Journal Title:International Journal of Health Science (IJHS) Initials: IJHS Frequency: March, July, November Print ISSN: 2827-959X Online ISSN:2827-9603 Editor in Chief: Aufa Rizka Azzumi, S.E.,M.A DOI: 10.55606 Publisher: Lembaga Pengembangan Kinerja Dosen International Journal of Health Science (IJHS) is a peer-reviewed international journal that publishes practices, ideas, and research in all health and nursing science or practice fields from a global viewpoint.This journal is SINTA 5 accredited (Decree of the Director General of Higher Education, Research and Technology Number 10/C/C3/DT.05.00/2025 dated March 21, 2025 concerning the Accreditation Rating of Scientific Journals for Period I of 2025) starting from Volume 2 Number 2 of 2022 to Volume 7 Number 1 of 2027. The International Journal of Health Science (IJHS) aims at highlighting evidence on Surgical Medical Practice, Pharmacy, Maternity, Child Health, Mental Health, Dental, Medical Education, Midwifery, Medicine and Nursing, Health Policy and Management, Community Nutrition, Environmental Health, Epidemiology, Reproductive Health, Health Promotion, Occupational Safety & Health, Other Health Professions to a global audience. The International Journal of Health Science (IJHS) publishes three times a year (in March, July, November). IJHS welcomes submissions of original research, theory and concept development, perspectives, letters to the editors, research methodology papers, study protocols, nursing philosophy papers, case studies, and guest editorials on various clinical and professional health and nursing topics. We also welcome "negative" results (i.e., studies that do not demonstrate a hypothesized difference or relationship). Discussion papers that focus on the concerns and challenges confronting health care in a particular nation are encouraged, as long as the discussion is supported by research. The authors are writing to both a global and a local audience. IJHS publishes most publications in health and nursing science or practice. There are no restrictions on authorship, as long as publications meet the stated objectives and scopes, particularly regarding consequences for health and nursing science or practice. IJHS's intended readership includes health scientists and nurses from all spheres and levels who are committed to advancing practice and professional development through the application of new knowledge and evidence, such as managers and senior members of the health and nursing professions; health and nurse educators as well as students; and researchers from other disciplines with interest in common issues and inter-disciplinary collaboration. Indexed by: Journal Sponsors and Partners :
Impact of Psychological Stress on Immunity in Chronic Infections (HIV and TB)
Human immunodeficiency virus (HIV) infection and tuberculosis (TB) remain major global health challenges, affecting not only morbidity and mortality but also patients’ quality of life and everyday functioning. In both chronic infections, psychological stress and common mental disorders—particularly depression and anxiety—often coexist and are strongly shaped by social determinants. These psychological conditions may, in turn, influence immune function and contribute to poorer clinical outcomes. This literature review explores the relationship between psychological stress, mental disorders, and immune alterations through a psychoneuroimmunology perspective. The review highlights how chronic stress activates the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system, increasing cortisol and catecholamines and forming a neuroendocrine–immune network that may suppress cellular immunity when stress is persistent. The findings support the importance of integrating medical care with psychological and social interventions to improve long-term outcomes among people living with HIV and TB.
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The Relationship Between Molecular Subtypes and Histological Grade of Nottingham Breast Carcinoma at dr. H. Jusuf SK Regional General Hospital
subtype and histological grade, both of which influence prognosis and therapeutic strategy. Although molecular classification using immunohistochemistry has become a standard component of breast cancer management, data regarding its correlation with histological grade in secondary healthcare facilities remain limited. This study aimed to analyze the relationship between molecular subtypes and histological grade of Nottingham breast carcinoma at dr. H. Jusuf SK Regional General Hospital. This retrospective analytical cross-sectional study included breast carcinoma patients diagnosed between January 2023 and September 2025. Only cases with complete immunohistochemical data (ER, PR, HER2, and Ki-67) were included in the analysis. Molecular subtypes were classified as Luminal A, Luminal B, HER2-enriched, and Triple-negative, while histological grading was determined using the Nottingham Histologic Score system (Grade I–III). The association between molecular subtype and histological grade was analyzed using Fisher’s Exact test, with statistical significance set at p < 0.05. A total of 51 patients met the inclusion criteria. Luminal B was the most frequent subtype (39.2%), followed by Luminal A (27.5%), HER2-enriched (25.5%), and Triple-negative (7.8%). Grade III tumors accounted for 51.0% of cases. HER2-enriched (69.2%) and Triple-negative (75.0%) subtypes were predominantly associated with Grade III tumors, whereas Luminal A tumors were more frequently associated with Grade II (57.1%) and lower-grade tumors. Statistical analysis demonstrated a significant association between molecular subtype and histological grade (Fisher’s Exact test, p < 0.05). These findings indicate a statistically significant relationship between molecular subtype and histological grade in Nottingham breast carcinoma. More aggressive molecular subtypes, particularly HER2-enriched and Triple-negative, are strongly associated with higher histological grade. This result highlights the biological concordance between molecular behavior and tumor differentiation and underscores the importance of comprehensive immunohistochemical evaluation in breast cancer management.
The Relationship Between Therapy Compliance and the Incidence of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients. A Study at the Primary Health Facility (FKTP) Pratama Clinic Tanjung Purwokerto
Background: Diabetic retinopathy is a microvascular complication of diabetes resulting from blood vessel damage in the retina, which can lead to blindness. Several studies indicate low levels of therapy adherence in diabetes mellitus patients. At FKTP Tanjung Clinic Purwokerto, one-third of diabetic patients fail to perform routine glycemic control. Objective: To examine the relationship between therapy adherence and the incidence of diabetic retinopathy in type 2 diabetes mellitus patients at FKTP Tanjung Clinic Purwokerto. Method: This study employed an observational analytic design with a cross-sectional approach. A total of 35 patients from FKTP Tanjung Clinic Purwokerto were selected through consecutive sampling. Therapy adherence was measured using the MMAS-8 questionnaire, while the incidence of diabetic retinopathy was determined via posterior segment examination using an indirect ophthalmoscope by an ophthalmologist. Fisher’s exact test was used for hypothesis testing. Results: Among the 35 respondents, 2.9% had high adherence, 42.9% had moderate adherence, and 54.3% had low adherence. The incidence of diabetic retinopathy was 28.6%, while 71.4% showed no signs of retinopathy. Fisher’s test analysis revealed a p-value of 0.474, indicating no significant relationship between therapy adherence and the occurrence of diabetic retinopathy in type 2 diabetes mellitus patients. Conclusion: There is no significant relationship between therapy adherence and the incidence of diabetic retinopathy in type 2 diabetes mellitus patients at FKTP Tanjung Clinic Purwokerto.
The Effect of Health Education About Tuberculosis on Knowledge and Attitudes Toward Preventing the Transmission of Tuberculosis in the Families of TB Patients at the Purbalingga Community Health Center
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and transmitted through the air when individuals with pulmonary TB cough and release bacteria that can be inhaled by others. Preventive efforts are necessary to reduce its spread, and health education is one strategy to increase public awareness. This study aimed to examine the effect of tuberculosis health education on the knowledge and attitudes of families in preventing TB transmission among patients’ families at the Purbalingga Community Health Center. This quantitative study used a pre-experimental method with a one-group pre-test–post-test design. A total of 48 families of TB patients were selected using purposive sampling. Data were collected through questionnaires measuring respondents’ knowledge and attitudes. Most respondents were female (79.2%), aged 46–55 years (39.6%), related to the patient as siblings (37.5%), and had a senior high school or vocational school education level (56.3%). The findings showed that knowledge improved from the adequate category before education (64.6%) to the good category after education (72.9%). Attitudes also changed significantly from mostly negative (66.7%) to positive (95.8%) after the intervention. Statistical analysis using the Paired Sample T-Test showed a p-value of 0.000 (<0.05), indicating a significant effect of health education on improving knowledge and attitudes toward preventing TB transmission. These results indicate that health education is an effective intervention to increase awareness and promote preventive behavior among families of TB patients.
Smartphone Addiction and Sleep Quality in Adolescents at SMA N 1 Singorojo
Smartphone addiction is the interest in using smartphones excessively and ignoring the negative effects that may arise. Smartphone use that exceeds reasonable limits has a high risk that can affect sleep disorders and a person's sleep quality. This study aims to analyze the relationship between smartphone addiction and sleep quality in high school adolescents. This type of quantitative research is a correlational design with a cross-sectional approach . The research sample calculated by the Slovin formula resulted in 236 respondents with the Disproportionale Stratified Random Sampling method . The instruments used were the Smartphone Addiction Scale (SAS) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. The results showed that most respondents experienced moderate and severe levels of addiction (40.7%) and poor sleep quality (71.2%). The Spearman Rank test showed a p value = 0.000 (p <0.05) and r = 0.469, which means there is a positive relationship with a moderate category between smartphone addiction and sleep quality in adolescents. So it can be concluded that the higher the level of smartphone addiction, the worse the sleep quality.
