Contagion: Scientific Periodical Journal of Public Health and Coastal Health
Journal title CONTAGION: Scientific Periodical Journal of Public Health and Coastal Health Subject Public Health Language English, Indonesia ISSN 2685-0389 (online) Frequency Three times a year in February-June, July-October, and November-January. DOI Prefix 10.30829/contagion by Crossref Editor-in-chief Putra Apriadi Siregar, M.Kes (Scopus ID: 57485278200) Publisher Fakultas Kesehatan Masyarakat (FKM) UIN Sumatera Utara Citation Analysis Sinta2, Dimension, ASCI (Asian Science Citation Index), Google Scholar, Email contagion@uinsu.ac.id Contagion: Scientific Periodical Journal of Public Health and Coastal Health, a scientific periodic journal of Public Health published by the Public Health Study Program of the Faculty of Public Health at UINSU Medan. These journals prioritize the collaboration of lecturers and students, with the scope of the discussion being about health science, public health, health and Islam, and coastal health. The journal is published three times a year in February–June, July–October, and November–January. Telp:+62895391495346||Email: contagion@uinsu.ac.id ||e-ISSN:2685-0389
Universitas Islam Negeri Sumatera Utara, Medan
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Analysis of the Phenomenon of Acute Respiratory Infection (ARI) in Children Under Five at the Boyolali Regency Regional Health Center
Boyolali is located at the foot of Mount Merapi, and characterized by a cold, humid climate with an average temperature of 20°C. Acute Respiratory Infections (ARI) affect the upper and lower respiratory tracts for less than 14 days and are caused by viruses, bacteria, or fungi. ARI remains among the top three causes of illness in Central Java. This study aims to analyze individual and environmental factors contributing of ARI incidence in children under five years of age. An observational cross-sectional design was employed, with data collected through questionnaires. The number of children under 5 years old recorded was 109,968, resulting in a minimum sample size of 383. Questionnaires were distributed across 6 service areas of the Boyolali Public Health Center. Data analysis used binary logistic regression techniques. Results: ARI in infants (sig < 0.05). The odds ratio is 4.307. This means that infants with good individual factors will increase the number of non-ARI infants by 4.307 times. Environmental factors in infants (sig < 0.05). The odds ratio is 152.660. This means that infants with favorable environmental factors will increase of non-ARI infants by 152.660 times. Based on the results of the Spearman correlation test. Individual factors are important in environmental factors. Conclusion: In this study, both individual factors and environmental conditions significantly influence the incidence of ARI in infants in the Puskesmas in Boyolali. Keywords: Acute Respiratory Infections, Analysis, Children, Risk Factors
Copyright (c) 2025 Sri Suparti http://creativecommons.org/licenses/by-sa/4.0
Collaborative Governance for Stunting Reduction: A Qualitative Case Study from Bangka Regency, Indonesia
Stunting remains a major public health challenge in Indonesia, requiring integrated and multisectoral responses. Collaborative governance provides a framework for aligning stakeholder roles in local-level health interventions. This study examines the implementation of collaborative governance in stunting mitigation efforts in Bangka Regency, Indonesia. A qualitative case study approach was employed, involving in-depth interviews with 15 key informants representing government agencies, academia, civil society, media, and the private sector. Data were collected between February and April 2025 and analyzed thematically using the framework of collaborative governance developed by Ansell and Gash, complemented by a SOAR (Strengths, Opportunities, Aspirations, Results) analysis. Findings indicate that although a formal convergence structure exists through the Stunting Reduction Acceleration Team (TPPS), notable gaps persist in role clarity, coordination, and monitoring mechanisms. Strengths identified include strong political commitment, accredited health facilities, and supportive local regulations on sanitation and smoke-free areas. However, implementation varies across stakeholders, with unequal participation and limited outreach to remote areas. The SOAR analysis revealed key aspirations, including equitable premarital health services, behavioral change strategies, and improved performance monitoring. The study underscores the potential of collaborative governance to advance stunting prevention efforts, while emphasizing the need for improved institutional alignment, capacity building, and integrated monitoring systems. Strengthening stakeholder engagement and leveraging local aspirations into measurable actions are critical to achieving sustainable health outcomes. Keywords: Collaborative governance, Stunting, Ansell and Gash, SOAR, Indonesia
Copyright (c) 2025 Then Suyanti, Dedeh Maryani, Petrus Polyando http://creativecommons.org/licenses/by-sa/4.0
The Relationship of Risk Factors to Incidence Prediabetes Young Age Groups
