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 Effect of Brand Image and Service Quality on Outpatient Loyalty Mediated by Patient Satisfaction
Patient loyalty is a strategic indicator for hospitals, particularly in mental health services where continuity of care is essential. This study analyzed the effect of brand image and service quality on outpatient loyalty mediated by patient satisfaction at RSJD Atma Husada Mahakam, a type A psychiatric referral hospital in East Kalimantan, Indonesia. An explanatory quantitative survey with a cross-sectional design was conducted among 200 outpatients selected using purposive sampling. Data were collected using a structured Likert-scale questionnaire measuring brand image, service quality, patient satisfaction, and patient loyalty. Data were analyzed using descriptive statistics, Pearson correlation, and partial least squares structural equation modeling (PLS-SEM) with SmartPLS. The measurement model met validity and reliability criteria, with AVE values ranging from 0.546 to 0.649 and composite reliability values ranging from 0.902 to 0.924. The structural model showed that brand image positively affected patient satisfaction (beta = 0.318; t = 3.934; p < 0.001) and loyalty (beta = 0.210; t = 2.920; p = 0.004). Service quality positively affected satisfaction (beta = 0.515; t = 7.648; p < 0.001) and loyalty (beta = 0.273; t = 4.042; p < 0.001). Patient satisfaction also had a positive effect on loyalty (beta = 0.408; t = 4.794; p < 0.001). Indirect effect testing confirmed that satisfaction significantly mediated the influence of brand image (beta = 0.130; t = 2.715; p = 0.003) and service quality (beta = 0.210; t = 4.113; p < 0.001) on loyalty. The findings indicate that strengthening service quality, maintaining a positive hospital image, and systematically managing patient satisfaction are central strategies for building outpatient loyalty in psychiatric hospital services.
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Clinical Outcomes, Rejection Patterns, and Immunosuppressive Strategies in Vascularized Composite Allotransplantation: A PRISMA-Based Systematic Review
Vascularized composite allotransplantation (VCA) is an innovative reconstructive option for patients with complex tissue loss involving the face, upper extremities, and other anatomical structures. This systematic review aimed to synthesize evidence on clinical outcomes, rejection patterns, and immunosuppressive strategies in VCA. A systematic review was conducted following the PRISMA framework. Studies published between 2021 and 2026 evaluating VCA, particularly hand and face transplantation, were identified using relevant keywords and MeSH-related terms, including VCA, hand transplantation, face transplantation, immunosuppression, rejection, and graft survival. VCA provides significant functional, sensory, aesthetic, and psychosocial benefits, contributing to improved daily activities and quality of life. Acute cellular rejection was the most frequently reported immunological complication, particularly during the early post-transplant period. Antibody-mediated and chronic rejection were less common but could contribute to progressive graft dysfunction and loss. VCA offers promising functional and psychosocial outcomes with generally favorable short- to medium-term graft survival. However, rejection and the long-term morbidity associated with lifelong immunosuppression remain major clinical challenges.
The Effect of Positive Affirmations on Reducing Stress Levels in Families with Schizophrenia Patients at Home
Families caring for schizophrenia patients at home often experience psychological distress manifesting as stress, anxiety, and emotional exhaustion—and even a decline in their quality of life. This is caused by fatigue, a lack of knowledge, and the burden of long-term treatment.(Mariani, 2024) . The research method used was a quasi-experimental design with a one-group pretest-posttest design. The study involved 25 respondents, and simple random sampling was the technique used. This design does not use a comparison group (control), but uses the first observation (pretest), which allows for testing changes that occur after treatment or posttest. The purpose of this study was to determine the effect of positive affirmations on reducing stress levels in families of patients with schizophrenia at home, specifically in Joyontakan Village. The results of this study showed a decrease in stress in families after positive affirmation training, which decreased from 16 people (64%) to 5 people (20%), while severe stress decreased from 7 people (28%) to 2 people (8%). Conversely, the normal category increased from 0 to 6 people (24%), and the mild stress category increased from 2 people (8%) to 12 people (48%). The results of the analysis showed a p-value < 0.001 (p <0.05). Thus, there was a significant difference between family stress levels before and after being given positive affirmations. These results indicate that positive affirmations have an impact on reducing stress levels in families caring for schizophrenic patients at home. Conclusion: Positive affirmations are effective in reducing stress levels in families with schizophrenic patients at home.
The Effect of Tuberculosis Self Management Education Based on Self Care Theory on Self Efficacy and Medication Adherence in Pulmonary Tuberculosis Patients
Non-adherence to medication is still a major problem that has an impact on therapy failure, drug resistance, and increased morbidity and mortality. Multi Drug Resistant TB (MDR-TB) cases in Indonesia are ranked 3rd (7.4%) after India and Russia. Through an educational approach that empowers patients through Tuberculosis Self Management Education (TSME) based on Self Care Theory, it is hoped that it will be able to increase self-efficacy and medication adherence to tuberculosis patients. This study aims to analyze the influence of Tuberculosis Self Management Education based on Self Care Theory on self-efficacy and medication adherence in tuberculosis patients. Methods: The study used a quasi-experiment design with pretest–posttest with control group, population of 68 with a sample of 34 intervention group respondents and 34 control group respondents with accidental sampling technique. The independent variables are TSME based on Self Care Theory, while the dependent variables include self-efficacy and medication adherence. The research instruments used were TBSES-21 self-efficacy questionnaire and MMAS-8 drug adherence. Data analysis used Paired t-test and Independent t-test. The study showed a significant improvement in self-efficacy and medication adherence in the intervention group after intervention compared to the control group (p = 0.000). Conclusion: There is an effect of TSME based on Self Care Theory on self-efficacy and medication adherence in pulmonary tuberculosis patients. This intervention is recommended to be applied, especially TB patients and their families, nurses in nursing services to support the success of tuberculosis treatment.
Implementation of Swallowing Therapy in Dysphagia Patients with Ischemic Stroke Diagnosis
Ischemic stroke is the acute onset of focal neurological deficits in vascular territories affecting the brain, retina or spinal cord due to cerebrovascular disease. The symptoms of stroke in general are partial or complete limb weakness, decreased cognitive function, difficulty swallowing or dysphagia, aphasia and dysarthria. Dysphagia is a swallowing disorder in which food and drinks take time to reach the stomach from the mouth. One of the interventions that can be given to patients is swallowing therapy. The purpose of this case study is to provide nursing care for ischemic stroke patients who experience dysphagia to overcome swallowing difficulties. This exercise requires patient participation by giving instructions or directions to patients both verbally and visually about how to swallow to increase swallowing muscle strength. There was one participant in the ischemic stroke patient. The exercise was given for 4 days 3 times a day for 15 minutes each exercise using the Mann Assessment of Swallowing Ability, a standardized instrument with established validity and reliability for dysphagia assessment in stroke patients. The results of the evaluation showed an improvement in the patient’ swallowing ability, namely before the intervention MASA 147 and after the intervention MASA 170. The application of swallowing exercises can be used as a nurse intervention in carrying out nursing actions independently for patients who experience swallowing disorders in ischemic stroke patients and can be continued by families at home.
The Effect of Strengthening Nurses' Clinical Roles on Service Quality in the Emergency Department
The Emergency Department (ED) is a service unit that requires nurses to possess strong clinical competencies to make rapid, accurate, and safe decisions. Strengthening nurses' clinical roles is an important factor in improving service quality, particularly in work environments characterized by high complexity and intense pressure. This study aimed to determine the effect of strengthening nurses' clinical roles on service quality in the Emergency Department of Awal Bros Panam Hospital (RSAB Panam). This study employed a quasi-experimental design with control and intervention groups. The study was conducted in the Emergency Department of RSAB Panam. The sample consisted of 32 emergency nurses who were divided into control and intervention groups, as well as patients receiving nursing care in the ED as respondents for service quality assessment. Total sampling was used for nurse participants. The intervention involved strengthening nurses' clinical roles based on Patricia Benner's theory through structured training, supervision, and clinical evaluationService quality was measured using the SERVQUAL instrument, which has demonstrated good validity (content and construct) and high reliability with Cronbach’s Alpha values >0.80. The data were analyzed using the Generalized Linear Model Repeated Measure. The results showed a significant effect of strengthening nurses' clinical roles on improving service quality in the ED. The Greenhouse–Geisser test indicated a p-value of 0.000, demonstrating a statistically significant change in service quality over time. The tests of between-subjects effects revealed a significant difference in service quality between the control and intervention groups with a p-value of 0.000. Improvements in service quality were more consistent in the intervention group compared to the control group. In conclusion, strengthening nurses' clinical roles has a significant effect on improving service quality in the Emergency Department.
The Effectiveness Ihsan Culture Focus-Care through Intentional Rounds on Patient Satisfaction
One indicator of service quality at hospitals is patient satisfaction. Organizational culture and caring practices play a role in increasing patient satisfaction. At Permata Jonggol Hospital,. the results of patient complaints convey a lack of nurses visiting patients, interactions occur for routine activities. Permata Jonggol has an IHSAN (Integrity, Harmony, Solutif, Entushiasim, Value) organizational culture but its implementation is not yet visible. There needs to be an intervention through periodic visits and structured communication called Intentional rounds by integrating the organizational culture. The study purpose was to identify differences in patient satisfaction and to determine the effectiveness of implementing IHSAN culture-focused care through intentional rounds. The research design used a quasi-experimental design with a pre-post test design. The population was nurses and patients in the inpatient ward using total sampling. A total of 60 respondents were included in this study, consisting of 30 respondents in the intervention group and 30 respondents in the control group. The results showed no difference in patient satisfaction before implementation between the intervention and the control group (0.446 > 0.05) but there was a significant difference in patient satisfaction after implementation between the intervention and the control group (0.001 < 0.05). There was a significant difference before and after the implementation of care in the intervention group (0.011 < 0.05), while in the control group, there was no difference in patient satisfaction (0.855 > 0.05). This care showed positive effects, however, the pattern of improvement from week to week appeared to fluctuate so that the consistency of the effects over time could not be ascertained.
Determinants of Improving Service Quality Based on the Kolcaba Comfort Model in the Emergency Department
Kolcaba's Comfort Theory emphasizes holistic nursing care by fulfilling patients' comfort needs in four contexts: physical, psychospiritual, sociocultural, and environmental. The Emergency Department (ED) is a high-pressure healthcare setting that requires not only rapid and accurate clinical interventions but also comfort-based nursing services. This study aimed to analyze the determinants of Kolcaba Comfort Theory–based nursing care in the Emergency Department of PMC Hospital, Pekanbaru. This study employed a quantitative method with a cross-sectional design. A total of 96 respondents were selected using purposive sampling. Data were collected using a questionnaire. The questionnaire was tested for validity and reliability before data collection. All items were declared valid based on the Pearson correlation test, and the instrument was reliable with a Cronbach’s alpha value > 0.70. Analyzed using chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis. The bivariate analysis showed significant associations between age (p=0.027), educational level (p=0.001), effective nurse communication (p=0.001), and service environment (p=0.001) with Kolcaba Comfort Theory–based nursing care. However, multivariate analysis revealed that only educational level (p=0.000; OR=31.889; 95% CI=6.395–159.014) and service environment (p=0.024; OR=0.155; 95% CI=0.031–0.785) remained statistically significant. Educational level was identified as the most dominant determinant. The final model showed a Nagelkerke R Square value of 0.707 and an overall classification accuracy of 90.6%. Conclusion: Kolcaba Comfort Theory–based nursing care in the Emergency Department of PMC Hospital, Pekanbaru is significantly influenced by patients’ educational level and the service environment, which contribute to achieving holistic patient comfort.
The Importance of Organizational Support in Preventing Obesity Among Nurses in Hospitals
Obesity in nurses is a growing occupational health problem and has implications for the quality of service and patient safety. Organizational support is seen as an important resource within the nursing management framework that can shape a health-promoting work environment and lower the risk of obesity. To analyze the relationship between organizational support and the incidence of obesity in nurses in hospitals. A quantitative study with a cross-sectional design was conducted on 227 nurses in a teaching hospital by 2025 nurses were selected as the sample using a purposive sampling technique. Obesity status is determined based on Body Mass Index (BMI). Organizational support was measured using a structured questionnaire that has been tested for validity and reliability. The analysis was carried out in univariate, bivariate, and multivariate logistic regression with a significance level of p < 0.005. The prevalence of obesity in nurses was 57.3%. Bivariate analysis showed that organizational support was significantly related to obesity incidence (p < 0.005). In a multivariate analysis, nurses with low organizational support were 5.582 times more likely to be obese than nurses with good organizational support (OR = 5.582; 95% CI: 2.064–15.094; p = 0.001), after controlling for confounding variables. Organizational support is a strong independent determinant of obesity in nurses.
Clinical Prehospital Interventions in Trauma Care: A Systematic Literature Review
Trauma remains a leading cause of mortality and disability worldwide, particularly among working-age individuals. A significant proportion of trauma deaths occur during the early post-injury period, underscoring the critical need for effective prehospital interventions. Various strategies including airway management, hemorrhage control, blood product resuscitation, oxygen therapy, and pharmacological treatments have been implemented, though their efficacy varies across studies. This study aims to identify and classify prehospital clinical interventions for trauma patients, assess the quality and strength of the evidence, and determine evidence gaps and their implications for clinical practice and trauma system policy. This systematic review adhered to PRISMA 2020 guidelines, searching in database Scopus (2020-2026) for studies on trauma patients receiving prehospital interventions (RCTs/cohort studies) reporting outcomes such as mortality, survival to discharge, hemodynamic stability, complications, or length of hospital stay. Methodological quality was assessed using Joanna Briggs Institute tools, with narrative synthesis due to study heterogeneity. Of 1,877 records, seven studies met inclusion criteria, primarily RCTs from high-income countries. Tranexamic acid (TXA) was most frequently studied, demonstrating reduced 28-day mortality and transfusion requirements without increased thromboembolic risk. Prehospital blood product resuscitation and oxygen therapy strategies yielded mixed or neutral findings. Prehospital TXA administration provides the most consistent survival benefit for bleeding trauma patients. Further high-quality research is needed to optimize other prehospital interventions and strengthen evidence-based trauma systems.
Optimizing the Role of Talent First Line Manager through Nursing Resource Development Strategy Based on External and Internal Analysis: Case Report
Abstract The role of the first line man The role of the first line manager (FLM) is strategic in improving hospital service quality as a link between managerial policies and clinical practice. However, the transition from clinical nurse to managerial position, along with the complexity of healthcare services, creates challenges in managing nursing human resources. This case report aims to develop a strategic human resource development plan to support the transition of FLM talent at Hospital X Jakarta. The study participants consisted of 41 head nurses serving as First Line Managers (FLMs) at RS X. The method used is a descriptive-analytic approach with field study, using primary data (interviews and observations) and secondary data (literature and documents). The analysis applies SWOT, IFE-EFE matrices, IE matrix, and TOWS, integrated with the Balanced Scorecard (BSC). The results show that Hospital Strengths include educational qualifications, clinical experience, and a structured head nurse selection system. Weaknesses include uneven managerial competencies, a non–talent-based appointment system, and high workload. Opportunities arise from digitalization, accreditation demands, and HR development, while threats include burnout risk, hospital competition, and regulatory changes. ager (FLM) is strategic in improving hospital service quality as a link between managerial policies and clinical practice. However, the transition from clinical nurse to managerial position, along with the complexity of healthcare services, creates challenges in managing nursing human resources. This case report aims to develop a strategic human resource development plan to support the transition of FLM talent at Hospital X Jakarta. The method used is a descriptive-analytic approach with field study, using primary data (interviews and observations) and secondary data (literature and documents). The analysis applies SWOT, IFE-EFE matrices, IE matrix, and TOWS, integrated with the Balanced Scorecard (BSC). The results show that Hospital Strengths include educational qualifications, clinical experience, and a structured head nurse selection system. Weaknesses include uneven managerial competencies, a non–talent-based appointment system, and high workload. Opportunities arise from digitalization, accreditation demands, and HR development, while threats include burnout risk, hospital competition, and regulatory changes. The recommended strategies include strengthening leadership competencies through continuous training, developing mentoring systems, implementing objective talent management, and optimizing the FLM role in improving service quality and patient safety.
Effectiveness of Various Chlorhexidine-Based Insertion Site Protocols in Preventing CRBSI among Hemodialysis Patients: A Systematic Review and Synthesis Without Meta-analysis (SWiM)
Chronic Kidney Disease (CKD) is a global health issue affecting 10–15% of the world's population, often progressing to End-Stage Renal Disease (ESRD). Hemodialysis (HD) is the primary renal replacement therapy; however, the use of a Central Venous Catheter (CVC) for vascular access increases the risk of Catheter-Related Bloodstream Infections (CRBSI). Skin pathogens such as Staphylococcus aureus account for 40–80% of CRBSI cases, contributing to increased morbidity and mortality. The use of chlorhexidine (Chlorhexidine Gluconate/CHG) at the insertion site aims to inhibit extraluminal bacterial colonization. However, the effectiveness of various CHG protocols remains a subject of debate due to the risk of contact dermatitis and cost-effectiveness. This systematic review aims to evaluate the effectiveness of various chlorhexidine-based insertion site care protocols in preventing CRBSI events in hemodialysis patient. This systematic review was conducted in accordance with the PRISMA 2020 guidelines, using the “Synthesis Without Meta-analysis” approach, and is registered with PROSPERO 2026 under CRD420261368887. A search was conducted in the EBSCO, PubMed, Sage Journals, ScienceDirect, Scopus, and Wiley databases using the keyword “chlorhexidine-based catheter insertion care for the prevention of CRBSI.” Articles published between 2010 and 2025 were searched, resulting in a total of 1,412 articles identified from the initial database search.. A total of 7 articles meeting the inclusion criteria, consisting of RCTs and quasi-experimental studies. The outcomes analyzed included catheter-related infections such as CRBSI, CLABSI, and CRI. The direction of effects was analyzed narratively, and study quality was assessed using RoB 2 and JBI. Four studies showed a reduction in the incidence of infection, while three studies showed no significant difference. No increased risk of infection was found in any of the studies. Most studies used chlorhexidine sponges or patches (4 studies, 57%); 28% used chlorhexidine-impregnated dressings; and the remainder used chlorhexidine solution. Most studies were of moderate to good quality, with some potential for bias. Three studies showed p-values < 0.05. Chlorhexidine-based care protocol interventions show a tendency to reduce catheter-related infections in hemodialysis, but results remain inconsistent. The implementation of evidence-based nursing practices, particularly tailored to tunneled and non-tunneled catheters, is necessary to optimize infection prevention.
The Effect of Implementing SBAR Handover on the Continuity of Nursing Care in Inpatient Wards
Continuity of nursing care is an important indicator of hospital service quality and is strongly influenced by the effectiveness of communication among nurses, particularly during handover. One communication method recommended to enhance patient safety is SBAR (Situation, Background, Assessment, Recommendation). Integrating the SBAR method with Jean Watson's caring theory is expected to strengthen clinical communication in a more humanistic and holistic manner. This study aimed to analyze the effect of SBAR handover implementation on the continuity of nursing care in the inpatient wards of Pekanbaru Medical Center Hospital. This study employed a quasi-experimental design with control and experimental groups.This study used a total sampling technique involving 30 inpatient nurses, who were divided into an experimental group (n = 15) and a control group (n = 15). Data were collected by measuring continuity of nursing care scores before and after the intervention. Data analysis was conducted using the Generalized Linear Model Repeated Measures to assess changes in scores over time and differences between groups. The results showed that before the intervention, the mean continuity of nursing care scores were 37.27 ± 5.92 in the control group and 35.67 ± 4.37 in the experimental group. Following the implementation of SBAR handover, scores increased in both groups; however, the improvement was greater in the experimental group, with a mean score of 50.93 ± 1.10 compared to 41.80 ± 3.45 in the control group. The control group showed a statistically significant improvement (p = 0.020), whereas the experimental group demonstrated a highly significant increase (p = 0.000). Between-group analysis revealed a significant difference (F = 9.414; p = 0.005), as well as significant time effects and time × group interaction effects (p = 0.000). In conclusion, the implementation of SBAR handover was effective in improving the continuity of nursing care in inpatient wards.
Perianal Herpes Zoster with Diabetes Mellitus: A Rare Case Report
Herpes zoster (HZ) is caused by the reactivation of latent varicella-zoster virus and most commonly affects the thoracic and trigeminal dermatomes. Involvement of the sacral dermatomes, particularly with perianal extension, is rare and can mimic various anorectal disorders, leading to delayed diagnosis in elderly patients with comorbidities. In this case report, herpes zoster in the perianal area significantly disrupted the patient's daily activities, requiring prompt diagnosis and management. A 78-year-old female presented with blisters accompanied by pain, burning, and tingling in the left buttock area extending to the anus. The dermatologic findings included multiple vesicles to bullae on an erythematous base containing clear fluid in a zosteriform arrangement, discrete to confluent, crusted form. A Tzanck test revealed multinucleated giant cells. The primary therapy consisted of oral acyclovir and mupirocin ointment. Herpes zoster involving the sacral to perianal dermatomes (S2-S4) can cause various functional complications, including neuritis characterized by sensory and motor deficits, which can affect the patient's daily activities. Antiviral treatment within the first 72 hours can help minimize complications. Pain should be controlled to prevent worsening the patient's quality of life. Early diagnosis and treatment, along with vaccination, can reduce morbidity and prevent complications, especially disruption of daily activities in patients with perianal HZ.
Effect of Garcinia mangostana Linn. Pericarp Extract Supplementation on Lipid Profile and Glycemic Parameters in Elderly Patients with Type 2 Diabetes Mellitus: A Double-Blind Randomized Controlled Trial
Type 2 Diabetes Mellitus (T2DM) in the elderly is frequently accompanied by dyslipidemia, increasing cardiovascular risk. Mangosteen pericarp, derived from Garcinia mangostana Linn., contains xanthones with antioxidant and anti-inflammatory properties that may improve metabolic parameters. The aim of this study is evaluate the effect of mangosteen pericarp extract supplementation on lipid profile, glycemic parameters, and insulin resistance in elderly patients with T2DM. This double-blind randomized controlled trial included 72 elderly T2DM patients allocated into a supplementation group (n=36) and a placebo-controlled group (n=36). Consecutive sampling was used for this study. Baseline and post-intervention assessments included fasting blood glucose, HbA1c, serum insulin, HOMA-IR, total cholesterol, LDL, HDL, and triglycerides. Within-group and between-group analyses were performed using parametric or non-parametric tests as appropriate, with p <0.05 considered statistically significant. Significant differences in baseline HbA1c and LDL levels were observed between groups (p<0.05). After intervention, a significant between-group difference was found only in HDL levels (p<0.05). Delta analysis demonstrated significant improvements in LDL and HDL in the supplementation group compared with controls (p<0.05). No significant differences were observed in fasting glucose, HbA1c, insulin levels, or HOMA-IR. Mangosteen pericarp extract supplementation significantly improved LDL and HDL levels but did not significantly affect glycemic control or insulin resistance.
Factors Influencing the Level of Depression in Post-Hysterectomy Women
Hysterectomy is one of the most commonly performed gynecological procedures to treat various conditions such as uterine fibroids, endometriosis, and malignancies. Although it can improve physical health, this procedure may lead to psychological impacts, particularly depression. So, hysterectomy can lead to depression influenced by biopsychosocial factors such as body image, social stigma, and family support, so analyzing factors associated with depression, particularly body image, among post-hysterectomy women at Sanjiwani General Hospital helps identify risks and improve psychological care for these patients. Based on this, this study aims to analyze factors associated with depression, particularly body image, among post-hysterectomy women at Sanjiwani General Hospital, Gianyar. This study used an analytical observational design with a cross-sectional approach. The sample consisted of 58 post-hysterectomy women selected using purposive sampling technique. Data were collected using the Multidimensional Body-Self Relations Questionnaire–Appearance Scales (MBSRQ-AS) to measure body image and the Depression Anxiety Stress Scale (DASS-21) to assess depression. Validity and reliability testing of these instruments were conducted prior to the study, showing that all items were valid (r-count > r-table) and reliable with a Cronbach’s alpha value > 0.70. Data analysis was performed descriptively, using the Chi-square test for bivariate analysis, and logistic regression for multivariate analysis with a significance level of 5%. Most respondents did not experience depression (67.2%), while 24.1% experienced mild depression and 8.6% experienced moderate depression. Bivariate analysis showed that body image (p=0.001), social stigma (p=0.006), and family support (p=0.002) were significantly associated with depression. Comorbidities were not significantly associated (p=0.054). Multivariate analysis showed that body image was the dominant factor influencing depression (p=0.048; OR=2.958; 95% CI: 1.011–8.658). Body image, social stigma, and family support are factors associated with depression among post-hysterectomy women, with body image being the most dominant factor.
The Effectiveness of Date Fruit Administration on the Duration of Active Phase I and PHAsE II Labor
Prolonged labor remains a primary risk factor contributing to the rising rates of cesarean sections. This condition is commonly triggered by inadequate uterine contractions or pelvic disproportion, which, if left unmanaged, can jeopardize the safety of both mother and fetus. Given the importance of maintaining a physiological (normal) birth process, this study aims to examine the effectiveness of date consumption as a natural alternative for strengthening contractions. The active compounds in dates play a vital role in optimizing uterine function mimicking the effects of the hormone oxytocin making this research strategically significant in efforts to reduce invasive medical interventions during childbirth of this study was to determine the effectiveness of dates on the duration of active phase I and phase II labor at the Pondok Gede Bekasi TPMB. Was a quasi-experimental study with a post-test with control group design. The research sample involved 64 respondents divided into two groups. One group was given date fruit intervention, and one control group was only given sweet tea. The sampling technique used purposive sampling. Data analysis used the Independent Sample T-test because the data were normally distributed. The results showed that dates were effective in reducing the duration of active phase I labor with a p-value = 0.000 (<0.05), but were not effective in reducing the duration of stage II labor in mothers in labor because they had a p-value of 0.327 (>0.05).
Literature Review: The Effect of Non-Pharmacological Methods on Perineal Pain Intensity and Wound Healing in Women with Normal Postpartum Recovery
Perineal pain following vaginal delivery is a prevalent issue that significantly impacts postpartum quality of life and surgical incision recovery. Non-pharmacological interventions, notably thermal therapies, offer a non-invasive alternative to medication. This systematic review evaluates the efficacy of non-pharmacological methods on perineal pain intensity and wound healing during normal postpartum recovery. A systematic search was performed across Google Scholar and NCBI PubMed for studies published between 2014 and 2025. Following PRISMA guidelines, 9 articles were selected for qualitative synthesis. Findings indicate that warm compresses facilitate vasodilation, enhancing blood circulation and tissue regeneration. Conversely, cold compresses effectively induce local analgesia, reducing inflammation, edema, and nerve sensitivity. Both methods significantly decrease pain scores and accelerate the REEDA (Redness, Edema, Ecchymosis, Discharge, and Approximation) healing scale. Non-pharmacological methods are safe, cost-effective, and evidence-based interventions that should be integrated into standard midwifery and nursing protocols to optimize maternal recovery.
Systematic Review: The Effect of the Enhanced Recovery After Surgery (ERAS) Protocol on Recovery, Pain Management, and Length of Hospital Stay in Cesarean Section Patients
Cesarean section surgery often causes pain and prolongs hospital stays. The Enhanced Recovery After Surgery (ERAS) protocol offers a fast and comprehensive recovery solution. This systematic review aims to evaluate the effect of the ERAS protocol on recovery, pain management, and length of hospital stay in cesarean section patients. Researchers selected the literature using the PRISMA guidelines. The selection stages include identification, screening, eligibility assessment, and inclusion. literature articles retrieved from PubMed, Google Scholar, ScienceDirect, and the Cochrane Library. The researchers used specific keywords such as ‘ERAS protocol,’ ‘cesarean section’, ‘postoperative recovery’, ‘pain management’, and ‘length of stay’ to limit the search to articles published in the past five years (2021–2026). This process yielded five relevant articles for analysis. The review results show the ERAS protocol effectively accelerates physiological function recovery and physical mobility. ERAS also significantly reduces pain scores. Furthermore, patients experience a shorter length of hospital stay. This protocol demonstrates high safety and efficiency profiles. Healthcare facilities must implement ERAS as a standard of maternal nursing care to improve the quality of service for cesarean section patients.