Analysis of Risk Factors for Acne Vulgaris in Grade X–XI Students at Rantepao Christian High School, North Toraja Regency
Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that often occurs in adolescents. Various factors have been reported to be associated with the occurrence and characteristics of acne, including genetic factors, dietary patterns, psychological stress, skin care habits, and cosmetic use. However, the relationship between these factors and acne severity varies across populations. Objective: This study aimed to analyze factors associated with acne severity in grades X–XI students at Rantepao Christian High School, North Toraja Regency. Methods: This was an observational analytical study with a cross-sectional design. The sample consisted of 100 grades X–XI students selected using a total sampling technique. Data were collected using a structured questionnaire that included information on family history of acne, consumption patterns of sweet foods and dairy products, stress levels, facial skin care habits, and cosmetic use. Stress levels were measured using the Perceived Stress Scale (PSS). Acne severity was assessed based on the number of acne lesions and categorized into several levels of severity through physical examination of the patients. Data analysis was performed using ordinal regression to evaluate the relationship between study variables and acne severity. Results: The distribution of acne severity showed that most respondents experienced mild acne (53%), followed by moderate acne (40%), and severe acne (7%). Bivariate analysis showed that consumption patterns of sweet foods and dairy products were associated with acne severity (p=0.002) and cosmetic use showed a significant association in the initial analysis (p=0.040). In multivariate ordinal regression analysis, consumption patterns of sweet foods and dairy products remained associated with acne severity (p=0.019), and stress levels showed an association in the multivariate model (p=0.027). Family history, facial skin care habits, and cosmetic use did not show a significant association after adjustment for variables in the analysis model. Conclusion: Several factors measured in this study showed an association with acne severity in the adolescent population studied.
Analysis of Online Game Addiction with Emotional Disorders in Grade IV, V, and VI Children at Mangunsari 01 Elementary School, Semarang City
Online game addiction in elementary school children is a growing problem along with technological developments. This condition can have a negative impact on children's emotional development, such as difficulty controlling emotions and decreased social interaction skills. This study was conducted with the aim of determining the relationship between online game addiction and emotional disorders in children at Mangunsari 01 Elementary School, Semarang City. Researchers used a quantitative method with a cross-sectional approach. The sample of this study was 45 respondents using a total sampling technique. The results showed a p-value of 0.000 (p <0.05), which means there is a significant relationship between game addiction and emotional disorders in Mangunsari 01 Elementary School, Semarang City. The correlation coefficient (r) value is 0.774. This value indicates that there is a very strong and unidirectional relationship between online game addiction and emotional disorders. Which means the higher the level of game addiction, the more abnormal the emotional disorders.
The Effect of Reproductive Health Education on Adolescent’ Attitudes Toward Premarital Sexual Behavior at SMK Ma’arif NU 1 Cilongok
Premarital sexual behavior among adolescents remains a reproductive health concern that requires attention. Reproductive health education is expected to influence adolescents’ attitudes toward risky sexual behavior. This study aimed to determine the effect of reproductive health education on adolescents’ attitudes toward premarital sexual behavior at SMK Ma’arif NU 1 Cilongok. This research used a quantitative analytic method with a pre-experimental one group pre-test and post-test design. The sample consisted of 209 respondents selected using a total sampling technique. The instrument used was an attitude questionnaire, and data analysis was performed using the Wilcoxon Signed Rank Test. The results showed that prior to receiving education, most respondents were in the moderate attitude category (92.8%). After the intervention, most respondents shifted into the high attitude category (99.5%). Statistical analysis showed a p-value of 0.000, indicating a significant effect of reproductive health education on adolescents’ attitudes regarding premarital sexual behavior. It is recommended that schools conduct reproductive health education regularly to improve attitudes and awareness among adolescents in preventing risky sexual behavior.
The Relationship Between Knowledge and Compliance with Occupational Safety and Health Implementation Among Nursing Profession Student
Occupational Safety and Health in Hospitals (K3RS) is an important effort in creating a safe working environment for health workers, including nursing students undergoing clinical practice. The high risk of workplace accidents highlights the importance of compliance with K3 implementation, which is influenced by, among other things, the level of knowledge. Objective: This study aims to analyze the relationship between knowledge and compliance with Occupational Safety and Health (OS H) implementation among nursing students at Muhammadiyah University of East Kalimantan. Method: This study used a quantitative method with a descriptive analytical design through a cross-sectional approach. The research sample consisted of 145 second-semester nursing students at Muhammadiyah University of East Kalimantan, selected using total sampling technique. The research instrument was a questionnaire on OSH knowledge and compliance that had been tested for validity and reliability. Data analysis was performed using Spearman's rank correlation test. Results: The analysis results showed a significant value of p = 0.000 (p < 0.05) with correlation coefficient of r = 0.558, indicating a significant and strong relationship between knowledge and compliance with OSH among nursing students. Conclusion: There is a significant relationship between knowledge and compliance with occupational safety and health (OSH) among nursing students. Increasing students' knowledge is expected to improve compliance with OSH during clinical practice.
Comparison of Support Vector Machine and Random Forest Classification Methods in Dengue Fever Sentiment Analysis
Dengue fever is a prevalent disease in Indonesia, caused by the dengue virus and transmitted by Aedes aegypti and Aedes albopictus mosquitoes. This study aims to analyze sentiment in tweets related to dengue fever using two machine learning algorithms: Support Vector Machine (SVM) and Random Forest. The dataset consists of 1,000 manually labeled tweets, categorized into three sentiment classes: Positive, Negative, and Neutral. The results indicate that the SVM algorithm outperformed Random Forest in terms of performance metrics. Specifically, SVM achieved higher accuracy (77.07%) compared to Random Forest (73.65%). Additionally, SVM demonstrated superior precision, recall, and F1-score, making it a more effective model for sentiment analysis in this context. These findings suggest that SVM is a promising tool for analyzing public sentiment on social media platforms, particularly for monitoring health-related issues like dengue fever. The study highlights the potential of machine learning techniques in improving public health surveillance and response by analyzing social media data for real-time insights.
The Relationship between Knee Functional Disability and Sleep Quality in Genitourinary Osteoarthritis Patients: A Systematic Literature Review
Knee osteoarthritis is a leading cause of chronic pain and functional disability, particularly among adults and the elderly, and is often accompanied by sleep disturbances. The functional disability of the knee and sleep quality are interrelated, contributing to a decline in patients’ quality of life. This systematic literature review aims to examine the relationship between knee functional disability and sleep quality in patients with knee osteoarthritis, evaluating the consistency and strength of this connection based on recent studies. Following PRISMA guidelines, a search of the Scopus, PubMed, Google Scholar, SpringerLink, and ScienceDirect databases was conducted for articles published from 2021 to 2025. Inclusion criteria encompassed studies on knee osteoarthritis patients, addressing knee functional disability and sleep quality through cross-sectional, cohort, or quasi-experimental designs. Ten articles met the inclusion criteria and were analyzed using a descriptive-narrative approach. Results showed a significant association between knee functional disability and poor sleep quality, with pain, stiffness, and activity limitations identified as key contributors. Many studies reported a bidirectional relationship, where sleep disturbances increased pain and worsened functional limitations. About 60% of studies highlighted sleep quality as a predictor of functional decline and knee osteoarthritis progression. These findings emphasize the importance of a rehabilitation approach that includes improving sleep quality to manage knee osteoarthritis effectively.
Comparison of Vital Signs and Oxygen Saturation Between Light Smokers and Heavy Smokers Among Engineering Students at Jambi University
Smoking remains a major public health concern, particularly among university students, as it can affect cardiovascular and respiratory physiological responses. This study aimed to compare vital signs and oxygen saturation between light smokers and heavy smokers among engineering students at Jambi University. This research used an analytic observational method with a cross-sectional approach conducted from February to August 2026. The population consisted of 1,713 engineering students, with a total sample of 104 respondents divided equally into light smokers (52) and heavy smokers (52). Data were collected through questionnaires and direct physiological measurements after a 20-meter shuttle run as standardized physical stress. Univariate and bivariate analyses were conducted using the Mann–Whitney test. The results showed that heavy smokers had higher mean systolic blood pressure (149.76 mmHg), diastolic blood pressure (99.07 mmHg), pulse rate (129.90 bpm), respiratory rate (27.13 breaths/min), and body temperature (37.45°C) compared to light smokers, while oxygen saturation was slightly lower (97.50%). Bivariate analysis indicated significant differences in all physiological variables (p < 0.05). In conclusion, smoking degree significantly affects vital signs and oxygen saturation after physical activity, with heavy smokers showing greater physiological responses and lower oxygen saturation.
