dysregulation, and excessive sebum production. Recently, probiotics have gained attention as a potential adjunct therapy due to their ability to regulate inflammation, improve skin barrier function, and modulate the gut–skin axis. This study aimed to evaluate the existing clinical evidence on the effectiveness of probiotics as a therapeutic approach for acne vulgaris. A systematic literature review was conducted following PRISMA 2020 guidelines. Electronic searches were performed in PubMed, Scopus, Web of Science, and Google Scholar using the keywords “probiotics”, “acne vulgaris”, “microbiome”, “oral probiotics”, “topical probiotics”, and “clinical trial” for studies published between 2000 and 2024. A total of 319 records were identified. After screening and eligibility assessment, 4 clinical trials met the inclusion criteria. Data were extracted and synthesized using a narrative approach due to heterogeneity of probiotic strains, dosages, and outcome measures. Four clinical trials met the inclusion criteria, consisting of three oral probiotic studies and one topical formulation study. The results demonstrated that probiotics significantly reduced acne severity, lesion counts, and inflammation. Oral probiotics, such as Lactobacillus plantarum, Lacticaseibacillus rhamnosus, and probiotic combinations with Arthrospira platensis improved skin hydration, modified sebum composition, and positively influenced skin microbiota. A topical Lactobacillus paracasei formulation showed comparable effectiveness to benzoyl peroxide in reducing inflammatory lesions, with fewer adverse effects. All probiotic treatments were well tolerated and associated with minimal side effects. Current evidence indicates that both oral and topical probiotics may serve as effective adjunct therapies for acne vulgaris by reducing inflammation, regulating the skin microbiome, and enhancing skin barrier function. However, variability in strains, treatment regimens, and study designs limits standardization. Larger, well-designed, strain-specific randomized trials are needed to determine optimal probiotic therapy for acne management.
Implementation of Dots as the Primary Determinant of Treatment Adherence During the Intensive Phase of Tuberculosis Patients
Tuberculosis (TB) remains a major public health burden, particularly in high-incidence countries such as Indonesia. The World Health Organization–recommended Directly Observed Treatment Short-course (DOTS) strategy plays a crucial role in improving treatment success; however, patient adherence during the intensive phase of treatment remains a significant challenge. This study aimed to analyze the relationship between the implementation of the DOTS strategy and adherence to anti-tuberculosis medication during the intensive phase among pulmonary TB patients in Bone Bolango Regency. This study employed a quantitative analytical design with a cross-sectional approach. A total of 75 respondents were recruited using total sampling. Data were collected through a structured questionnaire and analyzed using Chi-square tests and logistic regression analysis. The findings demonstrated significant associations between all DOTS components and treatment adherence, including government commitment (p = 0.006), microscopic examination (p = 0.003), treatment supervision (p = 0.000), drug availability (p = 0.002), and recording and reporting systems (p = 0.004). Treatment supervision was identified as the most dominant factor influencing adherence, with a p-value of 0.001 and an odds ratio (OR) of 0.133 (95% CI: 0.039–0.459). The implementation of the DOTS strategy is strongly associated with adherence to anti-tuberculosis medication during the intensive phase of treatment. Strengthening the role of treatment supervisors, ensuring consistent drug availability, and improving recording and reporting systems are essential to enhance treatment success.
The Relationship Spousal Support and Medication Adherence among Coronary Heart Disease Patients
Coronary heart disease (CHD) is one of the leading causes of mortality worldwide, including in Indonesia. Medication adherence is a crucial factor in preventing complications and improving quality of life among patients. This study aimed to examine the relationship between spousal support and medication adherence among patients with coronary heart disease. A quantitative study with a cross sectional design using a systematic sampling technique was conducted among 159 CHD patients attending the cardiac outpatient clinic at Dr. Moewardi General Hospital, Surakarta. Data were collected using a spousal support questionnaire and the Morisky Medication Adherence Scale MMAS 8 and analysed using the Spearman Rho test with a 95 percent confidence level. The results showed a significant positive relationship between spousal support and medication adherence with p value 0.001 and correlation coefficient r 0.482. Patients who received high spousal support demonstrated better medication adherence compared to those with low support. Spousal support plays an important role in improving medication adherence among patients with CHD and should be considered in long term disease management strategies.