Constraints and Barriers in Handling Severe Preeclampsia
WHO 2020 data shows a Maternal Mortality Rate (MMR) of 223 per 100,000. The Indonesian Health Profile in 2023, MMR in Indonesia is 189 per 100,000 live births. The most common causes of death are hypertension in pregnancy (412 cases), obstetric hemorrhage (360 cases) and other obstetric complications (204 cases). Preeclampsia is the most common hypertension in pregnancy in Indonesia, 7-10% of all pregnancies. Preeclampsia causes >70,000 maternal deaths and 500,000 fetal deaths worldwide each year. This study aims to explore in depth the obstacles and constraints in the management of severe preeclampsia at Dr. M. Djamil Padang General Hospital in 2025. Qualitative research methods. Informants were selected purposively with the following criteria: medical and nursing service managers, obstetrician/gynecologist specialists, midwives and nurses (in the emergency room or delivery room, obstetrics polyclinic, obstetrics inpatient, operating room, intensive care unit, and NICU), working for at least 1 year, directly involved in the management of severe preeclampsia, patients or their families. The number of informants was determined based on the saturation principle. Data collection techniques were in-depth interviews, field observations, document analysis, and FGDs. Data collection instruments used interview guidelines, voice recorders (with permission), and field notes. The analysis used was thematic. Data validity was verified by triangulation. Research results: Main strengths: the system is standardized (SOP, financing, evaluation). Main weaknesses: human resources, facilities, communication, and logistics. Biggest opportunities: strengthening the referral system and increasing human resources capacity. The main threat of patient overload due to referrals and delays in PEB management is influenced by several factors, including input, process, and output aspects of the healthcare system. Input Aspects (Men, Money, Methods)
The Relationship between Stress Level with Menstrual Cycle Disorders among Female Adolescents
Adolescent represents a critical transitional stage characterized by biological, psychological, and social changes, including the onset of menstruation as an indicator of reproductive maturity. Menstrual cycle disorders are common among adolescents and may be influenced by several stress. This study aimed to examine the association between stress levels with menstrual cycle disorders among female adolescents. A quantitative analytic observational study with a cross-sectional design was conducted among 278 female students selected through proportionate stratified random sampling. Data were collected using a standardized structured questionnaires, interviews, and anthropometric measurements, and analyzed using the Chi-square test. The results showed that most respondents were 16 years old (53.2%), and menarche predominantly occurring at the age of 12 years old (43.2%). The majority had mild stress levels. Bivariate analysis revealed significant associations between stress level (p = 0.000 ; p = 0.005). The conclusion of the study is that stress levels the factors most closely related to menstrual cycle disorders in adolescent girls.
Navigating Tuberculosis Treatment Challenges of Genetic Perspectives and DNA-Based Detection: A Literature Review
Tuberculosis remains a major global health problem, particularly because of the increasing burden of drug-resistant tuberculosis (DR-TB), including MDR-TB and XDR-TB. Resistance in Mycobacterium tuberculosis is driven mainly by spontaneous genetic mutations, adaptive evolution, tolerance mechanisms, and host microenvironmental factors, which complicate both treatment and diagnosis. This review aimed to examine recent advances in the genetic mechanisms underlying antibiotic resistance in M. tuberculosis and to evaluate the progress of DNA-based detection technologies for tuberculosis diagnosis and management. This literature review analyzed 49 scientific articles published between 2012 and 2026 to examine the molecular and genetic basis of drug resistance in M. tuberculosis. The study focused on identifying target gene mutations, efflux pump mechanisms, compensatory evolution, and heteroresistance. Furthermore, it evaluated the clinical application of advanced DNA-based diagnostic tools, including GeneXpert, line probe assays, targeted next-generation sequencing (tNGS), whole-genome sequencing (WGS), droplet digital PCR, and CRISPR-based detection. Information was qualitatively synthesized to compare the efficacy and limitations of these modern diagnostic strategies in global tuberculosis management. Drug resistance was primarily associated with de novo mutations in genes such as rpoB, katG, inhA, pncA, gyrA/gyrB, and rrs/eis, as well as compensatory mutations that preserve bacterial fitness. In addition, non-genetic tolerance, dormancy, and efflux pump overexpression contributed to bacterial survival. DNA-based technologies enabled faster and more comprehensive resistance detection than conventional methods, although limitations remained in sensitivity, mutation coverage, cost, and infrastructure requirements. Genetic mutations, evolutionary adaptation, and tolerance mechanisms form the core basis of drug resistance in M. tuberculosis. Integrating DNA-based diagnostics into clinical practice is essential to improve early resistance detection, support personalised treatment, and reduce the spread of drug-resistant tuberculosis.
The Impact of Sleep Quality on Clinical Outcomes in Hospitalized Children: A Systematic Review
Sleep is an essential physiological need in children that plays an important role in physical growth, neurological development, and the recovery process during illness. Hospitalized children are at high risk of experiencing sleep quality disturbances due to environmental, clinical, and psychological factors. Sleep disturbances during hospitalization are known to be associated with various adverse clinical outcomes. To identify the relationship between sleep quality and clinical outcomes in hospitalized children based on the latest scientific evidence. This systematic review was conducted in accordance with the PRISMA guidelines. Literature searches were performed in PubMed, ScienceDirect, Scopus, and Wiley. “poor sleep quality” AND “hospitalized children” AND “length of stay.” Included studies were quantitative studies involving hospitalized children aged 0–18 years that reported the relationship between sleep disturbances and clinical outcomes. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and the findings were analyzed using narrative synthesis. A total of six studies years 2021-2026 met the inclusion criteria. All studies reported decreased sleep quality during hospitalization, characterized by reduced sleep duration, increased nighttime awakenings, and decreased sleep efficiency. Sleep disturbances were associated with slower recovery, increased psychological distress, and a potential increase in length of hospital stay. The main contributing factors include environmental noise, medical interventions, pain, and anxiety. Non-pharmacological interventions were found to be effective in improving sleep quality. Sleep quality disturbances are common and multifactorial problems among hospitalized children and have a significant impact on clinical outcomes. Optimizing sleep quality should be integrated into clinical practice through simple interventions and family-centered approaches.
Strategic Plan for the Development of A Nursing Care Dashboard as A Clinical Decision Support Tool
The advancement of information technology has driven the transformation of data-based nursing systems through the utilization of nursing care dashboards to support clinical decision-making. This study aimed to analyze the development of a nursing system based on a nursing care dashboard in supporting clinical decision-making at Hospital A Tangerang. This study employed a case study design with an exploratory approach through observation, interviews, and document review. The respondents in this study consisted of 20 participants, including 10 nurse managers and 10 staff nurses working in inpatient units. The data were analyzed using SWOT, Internal Factor Evaluation (IFE), External Factor Evaluation (EFE), Internal - External (IE) Matrix, and TOWS. The results showed that the system was in a growth and build position with an IFE score of 2.88 and an EFE score of 3.06. Key strengths include integrated data availability, nursing staff competency, and management commitment, while weaknesses include limited analytical capability, suboptimal system integration, and underutilization of the dashboard in clinical decision-making. Strategic development focuses on optimizing dashboard utilization, enhancing nurses' digital competencies, and strengthening system integration. The development of a nursing dashboard-based system has the potential to improve the quality and timeliness of clinical decision-making and enhance nursing care quality.
Analysis of Factors that Have A Role in Improving Quality of Nursing Services in Inpatient Care
The quality of nursing care is a crucial aspect of the global health system, as nurses comprise the largest health workforce and are on the front lines of patient care. The quality of nursing care in hospitals is also influenced by several factors, such as leadership, organizational culture, burnout, and work motivation..This research aims to identify factors (leadership, organizational culture, burnout and motivation) that play a role in improving the quality of nursing services in the Inpatient Ward of Jakarta Harbor Hospital. The method used was a quantitative analytical research design with a cross-sectional approach. The research sample consisted of 100 health workers selected using total sampling techniques. The research sample consisted of 100 health workers selected using a total sampling technique. The dependent variable was the quality of nursing services, while the independent variables were leadership, organizational culture, burnout, and motivation. The research instruments used in this study had been tested for validity and reliability prior to data collection. The validity test results showed that all questionnaire items were valid, while the reliability test demonstrated good internal consistency with Cronbach’s alpha values greater than 0.70 for all variables..Data analysis was carried out bivariately using the chi-square test and multivariately using multiple logistic regression. The results of multiple logistic regression showed that the most dominant factor was the leadership variable with a p-value of 0.000 and an OR value of 153.415. The conclusion is that there is a relationship between leadership and motivation variables and the quality of nursing services in inpatient care at Pelabuhan Jakarta Hospital.
The Effect of Peer Group Education on Blood Pressure Control in Patients with Hypertension: Literature Review
Hypertension is a chronic disease with a high prevalence and is a major cause of global morbidity and mortality. Low medication adherence and inadequate patient knowledge are the main factors contributing to uncontrolled blood pressure. Peer group–based education has become one of the effective approaches to improving understanding, motivation, and health behavior changes among patients with hypertension. This review aims to comprehensively examine the effect of peer group education on hypertension control, including blood pressure, medication adherence, and lifestyle changes in patients with hypertension. This literature review used the PRISMA 2020 approach. Article searches were conducted through online databases including PubMed, ScienceDirect, and Google Scholar within the 2020–2025 publication period. The inclusion criteria comprised randomized controlled trials (RCTs), quasi-experimental, and experimental studies investigating peer group education interventions in adult patients with hypertension. A total of 7 articles published between 2022–2025 that met the inclusion criteria were critically appraised and analyzed descriptively and narratively to identify the effectiveness of peer group education interventions among patients with hypertension. The findings showed that peer group education significantly contributed to reducing blood pressure, improving medication adherence, and enhancing health behaviors such as dietary patterns, physical activity, and self-management. This intervention also improved patients' knowledge, motivation, and self-efficacy in managing hypertension. Peer group education is an effective intervention for hypertension control because it can improve adherence, promote healthier lifestyles, and reduce blood pressure.
Determinants of Discharge Planning Implementation
Discharge planning a day prior to discharge is vital for care continuity. TThis study aims to analyze the determinants of nursing service quality, including nurse competence, knowledge, motivation, and role perception. A descriptive correlational study with a cross-sectional design was conducted involving 110 associate nurses in the inpatient ward using a total sampling technique. Data were collected using structured questionnaires and observation checklists. Prior to data collection, the instruments were tested for validity and reliability. The validity test results indicated that all questionnaire items were valid, while the reliability test showed good internal consistency with Cronbach’s alpha values greater than 0.70 for each variable. Data were analyzed using multiple linear regression to determine the influence of nurse competence, knowledge, motivation, and role perception on the quality of nursing services.. The observation results showed a very high compliance rate (90.9 percent). The analysis proved that competence, knowledge, and nurse roles were not significant. Nurse motivation was proven to be the only dominant factor influencing the compliance level. In conclusion, intrinsic motivation determines nurse performance amidst competence and procedural homogeneity.
The Effect of Nursing Supervision on the Quality of Interprofessional Collaboration Among Nurses in Inpatient Wards
Interprofessional Collaboration (IPC) is essential for improving healthcare quality and patient safety in inpatient settings. This study aimed to analyze the effect of nursing supervision on IPC quality in inpatient wards. A quasi-experimental design was used with intervention and control groups, each consisting of 20 nurses with total sampling. IPC quality was measured five times (p1–p5) using an IPC instrument. The intervention group received structured nursing supervision, while the control group did not receive any intervention. The data were analyzed using descriptive and inferential statistics with multivariate analysis with GLM. The results showed a significant and consistent increase in IPC scores in the intervention group from the first to the fifth measurement, whereas the control group showed only a slight improvement. Multivariate analysis yielded a p-value of 0.001, indicating a statistically significant difference between the two groups. In conclusion, nursing supervision significantly improves the quality of Interprofessional Collaboration in inpatient wards.
The Effect of Transformational Leadership on the Quality of Nurses' Interprofessional Collaboration in Inpatient Wards
The quality of healthcare services is influenced by healthcare workers' ability to perform effective interprofessional collaboration (IPC). Transformational leadership of head nurses plays an important role in improving communication, coordination, and teamwork among healthcare professionals in inpatient wards. This study aimed to analyze the effect of transformational leadership of head nurses on the quality of interprofessional collaboration among staff nurses in hospital inpatient wards. This study used a quasi-experimental design with a non-equivalent control group design. The sample consisted of 50 respondents, including 25 participants in the intervention group and 25 in the control group selected using purposive sampling. The intervention group received supervision and transformational leadership reinforcement for one month. The instruments used were transformational leadership and PINCOM-Q questionnaires, which were valid and reliable with Cronbach's Alpha values of 0.912 and 0.894, respectively. The data were analyzed using General Linear Model Repeated Measure (GLM-RM). The mean transformational leadership score in the intervention group increased from 139.84 to 179.64, while the control group remained relatively stable. Multivariate analysis showed a significant difference in the intervention group (p=0.002; Partial Eta Squared=0.349). The mean IPC score in the intervention group increased from 62.56 to 71.80 with significant results (p=0.010; Partial Eta Squared=0.281). GLM-RM analysis demonstrated a significant effect of the intervention on transformational leadership (F=120.745; p<0.001) and IPC (F=7.543; p=0.008). Supervision and transformational leadership reinforcement were effective in improving transformational leadership among head nurses and the quality of interprofessional collaboration among staff nurses in hospital inpatient wards.
A Rare Case of Cutaneous Ulcer Caused by Pseudomonas Putida
Cutaneous ulcers are commonly caused by bacterial infections, most frequently Staphylococcus aureus. However, infection caused by Pseudomonas putida is extremely rare in humans. Pseudomonas putida is a gram-negative, obligate aerobic bacterium widely found in soil, water, and moist environments and is generally considered non-pathogenic. Nevertheless, under certain conditions, it may act as an opportunistic pathogen and cause infection, particularly in the presence of open wounds or environmental exposure. This report describes a rare case of a cutaneous ulcer caused by Pseudomonas putida in a 26-year-old male laborer. The patient presented with multiple painful ulcers with erythematous edges and purulent discharge on the anterior and lateral regions of the left foot. The lesions initially developed after minor trauma caused by a plant prick while working in a rice field. Laboratory investigations including pus culture revealed growth of Pseudomonas putida without fungal infection. Antibiotic susceptibility testing showed sensitivity to amikacin, gentamicin, and meropenem. The patient was treated with oral ciprofloxacin, topical gentamicin, analgesics, and saline compresses, resulting in gradual clinical improvement with resolution of the ulcers and residual hyperpigmented macules.
Factors Associated with HIV/AIDS Healthcare Access among PLHIV: A Systematic Review and Meta-Analysis
Access to HIV/AIDS health services remains a major challenge in many developing countries. Factors such as health literacy, insurance coverage, health service availability, and psychosocial barriers influence healthcare utilization among people living with HIV/AIDS (PLHIV). This study aimed to analyze factors associated with access to health services among PLHIV through a systematic review and meta-analysis. A systematic review and meta-analysis were conducted using articles published between 2019–2024 from databases including PubMed, Scopus, ScienceDirect, and Google Scholar. 5094 articles were obtained, of which only 5 articles were used. The meta-analysis showed that PLHIV with good knowledge had significantly better access to healthcare services compared with those with poor knowledge (POR=2.03; 95% CI: 1.19–3.46; p=0.010). Health insurance ownership was also significantly associated with healthcare access (POR=0.83; 95% CI: 0.74–0.93; p=0.002). Narrative synthesis indicated that healthcare accessibility, healthcare worker support, patient perceptions, stigma, and financial barriers strongly influenced viral load monitoring and ART adherence. Knowledge and health insurance ownership are important determinants of healthcare access among PLHIV. Strengthening HIV health literacy, improving healthcare financing systems, and expanding accessible HIV services are essential to improve continuity of care and viral load monitoring.
Dynamics of Mental Workload and Occupational Stress in the High-Risk Public Healthcare Sector: A Systematic Literature Review
Mental health issues in the workplace are a fundamental priority in healthcare systems, particularly in high-risk environments characterized by complex operational demands and acute time pressures. Increased cognitive load, when exceeding individual thresholds, has consistently been identified as a major catalyst for work-related stress, which subsequently impairs the clinical performance of healthcare practitioner. This research is designed to rigorously evaluate the correlation between mental workload quantified through the NASA Task Load Index (NASA-TLX) instrument and job stress manifestations, anchored in the conceptual framework established by the National Institute for Occupational Safety and Health (NIOSH). The investigation focuses on high-risk public healthcare sectors to map the underlying psychosocial dynamics affecting the workforce. The synthesis of findings demonstrates a significant and positive correlation between mental workload and professional stress. Specifically, the dimensions of mental demand, temporal demand, and effort emerged as the predominant predictors of psychological strain. Furthermore, the analysis indicates that organizational variables, notably social support and job control, function as critical moderating factors that either attenuate or exacerbate the intensity of the relationship between cognitive demands and perceived stress. The study concludes that mental workload is a pivotal determinant of job stress among healthcare professionals within high-risk public service domains. Consequently, there is an imperative for interventions rooted in cognitive ergonomics and the reinforcement of organizational support systems. Such proactive measures are vital to mitigate psychosocial risks and sustain the overarching quality of healthcare delivery.
Analysis of Factors Influencing the Quality of Nursing Care: Case Study in the Surgical Room
Nursing care quality is an important indicator in assessing healthcare service quality, particularly in surgical wards with high service complexity. Several factors such as competence, supervision, and workload are assumed to influence nursing care quality. This study aimed to analyze factors associated with nursing care quality in the surgical ward at Dr. M. Djamil General Hospital Padang in 2025. This study used an analytic design with a cross-sectional approach. The sample consisted of 96 nurses selected using proportional random sampling. Data were collected using structured s and analyzed using chi-square tests and logistic regression. The validity test showed that all questionnaire items on competence, supervision, workload, and nursing care quality variables were declared valid because the r-count values were higher than the r-table value (0.361). Meanwhile, the reliability test results indicated that all variables had Cronbach’s Alpha values greater than 0.70, meaning that the research instrument was reliable and appropriate for data collection. The results showed that 50% of nursing care quality was categorized as good. Most respondents had good competence (66.7%), good supervision (56.2%), and heavy workload (57.3%). Bivariate analysis showed that supervision and workload were significantly associated with nursing care quality (p < 0.05), while competence was not significantly associated (p = 0.279). Multivariate analysis showed that supervision was the most dominant factor influencing nursing care quality (p = 0.046; OR = 3.03).
The Potential of Probiotics from Fermented Rice Water on Fibroblast Proliferation and Migration: A Systematic Review
Fermented rice water (FRW) has been traditionally used for skin care, but its biological mechanisms on fibroblasts, key cells in wound healing, have not been fully characterized. This systematic review aims to evaluate the efficacy of FRW on fibroblast proliferation and migration and to identify the molecular pathways involved. A literature search was conducted through PubMed, Scopus, and Google Scholar using the keywords "fermented rice water," "fibroblast," and "wound healing" in publications from 2015 to 2025. Studies were included if they evaluated the effects of FRW on fibroblasts in vitro or in vivo. Risk of bias was assessed using SYRCLE RoB (Risk Of Bias). Four studies met the inclusion criteria. FRW increased fibroblast viability by up to 116% and accelerated diabetic wound closure from 27% to 71% compared to controls. Molecular analysis showed upregulation of Collagen I mRNA by 17%, Collagen III by 47%, and Elastin by 159%. FRW activated the NRF2 pathway, which increased the expression of antioxidant enzymes (SOD, CAT, HO-1) and decreased inflammatory mediators including TNF-α, NF-κB, and MMP-1. Bioactive metabolites from Lactobacillus plantarum, Bacillus cereus, and Aspergillus oryzae played a role in these therapeutic effects. FRW shows potential as a fibroblast bio-stimulator through multi-pathway modulation involving extracellular matrix synthesis, antioxidant, and anti-inflammatory effects, with prospects for application in chronic wounds and anti-aging that require further clinical validation.
The Impact of Gadget Screen Exposure in Children and Developmental Status Aged 12 - 72 Months
In 2023, Indonesia’s population of children under five reached 30.2 million. Current data indicates that 33.44% of early childhood individuals are exposed to digital devices, with many facing risks of psychological, cognitive, and socio-emotional impairments. Objective: This study aims to analyze the relationship between gadget screen exposure and the developmental status of children aged 12–72 months. A quantitative study with a cross-sectional design was conducted at Posyandu Puskesmas Pulo Gadung, East Jakarta, in 2025. A sample of 60 respondents was selected through purposive sampling. Data were collected using the Pre-Screening Developmental Questionnaire (KPSP) and a maternal questionnaire regarding gadget usage. Data were analyzed using univariate and bivariate (Chi-square) analysis. Bivariate analysis revealed a significant relationship between gadget exposure and developmental status ($p < 0.05$). High gadget exposure was predominantly associated with "doubtful" or "deviant" developmental outcomes. Excessive gadget use negatively impacts child development. It is crucial for health workers and parents to implement early stimulation and strict screen-time monitoring to ensure optimal growth.
Legal Protection for Midwives in Performing Medical Services Outside Their Authority: A Normative Juridical Analysis
Legal protection for midwives in healthcare practices, particularly in emergency situations, is a crucial issue in Indonesia's healthcare legal system. Although various regulations, such as Law Number 4 of 2019 concerning Midwifery, Law Number 17 of 2023 concerning Health, and Government Regulation Number 28 of 2024, regulate the authority and legal protection of healthcare workers, these regulations are still general in nature and do not provide operational clarity in emergency situations. This study aims to analyze the legal norms regarding midwives' authority and the forms of legal protection they provide for performing medical procedures outside of their formal authority, particularly in emergency situations. The research method used is normative juridical with a statutory and conceptual approach, through an analysis of Law Number 4 of 2019 concerning Midwifery, Law Number 17 of 2023 concerning Health, and Government Regulation Number 28 of 2024. The analysis was conducted qualitatively by interpreting existing legal norms to identify legal gaps related to the legal protection of midwives in emergency situations. The results of the study indicate that normatively, legal protection for midwives has been regulated, but the regulations are still general and do not provide operational clarity regarding medical actions in emergency conditions. This gives rise to multiple interpretations of norms and has the potential to create legal uncertainty in practice. Thus, it is necessary to strengthen more specific and operational regulations to ensure legal certainty and optimal legal protection for midwives.
The Role of Informed Consent as An Instrument of Legal Protection in Dental Services: A Comparative Literature Study in Indonesia
Informed consent is a fundamental ethical and legal requirement in healthcare that safeguards patient autonomy while protecting healthcare professionals from legal disputes. In dental practice, informed consent extends beyond obtaining a patient's signature, encompassing a comprehensive communication process that enables patients to make informed decisions regarding diagnosis, treatment alternatives, benefits, risks, and possible complications. Despite recent regulatory reforms through Law Number 17 of 2023 concerning Health and Government Regulation Number 28 of 2024, challenges remain in the consistent implementation of informed consent within Indonesian dental services. This study aimed to comprehensively review the role of informed consent as an instrument of legal protection for dentists in Indonesia by comparing existing scientific evidence with the current national legal framework governing dental practice. A systematic literature review employing a comparative legal approach was conducted following the PRISMA 2020 guidelines. Literature was retrieved from PubMed, Scopus, ScienceDirect, and Google Scholar using Medical Subject Headings (MeSH) and free-text keywords related to informed consent, dentistry, legal protection, and health law. Eligible studies addressing legal, ethical, and clinical aspects of informed consent in dental services were selected according to predefined inclusion and exclusion criteria. Relevant Indonesian legislation, including Law Number 17 of 2023 and Government Regulation Number 28 of 2024, was also analyzed. Extracted data were synthesized using qualitative thematic analysis. The review demonstrates that informed consent functions as both an ethical obligation and a legal safeguard by promoting patient autonomy, supporting shared decision-making, and providing documentary evidence of professional compliance. Medical records and informed consent collectively strengthen legal protection for dentists by documenting adherence to professional standards and reducing medico-legal risks. Nevertheless, implementation in Indonesian primary healthcare facilities remains constrained by high patient workloads, limited human resources, inconsistent documentation practices, inadequate digital infrastructure, and insufficient understanding of medico-legal responsibilities among healthcare professionals. Effective implementation of informed consent requires integration of comprehensive documentation, standardized operating procedures, continuous legal and ethical education, and strengthened electronic medical record systems. Harmonizing clinical practice with Indonesia's evolving legal framework will improve patient safety, reinforce professional accountability, and enhance legal protection for dentists delivering dental healthcare services.
Efficacy of Solvent Type on Antioxidant Activity of Artocarpus heterophyllus Leaves Extract: A Scoping Review
Jackfruit leaves (Artocarpus heterophyllus) contain various bioactive compounds that have the potential as natural antioxidants. The antioxidant activity of jackfruit leaf extract is influenced by the type of solvent used during the extraction process. Objective to identify the effectiveness of various types of solvents on the antioxidant activity of jackfruit leaf extract. This study used a scoping review method by reviewing articles from PubMed, ScienceDirect, and Google Scholar in 2020–2025 Searching strategy using the keywords "Artocarpus heterophyllus" OR "jackfruit leaves" AND "antioxidant activity" OR "antioxidant capacity" AND solvent OR "solvent type" OR "extraction solvent" . Included articles were English-language primary studies published between 2020 and 2025. A total of 11 articles that met the inclusion criteria were analyzed descriptively. The data were analyzed descriptively and presented in tabular form to identify patterns of findings related to the effectiveness of various solvent types on the antioxidant activity of Artocarpus heterophyllus leaf extrac. Ethanol and hydroethanol solvents showed higher antioxidant activity than other solvents. Strong antioxidant activity is related to the high content of phenolic and flavonoid compounds that were successfully extracted. The type of solvent affects the antioxidant activity of jackfruit leaf extract, with ethanol and hydroethanol being the most effective solvents in extracting bioactive antioxidant compounds.
Phacoemulsification Combined with Goniosynechialysis and Goniotomy fzor Primary Angle-Closure Glaucoma: A Mini Systematic Review
Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness and is commonly associated with elevated intraocular pressure (IOP). Objective to evaluate the effectiveness and safety of combining phacoemulsification (PEI), goniosynechialysis (GSL) or visco-goniosynechialysis (VGSL), and goniotomy (GT) in the management of PACG. A mini systematic review was conducted using Google Scholar, PubMed, and ProQuest up to March 2025. Eligible studies evaluating combined PEI, GSL/VGSL, and GT in PACG patients were screened independently by two reviewers and analyzed descriptively. Five studies involving 534 eyes from 475 patients were included, comprising two retrospective case series, one randomized clinical trial, and two multicentre observational studies. Follow-up periods ranged from one week to 24 months. Across studies, the combined procedure consistently demonstrated significant reductions in IOP and glaucoma medication use, while reported complications were generally mild and self-limiting. Combined PEI, GSL/VGSL, and GT appears to be a safe and effective surgical option for PACG with coexisting cataract. This review contributes to the growing evidence supporting angle-based surgical interventions for improving IOP control and reducing medication burden in PACG.
Persistent Hoarseness Associated with Laryngopharyngeal Reflux and Suspected Ortner’s Syndrome: A Case Report
Laryngopharyngeal reflux (LPR) is an extraesophageal inflammatory disorder caused by the retrograde flow of gastric contents into the laryngopharyngeal region, leading to chronic irritation of the upper airway mucosa. Persistent hoarseness is a common symptom; however, dysphonia may also reflect rare cardiovascular causes such as Ortner’s syndrome (cardiovocal syndrome), which results from recurrent laryngeal nerve dysfunction secondary to cardiovascular pathology. Diagnostic differentiation between these entities can be challenging due to overlapping clinical features. We report a 70-year-old woman with two months of persistent hoarseness following coronary artery stenting after myocardial infarction. She also experienced nocturnal cough, globus sensation, intermittent choking, and dysphagia. Flexible laryngoscopy showed bilateral vocal fold hyperemia and edema, posterior commissure hypertrophy, and partial glottic narrowing. The Reflux Symptom Index (RSI) score was 22 and the Reflux Finding Score (RFS) was 17, supporting LPR. Coronary angiography revealed total occlusion of the right coronary artery. Given her significant cardiovascular history, recurrent laryngeal nerve involvement due to suspected Ortner’s syndrome was also considered. This case highlights overlapping manifestations of LPR and cardiovocal syndrome, complicating diagnosis. Comprehensive multidisciplinary evaluation is essential, particularly in elderly patients with cardiovascular disease, to avoid attributing persistent hoarseness solely to reflux and to identify potential cardiogenic causes of dysphonia.
Combination Therapy with Corticosteroids and Mycophenolate Mofetil in the Management of Pemphigus Vulgaris: A Case Report
Pemphigus vulgaris (PV) is a rare, potentially life-threatening autoimmune blistering disease caused by IgG autoantibodies against desmoglein proteins, leading to acantholysis and intraepidermal blister formation. The incidence of PV ranges from 0.76 new cases per million population per year in Finland to approximately 3.5 new cases per million population per year in other regions. Early diagnosis and appropriate immunosuppressive therapy are crucial to prevent disease progression and complications. This study aims to report the clinical presentation, diagnostic approach, and therapeutic outcome of combination therapy using systemic corticosteroids and mycophenolate mofetil in a patient with pemphigus vulgaris. This is a descriptive case report of a 40-year-old female diagnosed with pemphigus vulgaris. Clinical evaluation, histopathological examination, and therapeutic response were documented and analyzed. A 40-year-old woman who presented with a one-week history of painful, generalized flaccid bullae and erosions involving the face, scalp, trunk, and extremities. Histopathological examination revealed suprabasal intraepidermal blistering with a characteristic row of tombstones appearance, confirming the diagnosis of pemphigus vulgaris.Initial treatment with systemic corticosteroids resulted in partial clinical improvement; however, new lesions continued to develop. The addition of mycophenolate mofetil as a steroid-sparing agent led to significant disease control, with cessation of new blister formation and gradual healing of existing lesions. The patient showed marked clinical improvement with good functional and vital prognosis, although long-term remission remains uncertain. This case highlights a severe and extensive presentation of pemphigus vulgaris and emphasizes the importance of clinicopathological correlation for accurate diagnosis. Early combination therapy with systemic corticosteroids and mycophenolate mofetil may be effective in controlling refractory disease and minimizing corticosteroid-related adverse effects.