Inflammatory Profiles and Glycemic Status in Type 2 Diabetes: Correlational Analysis of HbA1c, Leukocytes, and NLR
Background: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia due to impaired insulin secretion or action. Prolonged hyperglycemia elevates HbA1c levels, which may compromise leukocyte phagocytic function, leading to increased infection and inflammation risk. Leukocytosis has been linked to atherosclerosis and metabolic syndrome in T2DM, and an elevated neutrophil-to-lymphocyte ratio (NLR) is also associated with metabolic syndrome.Objective: This study aimed to investigate the correlation between HbA1c levels, leukocyte count, and NLR values in patients with T2DM at Kilisuci Hospital, Kediri City.Methods: A cross-sectional design was employed. Thirty T2DM outpatients from the Internal Medicine Polyclinic at Kilisuci Hospital were recruited via purposive sampling between March 17 and April 15, 2025, based on inclusion and exclusion criteria. HbA1c level served as the independent variable, while leukocyte count and NLR value were dependent variables. Data were analyzed using Kendall's tau-b correlation test.Results: No significant correlations were observed between HbA1c levels and leukocyte count (p = 0.858) or between HbA1c levels and NLR values (p = 0.830). However, a significant positive correlation was found between leukocyte count and NLR values (p = 0.000), with moderate strength (τ = 0.480).Conclusion: HbA1c levels do not correlate with leukocyte count or NLR values in T2DM patients. Nevertheless, a significant correlation exists between leukocyte count and NLR. Future research should include larger sample sizes, incorporate secondary data alongside primary data, and compare NLR with other inflammatory markers.
The Application of Oxygen Theraphy in Patiens with Mild Head Injuries to Improve Oxygen Saturation in Cases of Ineffective Breathing Patterns at the Emergency Departement of Pelamonia Hospital Makassar
Head injury is a global health issue with an increasing prevalence, primarily due to traffic accidents. This condition has the potential to cause hemodynamic disturbances, decreased oxygen saturation, and impaired cerebral perfusion, all of which impact patient clinical outcomes. In cases of mild head injury, decreased oxygenation can worsen neurological status and slow the recovery process. Oxygen therapy is a primary intervention in emergency care to maintain adequate oxygenation and prevent cerebral tissue hypoxia. Objective: To apply oxygen therapy to patients with mild head injuries to improve oxygen saturation in cases of ineffective breathing patterns. Methods: A case study was conducted through comprehensive nursing care, encompassing assessment, diagnosis, planning, implementation, and evaluation, using data collection techniques such as interviews, observations, physical examinations, and documentation. A literature review was conducted by reviewing relevant scientific literature. Results: The application of oxygen therapy demonstrated improved oxygen saturation, improved breathing patterns, hemodynamic stability, and increased patient consciousness. Conclusion: Oxygen therapy is effective as a nursing intervention in improving oxygenation status and clinical condition in patients with mild head injury and ineffective breathing patterns.
The Relationship Between Maternal Compliance and Atti-tude in Iron-Folic Acid Supplementation During Pregnancy and the Incidence of Stunting Among Toddlers
Stunting remains a critical public health issue in Indonesia, reflecting chronic nutritional deficiencies during the crucial first 1,000 days of life. This study focuses on the UPTD Puskesmas Warung Jambu in Bogor, where 123 children were recorded as stunted in 2024. The research addresses the problem of whether maternal compliance and attitudes toward Iron-Folic Acid (IFA) or Tablet Tambah Darah (TTD) consumption during pregnancy are linked to stunting outcomes in toddlers. The primary objective is to analyze the relationship between these maternal factors and the incidence of stunting in this specific population. Using a cross-sectional analytical survey method, data were collected from 69 mothers between November 17 and November 20, 2025, using questionnaires and anthropometric measurements processed via WHO Anthro software. Univariate analysis revealed a high stunting prevalence of 56.5%, while 68.1% of mothers were compliant with IFA consumption and held positive attitudes. Bivariate Chi-square analysis demonstrated a significant relationship (p=0.000) between maternal compliance and stunting, as well as between maternal attitudes and stunting (p=0.000). These findings synthesize the idea that consistent IFA intake (at least 90 tablets) and a proactive maternal mindset are vital for preventing growth failure. In conclusion, poor compliance and negative attitudes significantly increase the risk of stunting, highlighting the need for collaborative educational interventions by health workers and the government to ensure optimal nutrition during pregnancy.
The Relationship Between Physical Activity and Sitting Duration and the Incidence of Low Back Pain
Medical students are at high risk for musculoskeletal issues due to heavy academic workloads and prolonged sedentary habits. This study aims to investigate the relationship between physical activity intensity, sitting duration, and the incidence of low back pain (LBP) among students at the Faculty of Medicine, Universitas Kristen Indonesia, in 2025. An analytical observational research method with a cross-sectional design was employed. A sample of 104 participants was selected using simple random sampling, and data were collected through the Nordic Musculoskeletal Questionnaire (NMQ) and the International Physical Activity Questionnaire (IPAQ). The findings revealed that 51.9% of respondents experienced LBP, with 76.9% of students sitting for more than seven hours daily and 55.8% maintaining low physical activity levels. Statistical analysis using the chi-square test demonstrated a significant correlation between prolonged sitting duration and LBP incidence (p = 0.021). Conversely, physical activity levels showed no significant association with the occurrence of LBP (p = 0.984). In conclusion, excessive sitting duration is a primary risk factor for LBP in medical students, while physical activity levels do not directly influence its occurrence in this population. These results suggest an urgent need for ergonomic education and the promotion of active lifestyles to mitigate spinal health issues.
The Integration of Individual and Behavioral Factors in Needle Stick Injuries Among Nurses in Hospitals: A Literature Review
Needle stick injury (NSI) is one of the most common occupational hazards among nurses and poses a significant risk of transmitting infectious diseases. The occurrence of NSI is influenced by multiple interacting factors, requiring a comprehensive approach to understand these determinants in an integrated manner. This study aimed to analyze the integration of individual and behavioral factors associated with NSI among nurses. The findings indicate that individual factors such as age, education level, and years of service contribute to the basic capacity of nurses in understanding occupational risks. Behavioral factors, including unsafe practices, needle recapping, and non-compliance with standard operating procedures, are the direct causes of NSI. Work environment factors, such as safety training, occupational safety systems, and workload, influence the development of such behaviors. The study concludes that NSI is the result of an interaction between individual, behavioral, and work environment factors, with behavioral factors being the most dominant determinant. Therefore, prevention efforts should be carried out comprehensively by promoting safe behavior supported by a conducive work environment and safety system.
A Description of BCG Scars from BCG Vaccination Recorded in the Health Records of 1-Year-Old Children at Posyandu Centers in the Raja Basa Indah Public Health Center District, Bandar Lampung City in 2013
Immunization is an important measure for preventing infectious diseases that should be administered from an early age to boost children’s immunity against various dangerous diseases. One of the mandatory basic immunizations for infants is the Bacillus Calmette-Guérin (BCG) vaccine, which aims to prevent tuberculosis (TB). Following BCG vaccination, a scar typically forms at the injection site as a sign of the body’s immune response to the vaccine. This study aims to determine the characteristics of BCG scars in children aged ≤ 1 year recorded in the KMS at the Posyandu in the Raja Basa Indah Public Health Center, Bandar Lampung City, in 2013. The study used a descriptive survey method with an observational approach. The study population consisted of 707 children, and the sample comprised 88 children selected using simple random sampling. Data collection was conducted through direct observation of the presence of BCG scars on the children’s right upper arms and documentation based on the Health Development Card (KMS). Data analysis was performed using univariate analysis with SPSS version 16 and presented in the form of frequency distributions. The results showed that of the 88 children who had received BCG immunization, 67 children (76.1%) developed a BCG scar, while 21 children (23.9%) did not. The development of a BCG scar is influenced by several factors, such as the injection technique, vaccine dose, vaccine quality, and the child’s immune system. This study shows that most children who have received the BCG vaccine develop a scar as a sign of successful immunization.