Prediabetes is increasingly prevalent among young adults, presenting a critical opportunity for early intervention to prevent the onset of type 2 diabetes and associated cardiovascular complications. This study investigates the association between selected lifestyle-related risk factors and prediabetes incidence among undergraduate medical students. A total of 50 students from Diponegoro University (cohorts 2021 and 2022) were enrolled through purposive and random sampling methods. Clinical assessments included fasting blood glucose and 2-hour oral glucose tolerance tests, analyzed using the hexokinase method. Data on obesity (body mass index), sleep quality (Pittsburgh Sleep Quality Index), physical activity (International Physical Activity Questionnaire–Short Form), and family history of diabetes were collected through validated instruments. The prevalence of prediabetes was significantly higher among students with obesity (p < 0.001), poor sleep quality (p = 0.048), low physical activity (p = 0.005), and a family history of diabetes (p = 0.006). Multivariate analysis identified obesity as the most influential independent predictor (OR 7.30, 95% CI: 1.61–33.20, p = 0.010). These findings highlight the urgent need for preventive strategies targeting modifiable risk factors in young populations. Interventions focusing on healthy weight management, regular physical activity, and sleep hygiene may play a pivotal role in mitigating early metabolic risk Keywords: Prediabetes, Young Adults, Sleep Quality, Physical Activity, Medical Students
Copyright (c) 2025 Ardhia Amelia Savitri, Heri Nugroho Hario Seno, Edward Kurnia Setiawan, Meita Hendrianingtyas http://creativecommons.org/licenses/by-sa/4.0
The Anti-Inflammatory Potential of Statins in Oncology: A Focus on C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-Alpha (TNF-α) Modulation
Statins, widely known for their cholesterol-lowering effects, have demonstrated promising therapeutic potential in modulating chronic inflammation, a pivotal contributor to cancer progression. Elevated inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are frequently observed cancer patients and are associated with unfavorable prognoses. This narrative review synthesizes findings from 42 recent publications (2019–2024) retrieved via PubMed, Scopus, and Web of Science, focusing on statins’ impact on these biomarkers in oncologic contexts. The studies encompass both preclinical and clinical investigations examining statin type, dosage, cancer subtype, biomarker modulation, and synergy with conventional therapies. Findings indicate that lipophilic statins, such as simvastatin and atorvastatin, substantially reduce IL-6 and TNF-α levels by inhabiting the mevalonate pathway and RhoA activation, thereby downregulating transcription factors such as NF-κB. These downstream effects indirectly contribute to CRP suppression. Additionally, statins have demonstrated the capacity to enhance the efficacy of chemotherapeutic agents, particularly platinum compounds, doxorubicin, and taxanes, by sensitizing tumor cell sensitivity, reducing resistance, and promoting apoptosis. Despite these encouraging outcomes, most data derive from preclinical studies and small-scale clinical trials, often lacking standardized effect size reporting and longitudinal clinical endpoints. This review concludes that statins may serve as effective adjunctive agents in oncology through their anti-inflammatory properties. However, large-scale randomized controlled trials are essential to establish their long-term clinical utility, safety profile, and optimal application in cancer treatment Keyword: Statins, Cancer, Inflammation, IL-6, C-reactive protein
Copyright (c) 2025 Ariosta Ariosta, Banundari Rahmawati, Udin Bahrudin, Angela Kho http://creativecommons.org/licenses/by-sa/4.0
From Play to Practice: Designing the Menararia Board Game for Promoting Clean and Healthy Living Behavior Among School-Aged Children
Clean and Healthy Living Behavior in schools serves as a foundational step toward cultivating healthy and high-quality human resources for national development. This study aimed to develop a health promotion medium in the form of a board game called Menararia, designed to enhance knowledge and engagement among school-aged children. This research employed a qualitative research and development (R&D) design. Informants were selected purposively and consisted of three experts (a media specialist, a public health expert, and a practitioner) and three elementary school students. Data were collected through direct observation and in-depth interviews. The development process comprised strategic design, media development, and initial testing. During the strategic design phase, the team defined communication objectives using the SMART framework, launched a school-based improvement program called ARSHAT (Anak Bersih, Sehat, Kuat or Clean, Healthy, and Strong Children), identified key implementation partners (e.g., Jember Health Office, Semboro Health Center, and UNICEF Indonesia), and established an implementation timeline (March–May 2023). The development phase included creating educational materials based on eight indicators, designing game components (board, cards, and rules), and producing visual elements with consistent use of blue, white, and gray color schemes and child-friendly typography (Poppins, PhagsPa, Arial). Experts found the game largely appropriate but recommended minor adjustments. The Menararia board game shows strong potential as a health communication medium to promote Clean and Healthy Living Behavior among children. Initial feedback suggests it is engaging and contextually relevant, though minor content revisions are needed to optimize its effectiveness. Keywords: Clean and Healthy Living Behavior, Board Game, School-Aged Children, Health Promotion, Educational Media
Copyright (c) 2025 Taufan Asrisyah Ode, Ruri Andesmana, Sania Salsabila http://creativecommons.org/licenses/by-sa/4.0
Task Technology Fit in Hemodialysis Care: A Comparative Evaluation of the Renalmu.com Application in Indonesian Hospitals