Analysis of the Implementation of Stunting Handling Policy Programs
The prevalence of stunting in Bogor City in 2024 will be 18.2%. The national target is 14%. Policy analysis is needed to identify the success and obstacles of stunting management policy programs in the community. To conduct an analysis of the implementation and effectiveness of stunting handling policy programs in Bogor City based on stakeholder information. Qualitative descriptive research with in-depth interviews and observations of 16 informants consisting of (Head of Health Office, Head of Health Center, Coordinating Midwife, Posyandu Cadres, and Toddler Women) in Tanah Sareal and South Bogor Districts, Bogor City. Evaluation criteria based on William N. Dunn. Data were analyzed using NVivo 15 through thematic analysis. Data analysis produced 5 major themes, namely (program management and leadership, labor and cost barriers, social problems and citizens' habits, changes in officers' habits and responses, suggestions and expectations for the future), 12 categories and 65 codes. The policy runs effectively through the commitment of regional leaders (cross-sector coordination) and digital innovation of virtual referrals (Important Mess). The efficiency aspect is hampered by double input, limited nutritional personnel, and time-lag problems of logistics data. Socioculturally, parental denial and traditional parenting are challenges. However, the responsiveness of officers through the action of "picking up the ball" (sweeping) has proven to be successful in transforming people's behavior in fulfilling animal protein and toddlers' rest patterns. The stunting handling program in Bogor City has high responsiveness but is constrained by the efficiency of the workload of health workers and sociocultural barriers to the family. The Anuh Larang, Penting Lur, and Taleus Bogor programs increase the coverage of services, changes in family behavior, and community nutrition awareness. However, implementation still faces limitations in human resources, administrative burden, and regional capacity disparities.
Interventional Affecting Hemostasis Time after Arteriovenous Fistula Needle Removal in Hemodialysis Patients: A Meta-Analysis
Hemostasis following arteriovenous fistula (AVF) needle removal is a key determinant of vascular access outcomes in hemodialysis patients. This meta-analysis aimed to evaluate the effect of hemostatic dressings and needle bevel position on hemostasis time following arteriovenous fistula (AVF) needle removal in hemodialysis patients. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of eight electronic databases identified randomized controlled trials and quasi-experimental studies published between January 2016 and June 2025. Eligible studies evaluated the effects of hemostatic dressings and needle bevel position on hemostasis time following AVF needle removal in adult hemodialysis patients. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to substantial heterogeneity, random-effects meta-analyses were performed, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Seven studies met the inclusion criteria. Three studies evaluating hemostatic dressings demonstrated a significant reduction in hemostasis time at arterial sites (SMD = −1.23, 95% CI −2.36 to −0.11; p=0.032) and venous sites (SMD = −1.35, 95% CI −2.16 to −0.54; p=0.001). Four studies assessing needle bevel position showed that the bevel-down position significantly reduced hemostasis time compared with the bevel-up position (SMD = −1.30, 95% CI −2.45 to −0.14; p=0.028). All pooled analyses exhibited high heterogeneity.
Analysis of Pregnant Women's Preparedness for Pregnancy Hazards
Preparedness of pregnant women in recognizing danger signs during pregnancy is a crucial factor to prevent delays in the treatment of obstetric complications. The variation in results from previous research shows the need for in-depth analysis by combining sociodemographic, individual, social, and structural-systemic factors in one analytical model. This study aims to identify the related factors and determine the most dominant variables in influencing the preparedness of pregnant women. A quantitative study with a cross-sectional design was conducted on 121 pregnant women at the Dzakirah Clinic in South Tangerang using a total sampling technique. The research instrument has gone through a validity and reliability test process; all constructs are declared valid after one item on the anxiety variable is eliminated, and show adequate internal consistency (Cronbach's Alpha ≥ 0.70). Data analysis included univariate, bivariate (correlation test), and multivariate using multiple linear regression. Bivariate analysis showed that knowledge, family support information resources, cultural norms, healthy living behaviors, pregnancy app use, anxiety, information seeking, self-efficacy, social support, perception, attitude, and involvement in health programs had a significant relationship (p<0.05). Meanwhile, parity, income, and adherence to pregnancy screenings showed no statistically significant relationship. In the final regression model, the source of pregnancy information had the highest coefficient and became the most dominant variable in influencing preparedness. Preparedness of pregnant women is more influenced by access factors and information quality than demographic characteristics.
The Effectiveness of Aloe Vera Compresses in Reducing Body Temperature in Children with Fever Aged 6–12 Years
Children need a strong immune system so they are not easily infected with viruses and bacteria that can cause fever. For this reason, optimal attention is needed so that it is not easily infected by viruses and bacteria. There are other alternatives. Apart from using pharmacological drugs to lower a child's body temperature, the process of giving aloe vera compresses can also reduce the child's body temperature. Preliminary studies found that there are still some children who cannot take pharmacological drugs. To overcome this problem, an innovation was created in the form of an aloe vera compress which is believed to be able to reduce the body temperature of children with fever because it contains lignin and saponin. The aim of this study was to identify differences in children's body temperature before and after intervention. This research used a quasi-experiment with a one group pre test - post test design. The population was 15 respondents with fever aged 6-12 years using accidental sampling. The results of the comparison test before and after (paired t-test) showed a significance value of 0.00 (<0.05). This shows that the aloe vera compress is effective in reducing the body temperature of feverish children aged 6-12 years. Based on the average (mean) body temperature before the intervention (pre test) it was found to be 38.480 and the average (mean) body temperature after the intervention (post test) was 37.833.
Effectiveness of Audiovisual Distraction Techniques on Reducing Hospitalized Anxiety in Preschool Children : A Case Study
Hospitalization anxiety is a psychological response often experienced by preschool-aged children due to medical procedures that cause fear and discomfort. Untreated anxiety can lead to uncooperative behavior and hinder the treatment process. One non-pharmacological nursing intervention that can be used is audiovisual distraction techniques. This study aims to determine the effectiveness of audiovisual distraction techniques in reducing hospitalization anxiety in preschool-aged children. This study used a case study design with a pre-post test approach. The study subjects were 10 preschool-aged children undergoing medical procedures at RSDM. The intervention, in the form of audiovisual distraction by watching cartoons, was given during the nursing procedure. Anxiety levels were measured using the Face Anxiety Scale (FAS) before and after the intervention. The results showed a decrease in anxiety scores in all subjects, from moderate to very anxious to mild anxiety or even no anxiety after the intervention. Audiovisual distraction techniques have been proven effective in reducing hospitalization anxiety levels in preschool-aged children.
Knowledge and Attitudes Toward Cough Self-Medication among Parents of Toddlers
Cough is a common symptom in children and is frequently managed through self-medication. Limited parental knowledge may lead to inappropriate medicine selection, dosing errors, and potential adverse effects. To examine the levels of knowledge and attitudes and to analyse the association between knowledge level and attitudes towards cough self-medication among parents of toddlers in Parangjoro Hamlet, Grogol District, Sukoharjo Regency. A quantitative cross-sectional study was conducted among 99 parents of toddlers selected using purposive sampling. Data were collected using a validated and reliable questionnaire and analysed using univariate statistics and the Chi-square test. Most respondents had a good level of knowledge (70.71%), and 59.6% showed positive attitudes towards cough self-medication. There was a statistically significant association between knowledge level and attitudes (p=0.001). Higher knowledge was associated with more positive attitudes towards cough self-medication among parents of toddlers.
Knowledge of Gout and Gout Medication Use among Patients at A Community Pharmacy
Gout is a common metabolic disorder associated with hyperuricemia, recurrent joint pain, and reduced quality of life. In community pharmacies, patients often obtain gout medicines without adequate understanding of the disease and its pharmacotherapy. This study aimed to describe patient knowledge regarding gout and gout medication use at Ngimbrang Pharmacy, Temanggung, Indonesia. A prospective descriptive study was conducted from 1 March to 23 April 2025 using purposive sampling. A literature-based questionnaire was tested in 30 respondents and demonstrated 14 valid items with good reliability (Cronbach's alpha = 0.776). Data from 54 respondents were analyzed descriptively. Most respondents were male (54.0%), aged ≥60 years (31.0%), and worked as farmers (48.1%). Overall, 46.0% had sufficient knowledge, 41.0% had good knowledge, and 13.0% had poor knowledge. Misconceptions remained regarding alcohol, allopurinol, and diclofenac. Patient knowledge was generally moderate.
The Relationship between Health Workers’ Motivation and Support and Pregnant Women’s Adherence to Iron Supplements
Anemia in pregnancy is defined as a hemoglobin (Hb) level below normal thresholds and is commonly associated with inadequate intake of essential micronutrients, such as iron, folic acid, and vitamin B12, which are important for erythropoiesis. Poor adherence to iron and folic acid supplementation remains a major contributor to maternal anemia. Therefore, internal motivation and healthcare provider support are key factors in ensuring effective nutritional interventions during pregnancy. This study aimed to examine the association between internal motivation and healthcare provider support with adherence to iron supplementation among pregnant women in Karang Tengah, Sukabumi City, in 2026. A correlational study with a cross-sectional design was conducted involving 80 pregnant women selected through total sampling. Data were collected using structured questionnaires, while adherence was measured using the Morisky Medication Adherence Scale (MMAS-8), which has demonstrated reliability Cronbach’s alpha = 0.796. Data were analyzed using the Somers’ d test. The results showed that most respondents had moderate motivation (55.0%), perceived healthcare provider support as inadequate (56.3%), and demonstrated low adherence (46.3%). Statistical analysis revealed significant associations between both variables and adherence (p = 0.001). In conclusion, both factors are significantly associated with adherence to iron supplementation among pregnant women.
The Effect of Cigarette Smoke Exposure on the Incidence of Acute Respiratory Infections in Toddlers
ARI remains one of the leading causes of death among infants, and the incidence of ARI is still quite high in the working area of the Simpang Timbangan Community Health Center. This study aims to determine the relationship between exposure to cigarette smoke and the incidence of ARI among infants in the working area of the Simpang Timbangan Community Health Center. This study used a cross-sectional approach involving 90 households with infants (infants, mothers, and family members who smoke) selected through purposive sampling to assess the relationship between the presence or absence of family members who smoke, CO levels, smoking locations, and the number of cigarettes smoked per day. Statistical analyses used included the Mann-Whitney test, Fisher's exact test, and chi-square test. Results: There were 35.6% of toddlers who experienced ARI. Furthermore, toddlers who lived with family members who smoked were significantly 1.64 times more at risk of experiencing ARI, and among toddlers who lived with smokers, they were 4.55 times more at risk of experiencing ARI if the smokers smoked inside or outside the house. The number of cigarettes smoked per day was also significantly associated with ARI, but CO levels were not significantly associated with ARI. Thus, the presence or absence of smokers, the location of smoking, and the number of cigarettes smoked per day were significantly associated with ARI, although CO levels were not significantly associated.
Development of Nutraceutical Spirulina-Moringa Oleifera (Nutrismo) Products as Natural Immunomodulator and Antioxidant Supplements
Phycocyanin research shows fluctuating trends and remains underexplored, particularly in its application for functional food and nutraceutical development, creating significant research gaps and opportunities for innovation such as NutrisMO This study aims to identify research trends and gaps in phycocyanin studies and to analyze factors influencing consumer intention to use NutrisMO, a nutraceutical product based on Spirulina and Moringa oleifera.A Systematic Literature Review (SLR) was conducted using the PRISMA approach with data sourced from Scopus (2005–2024), analyzed באמצעות VOSviewer and Leximancer. In addition, a quantitative explanatory study was conducted with 150 respondents selected through purposive sampling to review public acceptance of NUTRISMO products. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with Smart-PLS. The SLR results indicate that research on phycocyanin is still limited and fluctuative, with identified gaps in food-related applications (21%), product-related challenges (8%), and C-phycocyanin concepts (6%), highlighting opportunities for further research and innovation. Meanwhile, the Smart-PLS analysis shows that all constructs meet validity and reliability criteria. Perceived Bioactive Content (β = 0.400), Health Awareness (β = 0.438), and Trust in Herbal Products (β = 0.440) significantly influence Perceived Benefit, which in turn strongly affects Intention to Use (β = 0.775). The model demonstrates moderate to strong explanatory power, with R² values of 0.513 for Perceived Benefit and 0.600 for Intention to Use. This study confirms that perceived benefit plays a crucial mediating role in shaping consumer intention to use nutraceutical products. It also emphasizes the need for further research on phycocyanin and supports the development of functional nutraceutical innovations like NutrisMO by integrating scientific evidence, health awareness, and consumer trust.
Analysis of Factors Causing Deterioration in Patients with Head Trauma
The incidence of head trauma continues to increase from year to year and causes death or disability in adults. Factors that cause deterioration in patients with head trauma are age, initial Glasgow Coma Scale (GCS), RTS (Revised Trauma Score), blood pressure, travel time to hospital (RS), and other organ trauma. Deterioration in head trauma patients can be seen from the Glasgow Outcome Scale (GOS). The problem formulation in this study is how the factors that cause deterioration in patients with head trauma are related. The purpose of this study is to describe the relationship between factors that cause deterioration in patients with head trauma and find the dominant factor. This research method is comparative analytic with a cross-sectional design. Respondents were selected using purposive sampling with a total of 48 respondents. Data on GOS, age, GCS, RTS, and blood pressure were collected from patient medical records. Data on travel time to hospital were collected from interviews with patients' families. The obtained data were subjected to multivariate analysis using logistic regression tests. The results showed that the variables of age, GCS, RTC, blood pressure, and travel time to hospital have a relationship with the GOS variable (p-value <0.005). The results of a multivariate logistic regression analysis showed that the most dominant factor influencing the worsening of severe head injury (GOS) was the RTC value (OR:16.18). In conclusion, a lower RTC value indicates a worse prognosis for head injury patients.
Analysis of Factors Causing Patient Waiting Time in the Emergency Department
Quality of service in the Emergency Department (ER) of a hospital is required to be fast, effective, and efficient. Overcrowding in the ER must be resolved as quickly as possible to ensure the workload is distributed effectively and the room is not overcrowded with healthcare workers, patients, and their families. Several methods used to alleviate overcrowding in the ER include speeding up/simplifying patient registration, triaging/sorting patients, and shortening patient waiting times by transferring patients to other rooms such as the ward, intensive care unit (ICU), inpatient wards, or other rooms. The purpose of this study was to analyze the factors contributing to patient waiting times in the ER of a hospital in the Bali Province. The factors influencing patient waiting times in the ER include registration time, triage time, consultation time for the attending physician, waiting time for laboratory results, waiting time for radiology results, and waiting time for transfer to the next room. This research method was comparative analytic with a cross-sectional design. The multivariate analysis used was logistic regression. Data collection involved observing factors affecting ER waiting times, with findings recorded on observation sheets. This study employed a purposive sampling technique, involving a total of 98 patients as respondents. Multivariate analysis revealed that the time of patient transfer to the next room was the most dominant factor associated with patient waiting times in the Emergency Department (ER), with an OR of 17.16 at a 95% confidence level. The conclusion of this study is that patient transfer time is a dominant factor affecting waiting times.
Analysis of Factors Affecting Compliance Antiretroviral Treatment in HIV AIDS Patients
Human Immuno deficiency Virus / Acquired Immune Deficiency Syndrome (HIV / AIDS) can not be cured but this infection can be controlled with antiretroviral drugs (ARVs). Compliance of people with HIV/AIDS (PLWHA) is very important to cope with HIV/AIDS. Non-compliance with antiretroviral therapy gives the effect of drug resistance so that the drug cannot function or fail. The purpose of this study was to determine the factors that affect the compliance of antiretroviral therapy program in PLWHA in Puskesmas Harapan. The design of this study is cross sectional. The respondents of this study were PLWHA patients undergoing antiretroviral therapy program in infection health centers totaling 25 respondents determined by purposive sampling. The Data was collected with a uestionnaire heet and Pill Count. Analysis of the data using Pearson correlation test, spearman rho and multivariate logistic regression CI ③ = 0.05. The results showed that ARV treatment adherence is related to knowledge (p = 0.017), side effects (p=0.418) no relationship, and support taking medication (p = 0.278) conclusion drug side effects are the dominant factors affecting ARV therapy adherence.
The Relationship between Head Nurse Controlling Function and the Completeness of Nursing Care Documentation
Nursing care documentation (ASKEP) is a vital clinical quality indicator influenced by ward unit management. This study analyzed the relationship between the head nurse's management controlling function and the completeness of ASKEP at RSUD Yowari, Papua. A quantitative analytical design with a cross-sectional approach was conducted among 34 staff nurses. Data were collected via standardized questionnaires and observation checklists, then analyzed using Fisher's Exact Test (). Respondents were predominantly female (94.1%), early adults (91.2%), held a Diploma-III (85.3%), and had <10 years of tenure (58.8%). Head nurse controlling was perceived as poor (76.5%), yet ASKEP completeness was high/complete (82.4%). Bivariate analysis indicated no significant relationship between variables (p=1.000; ). Staff documentation compliance is systemically independent, driven by external macro-organizational pressures (systemic-driven compliance) including national accreditation preparation and professional-legal safety motivation, rather than internal daily unit supervision.
The Relationship between Family Support and Anemia Prevention Efforts among Pregnant Women
Anemia in pregnant women remains a significant health issue and has the potential to cause various complications. The high prevalence of anemia among pregnant women indicates that prevention efforts still need to be improved, particularly through family support. The objective of this study was to determine the relationship between family support and anemia prevention efforts among pregnant women in the service area of the Baros Community Health Center in Sukabumi City. This study employed a correlational method with a cross-sectional approach. The population consisted of all pregnant women in the service area of the Baros Community Health Center in Sukabumi City, with a sample of 119 pregnant women selected using total sampling. The family support variable was measured using the PSS -Fa, with the validity test yielding a calculated r value > the table r value of 0.361, while the reliability test yielded a Cronbach’s Alpha value of 0.752. The anemia prevention efforts variable was based on the Guttman scale, with validity test results showing a p-value <0.05, indicating validity, except for items 9, 10, and 11, which were therefore excluded from the analysis; the reliability test yielded a Cronbach’s Alpha value of 0.373. Data were collected via questionnaires and analyzed using the Spearman rank test. Most respondents had strong family support, and most had effective anemia prevention measures in place; there was a significant association between family support and anemia prevention efforts among pregnant women (p = 0.000). There is a link between family support and efforts to prevent anemia in pregnant women. It is hoped that healthcare workers can enhance education and outreach regarding anemia prevention by involving families.
Relationship between Coping Mechanisms and Stress Levels in Patients with Diabetes Mellitus
The term "silent killer" is frequently used to describe diabetes mellitus (DM). Many sufferers of this illness are oblivious to the issue, which leads them to a point when major issues arise in the body's systems or different organs start to be impacted. This study sought to ascertain the connection between stress levels and coping strategies in individuals with diabetes mellitus. This was a cross-sectional, correlational, quantitative research. All diabetes mellitus patients in Cikondang Village, which is part of the Tipar Public Health Center's (UPTD Puskesmas) service area in Sukabumi City, made up the population. A total sample of sixty respondents was chosen. The instruments used were the Brief Coping Inventory for the coping mechanisms variable and the Perceived Stress Scale (PSS-10) for the stress level variable. The chi-square test was used in statistical analysis. The findings showed that most people had minor stress and used adaptive coping strategies. In patients with diabetes mellitus, coping strategies and stress levels are related, according to chi-square analysis, which produced a p-value of 0.016 (p<0.05). Conclusion: Patients with diabetes mellitus in Cikondang Village, within the service area of the Tipar Public Health Center (UPTD Puskesmas) in Sukabumi City, exhibit a correlation between coping strategies and stress levels.
Legal Aspects of the Use of Artificial Intelligence for Medical Diagnosis Under Law No. 17 Of 2023 on Health and Law No. 27 Of 2022 on the Protection of Personal Data
Health is a fundamental human right guaranteed by various international and national legal instruments, including the 1945 Constitution and Law No. 17 of 2023 on Health. The state has a responsibility to provide adequate health facilities and services to achieve the optimal level of public health. With the development of information technology, innovations such as Artificial Intelligence (AI) are beginning to be utilized in the health sector, particularly in medical diagnosis, as they can improve the accuracy and efficiency of services.The use of AI in medical diagnosis is supported by regulations that encourage health technology innovation, yet it also poses various challenges, particularly regarding ethical considerations, trust, accountability, and the protection of patients’ personal data as stipulated in Law No. 27 of 2022. Additionally, the use of AI requires proper risk management to uphold the principles of fairness, transparency, and security.Although regulatory frameworks related to health, technology, and data protection are in place, specific regulations regarding the use of AI in medical diagnosis remain unclear and incomplete. This creates legal uncertainty, particularly regarding liability in the event of a misdiagnosis. Therefore, the development of more detailed regulations is necessary to provide legal certainty and ensure that the use of AI in healthcare services is safe, ethical, and responsible. This study aims to explore the legal aspects of the use of Artificial Intelligence (AI) in medical diagnosis, in light of Law No. 17 of 2023 on Health and Law No. 27 of 2022 on Personal Data Protection. Patient data is a valuable asset that is not only sensitive but also vulnerable to misuse. The integration of AI in diagnosis requires access to large amounts of patient data to train algorithms and improve diagnostic accuracy. This study falls under the category of normative legal research, which focuses on legal norms found in legislation, legal doctrine, and other relevant regulations. It analyzes the legal framework, expert opinions, and relevant case studies to assess how AI can be integrated into the healthcare system while ensuring compliance with data protection regulations and safeguarding patients’ rights. This study investigates the implications of these laws on AI applications in medical diagnostics, with a focus on data security, patient consent, and the ethical use of AI in healthcare. It also examines how AI developers and healthcare providers must navigate these regulations to ensure privacy and transparency. The findings reveal that while this legislation provides a strong foundation for data protection in AI-based healthcare, challenges remain in its implementation.
The Effect of Squishy Play Therapy on Reducing Anxiety in Toddlers during Hospitalization
Hospitalization often triggers anxiety in children, characterized by reactions such as crying, fussiness, and restlessness, which vary among individuals. Play therapy can play an important role in distracting children from the pain or discomfort they experience. This study aims to examine the effect of squishy play therapy on reducing anxiety in toddlers during hospitalization. This was a quasi-experimental study with a one-group pretest-posttest design. This study involved purposive sampling techniques to recruit 15 children. Data were collected using a demographic questionnaire (age, gender, length of stay, and hospitalization history) and the Face Anxiety Scale (FAS). The collection process involved direct observation of anxiety levels before (pre-test) and after (post-test) the squishy play therapy intervention. Data analysis was performed using the Wilcoxon test, with the processing involving editing, coding, scoring, data entry, cleaning, and tabulating. The findings showed that the application of squishy play therapy resulted in a significant reduction in anxiety, with a p-value of 0.001 (p < 0.05). Thus, this intervention is proven to be effective in reducing anxiety in toddlers during hospitalization.This study is expected to contribute to the development of nursing practice through the use of squishy play therapy as an innovative non-pharmacological strategy that can be applied to improve the well-being of children in a hospital setting.
The Effect of Superior and Inferior Extremity Point Acupuncture Therapy on Improving Daily Living Activities in Stroke Patients
Stroke is a pathological condition that occurs due to the interruption or reduction of blood flow to certain parts of the brain. This condition can be caused by two main mechanisms: blockage of cerebral blood vessels or the sudden rupture of blood vessels in the brain. As a result, there is a significant decrease in the supply of oxygen and nutrients to the affected brain tissue. One of the common symptoms of stroke is weakness on one side of the body, known as hemiparesis, which leads to difficulties in performing activities of daily living (ADL). This study aimed to analyze the effect of acupuncture therapy (at superior and inferior extremity points) on improving activities of daily living (ADL) in stroke patients at the Holistic Nursing Therapy Clinic in Probolinggo. The research method used was a pre-experimental design with a one-group pre-test and post-test approach. The sample consisted of 91 respondents, selected using accidental sampling from May to June 2025. The research instrument used was the Barthel Index questionnaire sheet, with a validity value of r > (0,4438) and a reliability test of (0,884). The intervention was administered three times per week, with each session lasting one hour, for four weeks. Data were analyzed using the Wilcoxon test. The results showed that before the acupuncture therapy intervention, most respondents were in the moderate category (42 respondents, 46.2%). After the intervention, respondents were mostly in the independent and mild categories, each with 39 respondents (42.9%). The statistical analysis indicated that there was a significant effect of acupuncture therapy (at superior and inferior extremity points) on improving activities of daily living (ADL) in stroke patients, with a p-value of 0.001 (p = 0.001 < α = 0.05). Acupuncture therapy has a positive impact on patients’ physical condition, including improving muscle strength in extremities that were weakened due to stroke. It may also enhance blood flow and oxygenation to the brain, promote neuroplasticity and nerve regeneration, and ultimately improve the ability to perform activities of daily living.
Effectiveness of Providing Snakes and Ladders Game-Based Education to Mothers With Toddlers Regarding Stunting Prevention
Stunting is a chronic nutritional problem that affects the growth and development of toddlers. Increasing mothers’ knowledge through interactive educational media is one of the prevention efforts. This study aims to determine the effectiveness of snakes and ladders game-based education on stunting prevention at the Lorog Tawangsari Posyandu. The method used was a quantitative descriptive case study with purposive sampling of 15 mothers with toddlers. Knowledge was measured using pre-test and post-test questionnaires. The results showed an increase in good knowledge from 13.3% to 80% and a decrease in poor knowledge from 66% to 0%. Snakes and ladders game-based education is effective in increasing maternal knowledge and can be used as an alternative health education method.
Wound Repair in a Patient with Pemphigus Vulgaris: A Case Report
Pemphigus vulgaris is a rare autoimmune disease with a prevalence of 0.1-0.5 per 100,000 people that characterized by blisters and acantholysis. Wounds in this disease tend to be extensive and wet, causing skin integrity problems. Research on local therapeutic interventions in pemphigus vulgaris is still limited. The purpose of this report is to determine the patient's response to a combination of wound care interventions with 0.9% NaCl compresses, MEBO ointment, and antibiotic tulle. This report method is a case report with primary and secondary data sources. Primary data is obtained through direct observation of the patient's objective condition, anamnesis, and physical examination. Secondary data was obtained from statements from the patient's family who had provided written consent (informed consent) and the patient's electronic medical records. The patient is a 36-year-old man with a wound scale according to the Pemphigus Disease Area Index 97/120. The patient's wound improved, where the wet wound dried and re-epithelialization occurred after 4 days of treatment with MEBO ointment and antibiotic tulle. In the dry wound, the wound appeared clean of dead skin tissue and soft hemorrhagic crusts after 0.9% NaCl compresses.
Effectiveness of Brainstorming-Balanced Health Education in Improving Nutritional Diets in Stunted Toddlers
Stunting is a chronic nutritional problem that affects children's growth and development due to eating patterns that do not align with balanced nutrition. Mothers, as primary caregivers, play a crucial role, so effective and participatory nursing interventions are essential. This study used Dorothy E. Johnson's Behavioural System Theory as an environmental stimulus that influences behavioural systems. The objective of this study was to analyse the effect of health education using the brainstorming method on balanced nutritional eating patterns in stunted toddlers. This study used a quasi-experimental design with a one-group pretest-post-test approach. The health education intervention was conducted over three weeks through three stages. The Round Robin brainstorming method was used. The study sample consisted of 38 mothers of stunted toddlers, selected using purposive sampling. The measurement tool employed the Food Frequency Questionnaire (FFQ), which underwent validity and reliability tests, showing good content validity and an acceptable reliability coefficient (Cronbach’s alpha = 0.8). The research showed that the majority of children's eating patterns before the brainstorming method were in the poor category (76.3%), and after the intervention, 63.2% of toddlers' eating patterns were in the good category. The Wilcoxon test results indicated a significant effect of health education using the brainstorming method on changes in the dietary patterns of stunted toddlers. Health education using the brainstorming method had a significant effect on improving balanced nutrition in stunted toddlers.