Congenital Talipes Equinovarus : A Systematic Review of Relapse as a Primary Outcome of the Ponseti Method
Congenital Talipes Equinovarus (CTEV) or clubfoot is a common congenital musculoskeletal deformity characterized by cavus, adduction, varus, and equinus abnormalities. The Ponseti method is currently the gold standard for conservative treatment of idiopathic CTEV due to its effectiveness and minimally invasive approach. This systematic review aimed to evaluate recurrence rates following Ponseti treatment and identify factors associated with relapse. The review was conducted according to PRISMA guidelines using PubMed, Scopus, Embase, and Cochrane Library databases. Studies involving idiopathic CTEV patients treated with the Ponseti method and followed for at least two years were included. Of 310 identified articles, five studies met the eligibility criteria. Recurrence rates ranged from 3.7% to 67.3%, with an average of approximately 20–30%. The main factors associated with relapse were poor compliance with foot abduction brace use, higher Pirani scores, age at initial casting, and longer follow-up duration. Recurrence commonly presented as equinus, adduction, varus deformities, or dynamic supination. Although most relapses responded to repeat casting or minimally invasive procedures, severe cases required additional corrective interventions. Long-term follow-up, family education, and brace adherence remain essential for preventing recurrence and maintaining successful outcomes.
Emotional and Behavioral Problems Among Senior High School Adolescents
Emotional and behavioral problems among adolescents represent a critical issue influencing psychological and social development during a transitional phase of life. The aim of this study is to describe the prevalence and patterns of emotional and behavioral difficulties among adolescents at SMA Kristen Citra Bangsa Kupang, East Nusa Tenggara in 2024. This cross sectional study was conducted from July to August 2024 with a sample of 391 students from grades X to XII. Data collection was performed using the standardized Strengths and Difficulties Questionnaire (SDQ) to measure dimensions including emotional symptoms, conduct problems, hyperactivity, peer relationship issues, and prosocial behavior. The findings indicate that abnormal emotional symptoms were significantly more prevalent in female students (22.5%) than in males (4.9%), while abnormal prosocial behavior was more frequently observed in males (2.3%). Age-based analysis revealed that abnormal emotional problems peaked at age 15 (19.6%), whereas hyperactivity reached its highest abnormal levels at age 16 (4.8%). The study concludes that adolescent emotional and behavioral issues manifest in distinct patterns influenced by age and gender. These results synthesize the need for systematic mental health screening within schools to facilitate early intervention. Implementing gender-specific support and age-appropriate psychological services is essential to mitigate long-term negative consequences, such as academic decline and social withdrawal, thereby ensuring optimal adolescent development in the region.
Effectiveness of McRoberts and Rubin Maneuvers in the Management of Shoulder Dystocia: A Systematic Review
Shoulder dystocia is an obstetric emergency that occurs when the baby’s shoulder becomes stuck behind the mother’s pubic bone after the head has been delivered. It occurs in about 0.2–3% of vaginal births and can cause serious complications for both the mother and baby. Because it is difficult to predict, quick and effective management is very important. The two most common techniques used to manage shoulder dystocia are the McRoberts maneuver and the Rubin maneuver. The McRoberts maneuver involves flexing the mother’s legs toward her abdomen to widen the pelvic outlet and help release the baby’s shoulder. The Rubin maneuver involves applying pressure above the pubic bone or rotating the baby’s shoulder to reduce the obstruction and assist delivery. The McRoberts maneuver is usually the first method used because it is simple, fast, and effective. It is often combined with the Rubin maneuver to improve the chance of successful delivery. If these methods do not work, other obstetric maneuvers may be needed. Studies have explored whether using the McRoberts maneuver before shoulder dystocia occurs can prevent the condition. However, current evidence is still limited, and more research is needed to confirm its effectiveness. Overall, the McRoberts and Rubin maneuvers are important techniques for managing shoulder dystocia. Early recognition, prompt action, and proper training of healthcare professionals are essential to reduce complications and ensure a safer delivery for both mother and baby.
Holistic Care for Sleep Quality and Mental Health of Postnatal Mothers
The postpartum period is an important and vulnerable time for the health of mothers after childbirth. Data shows that the prevalence of sleep disorders and the risk of postpartum depression globally is 14%, in Asia 26-85%, and in Indonesia 50-70%. At the Gatak Community Health Center, integrated holistic interventions for sleep quality and mental health are limited. This study aims to examine the effect of holistic care on PSQI and EPDS in postpartum mothers through interventions consisting of relaxation techniques, education, and psychosocial support. Methods: A quasi-experimental one-group pretest-posttest design and purposive sampling were used on 15 postpartum mothers with the criteria of age 18-40 years, 1-6 weeks postpartum, good communication skills, and signing an informed consent form. Results: Paired t-test analysis (p<0.05) showed a significant effect of holistic care on the sleep quality and mental health of postpartum mothers through a comparison of pretest-posttest means. Conclusion: Holistic care is effective in reducing cortisol, improving sleep hygiene and social support, and can be implemented in primary care settings in Indonesia. Recommendations: Integrate PSQI/EPDS into maternal and child health guidelines, conduct training for midwives, and conduct further research using RCTs.
Pharmacological and Phytochemical Activities of Celery Roots and Stems (Apium graveolens L.): Literature Review
Celery (Apium graveolens L.) is an herbaceous plant of the Apiaceae family used in traditional medicine to lower blood pressure, treat digestive disorders, and maintain liver and kidney health. Comparative studies on phytochemical content and pharmacological activities of each plant part remain limited. This study aimed to review antioxidant, anti-inflammatory, and antihypertensive activities and identify phytochemical compounds in each part based on literature from 2020 to 2025. This study used a literature review design with the PICOS framework and secondary data from Google Scholar, PubMed, ScienceDirect, and ResearchGate, conducted at STIKes Al-Fatah Bengkulu over two months. The findings demonstrated that celery roots and stems possess antioxidant, anti-inflammatory, and antihypertensive activities attributed to flavonoids, phenolic compounds, phthalides, essential oils, coumarins, triterpenoids, and minerals. Antioxidant activity was reflected by free radical scavenging capacity and enhancement of endogenous antioxidant defense systems, while anti-inflammatory activity involved inhibition of pro-inflammatory mediators and inflammation-related enzymes. Antihypertensive effects were associated with inhibition of angiotensin-converting enzyme (ACE), vasodilation, diuretic activity, and improved electrolyte balance. Overall, celery stems exhibited more consistent pharmacological evidence, particularly for antihypertensive activity supported by clinical studies, whereas celery roots showed promising potential that requires further experimental and clinical validation. These findings provide scientific evidence supporting the development of celery as a standardized herbal medicine and phytopharmaceutical raw material.
The Relationship between Self-Compassion Ability and Stress Levels of Adolescents at SMP Negeri 3 Gondangrejo, Karanganyar
The developmental transition of adolescence in 9th-grade students is frequently accompanied by heightened psychosocial pressures, such as academic workloads and anxiety regarding continuing higher education. To mitigate the risk of mental health disorders, internal capacity in the form of self-awareness and self-acceptance (self-compassion) becomes a crucial aspect to explore. Objective: This study aimed to analyze the relationship between self-compassion capabilities and stress levels among adolescents at SMP Negeri 3 Gondangrejo Karanganyar. Methods: The research design utilized a quantitative approach with a census method (total sampling) involving 95 respondents from 9th-grade students. Data collection was conducted from March to April 2026 using questionnaire instruments. Univariate analysis was applied to describe demographic characteristics, while bivariate analysis employed the Spearman's Rank ( ) correlation test. Results: The majority of respondents were female (53.7%), fell within the age range of 15 years old (47.4%), and lived with their parents (76.8%). Univariate analysis indicated that most students possessed a high level of self-compassion (85.3%) and experienced low levels of stress (74.7%). Based on the Spearman's Rho correlation test, the correlation coefficient was -0.310 with a significant p-value of 0.002 ( ). Conclusion: There is a significant negative relationship with a moderate correlation strength between self-compassion and stress levels in adolescents. Higher self-compassion capabilities in students correspond to lower experienced stress levels. These findings imply the importance of integrating self-compassion-based psychoeducation within educational institutions and optimizing community psychiatric nursing care to maintain the psychological stability of adolescents.
The Effectiveness of Iron Supplementation Combined with Vitamin C on Increasing Hemoglobin Levels Among Pregnant Women
Gestational anemia remains a critical public health issue that significantly increases the risk of maternal and fetal complications. Despite high distribution rates of iron tablets in Deli Serdang, the incidence of anemia among pregnant women continues to rise due to low compliance and poor intestinal absorption. This quantitative study applied a pre-experimental One-Group Pretest-Posttest design in Wonosari Village, Tanjung Morawa, to evaluate the clinical effectiveness of co-administering oral iron tablets combined with Vitamin C on increasing maternal hemoglobin levels. A sample of 39 pregnant women was selected using purposive sampling. Capillary hemoglobin levels were measured using digital point-of-care testing before and after the intervention, with data analyzed via the Paired Sample t-Test. Laboratory findings showed that the mean hemoglobin level rose significantly from 11.21 g/dL at pretest to 13.60 g/dL at posttest, demonstrating a mean absolute increase of 2.39 g/dL. The proportion of healthy respondents rose from 66.65% to 97.43%, while mild anemia cases dropped from 33.35% to 2.57%. The inferential statistical analysis generated a value of $p < 0.000$, proving that the co-administration of oral iron tablets alongside Vitamin C is highly effective in elevating maternal hemoglobin levels and eradicating gestational anemia.