Hemodialysis services are essential for patients with end-stage renal disease (ESRD), offering routine treatment to sustain health and enhance quality of life. As the prevalence of ESRD continues to rise, hemodialysis units must focus on delivering high-quality care, optimizing resource management, and ensuring patient satisfaction. To support these goals, this study employs a quantitative comparative design with a cross-sectional approach to assess the effectiveness of the Renalmu.com application in hemodialysis services. The study will include 30 respondents from two hospitals, with data analysed using the Mann-Whitney U test to compare key variables. Data collection is scheduled to begin in September 2024 and conclude in March 2025. Preliminary results from the Mann-Whitney U test indicate that while both hospitals reported similar experiences across most dimensions of the Renalmu.com application, a significant difference was observed in the Task Technology Fit (TTF) dimension of data quality. Hospital 1 demonstrated superior data quality, reflected by a U-value of 56.500 and a p-value of 0.013. No significant differences were found in other TTF dimensions, including task characteristics (non-routine, interdependence), site graphic attractiveness, privacy/security, interactivity, data locability, authorization, compatibility, product timeliness, reliability, ease of use, and user relationships. These findings suggest that the primary distinction between the two hospitals lies in the effective utilization of data quality to support clinical decision-making in hemodialysis treatment Keywords: Task-Technology Fit, Dialysis, Quality Service improvement
Copyright (c) 2025 Umi Khoirun Nisak, Irwan Alnarus Kautsar, Yahya Arif Nugroho, Aditiawardana Aditiawardana, Hamid Al-Tameemmi http://creativecommons.org/licenses/by-sa/4.0
Improvement in Cognitive Function Through Brain Gymnastics For Nursing Home Residents: A Quasi-Experimental Study from Indonesia
Cognitive function in older adults is influenced by various factors, including age, gender, education, and physical activity, all of which can contribute to cognitive decline. This decline poses a growing challenge, particularly among institutionalized elderly populations. Brain gymnastics, a simple, low-cost, non-pharmacological intervention, has shown potential for improving cognitive function, yet evidence among nursing home residents remains limited and inconsistent. This study aimed to evaluate the effect of brain gymnastics on cognitive function among older adults residing in nursing homes in North Sumatera. A quasi-experimental design was employed, involving 56 participants aged 60 to 80 years, divided into intervention (n = 28) and control (n = 28) groups through purposive sampling. The intervention group engaged in a four-week brain gymnastics program, while the control group received a self-guided exercise leaflet. The study was conducted from January to March 2025. Cognitive function was assessed using the MoCA-INA at baseline and post-intervention. Descriptive statistics, Chi-square tests, paired t-tests, and independent t-tests were used for data analysis. At baseline, both groups exhibited moderate cognitive function (62.5% and 67.9%, respectively). Post-intervention, the intervention group showed a significant improvement in mean cognitive scores from 17.64 ± 4.09 to 22.00 ± 4.46 (p < 0.001, Cohen’s d = 1.52), whereas the control group demonstrated a smaller increase. An independent t-test revealed a significant difference in post-intervention scores between the intervention (22.00 ± 4.46) and control (17.00 ± 3.23) groups (p < 0.001, Cohen’s d = 3.89), indicating a strong effect of the intervention. These findings underscore the potential of brain gymnastics as a practical, scalable, and cost-effective strategy to enhance cognitive health. Its integration into routine elderly care may help delay cognitive decline and promote healthier aging, particularly in low-resource settings. Keywords: Brain Gymnastic, Older People, Cognitive Function, Nursing Home
Copyright (c) 2025 Siska Evi Simanjuntak http://creativecommons.org/licenses/by-sa/4.0
Maternal Work Status and Nutritional Knowledge as Predictors of Toddler Stunting: Evidence from Asahan Regency, Indonesia
Stunting remains a significant public health concern in Indonesia, particularly in rural and semi-urban areas where maternal knowledge and employment status intersect with child-rearing practices. This study investigates the relationship between maternal employment, maternal knowledge, and the incidence of stunting among toddlers in the catchment area of the Simpang Empat Primary Healthcare Center, Asahan Regency. A quantitative, cross-sectional design was utilized, with data collected from 57 mothers of children aged 12–59 months via structured questionnaires distributed through Google Forms. Key variables included maternal employment status, maternal knowledge of child growth and nutrition, and child nutritional status measured by height-for-age Z-scores (HAZ), in accordance with the WHO Child Growth Standards (2006). Descriptive analysis revealed that 52.6% of mothers were unemployed, and 54.4% exhibited limited knowledge of early childhood development and nutrition. The prevalence of stunting in the sample was 43.8%. Bivariate analysis using the chi-square test identified statistically significant associations between stunting and both maternal employment status (p = 0.000) and maternal knowledge (p = 0.003). Notably, stunting was more prevalent among children whose mothers had poor nutritional knowledge, regardless of employment status. These findings underscore the dual influence of socioeconomic and cognitive factors on child nutritional outcomes. Maternal employment alone does not mitigate the risk of stunting unless accompanied by sufficient nutritional literacy and caregiving capacity. The study highlights the urgent need for community-based health education initiatives through primary healthcare centers and cadres, supported by flexible and inclusive maternal support programs that address time constraints and knowledge gaps. Strengthening maternal knowledge across socioeconomic strata is critical to achieving Indonesia’s national stunting reduction targets and advancing global child development goals Keywords: Stunting, Maternal Work Status, Maternal Knowledge, Toddler Nutrition