Association of Mean Platelet Volume with Response to Neoadjuvant Chemotherapy in Rectal Cancer Patients
Rectal cancer is one of the most common malignant neoplasms in humans and ranks as the second most frequent cancer of the large intestine. The management of rectal cancer requires a multidisciplinary approach, including surgery, chemotherapy, and radiotherapy administered either before or after surgery to improve the chances of cure. Mean Platelet Volume (MPV) reflects platelet size and is associated with platelet production and activation. Platelet activation plays a crucial role in the development and progression of malignancy. This study aimed to determine the relationship between Mean Platelet Volume (MPV) and the response to neoadjuvant chemotherapy in patients with rectal cancer, as assessed using the Response Evaluation Criteria in Solid Tumors (RECIST). This study was an analytical study with a cross-sectional design, in which several variables were measured simultaneously at a single point in time. Data were collected from outpatients attending the Digestive Surgery Clinic at Adam Malik General Hospital, Medan. A total of 81 patients who met the study inclusion criteria were enrolled using a consecutive sampling method. Data were analyzed using the Shapiro–Wilk test to assess the normality of data distribution. One-way ANOVA or the Kruskal–Wallis test was used to analyze differences between qualitative variables, as appropriate. Receiver Operating Characteristic (ROC) analysis was performed to determine the diagnostic performance of Mean Platelet Volume (MPV). A total of 81 patients were included in this study, with the majority being female (n = 41). The mean age of the study subjects was 53.9 years. Tumors were most commonly located in the proximal rectum (33 patients), and the predominant histopathological differentiation was well differentiated, observed in 53 patients. Most patients with low MPV values (<8.6 fL) demonstrated a better response to chemotherapy, characterized by partial response and stable disease, whereas patients with high MPV values (≥8.6 fL) more frequently experienced progressive disease. There was no statistically significant association between Mean Platelet Volume (MPV) and response to neoadjuvant chemotherapy in patients with rectal cancer, as assessed using the RECIST criteria (p = 0.075). However, clinically, patients with lower MPV values tended to demonstrate a better therapeutic response compared with those with higher MPV values.
Effectiveness of Audio Visual Therapy in Reducing Anxiety and Pain in Children During Medical Procedures: Review Literature
Children often experience anxiety and fear when undergoing medical procedures. Audiovisual educational media can be used as a distraction and an educational tool to reduce this problem. To review the empirical evidence on the development and effectiveness of audiovisuals in reducing children pain, and anxiety during medical procedures. This is a review literature and retrieved articles from PubMed, Scopus, ScienceDirect, and Wiley databases published between 2020 and 2025. A total of 8,077 articles were initially identified through the database search using keywords audiovisual OR Virtual reality AND paediatric OR children AND anxiety. The study selection process was conducted following the PRISMA flow diagram, which involved screening, eligibility assessment, and removal of duplicates. The 8 articles were reviewed using JBI RCT appraisal tool and showed moderate to high quality. The selection followed the PRISMA diagram, with thematic analysis applied for data synthesis. The audiovisual media is proven effective as a non-pharmacological intervention to reduce anxiety, pain, and increase positive behaviour of children when undergoing medical procedures. Audiovisual have rule to distract children from pain and effect on the reducing anxiety including increase positive behaviour during procedures.
Prevalence of Anxiety in Physical Illness Patients
Anxiety patients with physical disorder was characterized by discomfort, sad, restlessness and worried. Patients have physiological, cognitive, affective, behavioral, and social reactions because of their anxiety and fear regarding their condition and the treatment they are receiving. This study aims to analyze the prevalence of anxiety among patients in general hospital. This study uses a cross sectional study carried out amongst 100 patient in general hospital using purposive sampling techniques. A semi-structured questionnaire for the study was used to collect data of the patients used Hospital Anxiety and Depression Scale (HADS) to rate the anxiety symptoms of the patients. HADS has been translated Indonesian languange with good reliability by means inter-rater valuation and analyzed by using Kappa Cohen coefficient (0,706). Data analysis was done quantitatively using frequency distribution. The study sample consisted of 100 patients with mean age 50,8 years, majority male patients (51%). Based on the HADS scores, 8 patients classified as patients suffering from excessive levels of anxiety, 21 patients had moderate anxiety and 40 patients had mild anxiety. This study found a prevalence of 75% of the patients in general hospital was experiencing anxiety.
Ankle Pump Exercise as Evidence-Based Nursing for Managing Hypervolemia in Chronic Kidney Disease Patients
Hypervolemia in patients with Chronic Kidney Disease (CKD) can cause lower extremity oedema. Non-pharmacological methods like ankle pump exercises and 30° leg elevation effectively reduce oedema and improve circulation by utilising muscle pump action and gravity to enhance venous return to the heart. The purpose of this case report evaluates the patient's response to the therapy provided. The method used is a descriptive design informed by evidence-based nursing (EBN). Data collection was conducted through interviews, observations, and the review of secondary data from medical records. The degree of oedema was measured using the Brodovicz pitting oedema scale. The study subject was Mrs S, a 60-year-old woman with stage V chronic kidney disease (CKD). She experienced fluid overload, shown by swelling, high neck vein pressure, weight gain, and low urine output. The intervention was carried out during four sessions, each lasting 40 minutes. The evaluation included the degree of oedema (Brodovicz pitting oedema), weight change, and foot circumference measurement. The results showed a decrease in the degree of oedema from 3 to 2, a decrease in weight from 48 kg to 46 kg, and an increase in urine output. Patients reported a reduction in heaviness and swelling in the lower extremities after the Ankle Pump Exercise and 30° leg elevation interventions, and no side effects were found during the implementation of these two interventions. Ankle pump exercise and 30° leg elevation proved to be effective, safe, and easy to apply as part of self-care. The results indicate that ankle pump exercise and 30° leg elevation can be used as non-pharmacological nursing interventions in the management of oedema in CKD patients with hypervolemia. Nurses play a crucial role in educating and guiding patients and their families to help them perform self-care interventions independently and continuously.
Global Research Trends on Peristomal Skin Complications in Ostomy Nursing Care: A Bibliometric Analysis
Peristomal skin complications (PSCs) are common adverse outcomes following ostomy surgery and continue to challenge ostomy nursing practice. Despite extensive clinical discussion, a comprehensive understanding of global research trends, collaborations, and thematic development remains limited. This study examined the global research trend on PSCs in ostomy nursing care through a bibliometric approach, focusing on publication growth, collaborative networks, and key research themes. Publications indexed in Scopus and PubMed between 2006 and 2026 were retrieved using Publish or Perish with the keywords “peristomal skin complication”, “peristomal dermatitis”, “peristomal skin damage”, and “ostomy skin complication”. A total of 482 records were identified of which 146 English-language publications met the inclusion criteria after duplicate removal and title-abstract screening. Data were analyzed using VOSviewer (version 1.6.19) to generate co-authorship, keyword co-occurrence, and network visualizations with a minimum threshold of five occurrences. Publication output increased significantly after 2015, indicating growing scholarly interest. The Journal of Wound, Ostomy and Continence Nursing was the leading source, and the United States contributed the most publications. Four thematic clusters were identified: nursing roles, postoperative complications, determinants of PSCs, and ostomy technologies. These findings highlight research gaps and support future efforts to enhance early risk detection, prevention strategies, and evidence-based ostomy nursing care.
Application Distal Leg Massage in Diabetes Mellitus Patient Post Lumbar Surgery with Peripheral Arterial Disease: Case Report
Postoperative lumbar surgery patients with diabetes mellitus are at risk of developing complex neurovascular disorders. Neurological deficits caused by lumbar nerve compression or diabetic neuropathy often result in numbness and tingling in the distal limbs, while impaired peripheral circulation related to diabetes mellitus can delay tissue healing. Distal limb massage is a non-pharmacological intervention that may help improve blood circulation and support peripheral nerve function recovery. To determine the effect of distal limb massage on improving peripheral circulation in post-lumbar surgery patients with diabetes mellitus and peripheral arterial disease (PAD). This descriptive case report with a nursing care approach was conducted from September 13 to 16, 2025, in Room UBK 2 of Welas Asih Hospital. A 46-year-old woman with a lumbar abscess and diabetes mellitus received distal limb massage twice daily for three days (30 minutes/session). Peripheral circulation was assessed using Ankle-Brachial Index (ABI) and plantar temperature before and after intervention and analyzed descriptively. After the intervention, the Ankle-Brachial Index (ABI) increased in the right leg from 1.04 to 1.08 and in the left leg from 0.75 to 0.82. In addition, the average plantar temperature increased by 0.3–0.5°C, indicating improved peripheral perfusion. Distal limb massage demonstrated potential effectiveness in improving peripheral circulation, as reflected by increased ABI values and plantar temperature, and may help reduce numbness and tingling in post-lumbar surgery patients with diabetes mellitus and PAD.
The Effectiveness of Family-Based Health Education on the Dash Diet (Dietary Approaches to Stop Hypertension) in Reducing Blood Pressure among Patients with Hypertension: A Literature Review
The global rise in hypertension cases has made it one of the leading causes of morbidity and mortality from cardiovascular diseases. Nonpharmacological approaches using the DASH diet have been shown to be effective in controlling blood pressure; however, their implementation requires family involvement supported by systematic health education. This study aims to analyze the effectiveness of health education on the DASH diet for families in reducing blood pressure in patients with hypertension based on a literature review. This study employed a literature review method, searching for articles on PubMed, ScienceDirect, and ResearchGate published between 2020 and 2025. A total of 339 articles were identified, and following the PRISMA screening process, 8 articles were selected for analysis. Selection was conducted according to the PRISMA flowchart, resulting in eight articles meeting the criteria for descriptive analysis. The study findings indicate that providing DASH diet education involving family participation can help improve dietary patterns in hypertensive patients and contribute to controlling and lowering blood pressure. DASH diet education involving the family has been shown to contribute to changes in eating behavior and blood pressure control in individuals with hypertension.
Diabetes Mellitus Type 5 (Malnutrition-Related Diabetes): Pathophysiology, Clinical Characteristics, and Therapeutic Challenges
Type 5 diabetes mellitus (T5DM), historically referred to as malnutrition-related diabetes mellitus (MRDM), represents an emerging and underrecognized subtype of diabetes that predominantly affects individuals in low- and middle-income countries (LMICs). Unlike type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), T5DM is characterized by severe insulin deficiency in the absence of autoimmune destruction or significant insulin resistance, reflecting a distinct pathophysiological mechanism linked to chronic undernutrition and impaired pancreatic development. Despite increasing recognition, variability in terminology, diagnostic criteria, and clinical characterization has limited its identification and management in both clinical practice and research settings. This narrative literature review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical features, and therapeutic approaches of T5DM, as well as to evaluate its distinction from classical diabetes subtypes and its implications for global health. A structured literature search was conducted across major electronic databases, including PubMed, Scopus, EMBASE, and Google Scholar, covering publications from January 2020 to March 2026. Relevant studies were selected based on predefined inclusion criteria encompassing epidemiological data, mechanistic insights, clinical characteristics, and treatment outcomes. Due to heterogeneity in study design, populations, and reported outcomes, findings were synthesized descriptively. The available evidence indicates that T5DM typically presents in young, underweight individuals with preserved insulin sensitivity, detectable but reduced C-peptide levels, and minimal risk of ketosis despite significant hyperglycemia. Pathophysiological mechanisms involve early-life nutritional deprivation leading to reduced β-cell mass, epigenetic modifications, and impaired insulin secretion. Therapeutically, patients often require lower insulin doses and may respond to selected oral antidiabetic agents, although evidence remains limited. Significant diagnostic challenges persist, particularly in resource-limited settings, where misclassification as T1DM or T2DM is common.
Artificial Intelligence in Clinical Laboratories: A Bibliometric Analysis of Research Trends and Applications
The progress of artificial intelligence (AI) has rapidly increased its use in clinical laboratories, making it easier to diagnose patients and run the laboratories more efficiently. Nonetheless, difficulties remain regarding the ethical aspects, uniformity, and reliability of algorithmic decision-making. This study seeks to delineate the evolution of AI applications in clinical laboratories over the preceding five years through a bibliometric analysis. We obtained original articles from the Scopus database published between 2021 and 2025 in the fields of medicine, computer science, and health professions. A systematic identification and screening process resulted in 1,891 documents, followed by filtering, duplicate removal, and eligibility assessment, giving in the inclusion of 994 studies in the final analysis. We conducted a bibliometric analysis to examine publication trends, changes in themes over time, co-occurrence of keywords, networks of international collaboration, and highly cited core studies. The results show that research output is growing quickly, and the focus is shifting from developing new methods to putting them into practice in the real world. Keyword mapping indicates that automation, diagnostic accuracy, and decision-support systems are becoming increasingly important. International collaboration is growing, but it is still unevenly distributed across regions. In conclusion, this study offers a thorough examination of the evolving research landscape of AI in clinical laboratories and underscores the need for enhanced global collaboration and the ethical, clinically reliable, and sustainable incorporation of AI in clinical laboratories.
Factors Associated with Blood Transfusion Compliance in Children with Thalassemia
Thalassemia reduces hemoglobin production, making blood transfusions the primary treatment. Compliance is essential during treatment. To determine the factors associated with compliance with blood transfusion in children with thalassemia.This study used a cross-sectional design involving 57 children with thalassemia at Bhayang Setukpa Lemdikpol Hospital in Sukabumi City, selected using total sampling. Data were collected using a validated structured questionnaire. Data were analyzed using chi-square and logistic regression to determine the relationship between each variable. The results showed a significant relationship between family support (p-value = <0.001), knowledge (p-value = 0.007), and duration of illness (p-value = <0.001) with blood transfusion compliance in children with thalassemia. There was a simultaneous relationship between family support, knowledge, and duration of thalassemia with blood transfusion compliance in children with thalassemia (R Square 0.732). There is a significant relationship between family support, knowledge, and duration of thalassemia with blood transfusion compliance in children with thalassemia.
Needs Analysis for Developing a Constraints-Led Traditional Game to Combat Sedentary Lifestyles in Elementary Students
The global epidemic of sedentary lifestyles and excessive gadget use has severely degraded the physical fitness of elementary school students, specifically their agility and cardiovascular endurance. While traditional games like Gobak Sodor offer motor skill benefits, they often lack precise physiological intensity control and utilize passive elimination systems. This study aims to develop and evaluate "Go Ben," a modified Gobak Sodor game designed using the Constraints-Led Approach (CLA) to combat sedentary behaviors. Employing the Borg and Gall Research and Development (R&D) methodology, the study involved Grade 5 students across five elementary schools in the Cirebon region. Participants were selected utilizing a purposive sampling technique, which initially involved a sample of 12 to 15 students for the preliminary field test, before expanding to a main sample of 60 students for operational field testing. The CLA framework was applied to manipulate task, environmental, and individual constraints, replacing passive elimination with active penalties and introducing cognitive tools like "Magic Cards". Following expert validation that scored the model at 95.3% feasibility, a quasi-experimental Pretest-Posttest Control Group Design was conducted on the 60 sampled students. The results demonstrated that the "Go Ben" intervention significantly enhanced agility, with median shuttle run times decreasing from 12.45 to 11.24 seconds (p < 0.001). Additionally, cardiovascular endurance improved significantly, with median Bleep Test scores rising from 18.54 to 20.00 (p < 0.001), successfully outperforming conventional physical education methods (p = 0.045). Ultimately, this CLA-modified game serves as a highly effective, continuous-flow physical training instrument designed to optimize students' physical conditioning, prevent early obesity, and simultaneously preserve local cultural heritage.
Design, Development, and Evaluation of the Low-Cost “SMART” Simulator for Postpartum Breast and External Genital Assessment
Clinical skills training in postpartum breast and external genital assessment is a core competency in midwifery education. However, opportunities for direct practice with postpartum women are increasingly constrained by ethical considerations, patient safety, privacy concerns, and limited clinical exposure. Although simulation-based education has proven effective in addressing these challenges, affordable and context-specific simulators for postpartum assessment remain scarce, particularly in low- and middle-income educational settings. This study aimed to design, develop, and evaluate the feasibility and educational effectiveness of the low-cost “SMART” simulator for postpartum breast and external genital assessment in midwifery clinical skills training. A research and development (R&D) design was employed, comprising design, development, and evaluation phases. Validation by content experts, simulated patients, and lecturers was conducted using structured instruments, while educational effectiveness was assessed through a pretest–posttest clinical skills evaluation. The “SMART” simulator demonstrated high content validity, anatomical accuracy, and instructional relevance. Simulated patients reported very high acceptability, particularly regarding comfort, privacy, and ethical safety. Lecturers rated the simulator as highly feasible and appropriate for skills laboratories, OSCE preparation, and community-based learning. Students showed significant improvement in clinical skills following simulation-based training. Importantly, the simulator was developed using affordable, reusable materials, enabling repeated use without substantial financial burden. The low-cost “SMART” simulator is a valid, feasible, and effective simulation-based learning tool for postpartum breast and external genital assessment. Its affordability and adaptability support equitable access to high-quality clinical skills training while maintaining ethical standards and patient safety.
Association Between Maternal Characteristics and the Incidence of Severe Preeclampsia Among Pregnant Women: A Literature Review
Severe preeclampsia remains a leading cause of maternal and perinatal morbidity worldwide. Identifying specific maternal characteristics is crucial for early intervention. This review synthesizes evidence regarding the association between maternal traits and severe preeclampsia incidence. A systematic literature search was conducted across PubMed, Google Scholar, and ScienceDirect for studies published between 2016 and 2025. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, five high-quality articles were selected based on strict eligibility criteria. Synthesis of the five core studies identifies advanced maternal age (>35 years), high pre-pregnancy Body Mass Index (BMI), chronic hypertension, parity, and inadequate antenatal care (ANC) as primary predictors. These factors significantly elevate the risk of progression to severe clinical features. Early screening of maternal risk profiles and optimized antenatal monitoring are essential to mitigate the incidence of severe preeclampsia.
Atypical Cutaneous Larva Migrans with Rapid Improvement after Initial Albendazole Therapy: A Case Report
Cutaneous larva migrans (CLM) is a zoonotic helminthiasis caused by the penetration of animal hookworm larvae into the human epidermis and characterized by pruritic serpiginous lesions. This disease is commonly found in tropical and subtropical regions due to exposure to soil or sand contaminated with dog or cat feces. Lesions typically appear on the lower extremities due to direct contact with the soil, but can occur in other locations, posing diagnostic challenges. This study aims to describe the clinical presentation of CLM with unusual lesion locations and highlight the rapid clinical response following initial albendazole therapy. This study used a descriptive observational design with a single case report approach. The study subject was a single patient diagnosed with Cutaneous Larva Migrans with atypical clinical manifestations based on history, physical examination, and the clinical judgment of the treating physician. The patient was selected purposively because of her atypical clinical presentation and interesting therapeutic response to report. The analysis was conducted descriptively, presenting the chronology of the disease course, diagnostic process, response to therapy, and clinical outcomes of the patient. The patient received 400 mg of albendazole once daily for three days and 10 mg of cetirizine once daily. After the first dose of albendazole, the sensation of larval movement and pruritus disappeared. A gradual evaluation revealed a decrease in lesion activity after the second dose, as well as drying of the migration path after the third dose. On the fifth day after therapy, the lesions appeared to be drying out with reduced erythema, indicating a rapid clinical response to anthelmintic therapy. CLM can occur in non-predilection sites such as the trunk and upper extremities, potentially presenting diagnostic challenges. A rapid clinical response to albendazole not only effectively halts larval migration but also has important diagnostic value in atypical presentations.
Implementation of Financial Management Patterns (BLUD): Analysis of Obstacles and Performance Improvement Strategies (Literature Study)
The implementation of the Regional Public Service Agency (BLUD) Financial Management System in Community Health Centers (Puskesmas) is one of the government's efforts to improve the efficiency of financial management and the quality of health services to the public. The BLUD system provides flexibility for health service units to manage financial resources more effectively and accountably. This study aims to analyze the implementation of BLUD financial management in Community Health Centers and identify various factors influencing its successful implementation. This study used a literature review approach by analyzing national and international scientific articles relevant to BLUD implementation in primary health care facilities. Data collection was conducted through a search of scientific databases and analyzed descriptively thematically. The study shows that BLUD implementation has a positive impact on financial management flexibility, operational efficiency, and improved health service quality. However, several obstacles are still frequently encountered, including limited regulatory support at the regional level. Increasing human resource capacity, strengthening organizational governance, and policy support from the regional government are important factors in supporting the successful implementation of BLUD in Community Health Centers.
Cytochrome P450 Monooxygenase and Pyrethroid Resistance in Anopheles: A Narrative Review
Malaria remains a major global public health problem, with approximately 282 million cases reported in 2024. Although vector control interventions such as long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) have significantly reduced malaria transmission, their effectiveness is increasingly compromised by pyrethroid resistance in Anopheles mosquitoes. This review examines the role of cytochrome P450 monooxygenase enzymes in mediating pyrethroid resistance. A literature search was conducted in PubMed, Springer, and Google Scholar for articles published between 2016 and 2026 using the keywords “Cytochrome P450,” “P450 monooxygenase,” “Insecticide Resistance,” “metabolic resistance,” “Pyrethroid,” “Anopheles,” and “malaria vector.” Of 10,854 articles identified, 142 were screened, and six relevant studies were included, focusing on resistance mechanisms, P450 characteristics, gene regulation, and vector control implications. The findings indicate that overexpression of specific P450 genes significantly enhances the detoxification of pyrethroids, thereby reducing insecticide susceptibility. Furthermore, interactions between metabolic resistance and target-site mutations contribute to elevated resistance levels. Recent evidence suggests that non-coding RNAs (ncRNAs) regulate detoxification pathways and contribute to adaptive resistance. In conclusion, insecticide resistance in Anopheles is a multifactorial process involving genetic, biochemical, and regulatory mechanisms. Understanding these mechanisms is crucial for developing more effective and sustainable vector control strategies.
Determinants of Diabetes Mellitus Complication Prevention in Rural Communities
Diabetes mellitus is a major global public health problem that contributes significantly to morbidity, mortality, and decreased quality of life due to its long-term complications. Rural communities are particularly vulnerable to diabetes mellitus complications because of limited access to healthcare services, inadequate health education, low socioeconomic status, and insufficient preventive health behaviors. The purpose of this study is to analyze the determinants of diabetes mellitus complication prevention in rural communities. This quantitative study with a cross-sectional design in May 2025. The study population consisted of 348 respondents with a sample of 186 respondents selected using random probability sampling. Data were collected through questionnaires. The results showed that all questionnaire items were valid, with r-count values ranging from 0.412 to 0.845, exceeding the r-table value. Reliability testing was conducted using Cronbach’s Alpha, and all variables demonstrated good internal consistency, including diabetes complication prevention (0.892), knowledge (0.846), motivation (0.874), and health examination (0.831). Analyzed using logistic regression. The results showed a significant relationship between education (0.000), type of employment (0.000), income level (0.00), knowledge (0.000), attitude (0.000), self-motivation (0.000), family support (0.000), and access to health services (0.000) with efforts to prevent DM complications. In contrast, age (0.067), gender (0.291), and anxiety level (0.080) were not significantly related. The most dominant variable was self-motivation with an OR of 144.7. The conculsion is education, occupation, income, knowledge, attitude, family support, healthcare access, and especially self-motivation significantly influenced diabetes complication prevention efforts in rural communities.
Denture Services for Older Adults Within the Framework of Universal Health Coverage: A Scoping Review Using the who Universal Coverage Cube
Older adults are particularly vulnerable to oral health problems, especially tooth loss, which affects chewing function, nutritional status, and quality of life. Dentures are an important rehabilitative intervention to address these issues. Although many countries, including Indonesia, have implemented Universal Health Coverage (UHC), coverage of denture services for older adults remains variable and limited. Objective isTo map denture services for older adults within the Universal Health Coverage framework using the WHO Universal Health Coverage Cube. Methods is This scoping review followed the Joanna Briggs Institute methodology and was reported in accordance with the PRISMA-ScR guidelines. Literature searches were conducted across multiple scientific databases and relevant grey literature sources. Eligible studies were analyzed descriptively and mapped according to the three dimensions of UHC: population coverage, service coverage, and financial protection. The results: A total of 20 studies were included in the review. The findings revealed considerable variation in denture services for older adults across countries. In terms of population coverage, older adults were not consistently prioritized as beneficiaries. Regarding service coverage, coverage was generally limited to basic removable dentures, with restrictions on materials and replacement frequency. In the financial protection dimension, older adults remained exposed to out-of-pocket payments despite formal inclusion of denture services in health policies. These findings indicate an imbalance across the three UHC dimensions. Conclusion is Although the UHC framework has been widely implemented, coverage of denture services for older adults remains suboptimal. Strengthening equity, service comprehensiveness, and financial protection is necessary to ensure more responsive health systems for ageing populations. The WHO Universal Health Coverage Cube provides a useful framework for identifying policy gaps.
The Relationship between Husband’s Support and the Readiness of Pregnant Women in Facing Labor
ABSTRACT Due to the labour, pregnant women often experience emotional changes such as anxiety, fear, and stress. Data showed that out of 56 pregnant women, 73.2% experienced moderate anxiety and 14.2% severe anxiety, with 62.5% of the severe anxiety group having poor labour readiness. This shows a tendency that high anxiety has an impact on low readiness for labour. One of the factors that influences labour readiness is support from the husband, as the closest person to the wife. This study aimed to find out the relationship between husbands' support and the readiness of pregnant women to face labour. This study used a correlational design with a cross-sectional approach. The population consisted of 43 people, with a sample of 39 respondents selected using simple random sampling. The instruments used were the husband’s support questionnaire and the readiness to face labour questionnaire. The questionnaires were tested for validity and reliability prior to data collection using the Pearson Product Moment for validity and Cronbach’s Alpha for reliability. The validity test showed r-values > r-table value (0.576), while the reliability test yielded Cronbach’s Alpha values of 0.903 and 0.906. Data analysis used the Spearman Rank Test. The results showed a value of r = 0.334 with p value = 0.037 (p < 0.05), which means there is a significant relationship between husband support and the readiness of pregnant women in facing childbirth. The results showed that active husband involvement during pregnancy and childbirth plays an important role in supporting maternal psychological readiness.
An Integrative Analysis of Therapeutic Communication, Nurse Competence, and Nursing Service Quality on Patient Satisfaction in Primary Health Care Centers: A Literature Review
Patient satisfaction is a key indicator of service quality in primary health care centers. However, it remains influenced by suboptimal therapeutic communication, nurse competence, and the quality of nursing care. Empirical evidence regarding the relationships among these factors is still fragmented and lacks integration. This literature review aims to analyze the influence of therapeutic communication, nurse competence, and the quality of nursing care on patient satisfaction in primary health care settings. A systematic search was conducted in PubMed, ScienceDirect, Google Scholar, and DOAJ for studies published between 2020 and 2025, following the PRISMA 2020 guidelines. The search strategy was guided by the PICO framework using the keywords “Nurse Competence,” “Patient Satisfaction,” “Primary Health Care Centers,” “Service Quality,” and “Therapeutic Communication.” Inclusion criteria comprised original research articles with cross-sectional designs involving healthcare patients and examining therapeutic communication, nurse competence, service quality, and patient satisfaction. A total of 1,972 articles were initially identified, of which 524 duplicates were removed. After the screening process, 15 articles met the inclusion criteria. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. All included studies demonstrated a statistically significant association between therapeutic communication, nurse competence, and the quality of nursing care with patient satisfaction (p < 0.05). Service quality emerged as the dominant factor, mediating the relationship among variables. Patient satisfaction is influenced by the integration of therapeutic communication, nurse competence, and service quality. Strengthening these three aspects is essential to improve the quality of care in primary health care centers.
Herbal Cooling Roll-On (Aloe Vera–Lavender) for the Management of Vasomotor Symptoms in Menopausal Women
Hot flashes are the most common vasomotor symptom experienced by women during the climacteric phase, often accompanied by sleep disturbances and anxiety. Hormone therapy is effective, but not all women can use it due to contraindications and the risk of long-term side effects. Therefore, non-hormonal interventions based on topical products are a potential alternative. Researcher are developing a cooling roll-on based on aloe vera, lavender hydrosol, and menthol in concentrations safe for skin application. The purpose of this study was to develop and evaluate the effectiveness of a cooling roll-on based on aloe vera, lavender hydrosol, and menthol as a non-hormonal intervention in reducing the intensity and frequency of hot flashes in menopausal women. This study used an experimental laboratory design followed by a pilot clinical trial. The initial phase involved the formulation of two cooling roll-on preparations based on aloe vera and lavender hydrosol, one with and one without added menthol. Evaluation of the preparation quality was carried out through pH testing using a calibrated pH meter and microbial contamination testing using the Total Plate Count (TPC) method. Furthermore, initial safety testing was conducted through patch tests on 10 respondents to assess potential skin irritation. Data were analyzed descriptively to assess the safety, stability, and feasibility of the product before proceeding to the clinical trial phase. The findings in this study are based on laboratory tests on coolant roll-on preparations, both with and without menthol, obtained data based on pH parameters. Preparations with menthol have an average pH of 5.91 and preparations without menthol have an average pH of 5.98. while microbial contamination (Total Plate Count/TPC) in both preparations has a TPC value <1.0 x 101 CFU/ml. Implications for Product Feasibility Based on these two parameters, it can be concluded that Initial safety is met (both formulations have met the basic criteria for topical safety, both in terms of pH and microbial contamination) and the formulation is stable (there are no significant changes due to the addition of menthol to).