The Effectiveness of Spiritual Education to Reduce Anxiety in Hemodialysis Patients
Chronic kidney disease (CKD) is a global health problem that affects millions of people, with hemodialysis as the primary therapy in the late stages of the disease. Hemodialysis patients often face anxiety due to physical, mental, and social changes. Spiritual support plays an important role in reducing anxiety and improving the quality of life. Objective: To evaluate the effectiveness of spiritual education in reducing anxiety in hemodialysis patients. Methods: Education using systematic observation of the literature review based on the guidance of the Joanna Briggs Institute (JBI). Literature review searches were conducted in various databases, PubMed, Google Scholar, BMC, ScienceDirect, Wiley Online Library, Breflands and ResearchGate. Using relevant keywords, resulting in 10 articles that are explained in depth. Results: Spiritual education was effective in reducing the anxiety of hemodialysis patients by improving understanding, providing meaning in life, and strengthening coping mechanisms. Supporting factors include nurse involvement, access to information, and family support. The obstacles found include limited resources and lack of awareness. Conclusion: Spiritual education contributes to improving the psychological well-being of hemodialysis patients. The role of nurses in providing a holistic approach is essential to help patients cope with physical, mental, and social challenges.
Determination of Dominant Factors of Community Nursing Practice Readiness of Final Year Nursing Students and Their Implications for Learning
Community nursing practice readiness is an important outcome of nursing education because it determines the ability of final-year nursing students to enter professional roles. This study aims to determine the dominant factors associated with practice readiness and explain their implications for learning. The study used a quantitative analytical design with a cross-sectional approach on final-year nursing students who had participated in community practice. Data were collected using a Likert-scale questionnaire measuring self-efficacy, practice experience, preceptor support, and practice readiness. Analysis was conducted using descriptive statistics, simple linear regression, and multiple linear regression. Separately, self-efficacy, practice experience, and preceptor support were positively and significantly related to practice readiness, with R² of 0.712, 0.669, and 0.794, respectively. In the simultaneous model, self-efficacy was the dominant factor with a beta of 0.63 and p<0.001. Preceptor support remained significant at the borderline significance, while practice experience was no longer significant. The final model explained 81% of the variation in practice readiness. This study concludes that students' self-efficacy is a key element of practice readiness. The novelty of the study lies in the simultaneous examination of three factors in the context of community nursing. Its contribution is to help institutions establish learning priorities based on factors that remain robust after all variables are analyzed statistically together. These findings provide an empirical basis for strengthening learning through simulation, reflection, decision-making, and targeted preceptor mentoring.
The Effectiveness of Combination Toothbrushing and Suctioning for Oral hygiene Protocol in Reducing VAP in Intubated Patient: A Systematic Review of Randomized Controlled Trials
Intubated patients admitted to intensive care units (ICUs) are highly susceptible to impaired oral immunity, resulting in rapid oral microbial colonization, dental plaque accumulation, dry mouth, and other oral health problems. Poor oral hygiene is strongly associated with ventilator-associated pneumonia (VAP), a leading cause of morbidity and mortality among mechanically ventilated patients. This study aimed to evaluate the effectiveness of combining toothbrushing and suctioning during oral hygiene in reducing the incidence of VAP in intubated patients. A systematic review was conducted using the PICO framework and PRISMA guidelines to identify and analyze relevant studies. The findings showed that oral hygiene interventions included swabbing, toothbrushing, suctioning, mouth rinsing, and oral moisturizing. Although not all reviewed studies demonstrated a statistically significant reduction in VAP incidence with the combined use of toothbrushing and suctioning, several reported lower VAP rates compared with swabbing alone. Variations in outcomes were likely influenced by differences in oral care protocols, mouthwash solutions, toothbrush types, suction devices, and intervention frequency. Overall, comprehensive oral hygiene incorporating toothbrushing and suctioning appears to improve oral health and may contribute to reducing VAP risk when supported by standardized evidence-based nursing protocols.
The Relationship Between Family Support and Fall Risk Prevention in Children in Inpatient Rooms Zal AR SUD Dr. H. Slamet Martodirdjo Pamekasan
Falls remain a major patient safety concern in hospital settings, including pediatric wards. Children are vulnerable to falls during hospitalization due to their active movements and curiosity toward their surroundings. This study aims to examine the relationship between family support and fall prevention efforts among pediatric patients in the ZAL A Inpatient Unit of Dr. H. Slamet Martodirdjo Regional Hospital, Pamekasan. An observational analytic study with a cross-sectional approach was conducted. From 114 families of children identified as fall-risk patients, 89 respondents were selected using simple random sampling. Data were collected using a 15-item family support questionnaire and the Humpty Dumpty Fall Scale, then analyzed using the Chi-Square test. The results showed that 82.0% of families provided adequate support, while 67.4% of children were categorized as high risk for falls. Among families with low support, 93.8% of children were classified as high risk, whereas among families with better support, 61.6% were high risk and 38.4% were low risk. The Chi-Square test showed a p-value of 0.029 (p < 0.05), indicating a significant relationship between family support and fall prevention outcomes. Stronger family support contributes to improved fall prevention among hospitalized children.
A Systematic Review of the Role of Medical Humanities in Fostering Medical Doctor Professionalism
The rapid advancement of healthcare technology and Artificial Intelligence (AI) has transformed medical practice by improving diagnostic accuracy, clinical decision-making, and healthcare efficiency. However, these developments have also raised concerns regarding the potential decline of humanistic values, empathy, ethical reasoning, and patient-centered care among future medical doctors. Medical humanities has emerged as an interdisciplinary educational approach that integrates ethics, philosophy, literature, history, arts, and narrative medicine to strengthen professionalism and humanistic competencies in medical education. This study aimed to systematically synthesize the existing evidence regarding the role of medical humanities in fostering medical doctor professionalism and to identify effective educational approaches applicable in the AI era. A systematic review was conducted following the PRISMA 2020 guidelines through comprehensive literature searches in major scientific databases. Eligible studies were selected based on predefined inclusion and exclusion criteria, followed by quality assessment, data extraction, and narrative thematic synthesis. The findings consistently demonstrate that medical humanities positively contributes to the development of empathy, communication skills, ethical decision-making, reflective capacity, and professional identity formation among medical students and medical doctors. Educational strategies such as narrative medicine, reflective writing, visual arts, literature-based learning, and ethics discussions were identified as effective interventions for strengthening professionalism. Despite methodological heterogeneity across studies, the overall evidence supports the longitudinal integration of medical humanities into competency-based medical curricula. This review concludes that medical humanities plays a fundamental role in preparing future medical doctors who are capable of utilizing AI while maintaining professionalism, ethical integrity, compassion, and patient-centered care in contemporary healthcare.
Non-Steroidal Anti-Inflammatory Drug Use and the Risk of Incident Heart Failure in Patients with Type 2 Diabetes Mellitus: A Systematic Review
Background: Patients with diabetes have a two to five times higher risk of experiencing heart function problems compared to the general population. In addition, it is known that the use of non-steroidal anti-inflammatory drugs (NSAIDs) is currently very widespread, which functions to manage chronic pain, even though it is known that the use of NSAIDs has side effects on the patient’s cardiorenal function. This systematic review aims to evaluate the relationship between the use of NSAIDs and the risk of incident heart failure in patients with type 2 diabetes mellitus by following the PRISMA 2020 guidelines. Methods: This study conducted a comprehensive search strategy on several journal sources, including: PubMed, Scopus, PMC Europe, and Openalex, The selected journals had criteria including: journals in the last 10 years, The type of research selected was an observational study evaluating the incidence of heart failure in adult patients with Diabetes mellitus who used NSAIDs. Two reviewers independently screened the studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results: Five study involving more than 3 million respondents was analyzed. It was concluded that short-term NSAID use was associated with increased risk of first-time hospitalization for heart failure. This risk was significantly higher in the elderly subgroup over 65 years of age and in patients with uncontrolled HbA1c levels.Conclusion: NSAID administration increases heart failure risk in patients with diabetes mellitus, particularly those over 65 and with poor glycemic control.