Copyright (c) 2025 Mestika Rija Helti http://creativecommons.org/licenses/by-sa/4.0
The Influence of Nutritional Status on the Incidence of Postpartum Hemorrhage in Three Community Health Centers (CHCs) in Dili, Timor Leste
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality in low- and middle-income countries, including Timor-Leste. This analytical cross-sectional study, conducted from January to December 2024 in three community health centers (CHCs) in Dili, examined the association between maternal nutritional status and the incidence of PPH. Nutritional indicators included pre-pregnancy body mass index (BMI), gestational weight gain, anemia status, and mid-upper arm circumference (MUAC). Data were collected from medical records of 130 postpartum mothers (65 with PPH, 65 without). The prevalence of PPH was 50%. Among participants, 22.1% had anemia (hemoglobin <11 g/dL), 50.8% had MUAC <23.5 cm, and 41.5% had a pre-pregnancy BMI outside the WHO normal range (18.5–24.9 kg/m²). Only 26.4% achieved gestational weight gain within Institute of Medicine guidelines. Logistic regression analysis revealed that anemia significantly increased the risk of PPH (OR = 3.4; 95% CI: 1.38–8.40; p = 0.011), while other nutritional indicators showed no significant association. These findings highlight the critical role of antenatal anemia screening and targeted nutritional interventions in reducing PPH risk. This study provides locally relevant evidence to inform maternal health strategies in Timor-Leste. Keywords: Postpartum hemorrhage, Pre-pregnancy BMI, weight gain, Mid-Upper Arm Circumference, Antenatal Care, Community health center
Copyright (c) 2025 Alcinda Pinto Fernandes http://creativecommons.org/licenses/by-sa/4.0
Evaluating SIMPUS Implementation at Teladan Community Health Center: a HOT-Fit Framework Analysis
Community Health Centers are required to implement a Community Health Center Information System (SIP) in accordance with Minister of Health Regulation No. 31 of 2019. Medan Teladan Community Health Center has implemented various information systems, one of which is e-Puskesmas, but still found obstacles. This study aims to evaluate the implementation of the Management Information System (SIMPUS) at Medan Teladan Community Health Center using the Human Organization Technology (HOT)-Fit method. This type of research is descriptive qualitative research. The study was conducted at Medan Teladan Community Health Center starting from December 2024 - July 2025. Informants in this study were 5 people consisting of the head of the community health center and medical record officers as key informants, registration officers, SP2TP officers and pharmacy service officers as supporting informants. Data analysis was carried out by data reduction, data presentation and drawing conclusions to identify relevant finding patterns in each aspect of HOT-Fit. The results of the study obtained an evaluation of the implementation using the HOT-Fit method on the human aspect, the user side has problems with input errors, where around 60% of informants reported data input. Organizational aspects, the organizational structure is in place, monitoring and evaluation have been carried out and guidelines for using the information system are in place even though they only adopt those from the Ministry of Health. Technology aspects, the quality of the system is still not optimal because the system has not been integrated with all programs and frequent server disruptions or data bridging failures, differences were also found between drug data in the system and actual stock in the pharmacy warehouse. Net benefit aspects, this system has succeeded in reducing dependence on manual processes and increasing data accuracy, but data integration across all programs is still an obstacle. It is recommended to the Medan City Health Office to encourage the integration of information systems between programs into one platform and ensure server stability. Keywords: System evaluation, information system, HOT-Fit
Copyright (c) 2025 Ahmad Fuadi Nasution, Sri Lestari Ramadhani Nasution, Ermi Girsang http://creativecommons.org/licenses/by-sa/4.0
Determinants of Health Workers Compliance in Implementing EMR in Regional Hospitals in Bali
Electronic Medical Records (EMRs) refer to the digitization of medical documentation and associated processes, aimed at enhancing data completeness and accuracy. This study examined the compliance of health workers with EMR system implementation. The research was conducted at Klungkung Regency Hospital in Bali, involving 520 participants, including general practitioners, specialists, nurses, midwives, medical record officers, health analysts, pharmacists, nutritionists, and radiographers. Data were collected using a structured questionnaire distributed via Google Forms, employing a total sampling technique. The findings revealed that several factors, namely competence in information technology, system knowledge, perceived benefits and ease of use, as well as organizational support and training, were significantly associated with EMR implementation. Among these, system knowledge exerted the strongest influence, with an Adjusted Odds Ratio (AOR) of 3.549. This suggests that respondents with a high level of system knowledge were over three times more likely to implement EMRs effectively compared to those with limited understanding. Knowledge plays a pivotal role in preparing health workers for technological adaptation. Those with sufficient knowledge are better equipped to navigate system features and apply them in accordance with established standard operating procedures. Health workers who possess a strong understanding of EMRs tend to be more receptive to adopting the system, underscoring the importance of comprehensive training and education. Enhancing knowledge through targeted training, socialization, and continuous professional development is essential to ensure the successful implementation and optimal utilization of EMRs in healthcare settings Keywords: Electronic Medical Record, Health Worker Compliance