Factors Associated with Inpatient Hospitalization Costs in Stroke Patients Undergoing Mechanical Thrombectomy or Coiling
Stroke is a catastrophic disease with a significant economic burden, particularly for neurointervention procedures such as mechanical thrombectomy and coiling. A disparity exists between standard costs and actual billing charges for these procedures at Dr. Mohammad Hoesin Hospital Palembang. This study aimed to analyze the factors influencing hospitalization costs of stroke patients undergoing mechanical thrombectomy or coiling. This was an analytical cross-sectional study with retrospective data collection from medical records of stroke patients who underwent mechanical thrombectomy or coiling at Dr. Mohammad Hoesin Hospital Palembang from January 2024 to September 2025. The study included 32 patients who underwent mechanical thrombectomy and 67 who underwent coiling. Sampling technique used was total sampling. Bivariate and multivariate analyses were performed to identify factors influencing hospitalization costs. The mean actual hospitalization cost for mechanical thrombectomy was IDR 97,679,947 ± 80,403,149, while for coiling it was IDR 119,286,035 ± 77,330,119 (approximately 20% higher). In the mechanical thrombectomy group, multivariate analysis revealed length of stay as the only significant independent factor influencing hospitalization costs (p<0.05). Meanwhile, in the coiling group, four significant independent factors were identified: complications, aggravating factors, NIHSS score, and number of coils (p<0.05). The factors influencing hospitalization costs differ between mechanical thrombectomy and coiling. For mechanical thrombectomy, length of stay is the dominant factor, whereas for coiling, clinical severity (complications, aggravating factors, NIHSS score) and procedural complexity (number of coils) are the main cost determinants.
Aging Effects on Carpal Tunnel Syndrome: Severity and Functional Decline
Carpal tunnel syndrome is a cumulative trauma disorder affecting the forearm and wrist, characterized by loss of sensation, weakness, and tingling in the thumb and the first two fingers. The prevalence of this condition continues to rise each year, with an incidence rate of 276 cases per 100,000 individuals. This study aims to analyze the relationship between age and the severity and functional status of carpal tunnel syndrome in the elderly at the Santo Yosef Nursing Home in Surabaya. The study employed an analytical observational design with a cross-sectional approach. The study population consisted of all 145 elderly residents at the Santo Yosef Senior Care Home in Surabaya, with a sample of 70 respondents selected using purposive sampling. Data were collected through interviews using a questionnaire and analyzed using Spearman’s correlation test with the aid of SPSS version 23. The results showed that age group had a significant relationship with SSS (p=0.017) and FSS (p=0.049). However, the Spearman test results showed r values of 0.284 and 0.236, indicating that the strength of the correlation between age and the severity or functional impact of carpal tunnel syndrome is relatively weak. Thus, there is a significant relationship between age and the severity and functional status of carpal tunnel syndrome, although the strength of this relationship is relatively low.
Nephroprotective Effects of Celery Extract (Apium graveolens L.) on Unilateral Ureteral Obstruction Models
Renal fibrosis represents the final pathological endpoint of chronic kidney injury, characterized by excessive extracellular matrix deposition and irreversible structural damage, ultimately leading to end-stage kidney disease (ESKD) necessitating renal replacement therapy. Given the largely irreversible nature of established fibrosis, current therapeutic approaches primarily aim to suppress fibrogenesis and delay further renal deterioration. Celery (Apium graveolens L.) contains bioactive compounds with potential nephroprotective properties. Unilateral ureteral obstruction (UUO) is a well-established experimental model of renal fibrogenesis, in which persistent obstruction leads to tubular injury and activation of profibrotic signaling pathways. This study aimed to evaluate the nephroprotective effect of celery ethanol extract on renal injury in UUO rat model. A post-test-only control group design was conducted using 25 rats randomly assigned into five groups: sham control, negative control (UUO), and three treatment groups receiving celery extract (125, 250, and 500 mg/kg body weight) for 14 days. Serum creatinine levels were measured from blood samples, while renal tubular injury scores were assessed through histopathological examination of kidney tissues. One-way ANOVA followed by a least significant difference (LSD) post hoc test revealed significant differences among groups (p < 0.05), with the 250 mg/kg dose showing the most pronounced effect, suggesting potential nephroprotective activity. These findings necessitate further investigations, including toxicity assessment and clinical studies, to establish its therapeutic applicability.
Postoperative Neurological Monitoring and Care Stratification in Adult Patients After Craniotomy: A Systematic Literature Review
The postoperative period following craniotomy is a critical phase because patients are at risk for early neurological deterioration, the need for escalation of care, delirium, delayed awakening, and other complications that can impact safety and clinical outcomes. An appropriate approach to neurological monitoring, including the selection of the care unit and stratification of observation intensity, is a crucial issue in modern neurosurgical practice. Synthesizes current scientific evidence regarding postoperative neurological monitoring and care stratification in adult patients after craniotomy, specifically regarding the safety of non-intensive care unit (non-ICU) care, the use of prediction scores, and postoperative clinical outcomes. This review used a systematic literature review design following the PRISMA 2020 principles and has been registered with PROSPERO (CRD420261350040). Searches were conducted in PubMed, Scopus, Web of Science, SAGE, and Springer Nature for articles published between 2020 and 2026. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools according to study design. Due to the heterogeneity of designs, interventions, and outcomes, the synthesis was conducted narratively and thematically. Of the initial 534 articles, 18 studies met the inclusion criteria. Four studies were of high quality and fourteen studies were of moderate quality. Three main themes were identified: (1) non-ICU monitoring pathways in selected patients can be safe when supported by structured neurological observation; (2) prediction scores and risk stratification help adjust monitoring intensity; and (3) structured postoperative pathways, including same-day discharge in selected patients, have the potential to reduce length of stay, costs, and ICU use without showing significant safety signals. Available evidence suggests that structured, risk-based postoperative neurological monitoring supported by strong nursing competencies has the potential to improve resource efficiency without compromising patient safety. However, the evidence remains largely based on observational studies.
Implementation of the Maternal Perinatal Responsive Surveillance Audit (AMP-SR) in Reducing Maternal and Infant Mortality Rates in Indonesia: A Prisma-Modeled Systematic Literature Review
The Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) remain major challenges in Indonesia’s health system, requiring a systems-based evaluation approach. The Maternal Perinatal Surveillance and Responsive Audit (AMP-SR) was developed as a strategy to identify the causes of maternal and neonatal deaths and improve the quality of healthcare services through an integrated surveillance and response system. This study aims to analyze the implementation of AMP-SR in reducing MMR and IMR through a Systematic Literature Review (SLR) using the PRISMA model. This study employed a Systematic Literature Review approach using the PRISMA framework. Articles were retrieved from Google Scholar through the Publish or Perish application using keywords related to AMP-SR and published between 2021 and 2026. A total of 50 articles were initially identified through the database search. After undergoing the identification, screening, eligibility, and inclusion stages, 12 articles met the inclusion criteria and were included in the final analysis. The findings indicate that AMP-SR is effective in identifying risk factors associated with maternal and neonatal mortality and improving the quality of healthcare services through a systematic audit process. However, several challenges remain, including poor documentation quality, limited human resources, and weak monitoring and follow-up of audit recommendations. Strengthening the reporting system, enhancing the capacity of healthcare workers, and optimizing the use of digital technology are essential factors in improving the effectiveness of AMP-SR implementation in reducing MMR and IMR in Indonesia.
Management of Gingival Enlargement in Patient with Fixed Orthodontic Appliances in Undiagnosed Type-2 Diabetic Patient : A Case Report
Gingival enlargement (GE) can be caused by inflammation, medications, or systemic conditions. Diseases such as hypertension and diabetes have a reciprocal relationship. This case report aims to discuss the clinical effectiveness of conventional gingivectomy in an orthodontic patient with undiagnosed type 2 diabetes. A 37-year-old female patient who had been undergoing orthodontic treatment for 2 years presented with complaints of swollen gums in the anterior region of the lower jaw that frequently bled while brushing her teeth over the past ±1 year. The patient denied persistent pain, uncontrollable bleeding, or a history of other systemic diseases. A general examination revealed a random blood glucose (RBG) level of 272 mg/dL, indicating uncontrolled diabetes with normal blood pressure. An intraoral examination showed gingival enlargement in the anterior mandibular region, particularly around tooth 33, accompanied by plaque and calculus. After blood glucose levels were controlled, conventional scalpel gingivectomy and gingivoplasty were performed. The gingival tissue appeared to cover nearly half of the tooth crown with a gingival overgrowth index of 2, leading to plaque accumulation and aesthetic concerns. The procedure was performed to remove excess gingival tissue, improve gingival contour, reduce plaque accumulation, support orthodontic treatment, and address the patient’s aesthetic concerns. Conventional gingivectomy has proven effective in managing gingival overgrowth when performed according to indications.
The Correlation between Perceived Social Support and Stress Levels among First-Year University Students
Students often experience various challenges related to their studies at university. These challenges can disrupt their health, particularly psychological issues such as stress. Excessive or prolonged psychological stress may interfere with learning success. This study aims to determine the relationship between perceived social support and stress levels among first-year students at the Muhammadiyah University of East Kalimantan (UMKT), Indonesia. This study uses a quantitative research design with a cross-sectional method. The population of this study was 3253 first-year students of Muhammadiyah University of East Kalimantan, then the sample used in this study was 401 respondents who were selected using stratified random sampling technique. The measuring instrument in this study used the MSPSS (Multidimensional Scale of Perceived Social Support) questionnaire and the DASS-42 (Depression Anxiety Stress Scale) questionnaire with an ordinal scale distributed via Google Form. Prior to use, both questionnaires were tested for reliability, resulting in a Cronbach's Alpha value of 0.895 (>0.6) for the MSPSS questionnaire and 0.825 (>0.6) for the DASS questionnaire. Both questionnaires were assessed as valid questionnaires because they have been widely used at the international level. The data of this study were analyzed using frequency distribution analysis techniques and the Spearman Rank method. Based on the statistical analysis, perceived social support did not have a statistically significant relationship with stress levels among students (p = 0.536, > 0.05). Most of the respondents in this study were dominated by female (67.3%) rather than male students (32.7%), then the age of the respondents was mostly late teenagers (99%) with the age range between 17 to 25 years. Furthermore, respondents experienced high perceived social support (52.4%). Then, majority of respondents experienced normal stress levels (41.6%). Social support can be obtained from family, friends, and other special people. From a public health perspective, the importance of the relationship between social support and stress can be demonstrated using the principle of five levels of prevention to prevent the negative impacts caused by excessive stress.
The Relationship between Food Security and Nutritional Status (Wasting): Literature Review
Malnutrition in toddlers remains a public health challenge in Indonesia. Malnutrition (wasting) is an important indicator reflecting the imbalance between children's nutritional intake and needs. One important factor associated with malnutrition is household food security. This study aims to analyze the relationship between food security and malnutrition in toddlers based on the results of a literature review. This study used a literature review to examine the relationship between food security and malnutrition. Data was obtained from Google Scholar, ScienceDirect, and PubMed using the keywords "malnutrition," "wasting," "food security," "nutritional status," and "child nutrition." The publication period was limited to 2021–2026. Articles were then screened based on relevance, full-text availability, and suitability to the research objectives. A total of 227 articles were identified, of which 11 met the inclusion criteria, and 5 articles. Data analysis was conducted descriptively by comparing and summarizing the findings from selected articles related to food security and the incidence of malnutrition in toddlers. The results indicate that most studies found a significant relationship between household food security and the nutritional status of toddlers. Households with low food security tend to have toddlers with malnutrition. Other factors such as energy intake, maternal education, family income, and sanitation conditions also play a role in influencing children's nutritional status. Inadequate food security impacts the quality and quantity of food consumption, thereby increasing the risk of malnutrition in toddlers. The conclusion of this literature review is that household food security is a significant factor associated with the incidence of malnutrition in toddlers.
Perceptions of Islamic Religiuos Figures on the Development of the Role of Exclusive Breastfeeding Ambassadors in Premarital Education as An Effort to Prevent Stunting
Stunting remains a public health problem in Padangsidimpuan City, with a prevalence reaching 30.3%. Stunting prevention needs to begin premarital by improving literacy among prospective brides and grooms. Islamic religious leaders are trusted figures in the community and have the potential to act as ambassadors for exclusive breastfeeding in premarital education. This study aims to explore the perceptions of Islamic religious leaders regarding the development of their role as exclusive breastfeeding ambassadors in premarital education as an effort to prevent stunting in Padangsidimpuan City. The study used a qualitative approach with a phenomenological design. Six informants were purposively selected, consisting of Islamic religious leaders involved in premarital counseling. Data were collected through in-depth interviews using a semi-structured interview guide and analyzed thematically. The analysis yielded five themes: 1) religious leaders' understanding of stunting and exclusive breastfeeding; 2) perceptions of developing their role as exclusive breastfeeding ambassadors; 3) readiness and capacity building needs; and 4) expectations for model development. Religious leaders demonstrated positive perceptions and expressed a willingness to act as exclusive breastfeeding ambassadors, with support from training, modules, educational media, standard operating procedures (SOPs), and cross-sector collaboration. Islamic religious leaders have significant potential to be empowered as exclusive breastfeeding ambassadors in premarital education. Developing a model supported by capacity building and cross-sector collaboration is expected to improve literacy among prospective brides and grooms and contribute to stunting prevention in Padangsidimpuan City.
The Effect of Hypertension Exercises on Reducing Blood Pressure in the Elderly at the Elderly Posyandu
Hypertension is a common degenerative disease among older adults and can lead to serious complications if not well controlled. Non-pharmacological approaches, such as hypertension exercise, are recommended to support blood pressure management. This study aimed to determine the effectiveness of hypertension exercise in reducing blood pressure among older adults at the Elderly Health Post (Posyandu Lansia). A quasi-experimental study with a one-group pretest–posttest design was conducted. A total of 30 elderly participants were recruited using total sampling. Blood pressure was measured before and after the intervention. Hypertension exercise was administered in three sessions (February 18, 21, and 23, 2026). Data were analyzed using univariate and bivariate methods to assess changes in blood pressure. The findings showed a significant reduction in average systolic blood pressure after each session. In the first session, the mean systolic pressure decreased from 151.8 mmHg to 136.4 mmHg. Similar reductions were observed in the second and third sessions, indicating a consistent downward trend following the intervention. Hypertension exercise is effective in reducing blood pressure among older adults.
Incidents of Self-Harm, Suicide Ideas, and Anxiety among Adolescents in An Islamic School: Risk Factors and Mental Health Implications
Self-harm, suicidal ideation and anxiety are mental health issues of growing concern among adolescents, including adolescents studying in Islamic schools. This study aims to describe the prevalence and influencing factors of self-harm, suicidal ideation and anxiety among adolescents in Islamic schools. Using a quantitative survey method, data were obtained from 300 students in Central Java through the Generalised Anxiety Disorder-7 (GAD-7) instrument as well as questionnaires related to self-harm experiences and suicidal ideation, the instrument validity and reliability values between 0.397-0.906. This research use purposive sampling technique and uses univariate analysis and bivariate analysis using the Spearman Rho-correlation test. Results showed that 25% of respondents had committed self-harm, 15% had suicidal ideation, and 40% experienced moderate to high anxiety. The main triggering factors included academic pressure, family conflict, and lack of social support. This study emphasises the need for early intervention and Islamic values-based mental health programmes to reduce the risk of mental disorders in adolescents. This adaptive programme can help adolescents manage stress through spiritual approaches and strengthening social support.
Analysis of Intelligence Capabilities Among Sepak Takraw Athletes
Sepak Takraw demands exceptional physical prowess and acrobatic agility; however, the cognitive mechanisms enabling high-speed tactical execution are frequently overlooked in regional training paradigms. This study aims to systematically evaluate the intelligence capabilities of competitive Sepak Takraw athletes in Demak Regency to establish a foundational cognitive profile for future talent identification and coaching optimization. Employing a quantitative descriptive research design, the study utilized a purposive sampling technique to select 60 active athletes, aged 15 to 25 years, who have previously competed at the regional level. Data were collected using the Culture Fair Intelligence Test (CFIT), a standardized instrument chosen to measure fluid intelligence and spatial reasoning independently of educational backgrounds. The descriptive statistical analysis revealed a mean intelligence quotient (IQ) score of 104.5, alongside a standard deviation of 8.2. Categorically, 65% of the athletes were classified within the average to high-average intelligence bracket (IQ 90-114), 15% demonstrated superior intelligence (IQ > 115), and 20% fell into the below-average category (IQ < 90). Furthermore, participants scored highest on spatial pattern recognition, averaging in the 65th percentile. The findings indicate that while baseline cognitive capabilities are fundamentally average, significant variance exists. The study concludes that current coaching methodologies must evolve beyond purely physical metrics to incorporate formal cognitive assessments, thereby fostering better tactical anticipation and adaptability.
Nurses’ Experiences in Implementing Fall Risk Prevention Procedures in Inpatient Units
Patient falls remain among the most frequent preventable adverse events in hospitals, posing challenges to patient safety in inpatient care. Preliminary observations at RSUD Bendan Pekalongan revealed inconsistent initial assessments, incomplete patient and family education, and facility limitations that weakened fall prevention practices. This descriptive qualitative study explored nurses’ experiences in implementing fall risk prevention procedures in inpatient units. Five purposively selected participants, including nursing management, patient safety committee members, head nurses, and staff nurses, provided data through in depth interviews, observations, and document reviews. Thematic analysis identified two main themes: institutional guidance for fall risk identification and practical implementation of prevention measures. Nurses reported using patient identification protocols, the Morse Fall Scale, risk labels, side rails, environmental checks, and patient family education. However, implementation was inconsistent due to workload pressures, uneven knowledge and training, limited patient family engagement, and damaged facilities. Although structural procedures exist, process fidelity remains suboptimal.
Peppermint Aromatherapy to Reduce Nausea and Vomiting in Post-Operative Patients: A Literature Review
Postoperative nausea and vomiting are common complications after surgery and can slow the recovery process and increase the patient's clinical burden. This review aims to synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of peppermint aromatherapy in reducing nausea and vomiting in postoperative patients. This study used a systematic literature review design with the PRISMA approach. Literature searches were conducted through PubMed, ScienceDirect, and Scopus databases in the period 2015–2025 with the keywords peppermint aromatherapy and nausea and vomiting and postoperative care. From the search results based on keywords, 123 articles were obtained, then selected articles were selected using PICOS criteria and limited to randomized controlled trial designs, as many as eight articles that met the inclusion criteria were analyzed qualitatively. All studies showed that peppermint aromatherapy through inhalation methods was able to reduce the intensity and frequency of nausea and vomiting compared to the control group, standard care, or placebo. Peppermint aromatherapy is effective as a non-pharmacological intervention in reducing postoperative nausea and vomiting and has the potential to be used as a safe and practical complementary therapy in nursing practice.
Implementing Diabetes Mellitus Self-Care Education to Improve Adherence to Self-Care Practices: Case Study
Diabetes Mellitus (DM) is a chronic metabolic disease that requires long-term management through pharmacological therapy and adherence to self-care. Non-compliance with self-care can lead to uncontrolled blood glucose levels and increase the risk of acute and chronic complications. Health education is one nursing intervention that can improve self-care adherence in DM patients. This study aims to analyse the effectiveness of implementing self-care education leaflets in improving self-care adherence among DM patients. This study used a case study design with a pre-post monitoring approach. Respondents were three DM patients selected purposively. The intervention, in the form of self-care education using leaflets, was administered once, followed by three monitoring sessions on October 24, 26, and 28, 2025. The instrument used was the Summary of Diabetes Self-Care Activities (SDSCA), which assesses four aspects: diet, physical activity, blood sugar monitoring, and foot care. The data analysis was descriptive, comparing SDSCA scores and Random Blood Sugar (RBS) levels before and after the intervention. Pre-test scores were obtained during the first evaluation, before respondents received self-care education through leaflets. Post-test scores were assessed through the second and third evaluations after the intervention. Changes in adherence were identified by increases in SDSCA scores for each respondent, while decreases in RBS levels evaluated glycemic control during the monitoring period. The results were presented in tables and narratively interpreted to describe changes in self-care behaviour and blood glucose levels after the educational intervention. Self-care adherence scores increased among all respondents following education. SDSCA scores increased from poor to adequate, then to good. This increase in adherence was accompanied by a gradual decrease in GDS levels at each evaluation. Self-care education using leaflets, accompanied by SDSCA monitoring, was effective in increasing self-care adherence and improving glycemic control in patients with diabetes mellitus.
Antidepressant Potential of Etlingera Calophrys in Mice Tail Suspension Test and Forced Swim Test
Depression is a mood disorder characterized by feelings of sadness, loss of interest, and decreased activity, and is associated with neurotransmitter imbalance and oxidative stress. The use of conventional antidepressant drugs still has limitations so that alternatives from natural ingredients such as Etlingera calophrys are needed which are known to contain potential bioactive compounds. This study aims to determine the antidepressant potential of methanol extract of Etlingera calophrys rhizome in mice (Mus musculus) using the Tail Suspension Test (TST) and Forced Swim Test (FST) methods. This study used the Chronic Mild Stress (CMS) model in mice which were divided into several treatment groups, namely normal control, negative control, positive control (amitriptyline 25 mg/kgBW), and extracts with doses of 100, 200, and 300 mg/kgBW. The parameters observed were the duration of immobility in the TST and FST tests. Data were analyzed using One Way ANOVA followed by the Tukey HSD test. Phytochemical screening results showed the presence of alkaloids, flavonoids, tannins, saponins, and terpenoids. In vivo tests showed that all doses of the extract were able to reduce the duration of immobility compared to the negative control, with a dose of 300 mg/kgBW providing the most significant effect and approaching the positive control (p < 0.05). The methanol extract of Etlingera calophrys rhizome has significant antidepressant activity, with a dose of 300 mg/kgBW being the most effective dose. These findings indicate that the methanolic extract of Etlingera calophrys rhizome exhibits significant antidepressant activity, which may be attributed to the synergistic effects of its bioactive compounds through modulation of monoaminergic neurotransmission and antioxidant mechanisms. In conclusion, Etlingera calophrys rhizome has promising potential as a natural antidepressant candidate, warranting further investigation at the molecular and clinical levels.
Comparative Effectiveness of Hot Dark Chocolate and Jesoma (Ginger, Soya, and Honey) on Dysmenorrhoea Pain Intensity among Female Students
Dysmenorrhoea is a common menstrual problem among adolescent girls and may interfere with daily activities and academic performance. Non-pharmacological interventions such as hot dark chocolate and herbal beverages are considered safer alternatives to manage menstrual pain. This study aimed to analyse the effectiveness of hot dark chocolate and Jesoma (ginger, soya, and honey) in reducing dysmenorrhoea pain intensity among female students at SMAN 3 Pontianak. This study employed a quantitative approach with a quasi-experimental design using two groups with pretest–posttest measurements. The sample consisted of female students who experienced dysmenorrhoea and were divided into a hot dark chocolate group and a Jesoma group. The sampling technique used was purposive sampling, with a total sample of 90 respondents, divided into 45 respondents in each group, based on calculations using G*Power with an additional 10% to anticipate dropout. Pain intensity was measured before and after the intervention using a Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. Data were analysed using the Wilcoxon test and Mann–Whitney test. The results showed a significant reduction in dysmenorrhoea pain intensity in both intervention groups (p < 0.05). The hot dark chocolate group demonstrated a moderate effect size (0.60), while the Jesoma group showed a large effect size (0.72). Comparative analysis indicated that Jesoma was more effective than hot dark chocolate in reducing dysmenorrhoea pain (p = 0.038). Both hot dark chocolate and Jesoma are effective non-pharmacological interventions for reducing dysmenorrhoea pain among adolescent girls; however, Jesoma demonstrates greater effectiveness.
Evaluative Study of Medication Adherence in Patients with Type 2 Diabetes Mellitus
Medication adherence is a critical factor in the successful management of Type 2 Diabetes Mellitus (T2DM). Poor adherence may lead to uncontrolled blood glucose levels and increased risk of complications. This study aimed to analyze the level of medication adherence and its association with patient characteristics among T2DM patients at Lepo-Lepo Primary Health Center, Kendari City. This study used an analytical observational design with a cross-sectional approach. A total of 81 respondents were selected using purposive sampling. Medication adherence was assessed using the Morisky Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), a widely validated and reliable instrument. The MMAS-8 has demonstrated good psychometric properties, with reported Cronbach’s alpha values ranging from 0.61 to 0.83 across different populations, indicating acceptable internal consistency. In addition, previous validation studies have confirmed its construct validity and reliability in patients with chronic diseases, including Type 2 Diabetes Mellitus, making it appropriate for measuring medication adherence in this study. Data were analyzed descriptively. The majority of respondents were aged 50–60 years and had a duration of diabetes of less than 5 years. Most patients demonstrated low medication adherence (MMAS-8 score <6), while a smaller proportion showed moderate adherence (score 6–7), and no respondents achieved high adherence (score = 8). Common non-adherence behaviors included forgetting to take medication, stopping medication when feeling better, and inconsistent medication intake. Medication adherence among T2DM patients at Lepo-Lepo Primary Health Center remains suboptimal, with the majority classified as having low adherence.
Analysis of Nutrition Education Needs as A Basis for Booklet Development in Chronic Kidney Disease Patients with Hemodialysis: A Study From the Patient's Perspective
CKD patients with Hemodialysis therapy require strict and continuous nutritional management. Low knowledge and non-compliance with diet are the main problems so that nutrition education is an important intervention, but often not tailored to the individual needs of patients. This study aims to identify the nutritional education needs of hemodialysis patients from a nutritionist perspective. Cross-sectional study design, data were collected using an online questionnaire via a Google Form link distributed via WhatsApp messages ( personal chat) . The collected data were downloaded in Excel format and processed and analyzed using descriptive analysis. The results showed that almost all (>95%) respondents agreed that the need for nutrition education includes specific materials related to hemodialysis diets based on Minangkabau local wisdom. An individual approach according to the clinical condition and characteristics of the patient, the use of educational media in the form of printed booklets with attractive designs (balanced images, text and colors) and family involvement in diet management can increase knowledge and adherence to diet and improve the quality of life of patients. The conclusion of this study is that patients need educational media in the form of printed media (booklets) with complete material, with a combination of clear writing and images, can be taken home and is based on local wisdom which is very important to improve knowledge, dietary compliance and quality of life of hemodialysis patients.
The Role of the Food and Drug Supervisory Agency (BPOM) in Committing the Distribution of Counterfeit Drugs in Consumer Legal Protection
The circulation of counterfeit drugs is a serious problem that threatens public health in Indonesia, particularly in Central Java. These dangerous counterfeit drugs not only harm consumers economically but can also cause fatal health effects, including poisoning, drug resistance, and even death. The Food and Drug Monitoring Agency (BPOM), as the government agency responsible for drug and food supervision, plays a crucial role in addressing this problem. BPOM's duties include supervision, law enforcement, and public education about the dangers and risks of using substandard drugs. This study aims to determine the role of BPOM in addressing the circulation of counterfeit drugs within the legal framework of consumer protection in Central Java. This research is a non-experimental study using qualitative descriptive methods, triangulation (combined) data collection, and inductive or qualitative analysis. The data collection techniques used were interviews, observation, and documentation, which were then processed and analyzed. Data were collected through in-depth interviews with the informants, as well as through observations and documentation of counterfeit drug cases provided by the Semarang City Food and Drug Monitoring Agency (BPOM). The study found that the Food and Drug Monitoring Agency (BPOM)'s role in addressing counterfeit drug distribution and protecting consumers in Central Java remains ineffective, with numerous counterfeit drug discoveries occurring. Factors such as limited inspection resources, low public awareness of the dangers of counterfeit drugs, and the complexity of distribution networks are key challenges, indicating that current oversight and law enforcement efforts are inadequate.
Determinants of Physical Education, Sports, and Health (PJOK) Learning Outcomes: An Analysis of Teacher Performance, Learning Models, and Evaluation Systems
This study aims to analyze the partial and simultaneous effects of Physical Education, Sports, and Health (PJOK) teacher performance, learning models, and learning evaluation systems on the PJOK learning outcomes of elementary school students. This quantitative research was conducted utilizing a total sampling technique, which involved a sample of 43 public elementary school PJOK teachers in Geyer District, Grobogan Regency. Data were collected through validated questionnaires and the odd semester learning outcomes scores of fifth-grade students for the 2025/2026 academic year. The data were statistically analyzed using multiple linear regression tests, t-tests, F-tests, and coefficient of determination analysis. The results of the study showed that: (1) teacher performance has a positive and significant effect on learning outcomes, evidenced by a calculated t-value of 6.104 (greater than the t-table of 2.022) with a significance of 0.000; (2) learning models have a positive and significant effect on learning outcomes with a calculated t-value of 4.167 (greater than the t-table of 2.022) and significance of 0.000; (3) the learning evaluation system has a positive and significant effect on learning outcomes, showing a calculated t-value of 4.784 (greater than the t-table of 2.022) with significance of 0.000; and (4) simultaneously, the three variables significantly affect learning outcomes with a calculated F-value of 111.473 (significance 0.000). Furthermore, the coefficient of determination of 0.896 indicates that these variables explain 89.6 percent of the total learning variance.