Application of Deep Breathing Relaxation Therapy on the Violent Behavior of Patients with Schizophrenia
Schizophrenia is a chronic mental disorder that triggers maladaptive emotional responses, such as violent behavior, which can endanger the patients themselves, others, or the environment. Deep breathing relaxation therapy serves as a non-pharmacological management that stimulates the parasympathetic nervous system, lowers stress hormones, and enhances anger control capabilities. To determine the effect of deep breathing relaxation therapy on violent behavior in patients with schizophrenia. This study utilized a one-group pre-test and post-test approach. The deep breathing relaxation therapy was implemented for 7 consecutive days with a duration of 15 minutes per day for 4 male respondents with violent behavior at RSJD Dr. Amino Gondohutomo. The instruments used were the Standard Operating Procedure (SOP) for deep breathing relaxation therapy along with a violent behavior observation questionnaire. This study has been declared ethically cleared under letter number 000.9/1347/II/2026. Prior to the intervention (pre-test), the respondents' average self-control capability score was 50% (poor). Following the intervention (post-test), the score increased to 82% (good). The patients became calmer, less irritable, and their aggressive impulses were reduced. The application of deep breathing relaxation therapy is effective and has a significant influence on enhancing self-control and reducing violent behavior in schizophrenic patients.
Eating Behavior in Response to Psychological Distress Emerging Adulthood Women
Emerging adulthood is a crucial transitional period prone to psychological distress, during which women are twice as likely to experience emotional mental health disorders that may trigger eating disorders. This study aims to examine the relationship between depression, anxiety, and stress and eight dimensions of eating behavior in young adult women. The study employed a quantitative correlational design with a cross-sectional approach, involving a sample of 127 female respondents (aged 17–25 years; 79.5% rural, 20.5% urban) from Blaru Village (Pati Regency) and Rejoso Village (Jombang Regency). The Depression Anxiety Stress Scales-21 (DASS-21) was used to measure psychological distress, while eating behavior characteristics were assessed using the Adult Eating Behavior Questionnaire (AEBQ). The results of the descriptive analysis showed a very high level of emotional distress among the respondents, with a prevalence of moderate to very severe depression reaching 100%, severe to very severe anxiety at 96.1%, and severe to very severe stress at 73.2%. The Spearman rank correlation test revealed a specific dualism in eating responses, in which depression, anxiety, and stress were found to have highly significant positive correlations (ρ < 0.01). The anxiety variable showed the strongest correlation with the tendency to refuse food or undereat due to emotions (rs = 0.359; ρ = 0.000). Conversely, psychological distress did not show a significant relationship (ρ > 0.05) with the six subscales of biological homeostasis-based eating behaviors (such as Hunger and Satiety Responsiveness). This study concludes that emotional mental disorders do not impair the basic mechanical functions of the digestive system but rather selectively disrupt the regulation of emotional eating control at the higher cortical cognitive level (cognitive override).
The Effect of Elderly Exercise on Blood Pressure Among Older Adults with Hypertension in Lumban Pea Village, Balige District, Toba Regency, 2026
The physiological aging process triggers a decline in vascular function, which impacts the high escalation of hypertension cases in the elderly population. This study aims to analyze the empirical effect of elderly gymnastics on reducing blood pressure among elderly hypertensive patients in Lumban Pea Village, Balige District, Toba Regency in 2026. This type of research was quantitative with a pre-experimental design using a one-group pretest-posttest design without a control group. The sample in this study consisted of 31 respondents selected using a purposive sampling technique from a total population of 35 hypertensive elderly. The elderly gymnastics intervention was conducted twice a week for three weeks with a duration of 30 minutes per session. Blood pressure measurements were taken using a calibrated digital sphygmomanometer 30 minutes before and after the entire intervention series. The results of the univariate analysis showed a decrease in mean systolic blood pressure from 150.00 mmHg to 140.48 mmHg, and diastolic pressure from 94.48 mmHg to 90.48 mmHg. The Shapiro-Wilk normality test indicated that the data were normally distributed ( ). Based on the bivariate Paired Sample T-Test, a p-value of 0.001 was obtained for systolic pressure and 0.003 for diastolic pressure ( ). In conclusion, elderly gymnastics has a significant effect on lowering systolic and diastolic blood pressure through the mechanism of blood vessel vasodilation and decreased sympathetic nerve activity.
The Effectiveness of Family-Based Digital Health Literacy in Improving Self-Health Monitoring in Active Farmers with Limited Mobile Phone Access
Active farmers are a group of workers at risk of experiencing various health problems due to physical workload, environmental exposure, and limited access to health information. Low digital health literacy and limited mobile phone ownership mean that self-health monitoring has not been carried out optimally. One effort to overcome this problem is through family-based digital health literacy. This study aims to analyze the effectiveness of family-based digital health literacy on improving self-health monitoring in active farmers who have limited access to mobile phones. This study used a Pre-Experimental Design with a One Group Pretest-Posttest Design approach. The study sample consisted of 32 active farmers selected using purposive sampling. Data were collected using a family-based digital health literacy questionnaire and analyzed univariately and bivariately using the Wilcoxon Signed Rank Test with a significance level of α = 0.05. The results showed that 17 respondents (53.1%) experienced an increase in digital health literacy scores after the intervention, while 15 respondents (46.9%) had scores that remained the same. The results of the Wilcoxon Signed Rank Test showed a Z value of -4.123 with Asymp. Sig. (2-tailed) = 0.000 (p < 0.05), indicating a significant difference between pre- and post-intervention scores. It was concluded that family-based digital health literacy effectively improved digital health literacy as an effort to support self-health monitoring in active farmers with limited access to mobile phones. This intervention can be used as a family-based health promotion strategy in community nursing practice, especially in rural communities.
Wound Healing Potential of Spatholobus littoralis Hassk: A Literature Review of Its Antioxidant, Anti-Inflammatory, and Antibacterial Activities
Spatholobus littoralis Hassk (Bajakah) is a traditional medicinal plant widely used in Indonesia, particularly in Kalimantan, for various health conditions. Previous studies have reported its antioxidant, anti-inflammatory, and antibacterial properties, which are essential in the wound healing process. This study aims to evaluate the potential of Spatholobus littoralis as a natural therapeutic agent in wound healing based on available experimental and clinical evidence. This study was conducted using a literature review approach by analyzing published articles related to the biological activities of Spatholobus littoralis, including antioxidant, anti-inflammatory, antibacterial, and wound healing effects. Articles were obtained from PubMed, ScienceDirect, Google Scholar, and GARUDA databases using predefined keywords. After the screening and selection process based on inclusion and exclusion criteria, a total of 28 articles were included in this review. The findings indicate that Spatholobus littoralis contains bioactive compounds, including flavonoids, phenolic compounds, tannins, and saponins, which contribute to wound healing through antioxidant, anti-inflammatory, and antibacterial activities. These mechanisms regulate oxidative stress, modulate inflammatory responses, and inhibit wound-associated pathogens. The included studies consistently suggest that these biological activities support the potential of Spatholobus littoralis as a natural wound-healing agent. However, variations in extraction methods, formulations, and concentrations were observed across the included studies. Spatholobus littoralis demonstrates significant antioxidant, anti-inflammatory, and antibacterial activities that support its potential as a natural wound-healing agent. However, further studies are needed to standardize extraction methods, determine the optimal dosage form and therapeutic dose, and evaluate its long-term safety and clinical effectiveness.
The Effect of Lavender Aromatherapy on Anxiety in Non-Hemorrhagic Stroke Patients
Non-hemorrhagic stroke occurs due to an interruption of blood flow to the brain caused by thrombus or embolus blockage in blood vessels. Stroke patients may experience psychological problems, including emotional instability, depression, and anxiety. One non-pharmacological intervention to reduce anxiety is lavender aromatherapy, which provides a relaxation effect. This study aimed to determine the effect of lavender aromatherapy on anxiety levels in non-hemorrhagic stroke patients. The study used a quantitative approach with a quasi-experimental one-group pretest-posttest design. The sample consisted of 36 non-hemorrhagic stroke patients in the working area of Mranggen 2 Community Health Center, selected using purposive sampling. Data were collected using the Hamilton Anxiety Rating Scale (HARS) questionnaire and analyzed through univariate and bivariate analysis using the Wilcoxon test. The results showed that before receiving lavender aromatherapy, most respondents experienced moderate anxiety (22 respondents; 61.1%). After the intervention, most respondents experienced mild anxiety (21 respondents; 58.3%). The Wilcoxon test showed a significance value of 0.000 (p < 0.05), indicating that lavender aromatherapy significantly reduced anxiety levels in non-hemorrhagic stroke patients. Lavender aromatherapy can be used as an effective complementary therapy to manage anxiety among stroke patients.