Copyright (c) 2025 Luh Gde Nita Sri Wahyuningsih http://creativecommons.org/licenses/by-sa/4.0
Maternal Risk Factors Associated with Low Birth Weight: A Case Control Study in Deli Tua District
Low birth weight (LBW) remains a significant public health concern in Indonesia, contributing to neonatal morbidity, mortality, and long-term developmental challenges. Although numerous studies have explored LBW, evidence on maternal risk factors in low-resource settings particularly within independent midwife practices remains scarce. This study examined the associations between maternal age, parity, antenatal care (ANC) visits, history of anemia, and gestational weight gain with LBW incidence in Deli Tua Sub-District, Deli Serdang Regency. A case–control design was employed from December 2024 to March 2025, involving 95 postpartum mothers (35 cases, 60 controls) selected through purposive sampling. Data were collected using validated questionnaires (Content Validity Index = 0.82; Cronbach’s α = 0.85) and maternal health records, and analyzed using Chi-square tests and multivariate logistic regression (SPSS version 22). Multivariate analysis identified maternal age at risk (<25 or >35 years) as the sole significant predictor of LBW (OR = 6.69; 95% CI = 3.21–25.22; p = 0.006). Parity (OR = 2.76; p = 0.077), ANC visits (OR = 1.22; p = 0.797), history of anemia (OR = 0.57; p = 0.421), and gestational weight gain (OR = 1.20; p = 0.773) were not significantly associated with LBW. The model demonstrated acceptable fit (Hosmer Lemeshow p = 0.49; Nagelkerke R² = 0.29). Maternal age emerged as the most influential determinant of LBW in this population. These findings underscore the importance of targeted surveillance for high-risk age groups and the enhancement of promotive and preventive strategies including improved ANC service quality, nutritional counseling, and family engagement in maternal care to reduce LBW incidence in resource-limited settings. Keywords: Anemia, Antenatal Care, Gestational Weight Gain, Low Birth Weight, Maternal Age, Parity
Copyright (c) 2025 Nur Mala Sari, Peny Ariani, Putri Ayu Yessy http://creativecommons.org/licenses/by-sa/4.0
Analysis of Factors Related to The Implementation of Case Management Care at The Badung Regency Hospital, Bali
Case management is a collaborative process involving the planning, coordination, monitoring, and evaluation of services provided to patients to meet their optimal health needs. This study aims to examine the factors associated with the implementation of case management care. This analytical cross-sectional study was conducted at Badung Regency Hospital, Bali. A total of 248 healthcare professionals—including doctors, nurses, and midwives who met the inclusion criteria participated in the study. Data were collected using a structured questionnaire and analysed through univariate, bivariate (Chi-square), and multivariate (binary logistic regression) methods. Chi-square analysis revealed that case manager knowledge, hospital management support, institutional policies, and multidisciplinary team collaboration were significantly associated with the implementation of case management (p < 0.05). The most influential factors were case manager knowledge (AOR = 21.16; 95% CI: 1.66–56.07) and multidisciplinary team collaboration (AOR = 13.2; 95% CI: 1.72–100.93). The findings suggest that enhancing case managers’ knowledge and fostering stronger interprofessional collaboration may significantly improve the implementation of case management care in hospital settings Keywords: Case management, Case manager knowledge, Collaboration, Hospital care
Copyright (c) 2025 Ni Luh Putu Dina Susanti, Luh Gde Nita Sri Wahyuningsih http://creativecommons.org/licenses/by-sa/4.0
Enhancing Work Motivation Through Transformational Leadership and Change Readiness in Health Workers During Digital Era Transitions
Digital transformation in healthcare requires adaptive leadership and a workforce equipped to navigate ongoing organizational change. This study investigates the relationship between transformational leadership, readiness for change, and work motivation among healthcare professionals in Indonesia. A cross-sectional quantitative design was employed, involving 216 participants from five private hospitals selected through purposive sampling. Data were collected using a validated questionnaire assessing transformational leadership, readiness for change, and work motivation, and analyzed using Spearman’s rank correlation. Findings revealed that most respondents perceived transformational leadership at a moderate level, exhibited high readiness for change, and reported moderate to high levels of work motivation. Significant positive correlations were identified between transformational leadership and work motivation (r = 0.501; p < 0.001), transformational leadership and readiness for change (r = 0.528; p < 0.001), and between work motivation and readiness for change (r = 0.647; p < 0.001)These results underscore the pivotal role of transformational leadership in enhancing employee motivation and fostering change readiness within healthcare settings. Strengthening leadership competencies, particularly in inspirational motivation, individualized consideration, and intellectual stimulation, is vital for the successful implementation of digital transformation initiatives. The study highlights the importance of structured leadership development and institutional support in cultivating a motivated, adaptable, and innovation-oriented healthcare workforce. Keyword: Digital Transformation, Healthcare Workforce, Readiness To Change, Transformational Leadership, Work Motivation