Evaluation of Drug Management and Improvement Strategies
The management of pharmaceutical supplies in hospitals involves nine interrelated cycles, ranging from planning to disposal. Objective: This study aimed to evaluate drug management practices at RSUD dr. H. L. M. Baharuddin in Muna Regency based on interviews with two key informants, namely the Head of the Pharmacy Installation and the Head of the Pharmacy Warehouse, and to assess compliance with Ministry of Health Regulation No. 72 of 2016. A descriptive design combined with the Hanlon method was employed, using criteria of problem magnitude, seriousness, effectiveness of intervention, and feasibility (PEARL factors). Result: The evaluation showed that most management cycles were adequately implemented; however, significant issues were identified in the storage stage. Key problems included the distance between multiple warehouses, complicating distribution and stock monitoring; the absence of CCTV; and inadequate physical security, such as lack of fencing. Hanlon analysis identified storage issues as the highest priority due to their impact on medication safety, security, and supply continuity. The frequency of incidents, risk of loss, and limited monitoring highlight the need for immediate intervention. Recommended improvements include optimizing storage layout, installing CCTV, strengthening access control, and enhancing physical security in line with national regulations. Although most cycles meet standards, storage management requires immediate improvement.
Risk Factors for Prediabetes in Productive Age: Analysis of NCD Screening Data
One way to prevent diabetes mellitus is by preventing prediabetes, or glucose intolerance. Prediabetes is a reversible condition, while diabetes is irreversible. Prediabetes offers a valuable opportunity to prevent or delay the progression to diabetes. Nearly 4-9% of people with prediabetes will develop diabetes each year. Within 3-5 years, prediabetes will develop into type 2 diabetes mellitus in around 25% of patients and as many as 70% of patients are predicted to experience diabetes mellitus throughout their lives. If current trends continue, efforts must be made to stem the wave of new cases that are likely to emerge in the future. Therefore, it is crucial to determine the most effective indicators for predicting the development of prediabetes and to identify people at higher risk of developing prediabetes.Various studies have shown a causal relationship between prediabetes and cardiovascular disease and all-cause mortality. This study aimed to analyze the risk factors for prediabetes in the productive age group (aged 15-64) in Balikpapan City. This research design uses a cross-sectional design, utilizing secondary data, namely the results of 2024 Non Communicable Disease screenings in Balikpapan City, Data were collected using a structured questionnaire administered directly to respondents and supported by secondary data from medical records. Sampling in this study used purposive sampling technique. The formula used to determine the sample size is the Lemeshow formula. A total of 290 subjects ( 94 males, 196 females, productive age; 15 – 64 years old) whom have prediabetes screening. Univariate, bivariate, and multivariate analyses were conducted using logistic regression. The data comes from medical records containing the variables age, gender, and prediabetes risk factors. Out of 290 subjects, results of analysis showed that age (p = 0.006; OR = 0.404), gender (p = 0.039; OR = 2.237), and physical activity (p = 0.046; OR = 2.148) were significantly associated with prediabetes. Based on the Odds Ratio (OR), specific gender groups were 2.2 times more likely to experience prediabetes compared to the reference group. Demographic factors and physical activity significantly influence prediabetes risk.
Effectiveness of Combining Family Support Programs and Health Education in Reducing Anxiety among Families of Patients in the ICU: A Systematic Review
Changes in the patient's condition, which can deteriorate or improve rapidly, often increase uncertainty and emotional pressure on the family including anxiety. Among various interventions, family support programs and health education can be implemented to reduce family anxiety. The purpose of this study is to evaluate the effectiveness of family support program and health education on anxiety in families of patients in the ICU. A systematic search was conducted across three databases (PubMed Central, ScienceDirect and Cochrane Library) for studies published up to 2023. Eligible studies met the following criteria (1) peer review studies in English and Indonesian; (2) involving adullt families treated in the ICU; (3) implementing family support programs or education; (4) standard care implemented in the control group; (5) measured variables include patient family anxiety; (6) quantitative experimental research; and (7) publications from 2015 to 2025. The screening process was conducted in two phases: title and abstract screening, followed by full-text assessment, with methodological quality evaluation. The tools used to measure bias risk were JBI and RoB 2. A total of 4,015 articles were identified, and only 8 of them met the criteria. Four articles discussed family support programs with an RCT design, and four articles discussed health education with quasi and pre-experimental designs. All articles showed a significant effect in reducing the anxiety of patients' families in the ICU. Future research is recommended to explore standardized intervention protocols and evaluate long-term outcomes.
Overall Survival and Progression-Free Survival Comparison of Bevacizumab Plus Chemotherapy Combination Regiment Versus Chemotherapy Only Regiment in Metastatic Colorectal Cancer: A Comparative Meta-Analysis and Systematic Review
Bevacizumab’s role in enhancing chemotherapy’s efficacy by inhibiting tumor vasculature has led to its incorporation in both first-line and second-line treatment protocols for mCRC. This meta-analysis and systematic review aim to provide a comprehensive comparison of the overall survival (OS) and progress-free survival (PFS) of bevacizumab plus chemotherapy versus chemotherapy alone in patients with metastatic colorectal cancer. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines using the PICO framework. Rigorous screening, data extraction, risk of bias assessment, and statistical analysis were performed to investigate the OS and PFS of bevacizumab plus chemotherapy versus chemotherapy alone in patients with metastatic colorectal cancer. A total of 79 articles were retrieved from online databases (PubMed, SagePub, Nature and Cochrane) using combinations terms such as “metastatic colorectal cancer,” “bevacizumab,” “chemotherapy,” “overall survival,” and “progression-free survival.” After three rounds of screening, seven articles directly relevant to the meta-analysis were selected for full-text reading and analysis. The pooled OS across all studies is 0.79 (95% CI: [0.68, 0.93]), indicating a statistically significant overall survival benefit for bevacizumab plus chemotherapy. The pooled PFS across studies was 0.68 (95% CI: 0.54–0.87), strongly favoring the combination therapy for improved PFS. Bevacizumab plus chemotherapy offers survival benefits for metastatic colorectal cancer, especially in overall survival. However, increased risks of hypertension and bleeding require careful patient selection and monitoring. Ongoing research is needed to optimize treatment protocols and safety.
Epidemiology of 4P Snack Consumption Behavior in Children as An Early Risk Factor for Non-Communicable Diseases
Snacking behavior among elementary school students contributes substantially to daily energy intake and may increase the risk of consuming foods high in sugar, fat, and food additives such as preservatives, colorings, flavor enhancers, and sweeteners (4P). The school food environment and family economic factors are assumed to influence such behavior. This study aimed to analyze the effect of pocket money and purchase location on 4P snacking behavior among elementary school students. A quantitative cross-sectional design was applied involving 23 fourth-grade students at SDN Karangrejo VI Jember by total sampling. Data were collected using structured questionnaires assessing pocket money categories, snack purchase locations, and 4P snacking behavior scores, which have been validated and are reliable. Data were analyzed using univariate and bivariate analysis with chi-square tests. The results showed that most students received IDR 6,000–10,000 as daily pocket money (57%) and predominantly purchased snacks at the school canteen (60%). The highest proportion of 4P snack consumption was 1–2 times per week (56.5%). Statistical analysis indicated no significant association between pocket money (p=0.231) or purchase location (p=0.366) and 4P snacking behavior. These findings suggest that children’s snacking behavior is influenced by more complex and interacting factors.
The Correlation between Blood Lead (Pb) Levels and Total Leukocyte Count among Silver Man Individuals
Lead (Pb) exposure remains an environmental health problem that affects groups with direct exposure, including silver man individuals who coat their bodies with paint. Lead is still found in various paint products due to its use as a pigment and additive, making it a potential major source of environmental lead exposure. Lead is known to affect the immune system through inflammatory mechanisms and oxidative stress, which may result in alterations in total leukocyte count. This study aimed to determine the association between blood lead (Pb) levels and total leukocyte count among silver man individuals. This study employed an analytic observational design with a cross-sectional approach involving 18 silver man individuals who were recruited using an accidental sampling technique among individuals who met the inclusion criteria. Blood Pb levels were measured using Atomic Absorption Spectrophotometry (AAS), while total leukocyte counts were analyzed using a hematology analyzer. The relationship between blood Pb levels and total leukocyte count was assessed using Pearsons correlation test. The results showed that all subjects had elevated blood Pb levels. Statistical analysis indicated no significant association between blood Pb levels and total leukocyte count, with a p-value of 0.420 (p 0.05) and a correlation coefficient (r) of 0.202, indicating a positive but very weak correlation. There was no significant association between blood lead (Pb) levels and total leukocyte count among silver man individuals. These findings highlight the importance of vigilance regarding lead exposure and the need for regular health monitoring among at-risk populations.
A Structural Equation Model of Quality-of-Life Determinants
Hypertension is a growing global health challenge, affecting about 51.3 million adults in Indonesia as of 2019. In urban areas like Babakan Ciparay, Bandung, it remains a leading cause of mortality among the elderly. Despite its prevalence, effective management of hypertension and its impact on quality of life (QoL) in this demographic are not well understood. This study examines the relationships between demographic factors (age, gender), clinical status (hypertension stage), and behavioral components (physical activity, self-management) in predicting the QoL of elderly hypertension patients. A quantitative cross-sectional study was conducted with 62 elderly participants at the Caringin Community Health Elderly Clinic in Bandung. Data were collected using the Physical Activities Scale for Elderly (PASE), Hypertension Self-Management Behavior (HSMBQ) and SF36 Quality of Life questionnaires, all of which exhibited strong reliability, with coefficients generally surpassing 0,70 across various international and Indonesian pilot tests. Additionally, the instruments demonstrated robust validity through consistent item-total correlation scores and convergent validity values ≥ 0,4. Analysis was performed using Partial Least Squares Structural Equation Modeling (PLS-SEM) and Importance-Performance Map Analysis (IPMA). The measurement model showed high reliability and validity. Structural analysis revealed that gender is a primary determinant of self-management, with a large effect size (f2=0.503) and a strong negative path coefficient (β=−0.580, p<0.001). Notably, physical activity had a significant negative impact on quality of life (β=−0.285, p=0.024), suggesting that high-exertion activity may reduce perceived well-being in this high-risk group. IPMA identified gender as critical for immediate intervention due to its high importance but low performance. The findings underscore a significant disconnect between clinical adherence and subjective well-being. Effective hypertension management in the elderly requires tailored, gender-specific interventions and personalized physical activity programs prioritizing psychosocial support and functional independence over strict biomedical metrics.
The Family as A Dominant Factor in Improving the Quality of Life of Diabetes Mellitus Patients: A Literature Review
Diabetes mellitus is a dangerous and life-threatening disease with significant morbidity and mortality rates worldwide. The lack of family role, function, and resilience has an impact on the physical and psychological aspects as well as the quality of life of patients. This study aims to determine the relationship between family factors, including family role, family function, and family resilience, in improving the quality of life of diabetes mellitus patients. This study used a literature review, reviewing 15 articles selected by the researcher from 53 articles that were assessed for suitability and obtained from searches on Google Scholar, PubMed, Science Direct, and Springer Nature Link websites and published between 2019 and 2025. The keywords used were "Family Role," "Family Functions," "Family Resilience," and "Diabetes Mellitus". The results of this study's analysis show that the role, function, and resilience of the family can help patients comply with their treatment regimen, follow a healthy diet, increase their confidence in fighting their disease, and cope with the stress and trauma experienced by patients due to diabetes mellitus. The conclusion of this study shows that family factors, including family role, family function, and family resilience, have a significant relationship with improving the quality of life of patients with diabetes mellitus.
The Effect of Healing Touch Therapy and Dzikr on the Quality of Life of Type 2 Diabetes Mellitus
Type 2 Diabetes Mellitus (T2DM) is one of the most common non-communicable diseases and remains a major global health challenge. This chronic metabolic disorder develops progressively and requires lifelong treatment and self-management. According to the World Health Organization (WHO, 2023), the global prevalence of diabetes continues to increase, affecting millions of people worldwide and contributing substantially to morbidity, mortality, and healthcare costs. Beyond its physical complications, T2DM can negatively affect patients' psychological well-being, social functioning, and overall quality of life. Improving the quality of life of patients with T2DM has therefore become an important objective of diabetes management. In addition to pharmacological treatment, complementary therapies such as healing touch and dzikir have gained attention for their potential benefits in enhancing physical comfort, reducing stress, promoting relaxation, and improving spiritual well-being. These interventions may contribute to better adaptation to chronic illness and ultimately improve patients' quality of life. Therefore, this study aimed to analyze the effect of healing touch and dzikir therapy on the quality of life of patients with Type 2 Diabetes Mellitus. Specifically, the study sought to identify patients' quality of life before and after receiving healing touch and dzikir therapy and to compare changes in quality of life between the intervention group and the control group. This research was conducted on DM patients at Kayen Health Center, Kayen District, Pati Regency. This study uses a quantitative approach. The quantitative approach is used to see the causal relationship between the independent variable and the dependent variable. Based on its level of explanation, this study is an associative type of research with a causal relationship pattern. The study involved 44 respondents divided into an intervention group (n=22) and a control group (n=22) with relatively homogeneous characteristics. The average quality of life score in the intervention group increased from 68.36 to 93.36 (a difference of 25.00 points), while in the control group it increased from 68.36 to 69.41 (a difference of 1.05 points). The paired t-test results showed a significant increase in the intervention group (p<0.001), while in the control group it was not significant (p=0.489). Comparison between the two groups also showed a significant difference (p<0.001), indicating that healing touch and dhikr therapy are effective in improving the quality of life of patients with Type 2 Diabetes Mellitus. Healing touch therapy and dhikr have been proven effective in improving the quality of life of Type 2 Diabetes Mellitus patients. The average quality of life score in the intervention group increased from 68.36 to 93.36, while the control group did not show any significant improvement. Statistical test results indicated a significant effect of healing touch therapy and dhikr on the quality of life of Diabetes Mellitus patients. 2 (p<0,001). The study involved 44 respondents divided into an intervention group (n=22) and a control group (n=22) with relatively homogeneous characteristics. The average quality of life score in the intervention group increased from 68.36 to 93.36 (a difference of 25.00 points), while in the control group it increased from 68.36 to 69.41 (a difference of 1.05 points). The paired t-test results showed a significant increase in the intervention group (p<0.001), while in the control group it was not significant (p=0.489). Comparison between the two groups also showed a significant difference (p<0.001), indicating that healing touch and dhikr therapy are effective in improving the quality of life of patients with Type 2 Diabetes Mellitus.
Effects of Foot Reflexology Therapy on Blood Pressure and Sleep Quality in Patients with Hypertension: A Quasi-Experimental Study
Hypertension still remains a major global burden. Sleep disturbances are associated with elevated blood pressure will affect sleep quality. Foot reflexology improves circulation and may reduce blood pressure; however, evidence on its combined effects on blood pressure and sleep quality remains limited. This study examined the effect of foot reflexology on sleep quality and blood pressure. A quasi-experimental time-series pre–post design with a control group was used. A total of 44 respondents in Central Java, Indonesia, were included. For three times aweek,t he intervention group gave foot reflexology therapy by applying pressure to the Taichong (LR3), Yongchung, and Taixi (KI3) points for 30 to 45 minutes and the control group received conventional therapy on their individual practices. The Pittsburgh Sleep Quality Index (PSQI) was completed after the intervention to measure the sleep quality. The systolic and Diastolic Blood pressure of all the samples was measured by the researcher. Data Analysis was done using Friedman test. The Friedman test showed significant improvement in sleep quality in the intervention group (p < 0.001), with no difference in the control group (p = 0.55). The intervention group had lower blood pressure than the control group after the third session (p < 0.001). Foot reflexology improved sleep quality and reduced blood pressure in patients with hypertension, supporting its use as a complementary intervention in holistic nursing care.
Literature Review: The Effectiveness of Bibliotherapy Intervention in Reducing Anxiety in Preschool Children During Hospitalisation
Anxiety in preschool children is caused by the hospitalisation process. Anxiety arises when they undergo hospitalisation and are faced with various new challenges, such as unfamiliar surroundings, interactions with strangers, meeting nurses, and fear of separation from their parents. An intervention used in an effort to reduce anxiety is bibliotherapy. With this intervention, it is hoped that the anxiety levels of preschool children as a result of hospitalisation can be effectively reduced. To evaluate the effectiveness of bibliotherapy intervention in reducing anxiety in preschool children during hospitalisation based on evidence based research. This study is an SLR/Systematic Literature Review with a PRISMA/Preferred Reporting Items for Systematic Reviews and Meta Analyses approach. The systematic review uses PICO. Research articles were searched using electronic databases, namely: Google Scholar, Ebsco, PubMed, Scopus, and Science Direct, covering the period from 2015 to 2025. The methodological quality was assessed using Joanna Briggs Institute tools and analysed using PRISMA 2020, with narrative synthesis due to study heterogeneity. From an initial 815 articles identified, 7 relevant studies met the inclusion criteria and were analyzed, primarily Quasi Experimental and RCTs. The keywords used were anxiety, bibliotherapy, children, preschool, and hospitalisation. The database search was analysed using PRISMA 2020. The titles were found to be relevant to the topic under review. Seven research articles were reviewed, and the results showed that bibliotherapy intervention provided effective evidence of reducing anxiety in preschool children during hospitalisation. The application of bibliotherapy intervention provided effective evidence of reducing anxiety in preschool children during hospitalisation.
Psychological Overview of Loss and Grief in Post-Abortion Mothers of First Pregnancy
Abortion in the first pregnancy often causes significant psychological effects, especially related to feelings of loss and grief. This condition can affect the emotional well-being of mothers, especially at a young age and without adequate social support. This study aims to describe the psychological condition of mothers after their first pregnancy abortion in relation to loss and grief based on the mother's age, gestational age, and the results of The Perinatal Grief Scale (PGS) measurement. This study used a quantitative descriptive design with a cross-sectional approach. The study used a purposive sampling technique, in which respondents were selected based on specific criteria determined by the researcher. The sample consisted of four respondents who met the inclusion criteria, namely mothers who had experienced abortion during their first pregnancy and received treatment at PKU Singkil Aisyiyah Boyolali Hospital between July and August 2025. Data were collected through subjective interviews and the Perinatal Grief Scale (PGS) questionnaire to assess the level of grief in mothers after abortion during their first pregnancy. The PGS questionnaire has been proven to be valid and reliable, with a Cronbach’s Alpha value of >0.90, and consists of three subscales: Active Grief, Difficulty Coping, and Despair. The data were analyzed descriptively to describe the level of grief experienced by the respondents. The results showed that total PGS scores ranged from 74 to 136, with moderate to severe grief categories. Respondents who were younger (23–25 years old) and had earlier pregnancies (10–13 weeks) showed more severe grief, especially on the Active Grief and Despair subscales. Conversely, more mature mothers (aged 27–30 years) with pregnancies of 14–16 weeks showed a better stage of acceptance thanks to family support and emotional maturity. The level of grief in mothers after their first pregnancy abortion is influenced by age, gestational age, and social support.
Aplication of Balloon Blowing for Respiratory Frequency in Children Aged 6-14 Years with Bronchopneumonia
Bronchopneumonia in children can cause impaired gas exchange characterized by increased respiratory rate and decreased oxygen saturation. Non-pharmacological interventions, such as balloon blowing, are considered effective for increasing lung expansion and strengthening respiratory muscles. This study aimed to determine the effectiveness of balloon blowing techniques on respiratory rate and oxygen saturation in children aged 6–14 years with bronchopneumonia. This study uses a case study method with a descriptive nursing care approach, implementing Evidence-Based Nursing, to determine the impact of the the Balloon Blowing technique intervention on children aged 6-14 years with a diagnosis of Bronchopneumonia. The sampling technique used is purposive sampling, namely, children aged 6-14 years with a diagnosis of Bronchopneumonia at a hospital in Central Java. The intervention lasted 20 minutes in a single session, using deep breathing techniques combined with balloon blowing. Data collection was conducted through a nursing assessment process that included interviews with parents and children regarding the patient's complaints, observation of the patient's condition, measurement of respiratory rate (RR), measurement of oxygen saturation (SpO₂) using an oximeter, and lung auscultation using a stethoscope to detect additional breath sounds. Measurements were conducted twice, namely before and after the intervention. The data obtained were analyzed descriptively by comparing changes in respiratory rate (RR), oxygen saturation (SpO₂), and the patient's subjective response before and after the intervention to determine the effectiveness of the Balloon Blowing technique in improving respiratory function in children with bronchopneumonia. The results showed that all patients experienced a decrease in respiratory rate from tachypnea to the normal range (from an average of 30.8 to 24.2 breaths/min) and an increase in oxygen saturation (from an average of 95.6% to 98%). In addition, patients reported subjective improvements, including reduced shortness of breath and increased comfort. The balloon blowing technique is a simple, safe, and effective non-pharmacological surgical intervention to improve respiratory function in children with bronchopneumonia.
Morphological Characteristics of Tibial Eminence and Their Association with Anterior Cruciate Ligament Injury in Patients at a Tertiary Orthopaedic Center in Indonesia
Anterior cruciate ligament (ACL) injury is one of the most common knee ligament injuries, often affecting athletes and active individuals. Morphological variations of the tibial eminence may influence ACL vulnerability. This study aimed to evaluate the relationship between tibial eminence morphology and ACL rupture in an Indonesian patient population. A cross-sectional study was conducted at RSUP Haji Adam Malik, Medan, Indonesia, between 2021 and 2023. Forty-five patients who underwent knee radiographs were enrolled, comprising 25 with ACL rupture and 20 without. Tibial eminence measurements—including medial height, lateral height, and width—were obtained from anteroposterior weight-bearing radiographs. Data were analyzed using Eta correlation, with p<0.05 indicating statistical significance. The ruptured ACL group showed significantly smaller medial height (9.20±1.57 mm), lateral height (8.98±1.55 mm), and width (9.92±2.76 mm) compared to controls (10.42±1.09 mm, 10.16±1.04 mm, and 13.70±2.19 mm, respectively). Eta correlation revealed moderate associations for medial (η=0.411) and lateral heights (η=0.406), and a strong association for width (η=0.607) with ACL rupture. Reduced tibial eminence dimensions, particularly width, are strongly associated with ACL rupture. Radiographic assessment of tibial eminence morphology may assist in risk stratification, especially among high-risk populations.
Scalp Cooling for Chemotherapy-Induced Alopecia in Breast Cancer: A Recent Literature Review
Chemotherapy significantly improves the prognosis of breast cancer patients. However, its most disturbing side effect is alopecia, which significantly reduces patients' quality of life. Scalp cooling (SC) was developed to minimize hair loss during chemotherapy. Study objective: To analyze the effectiveness, success factors, technical parameters, and tolerability of SC in breast cancer patients. Study methods: A literature review using the PRISMA approach, including English and Indonesian studies from 2021 to 2026. Keyword combinations: "scalp cooling" and "chemotherapy-induced alopecia" were used to search the literature through PubMed, Scopus, Google Scholar, and DOAJ. Of the 1,744 articles identified, ten articles met the inclusion criteria and underwent further analysis. Results: Scalp cooling was 40%-90% effective in preventing hair loss. It was most effective with taxane-based regimens compared to anthracycline-based regimens. The effectiveness of SC was influenced by the type, dose, and duration of chemotherapy, as well as the cooling temperature. Hair characteristics had no effect. SC contributed to hair recovery and reduced alopecia. It was well tolerated, with mild side effects. However, treatment discontinuation rates were observed in some studies. Conclusion: SC is an effective and evidence-supported supportive intervention to reduce the severity of chemotherapy-induced alopecia in breast cancer survivors. Its success depends on the regimen and requires optimization of technical parameters and patient education to improve its sustainability in clinical practice.
Relapsing Nephrotic Syndrome Complicated by Hypokalemia and Urinary Tract Infection: A Case Report
Relapse in adult nephrotic syndrome represents a clinically complex phase characterized not only by recurrent proteinuria but also by heightened vulnerability to metabolic and infectious complications. A 24-year-old male with a prior history of nephrotic syndrome presented with generalized edema, foamy urine, and dysuria. Urinalysis showed 3+ proteinuria, while laboratory evaluation revealed severe hypoalbuminemia (1.1 g/dL) and hypokalemia (2.9 mmol/L) with bacteriuria. A diagnosis of relapsing nephrotic syndrome complicated by moderate hypokalemia and urinary tract infection was established. The patient received step-down intravenous methylprednisolone, ceftriaxone, 20% albumin infusion, combined furosemide–spironolactone therapy, and cautious intravenous potassium replacement under continuous ECG monitoring. Within seven days, edema improved significantly and serum potassium normalized without complications. Infection-triggered relapse may worsen electrolyte imbalance through urinary losses and diuretic therapy. Early identification of hypokalemia and infection is essential to prevent cardiac and renal complications. Coordinated pharmacologic management allows safe correction while maintaining fluid balance. Prompt recognition and multidisciplinary management of relapse-associated infection and electrolyte disturbance are critical to improving outcomes in adult nephrotic syndrome.
Service Quality and Patient Satisfaction Assessment Using Servqual and ZoT Models
Healthcare service quality is a critical determinant of patient satisfaction, particularly in primary healthcare settings such as Puuwatu Primary Healthcare Center, which continues to receive complaints regarding service timeliness, staff courtesy, and physical facilities. Objective: This study aimed to assess service quality at Puuwatu Primary Healthcare Center and to identify service dimensions requiring improvement using the SERVQUAL and Zone of Tolerance (ZoT) models. Method: This descriptive quantitative study involved 100 outpatients selected using the Slovin formula. Data were collected through a structured questionnaire comprising 29 SERVQUAL indicators and were analyzed using gap (GAP) scores, Mean Service Adequacy (MSA), Mean Service Superiority (MSS), and ZoT analysis. Result: The findings revealed negative GAP scores across all service dimensions, indicating that the services provided did not meet patient expectations. ZoT analysis demonstrated that only the assurance dimension achieved a positive score, while responsiveness, empathy, and reliability remained within the tolerance zone but below expected standards. The tangible dimension exhibited the highest level of dissatisfaction. Conclusion: Service quality improvement efforts should prioritize upgrading physical facilities and strengthening service consistency and responsiveness to enhance overall patient satisfaction.
Analysis of the Influence of Organizational Citizenship Behavior Examined from Transformational Leadership Style Mediated on Job Satisfaction of Pharmacys Installation Employees
Regulation of the Minister of Health of the Republic of Indonesia Number 72 of 2016 emphasizes the importance of competent and organized pharmaceutical human resources in supporting pharmaceutical services in hospitals. The quality of service is highly dependent on the performance of strategic human resources in realizing rational and effective treatment. The application of the right leadership style can increase job satisfaction and foster Organizational Citizenship Behavior (OCB) in pharmaceutical employees. This study aims to determine the effect of transformational leadership style on OCB mediated by job satisfaction. This type of research is a non-experimental descriptive study. The sample size in this study was determined using a total sampling method, resulting in 61 participants, comprising all employees of the Pharmacy Installation of Bahteramas Regional Hospital. The research instrument was a questionnaire using a likert scale, it was declared valid and reliable through convergent validity testing and analyzed using the SmartPLS 4 statistical test. The results of the study indicate that there is an influence of transformational leadership style on OCB with a p-value of 0.00 < 0.05 and a path coefficient of 0.625 indicating a strong relationship. There is an influence between transformational leadership style on job satisfaction with a p-value of 0.00 < 0.05 and a path coefficient of 0.910 indicating a very strong relationship and there is an influence between job satisfaction on OCB with a p-value of 0.00 < 0.05 and a path coefficient of 0.372 indicating a moderate relationship. The results of this study indicate that there is an influence of transformational leadership style on OCB through job satisfaction in the form of partial mediation as indicated by the confidence interval (CI) value not exceeding 0, namely 0.188 to 0.486. Based on the results of the study, it can be concluded that there is an influence between transformational leadership style and Organizational Citizenship Behavior (OCB) through the mediating variable of job satisfaction in all employees of the Bahteramas Regional Hospital Pharmacy Installation
The Role of Job Satisfaction in Mediating Organizational Culture and Work Life Balance on the Performance of Health Workers
Healthcare workers' performance is a crucial factor in ensuring service quality and patient safety in hospitals. This study aimed to analyze the effects of organizational culture and work-life balance on healthcare workers' performance, with job satisfaction serving as a mediating variable at Bali Mandara Eye Hospital. This study employed a quantitative approach with an explanatory research design. The respondents consisted of 115 civil servant healthcare workers used proportionate stratified random sampling, including physicians, nurses, and other healthcare professionals. Data were collected through questionnaires and analyzed using the Structural Equation Modeling–Partial Least Square (SEM-PLS) method. The results indicated that organizational culture had a positive and significant effect on job satisfaction (β = 0.391; p < 0.05), as did work-life balance (β = 0.488; p < 0.05). Job satisfaction also had a positive and significant effect on healthcare workers' performance (β = 0.686; p < 0.05). In contrast, organizational culture and work-life balance did not have significant direct effects on healthcare workers' performance. Mediation analysis revealed that job satisfaction fully mediated the relationship between organizational culture and performance (β = 0.268; p < 0.05), as well as the relationship between work-life balance and performance (β = 0.335; p < 0.05). This study concludes that improving healthcare workers' performance can be achieved more effectively through enhancing job satisfaction, supported by a positive organizational culture and the implementation of a good work-life balance.