Understanding the Triage System With the Level of Anxiety of Patient Families in the Emergency Room
The Emergency Department (ED) is the primary entry point for patients requiring urgent medical attention, and the triage system used to classify patients by severity often becomes a source of confusion for waiting families. When families do not understand why patients are treated in a particular order rather than by arrival time, feelings of worry and distress tend to increase. This study aimed to determine the relationship between family understanding of the triage system and the level of anxiety experienced by patients' families in the Emergency Department of RSUD Dr. Moewardi Surakarta. This research applied a quantitative observational-analytic design with a cross sectional approach. Ninety respondents were recruited through purposive sampling based on inclusion criteria. Data were collected using a validated triage-understanding questionnaire and the Hamilton Anxiety Rating Scale (HARS), then analyzed using the Spearman Rank correlation test. The results showed that most respondents had insufficient understanding of the triage system (62.2%) and experienced severe anxiety (42.2%). The correlation test produced a p-value of <0.001 (p<0.05) with a correlation coefficient of 0.504, indicating a moderate, positive, and statistically significant relationship: the lower the family's understanding of triage, the higher their anxiety level, and vice versa. These findings suggest that structured therapeutic communication and triage education for waiting families could be an effective strategy to reduce anxiety in the emergency setting.
The Effect of Seaweed Pudding as a Complementary Therapy on Increasing Hemoglobin (HB) Levels in Anemic Pregnant Women
Anaemia in pregnancy continues to be a significant public health concern that heightens the likelihood of maternal and perinatal complications. Alongside iron tablet supplementation, there is a necessity for supplementary therapy utilising locally recognised foods for pregnant women. Seaweed (Eucheuma cottonii) is rich in iron, minerals, and bioactive substances that may aid in haemoglobin synthesis. This research is to examine the impact of seaweed pudding as an adjunct therapy on the elevation of haemoglobin (Hb) levels in anaemic pregnant women. The study employed a quasi-experimental framework utilising a pretest-posttest control group methodology. A sample of 36 anaemic pregnant women was split into an intervention cohort (n=18) that was administered seaweed pudding along with iron supplements, and a control cohort (n=18) that got solely iron supplements for a duration of 14 days. Haemoglobin levels were assessed prior to and following the intervention utilising a digital hemoglobinometer. Data evaluation was performed utilising paired sample t-tests and independent sample t-tests, with a significance threshold of p<0.05. The findings indicate that the mean Hb levels in the intervention group rose from 9.72±0.51 g/dL to 11.12±0.48 g/dL, whereas the control group had an increase from 9.68±0.56 g/dL to 10.28±0.52 g/dL. The elevation of Hb levels in the intervention group was markedly greater than that in the control group (p<0.001). The utilisation of seaweed pudding as an adjunct therapy significantly elevates haemoglobin concentrations in pregnant women suffering from anaemia and may serve as a community-based dietary strategy for the prevention and treatment of anaemia in pregnancy.
Self-Confidence and Knowledge Level of Indonesian Red Cross (PMI) Volunteers in Administering First Aid to Traffic Accident Victims
Introduction: Traffic accidents occur widely across regencies and cities in Central Java, including Kendal Regency, where data indicates 490 incidents resulting in 485 victims with minor injuries and 129 fatalities. Minimizing these impacts requires prompt and appropriate first aid from trained responders, such as Indonesian Red Cross (PMI) volunteers. The success of first aid interventions is heavily influenced by cognitive factors—specifically knowledge—and psychological factors, namely self-confidence. This study aims to assess the self-confidence and knowledge levels of PMI volunteers regarding first aid for traffic accident victims. Methods: This study employed a quantitative, descriptive survey design. The sample consisted of 43 PMI volunteers selected via accidental sampling. Data were collected using a self-confidence questionnaire (adapted from Lauster) and a knowledge assessment questionnaire. Univariate analysis was performed to determine frequency distributions. Results: The respondent profile was predominantly female (60.5%), with an average age of 21 years and a majority holding a high school education (65%). Findings indicate that the majority of PMI volunteers (97.6%) possessed a "Good" level of knowledge. Most respondents also demonstrated a high level of self-confidence (56%), driven by the alignment between cognitive mastery and field experience. Discussion: Based on the findings, it is concluded that all volunteers should be provided with equal opportunities to learn, practice, and actively participate in handling field cases, particularly those involving victims with severe bleeding.
Therapeutic Effects of Cajuput Oil (Melaleuca Cajuputi) in Respiratory Health
Respiratory tract diseases present significant challenges to global public health, requiring the development of multi-targeted, therapeutic interventions. Cajuput oil (Melaleuca cajuputi or Melaleuca leucadendra) and its primary monoterpene constituent, 1,8-cineole (eucalyptol), have demonstrated a broad spectrum of anti-inflammatory, antioxidant, spasmolytic, and antimicrobial properties. This systematic review synthesizes preclinical and clinical evidence to evaluate the therapeutic efficacy, underlying molecular mechanisms, clinical safety, and formulation advancements of cajuput oil and 1,8-cineole in managing upper and lower respiratory tract diseases. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic literature search was executed across PubMed, EuropePMC, and OpenAlex databases up to early 2026. Primary studies investigating the therapeutic effects of cajuput oil or 1,8-cineole in preclinical (in vitro and in vivo) and clinical respiratory disease models were selected. Six independent reviewers conducted the study screening, selection, data extraction, and risk of bias assessment. Result: Thirteen original studies met the rigorous eligibility criteria. In vivo animal models of pulmonary emphysema, pulmonary fibrosis, and allergic asthma showed that 1,8-cineole significantly attenuates tissue destruction, inflammatory cell infiltration, and fibrotic deposition. These cellular responses were mediated by the upregulation of Nrf2-driven antioxidant cascades and the suppression of NF-κB, p38 MAPK, and STAT6 inflammatory signaling pathways. Spasmolytic activities in human bronchial tissues were achieved via reversible H₁-receptor blockade and H₂-receptor/α-adrenoceptor activation. Furthermore, 1,8-cineole exhibited strong antimicrobial and antibiofilm properties against multidrug-resistant Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. In clinical trials and observational studies, oral administration of 1,8-cineole (including a novel amoxicillin-clavulanate-cineole formulation) significantly improved symptom severity and accelerated recovery in acute bronchitis, rhinosinusitis, and lower respiratory tract infections with excellent tolerability.
Parents' Experiences in Managing Treatment Compliance of Children with Thalassemia: A Phenomenological Study
Background: Thalassemia major is a chronic genetic disorder that requires lifelong treatment, including routine blood transfusions and iron chelation therapy. This chronic condition demands the absolute involvement of parents as primary caregivers in managing treatment compliance to ensure an optimal quality of life for the child. Objective: This study aimed to explore in depth the subjective experiences of parents in managing treatment compliance for children with thalassemia. Methods: This study utilized a qualitative design with a descriptive phenomenological approach. Informants were selected using a purposive sampling technique at RSUD Dr. Moewardi Surakarta, involving 6 parents as primary participants. Data were gathered through in-depth interviews, non-verbal observations, and medical record documentation. The data were then analyzed using qualitative thematic analysis. Results: The analysis revealed 4 major themes: (1) Psychological shock and initial acceptance process, (2) Parents' adaptive strategies in maintaining child compliance, (3) Social support networks as a reinforcing factor, and (4) The dynamics of compliance between blood transfusion (high due to immediate clinical impact) and iron chelation therapy (low due to boredom and side effects). Conclusion: Parents of children with thalassemia face complex psychosocial and technical challenges. There is an imbalance in adherence between blood transfusion and iron chelation. These results emphasize the crucial need for family-centered nursing interventions and sustainable psychological support to mitigate caregiver burnout.
Risk Factors for Sexual Dysfunction in Postpartum Mothers in Makassar City
Postpartum sexual dysfunction remains an under-recognized problem despite its high global prevalence, ranging from 41% to 83% within the first six months after delivery. In Makassar, Indonesia, sociocultural taboos and the exclusive focus of primary postpartum care on uterine involution, wound healing, lactation, and immunization have left sexual function screening largely unaddressed. This study aimed to identify the risk factors associated with sexual dysfunction among postpartum mothers in Makassar City. An analytical observational study with a cross-sectional design was conducted among 117 postpartum mothers selected through consecutive sampling. Sexual function was measured using the Female Sexual Function Index (FSFI), and data were analyzed using Chi-Square followed by multiple logistic regression. The results showed that 82.9% of respondents experienced sexual dysfunction. Pregnancy complications were the only variable significantly associated with sexual dysfunction (p = 0.001; Adjusted OR = 52.63; 95% CI 4.78–500.00), indicating markedly higher odds of sexual dysfunction among mothers with pregnancy complications, while age, parity, education, occupation, income, and residence showed no significant associations. These findings highlight the need for structured sexual function screening and integrated biopsychosocial education in primary postpartum care services.