Copyright (c) 2025 Ellynia Ellynia, Andrianto Widjaja, yarwin yari, Khalida Ziah Sibualamu, Rizqa Wahdini, Sarah Geltri Harahap http://creativecommons.org/licenses/by-sa/4.0
Response Time and Patient Satisfaction in Islamic Hospital: A Cross Sectional Study
Timely delivery of emergency services is a critical priority in healthcare systems worldwide, with both speed and accuracy in patient care serving as essential indicators of service quality. This study investigates the relationship between nurses’ response time and patient satisfaction in the emergency department of Ibnu Sina Islamic Hospital, Pekanbaru. A quantitative, cross-sectional design was employed from December 2023 to July 2024. The study population consisted of family members accompanying patients to the emergency department. Using accidental sampling and the Slovin formula, a total of 94 participants were selected. Data were analyzed using the Chi-Square statistical test. Among the respondents, 83 individuals (88.3%) rated the response time as fast, while 11 (11.7%) perceived it as slow. In terms of satisfaction, 72 respondents (76.6%) reported being satisfied, whereas 22 (23.4%) expressed dissatisfaction. Chi-Square analysis revealed a statistically significant association between response time and patient satisfaction (p = 0.003, p < 0.05), indicating that faster response times are positively correlated with higher levels of patient satisfaction in the emergency department. Keywords: Nurse, Response Time, Patient Satisfaction, Emergency Department, Hospital.
Copyright (c) 2025 Dilgu Meri http://creativecommons.org/licenses/by-sa/4.0
Sarcopenic Obesity in Postmenopausal Women: Associations Between Fat Mass, Muscle Mass, and Lower Limb Strength in an Indonesian Clinical Cohort
Sarcopenic obesity is an emerging public health concern, particularly among postmenopausal women. This condition is characterized by increased fat mass and reduced muscle mass, both of which negatively impact quality of life and physical function. This study employed an analytical design with a cross-sectional approach, involving 51 obese women aged 45 years and older who received care atthe Nutrition Clinic of Dustira Hospital. Fat and muscle mass were assessed using Bioelectrical Impedance Analysis (BIA), while leg muscle strength was measured with a leg dynamometer. The chi-square test was used to examine associations between variables due to its suitability for categorical data analysis. Results indicated that the majority of participants were aged 45–55 years, with 52.9% classified as having obesity category I. Descriptive analysis revealed that 66.7% of subjects had elevated fat mass, particularly intramyocellular lipid (IMCL); 80.4% exhibited very low muscle mass; and 58.8% demonstrated poor leg muscle strength. Statistical analysis showed significant associations between fat mass and leg muscle strength (p = 0.003), and between muscle mass and leg muscle strength (p < 0.001). Effect sizes measured using Cramer's V indicated a strong strength of association. These findings underscore the importance of resistance training interventions in managing sarcopenic obesity among postmenopausal women. Enhancing muscle mass and reducing fat mass, especially IMCL, may contribute to improved leg muscle strength and overall quality of life. Keyword: Fat Mass, Leg Muscle Strength, Muscle Mass, Sarcopenic Obesity, Postmenopausal Women.
Copyright (c) 2025 Wendra Wendra, Teguh Tanuwidjaja, Kishanty Hardaningtyas, Aulia Rahma Fazamuthi http://creativecommons.org/licenses/by-sa/4.0
Community-Based Risk Factor Surveillance and Its Role in Prevention of Non-Communicable Diseases in Padang: A Qualitative Study
The rise in non-communicable diseases (NCDs) is driven by risk factors such as smoking, physical inactivity, low consumption of fruits and vegetables, and alcohol use. Community-based surveillance of these risk factors is essential for NCD prevention; however, the availability and use of accurate data remain limited in many regions. Therefore, research is needed to enhance both the quality and utilization of surveillance data in NCD prevention efforts. This study aims to examine community-based risk factor surveillance activities and their role in preventing NCDs in Padang. A qualitative approach using a phenomenological method was employed. Research informants included individuals responsible for NCD programs at community health centers, health cadres, and members of the productive-age population in Padang in 2024. Informants were selected through purposive sampling. Data were primarily collected via in-depth interviews guided by a structured interview protocol. Interview transcripts were analyzed using an interactive analysis model, which included data reduction, data presentation, and conclusion drawing/verification. Findings indicate that risk factor data collection at integrated health posts was conducted both manually and electronically, with data entered into the Ministry of Health’s Asik application. Data processing and analysis were performed using the Asik application, with descriptive interpretations presented in tables and diagrams. Dissemination of risk factor information occurred through mini-workshops, although not all stakeholders were involved. Surveillance results were used to inform NCD prevention programs through counseling and community outreach. Overall, community-based risk factor surveillance data were collected manually and electronically via the Asik application, analyzed descriptively, and disseminated through workshops and follow-up activities supporting NCD prevention. The study highlights the need to improve the quality and use of community-based surveillance data, increase stakeholder engagement, evaluate intervention effectiveness, and assess the impact of surveillance applications on data processing and ongoing monitoring of NCD risk factors. Keyword: Surveillance, Risk Factors, Prevention, Non-Communicable Diseases.