The Effect of Momsite Education on Wound Healing Post-Caesarea Seciton in Postpartum Mother
Post-caesarean wound healing is influenced by the mother’s knowledge and behavior in wound care. Conventional education often fails to provide adequate information on self-care after childbirth. Digital education through a Momsite allows for interactive, flexible, and repeated access to health materials, potentially improving health literacy, wound care behavior, and optimal wound healing. To examine the effect of Momsite education on post-caesarean wound healing in postpartum mothers at Banten Hospital. A quasi-experimental pretest-posttest control group design was used. The sample included 66 postpartum mothers following caesarean sections, divided into 33 respondents in the intervention group and 33 in the control group, selected by purposive sampling. Instruments included validated and reliable questionnaires on knowledge and wound care behavior (Cronbach’s alpha = 0.934–0.973), as well as wound healing assessment using the REEDA scale. Data analysis involved Paired t-test, Independent t-test, and Hotelling’s T² with significance set at p<0.05. Momsite education significantly influenced knowledge, wound care behavior compliance, and post-caesarean wound healing (p<0.05). The largest effect was on wound care behavior (Partial η² = 0.827), followed by knowledge (Partial η² = 0.630) and wound healing (Partial η² = 0.518). Momsite education is effective in enhancing post-caesarean wound healing in postpartum mothers.
Isometric Exercise Training and Its Effects on Cardiovascular Health Indicators in Prehypertensive Individuals
Hypertension is a chronic condition marked by consistently elevated blood pressure, defined as ≥130/80 mmHg by the ACC/AHA. It is a major global health issue contributing to cardiovascular disease and mortality. As of 2021, the WHO reported 1.28 billion cases worldwide. Current strategies for managing hypertension emphasize lifestyle interventions alongside pharmacological treatments. Isometric exercise training has gained attention due to its potential in reducing blood pressure and improving vascular health. This study aims to evaluate the physiological mechanisms underlying isometric exercise training’s impact on cardiovascular health indicators, focusing on NO production, BP, and RPP. This article was constructed using a literature review methodology. Scientific articles were sourced from PLoS ONE, Science Direct, PubMed, and Google Scholar. Articles published within the last 5 years were included to ensure the review's relevance and accuracy, resulting in 53 included studies. Isometric exercise training involves muscle contractions without changing muscle length or joint movement. It strengthens muscles, improves endurance and joint stability by activating type I and II fibers, enhancing neuromuscular coordination. This training triggers cardiovascular and musculoskeletal adaptations, such as nitric oxide release from hypoxia and shear stress, and activates the parasympathetic system to lower blood pressure. It reduces resting blood pressure, afterload, and rate pressure product, improving cardiac efficiency. Movements like wallsquats engage major lower limb muscles, with deeper knee flexion increasing force and stimulating endothelial NO production. Isometric exercise training is a low-risk, effective intervention that improves cardiovascular health and reduces blood pressure, highlighting its potential as a non-pharmacological approach for hypertension management.
The Correlation Between Frequency of Mineral Water Consumption, Coffee, Length of Employment with Serum Creatinine Levels and Estimated Glomerular Filtration Rate among Brick Craftsmen
Chronic Kidney Disease (CKD) leads to a decline in renal function, thereby affecting fluid and electrolyte balance in the body. Risk factors for CKD include advanced age, chronic diseases, kidney disorders, unhealthy lifestyles, and adverse environmental conditions. Prolonged exposure to extreme heat, combined with unhealthy lifestyle behaviors such as inadequate water intake and frequent consumption of caffeinated beverages, may lead to dehydration. Prolonged dehydration can reduce extracellular fluid volume, leading to impaired kidney function. This study aimed to analyze the correlations between the frequency of coffee consumption, water intake, and length of employment with serum creatinine levels and estimated glomerular filtration rate (eGFR) among brick craftsmen in Sokaraja Sub-District, Banyumas. The study employed a cross-sectional design involving 23 respondents selected using accidental sampling. Data analysis was conducted using Spearman and Pearson correlation tests at the 95% confidence level, and a multivariate analysis was performed with multiple linear regression. The bivariate analysis showed significant correlations between coffee consumption, water intake, and work duration and serum creatinine levels and eGFR values (p < 0.05). However, age and length of employment were not statistically significantly associated in the bivariate analysis (p > 0.05). Multivariate analysis indicated that water intake had a significant effect on serum creatinine and eGFR, although this effect was influenced by respondents' age. An increase in coffee consumption was associated with elevated creatinine levels and reduced estimated glomerular filtration rate (eGFR). Inadequate water intake results in dehydration, thereby impairing renal function in the elimination of metabolic waste. Prolonged working hours in hot environments increase the risk of oxidative stress and renal tubule injury.
The Effect of Methotrexate as An Alternative Therapy in Cushing Syndrome Induced by Methylprednisolone in Multibacillary Morbus Hansen with Erythema Nodosum Leprosum
Long-term high-dose corticosteroid therapy in Erythema Nodosum Leprosum (ENL) and Multibacillary Morbus Hansen (MB-type MH) can cause side effects, one of which is Cushing's Syndrome. A 25-year-old male patient with ENL and MB-type MH experienced Cushing's Syndrome due to a history of treatment with oral methylprednisolone 32 mg/day for 1 year with supervision as a management of his disease. Management during hospitalization with Multidrug Treatment-Multibacillary (MDT-MB), methotrexate 25 mg/week, folic acid 1 mg/day and topical therapy in the form of 10% urea cream twice a day. After 4 days hospitalized, this patient's condition improved. Methotrexate is a therapeutic option for ENL because of its anti-inflammatory mechanisms that specifically target the pathogenic pathways that cause ENL, especially inflammation and cytokine storm caused by neutrophils. Administration of methotrexate as an alternative therapy in treating ENL and MB-type MH with Cushing's syndrome can be considered.
Efficacy and Safety of Oral Jak Inhibitor as Current Therapy of Vitiligo: A Systematic Review
Vitiligo is an autoimmune depigmenting disorder driven by IFN-γ–mediated, CD8+ T cell cytotoxicity against melanocytes via JAK-STAT signaling. While topical ruxolitinib (JAK1/2) is FDA-approved, the efficacy and safety of oral JAK inhibitors for vitiligo remain under investigation. This systematic review evaluates current evidence for oral JAK inhibitors (upadacitinib, abrocitinib, tofacitinib) in vitiligo, including their use with adjunctive therapies. Following a PRISMA-ScR approach, PubMed was searched (2019–2026) using MeSH terms (“JAK Inhibitor” AND “Vitiligo”). Eligible designs included case reports, case series, and randomized controlled trials. Studies are organized into table with each selected data. The data extracted are explained. Evidence consists predominantly of case reports/series and one randomized trial. Oral JAK1-selective agents (upadacitinib, abrocitinib) and JAK1/3 inhibitor tofacitinib frequently produced meaningful repigmentation, especially on facial sites, with response often enhanced by light-based adjuncts (NB-UVB or 308-nm excimer). Reported examples include ~60–90% facial repigmentation with upadacitinib or abrocitinib when combined with excimer or in patients with concomitant atopic dermatitis, and near-complete facial repigmentation with tofacitinib, particularly in sun-exposed areas or when paired with NB-UVB. Abrocitinib’s higher JAK1 selectivity may preserve JAK2-mediated melanocyte survival signals, potentially explaining benefit in a case where vitiligo worsened on upadacitinib but improved after switching to abrocitinib. Safety across studies was generally acceptable, with mostly mild adverse events (e.g., acne, upper respiratory infections, fatigue, nasopharyngitis, weight gain, lipid elevations). Laboratory abnormalities were typically minimal. Oral JAK inhibitors show promising efficacy for vitiligo, particularly for facial lesions and when combined with phototherapy, with an overall favorable short- to mid-term safety profile. Adjunctive light therapy likely augments outcomes and may permit lower systemic doses.
The Relationship between Maternal Attention to Foetal Movement and Enhanced Mother-Fetus Bonding: A Scoping Review
Fetal movement is an early sign that the fetus can interact with its environment, signaling to the mother that an emotional bond is being established, known as maternal-fetal attachment. Several studies have shown that observing fetal movement has a positive relationship and increases maternal-fetal attachment, resulting in improved and more tangible fetal development. This study was to discribe The relationship between maternal attention to foetal movement and enhanced mother-fetus bonding: A scoping review. The PRISMA-ScR standards were followed in the structuring of this descriptive observational study using a scoping review technique. A literature search covering the years 2015–2025 was carried out in a number of worldwide databases, including PubMed, ScienceDirect, Wiley Online Library, Google Scholar, and EBSCO. Maternal attention, foetal mobility, and maternal-fetal bonding were the terms used in a Boolean search to find articles. Identification, screening, eligibility evaluation, and full-text review were all part of the selection procedure. Six articles that met the inclusion criteria were analyzed and synthesized thematically. After synthesis, the review results were grouped into three main themes: 1. Impact of Fetal Movement Awareness and Education During Pregnancy, 2. Utilization of Health Services and Clinical Behavior, and 3. Obstetric and Neonatal Outcomes. Maternal attention to fetal movements plays a significant role in strengthening maternal–fetal attachment.
Self-Acceptance of Tuberculosis: Determinants that Influence It: A Literature Review
Tuberculosis (TB) remains one of the world's major health problems and a leading cause of death from infectious diseases. The disease is triggered by the Mycobacterium tuberculosis bacteria, which usually attacks the lungs but can infect other organs in the body. The purpose of this literature review is analyze several studies that discuss the determining factors that influence self-acceptance in TB patients. In this study, the search strategy was carried out using databases and keywords. The databases used were Google Scholar, DOAJ, and ResearchGate. The keywords used were tuberculosis, "self-acceptance," "social stigma," "family support," "social support," "self-esteem," "self-efficacy," "mindfulness," anxiety, depression, and knowledge. Critical Appraisal Skills Program was then conducted. There were ten articles that met the inclusion criteria. The results of all articles showed that the self-acceptance of tuberculosis patients was influenced by several factors, including: social stigma, family support, social support, self-esteem, self-efficacy, mindfulness, anxiety, depression, and knowledge.
Comparable Effects of Ticagrelor and Clopidogrel Based on Platelet Aggregation Test in Patients with Acute Coronary Syndrome
Ticagrelor and clopidogrel are P2Y₁₂ receptor inhibitors commonly administered as part of dual antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Although ticagrelor demonstrates a more rapid onset of action and stronger platelet inhibition than clopidogrel in pharmacodynamic studies, its superiority in routine clinical practice remains debated. This study aimed to compare the effects of ticagrelor and clopidogrel on platelet aggregation in ACS patients undergoing PCI. A cross-sectional comparative study was conducted involving 33 ACS patients who were consecutively recruited from patients undergoing PCI and receiving either ticagrelor or clopidogrel. Platelet aggregation was evaluated using light transmission aggregometry with adenosine diphosphate (ADP) as the agonist at concentrations of 1, 2, 5, and 10 µM. Differences in platelet aggregation between treatment groups were analyzed using the Mann–Whitney U test. No statistically significant differences in platelet aggregation were observed between the ticagrelor and clopidogrel groups at all ADP concentrations tested (all p > 0.05). These findings suggest comparable platelet inhibitory effects between both P2Y₁₂ inhibitors in ACS patients undergoing PCI. Ticagrelor and clopidogrel demonstrated similar platelet aggregation profiles, indicating comparable platelet reactivity under both treatment regimens in ACS patients undergoing PCI in real-world clinical settings.
Empowerment of Health Cadres in Early Detection Screening for Stunting in Toddlers Using the ‘Menuju Sehat’ Growth Monitoring Card
Stunting remains a significant health issue with relatively high prevalence rates at the local level, including in Gentan Village. Early detection through Posyandu clinics has not been optimal due to the limited capacity of community health workers to screen for growth in young children. Therefore, capacity building for these workers through training is essential. The aim of this study is to determine the improvement in community health workers ability to detect stunting at an early stage following training. This activity employed a community nursing care approach comprising the assessment, diagnosis, planning, implementation and evaluation stages. The target group for the activity was 27 health cadres. The intervention was carried out using a one-group pre-test post-test design and observation through the provision of education on stunting screening, demonstrations of anthropometric measurements, and the completion of the Kartu Menuju Sehat (KMS) chart. The analysis was carried out by comparing the pre-test and post-test results to assess changes in the volunteers knowledge and skills following the training. The data are presented as percentages and frequency distributions. The results showed an increase in the health workers’ knowledge following the intervention. The number of health workers in the ‘good knowledge’ category increased from 12 (42.9%) to 27 (100%). All cadres (100%) demonstrated good skills in performing anthropometric measurements. The cadres’ ability to complete the KMS charts also improved from 11 cadres (39.3%) to 21 cadres (75.0%). There was an improvement in the cadres’ knowledge, skills and ability to carry out the early detection screening process.
Iron Chelation, Vitamins, and Supplements for Thalassemia Patients: Scoping Review
Thalassemia major and transfusion-dependent thalassemia (TDT) are hereditary hemoglobinopathies that require lifelong blood transfusions and iron chelation therapy to prevent complications related to iron overload. Despite advances in chelation therapy, patients continue to experience complications such as oxidative stress, endocrine disorders, and bone health deterioration. This scoping review aimed to synthesize evidence from research articles regarding the role of iron chelation agents, including deferoxamine (DFO), deferiprone (DFP), and deferasirox (DFX), together with vitamin and supplement interventions in the management of thalassemia patients. This study used the PRISMA-ScR guidelines to identify scientific articles published between 2016 and 2025 from the PubMed and Scopus databases. Eligible studies were selected through title, abstract, and full-text screening according to predefined inclusion and exclusion criteria. Data were extracted, categorized by intervention type, and synthesized descriptively to examine the role of iron chelation therapy, vitamin C, vitamin D, vitamin E, folic acid, calcium, and antioxidant supplements in thalassemia management. A total of 29 articles met the inclusion criteria and were reviewed. The main findings demonstrated that vitamin C enhances the effectiveness of iron chelation therapy, particularly when combined with DFO. Vitamin D and calcium supplementation improve bone mineral density and reduce the risk of osteoporosis. Vitamin E and other antioxidants help reduce oxidative stress, while appropriate folic acid supplementation prevents deficiency without causing excessive accumulation. The combination of iron chelation therapy with vitamins and supplements provides benefits in reducing complications associated with iron overload, improving bone health, and decreasing oxidative stress in patients with thalassemia. This review offers evidence-based insights to optimize nutritional management in patients with thalassemia undergoing iron chelation therapy.
Complex Systemic and Pulmonary Venous Anomalies in a Child with Situs Ambiguus, Interrupted Inferior Vena Cava, and Atrioventricular Septal Defect with Prior Pulmonary Artery Banding: A Case Report
Congenital heart disease associated with situs ambiguus is frequently characterized by complex and heterogeneous abnormalities of systemic and pulmonary venous return. These anomalies are associated with atrioventricular septal defects and interrupted inferior vena cava, particularly in the setting of heterotaxy syndromes. We report a 2-year-old male child (10.5 kg) with complex congenital heart disease and inconsistent findings across multiple echocardiographic studies. Initial assessments suggested atrioventricular septal defect with variable ventricular balance and systemic venous anomalies. Cardiac CT demonstrated situs ambiguus, levocardia, common atrioventricular canal features, anomalous hepatic venous drainage into the left atrium, and partial anomalous pulmonary venous drainage, and absent of left SVC. Intraoperatively, more complex anatomy was identified, including two large atrial septal defects or common atrium without ventricular septal defect, cleft mitral valve, left superior vena cava draining into the left atrium, interrupted inferior vena cava with hepatic venous drainage into the left atrium, and partial anomalous pulmonary venous return to the right atrium. Surgical repair included atrioventricular valve repair, baffling of left superior vena cava and hepatic venous drainage using bovine pericardium, closure of atrial septal defects. Tricuspid and mitral valve repair and finally removal of pulmonary artery band and augmentation of main pulmonary artery with bovine pericardium. The postoperative course was complicated by arrhythmias requiring temporary pacing, low cardiac output syndrome, and need for peritoneal dialysis, followed by full recovery and discharge after 10 days to home. This case highlights rare combination of systemic and pulmonary venous anomalies associated with atrioventricular septal defects and interrupted inferior vena cava which illustrate the limitations of echocardiography and CT in complex systemic and pulmonary venous anomalies with heterotaxy syndromes and underscores the importance of intraoperative assessment.
Antidepressant Activity of Etlingera Rubroloba Rhizome Extract using Tail Suspension and Forced Swimming Tests
Epression is a mental health disorder characterized by mood changes, loss of interest, and physiological disturbances, which are associated with dysfunction of the monoaminergic system in the brain. The limitations of conventional therapies have prompted the exploration of natural sources, including plants from the Zingiberaceae family, which are known to be rich in bioactive metabolites with neuropharmacological potential. Etlingera rubroloba is one of Indonesia’s endemic plants with potential as an antidepressant agent; however, scientific studies on it remain limited. This study aims to evaluate the antidepressant activity of Etlingera rubroloba rhizome extract and to identify its secondary metabolites that may play a role in this effect. Extraction was performed via maceration using methanol, followed by phytochemical screening using tube assays. Antidepressant activity was tested in vivo on mice induced with Chronic Mild Stress (CMS), using the Tail Suspension Test (TST) and Forced Swimming Test (FST). The observed parameter was immobility time. Data were analyzed using a One-Way ANOVA test with a significance level of p < 0.05. Results: Phytochemical screening results indicated the presence of alkaloids, flavonoids, tannins, saponins, and terpenoids in the extract. Antidepressant activity tests showed that E. rubroloba rhizome extract significantly reduced immobility time in the TST and FST (p < 0.05) compared to the negative control. This effect was dose-dependent, with a dose of 300 mg/kg body weight providing the most optimal activity and comparable to the positive control (amitriptyline). Etlingera rubroloba rhizome extract possesses significant antidepressant activity and has potential for development as a natural antidepressant agent. This effect is thought to involve multimodal mechanisms, including the modulation of monoamine neurotransmitters, increased neuroplasticity, as well as the antioxidant and anti-inflammatory activities of its secondary metabolites.
Effectiveness of Lifestyle Interventions Based on Diet, Physical Activity, and Digital Technology in the Prevention and Management of Type 2 Diabetes Complications: A Systematic Review
Type 2 Diabetes Mellitus (T2DM) requires comprehensive lifestyle management to prevent life-threatening microvascular and macrovascular complications. Although diet and physical activity are the main pillars, the integration of digital technology offers new potential for improving compliance and clinical outcomes. Objective: This systematic review aims to synthesize evidence on the effectiveness of multidomain lifestyle interventions (diet, physical activity, digital technology) on glycemic control, cardiovascular complication risk, and quality of life in T2DM patients. A systematic literature search was conducted in PubMed, Scopus, and SAGE Journals databases for English and Indonesian articles published between 2020 and 2025. Study selection followed the PRISMA 2020 guidelines, using the Search String pumped ("Diabetes Mellitus, Type 2"[MeSH] OR "T2DM" OR "prediabetes") AND ("Life Style"[MeSH] OR "diet" OR "physical activity" OR "exercise") AND ("Telemedicine"[MeSH] OR "mobile app" OR "digital health") AND ("Randomized Controlled Trial" OR "Cohort Study". Search String Scopus TITLE-ABS-KEY(("Diabetes Mellitus, Type 2" OR "T2DM") AND ("Life Style" OR "diet" OR "exercise") AND ("digital health" OR "mobile app") AND ("RCT" OR "Cohort")). Search String sage journal ("Type 2 Diabetes” OR "T2DM") AND ("Lifestyle" OR "Diet" OR "Physical Activity") AND ("Digital Health" OR "App). Methodological quality was assessed using the Joanna Briggs Institute (JBI) instrument. Due to high clinical heterogeneity, data were synthesized narratively. A total of 20 studies (17 RCTs and 3 Prospective Cohort Studies; N > 50,000) met the inclusion criteria. Low-carbohydrate and plant-based dietary interventions significantly reduced HbA1c with Mean Differences (MD) ranging from -0.5% to -1.3% and supported diabetes remission (NNT=5.3). The combination of aerobic and resistance physical activity reduced inflammatory markers and improved insulin sensitivity. Digital technology-based interventions (apps/CGM) recorded an average HbA1c reduction of -0.4% to -1.8% (p<0.01) and increased Time-in-Range (+31 minutes/day). Long-term evidence shows that combined lifestyle interventions reduce cardiovascular mortality (Hazard Ratio [HR] 0.54; 95% CI 0.3–0.9) and diabetes incidence (HR 0.76) over a 20–30-year follow-up period. The combination of dietary modification, structured physical activity, and digital technology provides superior clinical effectiveness compared to single interventions. Despite limitations such as heterogeneity in intervention duration, the evidence supports the integration of hybrid (digital-physical) care models into standard nursing practice for the prevention of long-term complications.
The Relationship between Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with the Severity of Acute Coronary Syndrome
Cardiovascular diseases pose a major health problem, representing a significant threat to the global population due to their high mortality rates. According to the World Health Organization (WHO), cardiovascular diseases were the leading cause of death worldwide in 2021. This condition is caused by the accumulation of fatty deposits in the arteries, known as atherosclerosis, which obstructs blood flow and increases the risk of heart attacks. This study aimed to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the severity of acute coronary syndrome at Adam Malik General Hospital. This study was an analytical study with a retrospective design, utilizing secondary data obtained from patients’ medical records over a specific period. Patient data were collected from January 2023 to December 2024 from patients hospitalized at Adam Malik Hospital. Sampling was conducted using a total sampling technique, including all 208 patients who met the inclusion criteria during the study period. The collected data were then analyzed using the Kolmogorov–Smirnov test to assess the normality of data distribution. Among 208 patients, 76% were male, with a mean age of 62.2 years (range: 36–81). Most patients had low SYNTAX II scores (74%). The mean NLR and PLR values were 3.58 and 134.35, respectively. A significant positive correlation was observed between NLR and SYNTAX II score (r = 0.284; p < 0.001) and between PLR and SYNTAX II score (r = 0.143; p = 0.039). This study demonstrated a significant positive correlation between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the severity of acute coronary syndrome based on the SYNTAX II score. NLR showed a stronger correlation than PLR, highlighting its superior potential as an inflammatory biomarker for assessing disease severity in patients with acute coronary syndrome.
Evaluation of Service Quality on Patient Satisfaction at the Hialu Community Health Center in North Konawe Regency Using an Integration of the Servqual and Quality Function Deployment (QFD) Models
On the front lines of primary health care in Indonesia, especially in rural areas and geographical conditions that pose challenges (North Konawe). Growing public expectations require the ongoing monitoring of service quality to provide assurance that patients are satisfied with their care. This study aims to evaluate service quality and determine priority improvement strategies in inpatient health centers using an integrated SERVQUAL and Quality Function Deployment (QFD) approach. This study used a quantitative descriptive-analytical design conducted at the Hialu Inpatient Health Center, North Konawe Regency. The data was collected using a SERVQUAL-based structured questionnaire that assessed the patients' expectations and perceptions about five service quality dimensions: tangible, reliability, responsiveness, assurance, and empathy. The questionnaire included 24 statements items value evaluated by the five-step Likert scale. The research participants were outpatients and inpatients, patients or their guardians who received services based on purposive sampling techniques. There were 97 respondents in the sample. The SERVQUAL method was used to analyze the data, which calculated the difference between patients' perception and expectations. Subsequently, the attributes with negative gap values were considered as voice of customer that was to be arranged in a QFD analysis, whereby HOQ would exhibit the priorities for improvement of service quality. Eight service indicators possessed negative gap values in the dimensions of tangibles, reliability, responsiveness and assurance. There was no negative gap to the empathy dimension, suggesting that we met patient expectations around empathy. Based on a QFD analysis, the facility's structure enhancements, staff responsiveness improvement and service procedures optimization were found the key technical priorities. SERVQUAL and QFD together provide an effective tool in identifying service quality gaps as well as prioritizing improvements at the Inpatient Community Health Center. These technical priorities are expected to enhance services provision and patients satisfaction.
Nursing Inovation: Telenursing Interventions to Improve Medication Adherence and Blood Pressure Control among Hypertension Patients in Primary Health Care: Systematic Review
Hypertension is a chronic condition with a high global prevalence that requires long-term management. One of the main challenges in achieving optimal blood pressure control is poor medication adherence. Technology-based approaches, such as telenursing, offer innovative solutions to enhance patient engagement in disease management. Methods: A Systematic Literature Review (SLR) was conducted following the PRISMA guidelines. Literature searches were performed in Scopus, PubMed, ScienceDirect, and Google Scholar for studies published between 2021 and 2026. A total of 4,301 records were identified, and seven randomized controlled trials (RCTs) met the inclusion criteria. The findings showed that most telenursing interventions significantly improved medication adherence and reduced blood pressure levels. Multicompoent interventions combining education, remote monitoring, and reminder systems demonstrated greater effectiveness compared to single-component approaches. Telenursing represents a promising strategy for hypertension management in primary healthcare. Its implementation requires adequate system support and evidence-based practice standards to optimize nursing care delivery.
Effectiveness Music Therapy in Reducing Pain and Anxiety in Preschool Children in the Emergency Room: Literature Review
The Emergency Department (ED) is a healthcare setting with a high risk of causing pain and anxiety in pediatric patients due to invasive procedures and emergency situations. If these conditions are not properly managed, they can negatively impact the care experience and increase the risk of psychological trauma. Music toy therapy, as a non-pharmacological intervention based on active distraction, has the potential to reduce pain and anxiety in children in the ED. This literature review aims to analyze the latest scientific evidence regarding the effectiveness of music toy therapy in pediatric patients in the ED. The method used was a traditional literature review with article searches conducted via Google Scholar and PubMed for the years 2021–2025. The literature search yielded 273 articles from Google Scholar and 21 articles from PubMed. Article selection was conducted using the PRISMA flowchart, resulting in five articles that met the inclusion criteria. The keywords used for searching Indonesian journal articles included “Music Toy Therapy,” “Pain,” “Child Anxiety,” and “Emergency Department”. The review findings indicate that music toy therapy has a positive effect on reducing pain and anxiety in children, particularly among preschoolers and early school-age children. Music toy therapy is a safe, easy-to-implement, and potentially effective intervention for improving the quality of pediatric nursing care in the emergency department through a holistic approach that involves families and the active role of nurses.
Clinical Impact of Modified Early Warning System on Reducing Maternal Morbidity: A Review
The globally high maternal morbidity rate necessitates obstetric-specific monitoring systems capable of detecting physiological deterioration earlier than general adult early warning tools. This narrative review analyzes empirical evidence regarding the clinical impact of the Modified Early Obstetric Warning System (MEOWS) in reducing maternal morbidity. A structured synthesis of fourteen primary studies retrieved from PubMed, ResearchGate, and Elsevier between 2015 and 2025 was conducted using the following keywords: ("maternal early warning system" OR "MEOWS") AND ("maternal morbidity" OR "clinical impact"). The search yielded a total of 112 articles. After removing duplicates and irrelevant titles, 62 articles were screened based on abstracts. Subsequently, 38 full-text articles were assessed for eligibility using predefined inclusion and exclusion criteria, of which 14 studies met all criteria and were included in the final review. The review followed four stages: identification, screening, eligibility assessment, and data extraction. MEOWS demonstrates strong predictive efficacy, with sensitivity ranging from 72.9% to 96.9% and specificity from 62% to 99.9%, consistently outperforming general adult early warning systems. When integrated with standardized clinical pathways, MEOWS achieves a 100% negative predictive value and significantly reduces incidences of eclampsia, HELLP syndrome, and pulmonary edema. MEOWS is a reliable, cost-effective screening tool for early maternal morbidity risk detection. Its maximum clinical impact is realized when functioning as a trigger for standardized response protocols rather than as a passive monitoring tool. This review provides an evidence-based framework for policymakers and health facility managers to integrate physiological triggers with standardized response protocols, particularly in resource-limited settings.