Optimizing Early Detection: Key Factors Influencing Hospital Early Warning System Implementation – A Systematic Review
Early Warning System (EWS) is a clinical tool used to detect early signs of patient deterioration and prevent delayed interventions. Despite broad implementation, challenges persist related to healthcare providers’ readiness, organizational support, system design, and varied care environments. This study aims to identify and analyze factors influencing EWS implementation based on recent empirical evidence to support more effective and sustainable use in healthcare settings. A systematic review was conducted using five electronic databases: PubMed, Scopus, ScienceDirect, SpringerLink and ProQuest. The search employed key terms including “Early Warning System,” “EWS score,” “National Early Warning Score,” “NEWS2,” “hospital,” “implementation,” “adherence,” “barriers,” “facilitators,” and “healthcare professionals.” A total of 1,163 articles were initially identified. Following duplicate removal, title and abstract screening, and full-text assessment in accordance with PRISMA guidelines, 23 peer-reviewed articles met the inclusion criteria. Eligible studies were open-access, published in English between 2018 and 2025, and reported original empirical findings related to EWS implementation. This review was registered with PROSPERO. The included studies identified four major categories of factors influencing EWS implementation: (1) Individual factors, including clinical experience, attitudes, knowledge, and emotional readiness; (2) Organizational factors, such as managerial support, patient safety culture, infrastructure, and institutional policies; (3) Intervention-related factors, including system design, training quality, and integration with information technology; and (4) Environmental factors, encompassing resource availability, facility conditions, and the need for local adaptation. Successful implementation of Early Warning Systems requires a comprehensive and integrated approach. Effectiveness and long-term sustainability are influenced by the extent to which implementation strategies are aligned with local clinical contexts, supported by structured training programs, embedded within a strong patient safety culture, and reinforced through multidisciplinary collaboration.
Accuracy of Procalcitonin, C-Reactive Protein, and Mean Platelet Volume as Infection Markers in Neonatal Sepsis
Neonatal sepsis remains a significant cause of morbidity and mortality, yet diagnosis is limited by nonspecific symptoms and delayed blood culture results. This study evaluated the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP), and mean platelet volume (MPV) as early biomarkers of neonatal sepsis. A retrospective cohort study was conducted in the Neonatology Unit of H. Adam Malik General Hospital, Medan, from January to December 2024. The sampling technique used is consecutive sampling. Of 346 neonates screened, 121 met the inclusion criteria and had concurrent PCT, CRP, MPV, and blood culture results. Clinical and laboratory data were extracted from electronic medical records. Diagnostic performance was assessed using sensitivity, specificity, predictive values, likelihood ratios, and ROC analysis. Among 121 neonates, 31.4% had positive blood cultures. MPV showed no significant difference between culture-positive and culture-negative groups (p = 0.104) and demonstrated limited discriminatory value (AUC 0.592). CRP was significantly associated with culture results (p = 0.037), showing high specificity (94.7%) but low sensitivity (30.0%) at ≥1 mg/L (AUC 0.624). PCT demonstrated the strongest performance, with significantly higher levels in culture-positive neonates (p = 0.022), sensitivity of 64.5%, specificity of 69.0%, and an AUC of 0.672. Diagnostic accuracy was 66.7% for PCT, 85.1% for CRP, and 55.4% for MPV. PCT provided the most balanced diagnostic utility for neonatal sepsis, while CRP served as a highly specific rule-in marker. MPV showed limited usefulness. Although these biomarkers contribute to early assessment, they are insufficient as standalone diagnostic tools and should be integrated with clinical evaluation and microbiological testing.