Copyright (c) 2025 Abdiana Abdiana, Masrul Masrul, Hardisman Hardisman, Najirman Najirman, Rizanda Machmud, Firdawati Firdawati, Yantri Maputra, Musfardi Rustam http://creativecommons.org/licenses/by-sa/4.0
Socioeconomic and Maternal Predictors of Toddler Malnutrition: Evidence From Rural Indonesia
Deli Serdang Regency in North Sumatra remains a priority area for malnutrition interventions due to persistent socioeconomic disparities, under-resourced rural health systems, and chronic food insecurity. Although national data (Riskesdas 2018) report a stunting prevalence of 21.3%, localized health surveillance in villages such as Tanjung Anom indicates rates exceeding 30%, highlighting elevated nutritional risk among toddlers. A matched case-control study was conducted involving 64 toddlers aged 12–59 months (32 malnourished, 32 well-nourished), matched 1:1 by age group and gender. Malnutrition was defined according to WHO anthropometric Z-scores (< -2 SD for weight-for-age or height-for-age). Data collection included direct anthropometric measurement and structured maternal interviews, incorporating a 24-hour dietary recall. Conditional logistic regression was employed to account for matching, and standardized protocols were implemented to minimize selection and information bias. After adjusting for confounders, four key risk factors were significantly associated with malnutrition: poor maternal nutritional knowledge (adjusted OR = 3.91; 95% CI: 1.18–12.95; p = 0.026), low household income (aOR = 10.23; 95% CI: 2.00–52.39; p = 0.005), recent infectious disease (aOR = 6.11; 95% CI: 1.79–20.84; p = 0.004), and insufficient food intake (aOR = 72.30; 95% CI: 12.98–402.61; p < 0.001). The wide confidence interval for dietary intake reflects limitations in sample size and variability in exposure. This study is among the first matched case-control investigations in rural North Sumatra to quantitatively link maternal nutrition knowledge with child nutritional status using localized data and WHO standards. The findings underscore the need for targeted, nutrition-sensitive interventions, including strengthening Community Health Post (Posyandu) services, enhancing maternal nutrition education, promoting community home gardens, and improving rural health infrastructure. This model offers potential for scale-up through multisectoral collaboration and context-specific policy adaptation Keywords: Malnutrition, toddlers, maternal knowledge, food intake, infectious disease, Deli Serdang, nutrition-sensitive policy
Copyright (c) 2025 usti fina http://creativecommons.org/licenses/by-sa/4.0
Systemic Barriers to Postpartum Midwifery Visits and Their Effect on Exclusive Breastfeeding in Rural Indonesia
Postpartum visits by independent midwives play a critical role in initiating and sustaining exclusive breastfeeding. However, operational and institutional barriers may compromise their effectiveness, particularly in semi‑urban and rural settings such as Deli Tua District. This study examined the association between these barriers and exclusive breastfeeding practices among mothers in Deli Tua. A quantitative cross-sectional study was conducted in 2025, involving all independent midwives in the district (n = 85) and a purposive sample of 120 postpartum mothers (1–6 weeks post-delivery). Data were collected using structured questionnaires and analyzed through Chi-Square tests and multivariate logistic regression at a 95% confidence level. Key barriers negatively associated with exclusive breastfeeding included lack of government incentives (OR = 0.23; 95% CI: 0.09–0.61; p = 0.004), excessive workload and fatigue (OR = 0.33; 95% CI: 0.14–0.78; p = 0.013), high operational costs (OR = 0.38; 95% CI: 0.17–0.83; p = 0.015), and limited time for visits (OR = 0.43; 95% CI: 0.19–0.96; p = 0.043). Conversely, institutional support from health centers significantly increased the likelihood of breastfeeding success (OR = 2.01; 95% CI: 1.01–4.01; p = 0.046). Socio-cultural factors such as stigma and customary practices showed no significant association. To enhance the effectiveness of postpartum care and promote exclusive breastfeeding, the study recommends implementing performance-based incentives, reducing workload burdens, providing financial subsidies, and establishing standardized visit-time guidelines. Strengthening cross-sectoral collaboration and resource allocation is essential to improve service delivery and breastfeeding outcomes. Keywords: Exclusive breastfeeding, postpartum care, health system barriers, community midwives, maternal health services
Copyright (c) 2025 Peny Ariani1, Putri Ayu Yessy Ariescha, Dinillah Salsabila Bahar http://creativecommons.org/licenses/by-sa/4.0
Effect of Freeze-Dried Soyghurt on Malondialdehyde (MDA) Levels in Hypercholesterolemic Rats