The Effect of Local Wisdom-Based Health Education and Mentoring on Changes in Knowledge about Nutrition for Pregnant Women at the Wara Selatan Community Health Center in 2026
Background: Knowledge of pregnant women about nutrition is an important factor that influences the behavior of meeting nutritional needs during pregnancy. Low knowledge can increase the risk of chronic energy deficiency (CED), anemia, low birth weight (LBW), and stunting. One effort that can be done to improve the knowledge of pregnant women is through mentoring and health education based on local wisdom that utilizes the potential of local culture and food so that it is more easily accepted by the community. Objective: This study aims to analyze the effect of mentoring and health education based on local wisdom on changes in knowledge about nutrition of pregnant women at the Wara Selatan Community Health Center, Palopo City in 2026. Method: This study used a quasi-experimental design with a one group pretest-posttest design approach. The study was conducted at the Wara Selatan Community Health Center, Palopo City in May–June 2026. The study population was all 44 pregnant women who visited the Wara Selatan Community Health Center. The sample was determined using a total sampling technique so that 44 respondents were obtained. Data collection was carried out using a questionnaire on knowledge about nutrition of pregnant women before and after the intervention. Data analysis used the Wilcoxon Signed Rank Test with a significance level of α = 0.05. Results: Before the intervention, the majority of respondents had poor knowledge (47.7%), while after the intervention, the majority were in the sufficient (45.4%) and good (43.2%) categories. The Wilcoxon Signed Rank Test results showed a Z value of -5.014 with Asymp. Sig. (2-tailed) = 0.000 (p<0.05), indicating a significant difference in knowledge before and after the intervention. Conclusion: Local wisdom-based health education and mentoring significantly improved nutritional knowledge among pregnant women at the Wara Selatan Community Health Center in Palopo City. This intervention model can be used as an innovation in antenatal care to improve the knowledge of pregnant women and support efforts to prevent CED, anemia, low birth weight (LBW), and stunting during the first 1,000 days of life.
The Effect of Benson and Murottal Al-Qur'an Relaxation Therapy Surah Ar-Rahman on the Quality of Life of Diabetes Mellitus Patients in the Kaliwungu Kudus Health Center Area
Diabetes Mellitus is a chronic disease that can reduce the quality of life of patients from physical, psychological, social, and environmental aspects. This study aims to analyze the effect of the combination of Benson relaxation therapy and the murottal Al-Qur'an Surat Ar-Rahman on the quality of life of Diabetes Mellitus patients in the working area of the Kaliwungu Kudus Health Center with a quasi-experimental pretest–posttest control group design. A total of 36 respondents were divided into intervention and control groups of 18 people each, with measurements using WHOQOL-BREF. The results showed that the median quality of life of the intervention group increased from 43.00 to 78.13 after seven days of intervention with a significant Wilcoxon test (p=0.000), while the control group showed no significant change with a median of 39.00 to 40.13 (p=0.068). The Mann–Whitney test showed significant differences between the two groups (p=0.000), so it can be concluded that the combination of Benson relaxation therapy and Qur'anic murottal is effective in improving the quality of life of Diabetes Mellitus patients and has the potential to be applied as a complementary intervention in nursing practice.
The Effect of Supplementary Feeding (PMT) for Fifty-Six (56) Days on Weight Gain Among Underweight Toddlers in the Working Area of Blang Kuta Community Health Center
Lack of access to nutritious food is a major obstacle to health development worldwide, but this problem is particularly acute in areas such as Pidie Jaya Regency, where children often suffer from malnutrition. The Supplementary Feeding Program (PMT) is one way to ensure that malnourished toddlers receive the nutrition they need, including higher intakes of calories and protein. This research intends to evaluate the impact of providing PMT for 56 days on the weight gain of undernourished toddlers within the area served by the Blang Kuta Community Health Center in the Bandar Dua District of Pidie Jaya Regency. This study employed a quantitative descriptive-analytical approach combined with a single-group pre-experimental design (pretest-posttest). Total sampling from the community was used to determine the study sample size, which consisted of 26 malnourished children who received PMT for 56 days. A significance level of 0.05 was used to evaluate the data using the Paired Sample t-Test. The study findings showed a significant change in body weight before and after PMT administration, with an average increase of 0.281 kg (p = 0.005). These findings indicate that the body weight of malnourished toddlers increased significantly after receiving PMT prepared from local food ingredients. In summary, the PMT program, when applied consistently and sustainably, plays a crucial role in improving the nutritional status of children and aids in efforts to lower malnutrition rates at the community health center level.
The Correlation between Vitamin C Intake, Fiber Intake, and Academic Stress Levels with Anemia Incident among Female Students at the Medicine Faculty of State University of Surabaya
Anemia remains a critical public health problem, particularly among young women, including female university students. Its occurrence is influenced by dietary intake and psychological factors such as academic stress. This study aimed to analyze the relationship between vitamin C intake, fiber intake, academic stress, and anemia incidence among female medical students at Universitas Negeri Surabaya. A cross-sectional analytical observational design was used with 85 respondents selected through proportional stratified random sampling. Vitamin C and fiber intake were assessed using the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ), academic stress was measured with the Perceived Academic Stress Scale (PASS), and anemia status was determined through hemoglobin measurement using the Easy Touch GCHb device. The Chi-Square test analyzed associations between nutrient intake and anemia, while Fisher’s Exact Test examined the relationship between academic stress and anemia. The results showed significant associations between vitamin C intake and anemia (p < 0.001), fiber intake and anemia (p < 0.001), and academic stress and anemia (p = 0.003). Anemia was common among respondents with insufficient vitamin C intake, low fiber intake, and high stress levels. These findings indicate that adequate nutrition and effective stress management are important for reducing anemia risk among female students in this population
Microplastics in Indonesia's Aquatic Ecosystems: Hidden Threats to Human Health and Environmental Sustainability
Microplastics have become a widespread environmental threat in Indonesia's aquatic ecosystems, an archipelagic country that has historically and recently been recorded as one of the world's major contributors to plastic pollution. Although studies on the presence of microplastics in Indonesian waters have been quite developed in terms of the quantity of publications, synthesis that specifically integrates the dimensions of human health and environmental sustainability in an integrated manner is still relatively limited, making it difficult to formulate a comprehensive picture for research and policy development. This study aims to identify the distribution and characteristics of microplastics in Indonesia's aquatic ecosystems, analyze their impact on human health, and examine their implications for environmental sustainability. The approach used is Systematic Literature Review (SLR) following the PRISMA protocol with the PICOS framework, covering articles published in the range of 2017–2026. Of the 64 articles identified, 15 primary studies were obtained along with one comparative narrative review that was synthesized thematically. The results of the synthesis show that microplastics are widespread ranging from small rivers to open seas, with local anthropogenic pressures, rather than the mere presence of water bodies, as the main determinant of pollution intensity, while mangrove areas consistently function as natural accumulation points. In the health dimension, the consumption of marine products was identified as the most documented route of exposure, although the level of quantifiable risk was still limited by the lack of Indonesia's population-based toxicology reference values. This synthesis also reveals significant geographical biases, with the majority of studies concentrated on the island of Java. These findings confirm that microplastic pollution is a multidimensional issue that connects ecosystem quality, food safety, and public health, and recommends expanding research to the eastern region of Indonesia and developing local toxicology reference values as future research priorities.
Dermatological Disease Patterns by Age and Sex: A Two-Year Analytical Study in an Urban Private Practice, Jakarta (2024–2025)
Background: Skin diseases represent a major burden in outpatient dermatology settings in Indonesia. The pattern of dermatological diagnoses varies substantially by age group and sex, reflecting differences in hormonal milieu, environmental exposures, and immune function. Objective: To describe and analytically assess the distribution of dermatological diagnoses stratified by age group and sex among patients attending in a private health and beauty clinic in Menteng, Central Jakarta, from January 2024 to December 2025. Methods: A cross-sectional, analytic observational study was conducted using secondary data from the clinic’s visit records. A total of 8,105 patient visits were included. Diagnoses were classified by ICD-10 code and stratified into eight broad age groups: Infants (<1 years), Young Children (1-4 years), Older Children (5-9 years), Young Adolescent (10-14 years), Older Adolescents (15-19 years), Young Adults (20-24 years), Adults (25–59 years), and Elderly (≥60 years). Chi-square (X²) goodness-of-fit was used for hypothesis testing. Results: Female patients predominated (74.9%; x2 = 2,016.761, p < 0.001). The most common diagnoses were acne vulgaris (n = 1,230; 15.2%), atopic dermatitis (n = 756; 9.3%), chloasma (n = 740; 9.1%). Acne vulgaris peaked in the Adults group (65.2% of all acne cases), chloasma in the Adults group (87%), and atopic dermatitis in the Adults group (34.9%). Chi-square analysis revealed that all top-10 diagnoses showed statistically significant non-uniform age distribution (all p < 0.001). Conclusion: Dermatological diagnoses at this private health and beauty clinic are age- and sex-patterned. These findings provide a basis for age-targeted prevention, early detection, and clinical resource allocation in urban private dermatology practice.