The Relationship Between the Implementation of Body Ergonomics and the Risk of Work Injuries among Nurses
The proper application of ergonomics plays an important role in preventing work injuries among nursing personnel who perform high levels of physical activity. Inadequate ergonomic practices may increase the risk of musculoskeletal complaints in nurses during routine clinical tasks. This study aimed to determine the relationship between the application of body ergonomics and the risk of work injuries among nurses at RS TK. II Moh. Ridwan Meuraksa. This study employed a quantitative approach with a cross-sectional design. A total of 132 nurses, including implementing nurses and heads of wards, were selected using a total sampling technique. The application of body ergonomics was assessed using the Ovako Working Posture Analysis System (OWAS), while the risk of work injury was measured using the Nordic Body Map (NBM). Instrument validity was tested using the Pearson Product Moment correlation (N = 30; r table = 0.361), and all items were declared valid. Reliability testing yielded a Cronbach’s Alpha value of 0.964 for the NBM (very high reliability) and 0.673 for the OWAS (moderate reliability). Data were analyzed using the Chi-square test. The results showed no significant relationship between the application of body ergonomics and the risk of work injuries among nurses (p-value = 0.582). Among individual characteristics, only age was significantly associated with the risk of work injury (p-value < 0.001), whereas BMI, height, and education level showed no significant association. Nurses performed various activities, including computer-based nursing documentation, vital sign assessment, wound care, infusion and catheter removal, medication administration, blood glucose monitoring, and patient mobilization. The most frequently reported musculoskeletal complaints were experienced in the neck, shoulders, back to waist, arms, wrists, knees, and calves. Musculoskeletal injuries among nurses are influenced by workload, working posture, and duration of work. Therefore, the role of nursing management in providing ergonomics training is essential, particularly for young nurses.
Comparative Study on the Effectiveness of Garlic and Coffee in Developing A Natural Mosquito Repellent Spray: A Comprehensive Review
Mosquito-borne diseases remain a significant global public health concern. While chemical repellents are effective, they pose environmental and health risks, creating a demand for safer, natural alternatives suitable for school environments. This systematic literature review compares the effectiveness of garlic (Allium sativum) and coffee (Coffea sp.) as natural mosquito control agents, focusing on their repellent, larvicidal, and ovicidal properties. The review methods involved systematically searching PubMed, Google Scholar, Scopus, and Web of Science for peer-reviewed articles published between 2015 and 2025. Search terms included combinations of garlic, Allium sativum, coffee, Coffea, mosquito, repellent, larvicidal, and species-specific terms. Two independent reviewers screened the articles and extracted the data. Study quality was assessed using criteria for observational studies. Based on the records identified, 12 studies literature article met the inclusion criteria after full-text review. Garlic extracts (25–100 mg/100 mL) demonstrated rapid mosquito mortality (50–96.67% within 24 hours) and strong adult repellency due to organosulfur compounds, particularly allicin. Coffee extracts showed moderate larvicidal effects (LC₅₀: 200–400 ppm) and ovicidal properties, with slower action but broader life-stage targeting. Quality assessment revealed moderate-to-high study quality, with some methodological limitations. Current evidence suggests that garlic provides stronger immediate repellent effects, while coffee offers more sustained larvicidal control. However, the small number of head-to-head comparison studies limits definitive conclusions. Combined formulations warrant further investigation. Both ingredients show promise as components of school-based, environmentally friendly mosquito control programs.
Centella Asiatica Leaf Extract Increases FGF2 and Improves Paw Histopathology in Acute-Inflammation Rats
Excessive acute inflammation causes oedema and tissue injury, while conventional anti-inflammatory drugs are limited by adverse effects. Centella asiatica contains bioactive compounds with anti-inflammatory and pro-healing properties; VEGF and FGF2 mediate angiogenesis and tissue repair. To evaluate the effect of C. asiatica leaf ethanol extract on serum VEGF and FGF2 levels and paw histopathology in rats with acute inflammation. Thirty male Wistar rats were randomised into five groups: normal, negative control (carrageenan), positive control (sodium diclofenac), and extract 2 and 4 g/kgBW orally. Acute inflammation was induced by subplantar carrageenan; paw volume, serum VEGF and FGF2 (ELISA), and haematoxylin-eosin histopathology were assessed. Data were analysed by ANOVA and post hoc LSD. FGF2 differed significantly among groups (p<0.001); carrageenan lowered FGF2 whereas the extract increased it (2 g/kgBW 410.76; 4 g/kgBW 335.42 pg/mL). VEGF was unchanged (p=0.713). The 4 g/kgBW dose reduced oedema and neutrophil infiltration comparably to the positive control. C. asiatica leaf ethanol extracts increased FGF2 and improved acute-inflammation histopathology, particularly at 4 g/kgBW.
Ethanol Extract of Gotu Leaves (Centella asiatica (L.) Urban) Increases PDGF Levels but Does Not Change TNF-α and Malondialdehyde in Wistar Rats in a Carrageenin-Induced Acute Inflammatory Model
Conventional anti-inflammatory therapies with NSAIDs and glucocorticoids are limited by gastrointestinal, renal, and metabolic side effects, thus encouraging the search for plant-based alternatives. Gotu kola leaves (Centella asiatica (L.) Urban) are rich in triterpenoids and flavonoids which are reported to have anti-inflammatory and wound-healing activities. This study aimed to analyze the effect of gotu kola leaf ethanol extract on tumor necrosis factor-alpha (TNF-α), platelet-derived growth factor (PDGF), malondialdehyde (MDA), and leg edema volume in male Wistar rats with carrageenan-induced acute inflammation model. Thirty rats were randomized into five groups (n=6): normal, negative control (carrageenan), positive control (carrageenan + sodium diclofenac), and two extract treatment groups of 2 g/kgBB and 4 g/kgBB orally. Edema was measured with a plethysmometer in the first minute and every hour for 4 hours; Serum TNF-α, PDGF, and MDA levels were measured by ELISA. Data were analyzed with one-way ANOVA and LSD follow-up test (α=0.05). Screening for positive phytochemicals of flavonoids, alkaloids, saponins, tannins, phenols, glycosides, and steroids/triterpenoids. PDGF levels differed significantly between groups (p=0.001), highest in the 4 g/kgBB group (2.14±0.12 ng/mL) and lowest in the negative control (1.66±0.10 ng/mL). The volume of edema was significantly different at the beginning and 1st hour (p=0.001) but not at the 2nd to 4th hour. The levels of TNF-α (p=0.423) and MDA (p=0.072) were not significantly different. Ethanol extract of Centella asiatica leaves, especially at a dose of 4 g/kgBB, increased PDGF and decreased early-phase edema, showing modulation potential towards tissue repair, but had no significant effect on TNF-α and MDA in this acute model.
Evaluation of the Implementation of the Ten Steps to Successful Breastfeeding
Exclusive breastfeeding is an important strategy to reduce infant morbidity and mortality. The Indonesian government has implemented the Ten Steps to Successful Breastfeeding (TSSB) policy through Government Regulation No. 33 of 2012. However, the coverage of exclusive breastfeeding in Tangerang Regency remains below the national target of 80%. This study aimed to evaluate the implementation of the Ten Steps to Successful Breastfeeding in public health centers and analyze factors influencing exclusive breastfeeding success. This study used a quantitative case-control design. The case group consisted of inpatient PONED health centers and the control group consisted of non-inpatient PONED health centers in Tangerang Regency. A total of 528 respondents participated in the study, including 176 health workers and 352 breastfeeding mothers with infants aged 6–12 months, selected using purposive stratified sampling. Data were collected using validated questionnaires and analyzed using univariate, bivariate (chi-square), and multivariate (multiple logistic regression) analyses. The results showed a significant relationship between the implementation of the Ten Steps to Successful Breastfeeding and the success of exclusive breastfeeding (p < 0.05). Among mothers, knowledge, attitude, family support, and health worker support were significantly associated with exclusive breastfeeding. Among health workers, knowledge, attitude, and the availability of facilities and infrastructure were significantly related to the implementation of the program. Health worker support was identified as the most dominant factor influencing exclusive breastfeeding success.In conclusion, the implementation of the Ten Steps to Successful Breastfeeding plays an important role in increasing exclusive breastfeeding coverage. Strengthening health worker support and improving facilities in health centers are necessary to enhance the success of exclusive breastfeeding programs.
Coping Mechanisms and Symptom Levels of Depression in Cancer Patients
A diagnosis of cancer in adults is often accompanied by negative impacts on mental health, such as changes in body image and function, persistence, pain, distress and anxiety, as well as fear of recurrence and death due to cancer, resulting in negative impacts. its impact on mental health. increased risk of depression among adults with cancer. Depression is a common problem among individuals suffering from cancer. The aim of this research is to determine the characteristics, management of coping and depression. This research used a descriptive method, the number of samples in this study was 85 respondents. The sampling technique in this research is purposive sampling and the questionnaires used were the Cancer Coping Questionnaire and BDI II, Coping mechanisms and depressive symptoms were assessed using the CCQ and BDI-II, respectively, both of which have established validity and reliability. The majority of respondents had adaptive coping mechanisms, 68 respondents (80.0%), the majority of respondents minimal depression 57 respondents (67.1%), indicating that the majority of respondents who had adaptive coping minimal depression, 51 respondents (75%). Cancer sufferers experience several changes, namely fatigue, loss of appetite, and changes in body weight. Depression causes a decrease in the quality of life of cancer patients by worsening physical symptoms, and increasing the negative impact on patients and their families during illness. Coping mechanisms can control the strengthening of problems so that cancer patients can control the symptoms of depression that arise with good coping mechanisms in resolving problems.
Association between Physical Activity and Sleep Quality among First-Year Nursing Student
Sleep is a biological necessity that is important for physical and mental recovery, especially for first-year students who are undergoing academic transition. Changes in activity patterns, academic workload and organizational involvement affect sleep quality. Physical activity is known to play a role in improving sleep quality, but empirical evidence varies. The study aims to determine the relationship between physical activity and sleep quality among early-level nursing students at STIKes Permata Nusantara. The design of this study is correlational with a cross-sectional approach. The study population consisted of 94 students, with 35 respondents selected using purposive sampling. Physical activity was measured using the Global Physical Activity Questionnaire (GPAQ) demonstrated acceptable validity when correlated with accelerometer data (r= 0,48) and reability (Cronbach’s α=0,73). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) demonstrated acceptable validity (r=0,45-0,85) and reliability (Cronbach’s α=0,776). Bivariate analysis was performed using correlation tests. The results showed that most respondents had light physical activity (42,9%) and poor sleep quality (74,3%). The correlation test results showed a significant negative relationship between physical activity and sleep quality (p<0,032). Researchers concluded that physical activity has a significant negative relationship with sleep quality, and excessive physical activity during academic transitions can contribute to sleep disturbances.
Website-Bassed Early Detection to Prevent Postpartum Depression
Postpartum depression is a serious mental health disorder that affects the well-being of both mother and baby, with a global prevalence of 10–20%. In South Tangerang, 32.5% of mothers experience baby blues, which carries a risk of developing into depression. Early detection is still hindered by inefficient manual screening, social stigma, and a lack of privacy. This research emphasizes the need for a digital screening system that facilitates early intervention. The study was a Research and Development (R&D) approach with the ADDIE model and an explanatory sequential mixed methods design. Quantitative data were collected through a one-group pretest-posttest design involving 136 postpartum mothers at three Community Health Centers in South Tangerang using purposive sampling. The EPDS and TAM instruments were used, while qualitative data were obtained through in-depth interviews. Data were processed and analyzed using SPSS through editing, coding, data entry, and cleaning stages. Quantitative analysis included descriptive, bivariate, and multivariate analysis, while qualitative data were analyzed using thematic analysis. The NABILAH website was rated “Very Feasible” by experts (100%), media experts (98.91%), and accepted by users (88.84%). Depression scores decreased significantly from week 1 to week 4 after the intervention (p = 0.000). Lack of physical activity was identified as the dominant factor (OR 14.357). Qualitative analysis showed that the system effectively addressed privacy and time efficiency constraints and provided a sense of security for mothers. The NABILAH model has been proven effective and feasible as a digital screening solution in primary care services.
The Effect of Coloring Play Therapy on Anxiety Levels in Children During Hospitalization
Hospitalization can be an anxiety-inducing experience for preschoolers due to the unfamiliar environment and frightening medical procedures. One intervention that can help reduce anxiety is coloring. This study aims to determine the effectiveness of coloring play therapy on children's anxiety levels during hospitalization. The method used is a case study, with a pediatric nursing care approach, applying Evidence-Based Nursing. The research subjects were taken using a purposive sampling method and the results obtained were five preschool-aged children (4-6 years old) who were treated in the Anggrek Ward of Dr. Soeratno Gemolong Sragen Hospital, from June 14-20, 2025. Anxiety levels were measured using the Faces Anxiety Scale (FAS) with a score range of 0-4 through observations and interviews with parents before and after the intervention. Data were analyzed using descriptive analysis with results showing that before the intervention, children experienced anxiety with FAS scores between 1-3, characterized by crying, fussiness, and fear of medical procedures. After coloring therapy, anxiety levels decreased in all subjects, with FAS scores dropping to 0-1. Children appeared calmer and more cooperative during the intervention. The study concluded that coloring play therapy was effective in reducing anxiety levels in preschool-aged children during hospitalization.
Evaluation Implementation of Immunization Program: A Qualitative Study
Some infectious diseases that can be prevented by vaccination include, especially pneumonia, respiratory diseases, and sepsis, causing approximately 23% of neonatal deaths globally. However, in implementation, there are still many health centers that have not been able to achieve the target of immunization for children. Evaluation of program implementation is needed to find obstacles and opportunities in improving achievements. The purpose of this study is to analyze and evaluate the implementation of immunization programs based on CIPP theory. This research is qualitative with a case study approach. The study was conducted in 8 villages in the working area of the Bandung Health Center in July 2025. The informant was 25 person selected by purposive sampling. Analysis based on the CIPP approach with input, process, and output indicators. Data will be collected through in-depth interviews. The questionnaire will be used to collect qualitative. The instrument was valid and reliable by expert test. The informants in this study consisted of the head of the health center, cadres, village midwives, and the community. Data analysis uses Miles and Huberman’s principles and a matrix. Obstacles to the immunization program include: the number of Human Resources (HR) is still not ideal, the availability of vaccines is often late and limited, supervision is still not optimal and the budget does not involve the private sector, immunization schedules are tentative according to conditions, training and supervision that are not routinely carried out and still lie in the doubts and rejections of a small part of the community as well as limited service coverage in certain areas. Conclusion: Efforts to solve problems must emphasize 6 main points, namely: strengthening human resources, optimizing and validating data, strengthening cold chains, increasing community participation, strengthening cross-sectoral coordination, and equitable distribution of immunization services.
The Effectiveness of Binaural Beats Music Therapy in Reducing Anxiety Levels in Pre Urological Surgery Patients
Preoperative anxiety is a psychological response often experienced by patients before undergoing surgical intervention and can lead to increased physiological responses such as heart rate, blood pressure, and stress hormones. This condition can disrupt patient stability and slow recovery. Therefore, an effective, safe intervention that minimizes side effects is needed to reduce this anxiety. One non-pharmacological intervention is binaural beats music therapy, which stimulates alpha and theta brain waves to increase relaxation and reduce sympathetic nervous system activity. This study aims to determine the effectiveness of binaural beats music therapy in reducing anxiety levels in preoperative urology patients at Ir. Soekarno Sukoharjo Regional General Hospital. The method used was an intervention in preoperative patients who received binaural beats music therapy for 30 minutes via a headset. Then, anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after the intervention, with its validity and reliability confirmed through preliminary testing. The sample consisted of five patients selected through purposive sampling who met the following inclusion criteria: experiencing moderate to severe anxiety, being conscious and cooperative, having no hearing impairment, and being willing to participate in the intervention. The results showed that all patients experienced a decrease in anxiety scores after therapy. Three patients experienced a decrease in anxiety levels from moderate (14-18) to mild (9-12), while two patients experienced a decrease in anxiety levels from severe (23-21) to moderate (15-16). These findings suggest that binaural beats therapy is effective in helping reduce anxiety in preoperative patients, particularly those undergoing urological surgery.
The Effectiveness of Intradialytic Exercise on Fatigue Levels in Patients with Chronic Kidney Disease Undergoing Hemodialysis: A Systematic Review
Chronic Kidney Disease (CKD) is a global health problem requiring long-term renal replacement therapy, including hemodialysis. Although hemodialysis is essential for survival, patients often experience fatigue, which negatively impacts functional capacity, daily activities, and quality of life. One non-pharmacological approach to reducing fatigue is intradialytic exercise, defined as physical activity performed during hemodialysis sessions. This systematic review aimed to evaluate the effectiveness of intradialytic exercise in reducing fatigue levels in patients with chronic kidney disease undergoing hemodialysis. The systematic review was conducted using the PICO framework. Articles published between 2020 and 2025 were identified from PubMed, ScienceDirect, and Google Scholar databases. A total of 137 articles were retrieved, and inclusion criteria were selected using full-text studies with quasi-experimental designs, randomized controlled trials, or pre-experimental studies examining intradialytic exercise and fatigue outcomes in hemodialysis patients. Study selection followed PRISMA guidelines, and data were extracted based on study design, sample size, intervention type, and outcomes. Therefore, ten articles that met the inclusion criteria were used. Findings consistently demonstrate that intradialytic exercise, including flexibility, aerobic, resistance, and stretching exercises, significantly reduces fatigue levels in patients undergoing hemodialysis. Several studies also report improvements in activity tolerance and dialysis adequacy. Intradialytic exercise is an effective and safe non-pharmacological nursing intervention to reduce fatigue in CKD patients undergoing hemodialysis. Integrating intradialytic exercise into routine hemodialysis care can improve patient well-being and quality of life.
Relationship between Exposure Contact History, Personal Hygiene, and Neighbor's Contact History with Leprosy
Latar belakang: Kusta adalah penyakit infeksi menular yang disebabkan oleh bakteri Mycobacterium leprae, yang dapat menyebabkan kerusakan jaringan dan berpotensi mengakibatkan kerusakan permanen pada bagian tubuh tertentu. Selama lima tahun terakhir (2020–2025), terjadi kecenderungan kasus secara fluktuatif dengan jumlah berturut-turut kejadian kusta 12,12, 21,18,22, dan 24 kasus di Sukoharjo, target nasional untuk pemberantasan kusta adalah kurang dari satu kasus per 10.000 orang . Penemuan Kasus Baru Kusta (NCDR/New Case Detection Rate ), persentase kasus baru di Kabupaten Sukoharjo sebesar 2,61 % pada tahun 2025. Penyebab kasus kusta di Kabupaten Sukoharjo Penemuan kasus baru kusta diduga berasal dari riwayat kontak paparan, faktor personal hygeine, dan riwayat dengan kontak tetangga sebagai penyebab ditemukannya kasus kusta di Kabupaten Sukoharjo. Tujuan penelitian: Tujuan penelitian ini adalah untuk menganalisis hubungan riwayat kontak paparan, personal hygiene, dan riwayat kontak dengan tetangga terhadap kusta di Kabupaten Sukoharjo. Metode penelitian: studi ini menggunakan pendekatan kuantitatif dengan studi kasus -kontrol. Penelitian dilakukan pada bulan Desember hingga Maret 2026 di beberapa lokasi di Kabupaten Sukoharjo , antara lain Bendosari, Bulu, Baki, Weru, Tawangsari , Sukoharjo, Polokarto , Nguter, Grogol, Gatak, dan Mojolaban. Sampel terdiri dari 24 responden kasus dan 24 responden kontrol . Teknik pengambilan sampel menggunakan purposive sampling. Pengambilan sampel dengan rasio 1: 1. Analasis data bivariat menggunakan uji chi-square. Hasil: Hasil uji statistik menunjukkan hubungan kontak paparan (p-value 0.003, OR= 7.000), personal Hygiene (p-value 0.020 OR= 4.048), sedangkan yang tidak terdapat hubungan yaitu kontak tetangga (p-value 0.247 OR= 1.970). Oleh sebab itu, diperlukan peningkatan skrining dari petugas kesehatan melalui kontak paparan dan edukasi kepada masyarakat tentang kusta dan cara pencegahannya.
The Effect of Tiktok-Based Anemia Education on Knowledge, Adherence to Iron Supplement Consumption, and Hemoglobin Levels among Adolescent Girls: A Literature Review
Anemia among adolescent girls remains a significant public health problem, largely driven by inadequate iron intake and low adherence to iron supplementation programs. Traditional health education methods are often less engaging for Generation Z, highlighting the need for innovative digital approaches. TikTok, a widely used social media platform, offers short-form audiovisual content that may enhance health education delivery. This study aimed to examine the effectiveness of TikTok-based anemia education in improving knowledge, adherence to iron supplementation (Tablet Tambah Darah/TTD), and hemoglobin levels among adolescent girls. A literature review was conducted using articles retrieved from PubMed/MEDLINE, ScienceDirect, Google Scholar, and the Indonesian Publication Index (IPI). The search covered publications from 2020 to 2025 using the keywords: (“TikTok” OR “short-form video” OR “social media intervention”) AND (“anemia” OR “iron deficiency”) AND (“adolescent girls”) AND (“knowledge” OR “adherence” OR “hemoglobin”). A total of 116 articles were initially identified. After screening titles and abstracts, 74 articles were retained, and 44 full-text articles were assessed for eligibility. Based on predefined inclusion and exclusion criteria, 20 studies were included in the final analysis. Data were analyzed using thematic analysis to identify patterns related to intervention characteristics, outcomes, and effectiveness. The findings indicate that TikTok-based and other audiovisual educational interventions significantly improve adolescents’ knowledge of anemia, increase adherence to iron supplementation, and contribute to improved hemoglobin levels. TikTok-based education represents an effective and innovative digital health promotion strategy for strengthening anemia prevention efforts among adolescent girls.
Effectiveness of Using Cold Esaline Compress in Reducing the Area of Hematoma after Coronary Intervention Percutaneous Femoral Access
Percutaneous Coronary Intervention (PCI) with a transfemoral approach is an invasive procedure commonly used in the management of coronary artery disease. This study aims to evaluate the effectiveness of esaline cold compress application in reducing hematoma size at the femoral access site in patients undergoing PCI. This study employed a Randomized Controlled Trial (RCT) design with a consecutive sampling technique. The sample consisted of 80 respondents who underwent transfemoral PCI, including 40 respondents in the intervention group and 40 respondents in the control group. Participants were recruited consecutively based on predetermined inclusion and exclusion criteria and were randomly allocated into intervention and control groups. The intervention group received esaline cold compresses applied to the femoral access area after sheath removal, while the control group received standard care. Data were collected through observation of hematoma size, pain scale, and patient comfort for 24 hours post-procedure. Data analysis was conducted using the Mann–Whitney U test with a significance level of 0.05. The results showed that the characteristics of respondents in both groups were relatively homogeneous. There was a statistically significant difference in hematoma size between the intervention group and the control group (p = 0.001 < 0.05). Specifically, the group receiving esaline cold compresses demonstrated a mean rank of 30.41 with a total rank of 1216.50. The application of esaline cold compresses was proven to be statistically and clinically effective in preventing and minimizing the extent of hematoma following femoral access PCI.
Religious Factors (Spirituality and Religiosity) as Important Aspects in Improving the Quality of Life of Type 2 Diabetes Mellitus Patients: A Literature Review
Diabetes mellitus is a non-communicable and degenerative disease that causes an increase in mortality rates worldwide. This chronic disease continues to experience a rise in the count of individuals affected, making it one of the current global health problems. This study aims to identify the function of religion (spirituality and religiosity) as an important factor in improving the quality of life of patients with type 2 diabetes mellitus. The search strategy used was Google Scholar and PubMed, covering the period from 2018 to 2025. The keywords used were Spirituality, Religiosity, Quality of Life, and Type 2 Diabetes Mellitus. The Critical Appraisal Skills Program (CASP) was then conducted. From a total of 17,810 articles that were identified, there were 15 articles that met the inclusion criteria linking spirituality and religiosity with quality of life in patients with diabetes mellitus. Religious factors, namely spirituality and religiosity, significantly affect the quality of life of people with diabetes mellitus.
Factors Associated with Ocular Disorders in Children with Systemic Lupus Erythematosus (SLE)
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease involving multiple organs and causing systemic damage, characterized by the formation of autoantibodies and immune complexes. Ocular involvement is estimated to occur in approximately one-third of individuals with SLE and may affect various ocular structures. Ocular manifestations associated with SLE are highly variable and may lead to delayed diagnosis, potentially resulting in poor outcomes and vision-threatening complications. To analyze risk factors associated with ocular disorders in children with systemic lupus erythematosus (SLE). This was an analytic cross-sectional study conducted at the Allergy-Immunology outpatient clinic and pediatric inpatient ward of Adam Malik General Hospital starting in April 2025. The sampling technique used was consecutive sampling. A total of 41 patients with SLE were analyzed. The duration of treatment was found to be a risk factor associated with ocular disorders in children with SLE (p=0.005). The prevalence of ocular disorders among children with SLE was 29.3%. The most common ocular disorder observed in children with SLE undergoing treatment was ocular hypertension, found in 9 patients (22%). Based on ordinal regression analysis, each additional year of treatment duration increased the likelihood of worsening therapeutic outcomes by 1.76 times (p<0.05). Treatment duration is a significant risk factor for ocular disorders in children with systemic lupus erythematosus, with ocular hypertension being the most common type of ocular disorder. Longer treatment duration increases the likelihood of worsening therapeutic outcomes.
Analysis of Risk Factors Associated with Falls among Stroke Patients
Stroke is one of the leading causes of disability and mortality worldwide, including in Indonesia. Older adults with stroke are at high risk of experiencing long-term complications, one of which is falls due to impaired motor function, balance, and physical function. This study aimed to identify the risk factors associated with falls among post-stroke patients in three provinces in Indonesia. This quantitative study employed a cross-sectional design and was conducted in South Kalimantan, Jakarta, and Palembang. The independent variables were fall risk factors, while the dependent variable was the occurrence of falls among post-stroke patients. Data were collected using the Morse Fall Scale (MFS) with an intraclass correlation coefficient (ICC) of 0.825, sensitivity of 66.7%, and specificity of 81.6%. A total of 150 post-stroke patients were recruited using purposive sampling and the analysis using Chi Square Test. The analysis showed that, among the eight characteristics examined, four variables were significantly associated with fall risk: age (p = 0.040), sex (p = 0.045), marital status (p = 0.041), and stroke duration (p < 0.001). In contrast, education (p = 0.508), occupation (p = 0.966), health problems (p = 0.166), and body mass index (BMI) (p = 0.123) were not significantly associated with fall risk. These findings highlight the importance of considering demographic characteristics and stroke duration in the identification and prevention of fall risk among post-stroke patients.
Navigating Therapy for Hyperthyroidism in Lactation: A Case Report and Review of Antithyroid Drug Safety
Graves’ disease is the leading cause of hyperthyroidism in women of reproductive age and may relapse in the postpartum period, when immune reactivation and the desire to continue breastfeeding complicate antithyroid drug selection. This case report aims to describe the therapeutic decision making process in a breastfeeding mother with Graves’ hyperthyroidism and to provide practical insights that help bridge the gap between guideline recommendations and day to day clinical practice in navigating treatment options during lactation. Current guidelines indicate that methimazole at doses up to 20 mg per day can be used safely during breastfeeding. We report a 32‑year‑old woman with long‑standing Graves’ disease who experienced biochemical and clinical relapse two months postpartum, after discontinuing antithyroid therapy. At presentation, she was still breastfeeding her 9 month old infant. Hyperthyroidism was confirmed by markedly elevated free thyroxine and suppressed thyroid‑stimulating hormone, in the context of diffuse goiter and prior ophthalmopathy, findings consistent with postpartum Graves’ relapse rather than postpartum thyroiditis. Methimazole was reintroduced and titrated to 20 mg/day, with subsequent improvement in maternal symptoms and thyroid function, while breastfeeding was continued without clinical evidence of impaired growth or neurodevelopment in the infant. This case illustrates that methimazole at a daily dose of 20 mg can provide effective control of postpartum Graves’ hyperthyroidism without necessitating interruption of breastfeeding, in line with international recommendations that classify low to moderate doses of MMI as safe during lactation. Careful monitoring of maternal thyroid status and individualized counselling are essential to balance disease control with maintenance of lactation.
Analysis of Nutritional Problems among Adolescent Girls
Adolescent nutritional problems in Indonesia are increasingly complex due to the double burden of malnutrition, including undernutrition, overnutrition, anaemia, and chronic energy deficiency (CED). A preliminary study in Rancabungur District, Bogor Regency, indicated that many adolescent girls were at risk of anaemia and chronic energy deficiency (MUAC < 23.5 cm). Most adolescents frequently consumed fast food, had low intake of vegetables and fruits, and did not regularly consume iron supplementation. This study aimed to analyse nutritional problems among adolescent girls in Rancabungur District, particularly to identify nutritional status and the distribution of undernutrition, overweight, obesity, anaemia, and CED. A mixed-methods approach with a sequential explanatory design was employed. The quantitative phase used a cross-sectional design with bivariate and multivariate analyses, while the qualitative phase involved in-depth interviews. Among 216 adolescent girls, 62.9% experienced nutritional problems, including CED (19.4%), overweight (15.7%), undernutrition (13.4%), anaemia (6.5%), and obesity (3.2%). Teacher support (OR = 28.465), eating habits (OR = 8.948), and mass media (OR = 8.184) were significant determinants, with teacher support identified as the most dominant factor. Motivation (OR = 0.09) and health services (OR = 0.05) acted as protective factors. Qualitative findings indicated that low nutrition literacy, peer influence, and limited family and school support contribute to these issues.