The reduction of malondialdehyde (MDA) levels, a biomarker of lipid peroxidation holds clinical relevance in assessing oxidative stress associated with hypercholesterolemia. This study investigated the potential of freeze-dried soybean sourdough as a non-pharmacological intervention to lower cholesterol and mitigate oxidative stress in hypercholesterolemic rats. Thirty male Wistar rats were randomly assigned to 5 groups: negative control, positive control, Treatment 1 (high-fat diet containing 30% lard and simvastatin 5 mg/kg body weight), Treatment 2 (high-fat diet supplemented with soybean sourdough at 10 g/kg body weight), and Treatment 3 (high-fat diet combined with soybean sourdough and simvastatin). The intervention period lasted four weeks. Significant reductions in MDA levels were observed in Treatment Groups 1, 2, and 3, with the most pronounced decrease – 45% ( (p < 0.01) – recorded in Treatment Group 2. These findings suggest a possible interaction between soyghurt and simvastatin that may affect simvastatin's efficacy. Further research is needed to further explore this interaction and its underlying mechanisms. Keywords: Hypercholesterolemia, Soyghurt, Simvastatin, Malondialdehyde
Copyright (c) 2025 Eka Noneng Nawangsih, Aprilia Grace, Bagus Natakusuma Tirtawijaya http://creativecommons.org/licenses/by-sa/4.0
The Effect of Religiosity on Life Satisfaction Among Students in the Faculty of Teacher Training
Despite the widespread Islamization in Indonesia, a corresponding increase in life satisfaction among its population has not been clearly observed. This study investigates the impact of religiosity on life satisfaction among students in the Faculty of Teacher Training at the Islamic State University of North Sumatra. Employing a quantitative, cross-sectional design, the research was conducted between October and November 2023. The study population comprised 7.801 students, from which a sample of 380 was selected. The primary variables examined were religiosity (independent variable) and life satisfaction (dependent variable). Data were analyzed using both univariate and multivariate methods: descriptive statistics for univariate analysis and linear regression for multivariate analysis. All statistical procedures were performed using JASP software, version 17. Findings indicate that religiosity significantly influences life satisfaction among students in the Islamic education faculty (p < 0.001). Students with high levels of religiosity were found to be 6.730 times more likely to report greater life satisfaction. These results suggest that religiosity is a strong predictor of life satisfaction and that the regression model provides a robust explanation of the observed data. Nonetheless, the model may not capture all contributing factors, and future research should explore additional variables that may affect life satisfaction. Keyword: Islamization, Life Satisfaction, Religiosity, Students
Copyright (c) 2025 Fauziah Nasution, Nurussakinah Daulay, Masganti Sitorus http://creativecommons.org/licenses/by-sa/4.0
Sexual Violence Prevention Education through Snakes and Ladders Game for Adolescents at Thamavitya Mulniti School Thailand
Child sexual abuse is increasingly common in many countries and is a global concern. The Multi-disciplinary Teams (MDTs) reported 2,250 children recorded cases involving other forms of sexual violence such as molestation with a range of 561 boys and 1,689 girls. Child sexual abuse is still frequent and unresolved in Thailand. Sex education is essential for health promotion, and media plays an important role in promoting individual health status and prevention efforts. This study aims to educate the prevention of sexual violence through educational game media, namely snakes and ladders for adolescents to see the level of knowledge of adolescents regarding the prevention of sexual violence. This study is a quantitative study using a one group pretest posttest design, namely by conducting a pretest and posttest on 31 students at Thamavitya Mulniti School Thailand. Data on pre-test scores and post-test scores were analyzed using Paired Samples T-test with a 95% confidence level. Students' knowledge was obtained before education and snake and ladder games with an average score of 74.97 and students' knowledge after education and snake and ladder games with an average score of 83.16. The results of the study obtained P-Value 0.006≤0.05 means that at Alpha 5% there is a difference between the average knowledge of Pre-Test and Post-Test. There was an increase in student knowledge between before the intervention and after the intervention. The conclusion of this study is that there is an effect of sexual violence education with snakes and ladders on increasing adolescent knowledge. Keywords: Adolescent, sexual violence, snakes and ladders game
Copyright (c) 2025 Rapotan Hasibuan, Siti Kholijah, Putra Apriadi Siregar, Nuraisyah Wulandari Panjaitan, Arfan Mapa http://creativecommons.org/licenses/by-sa/4.0
Work Stress and Its Association with Employee Performance: Evidence from the North Sumatra Provincial Health Office
Work-related stress is a growing concern in public institutions, particularly in health departments where employees often face complex administrative tasks, urgent program execution, and public accountability pressures. This study aims to examine the relationship between work stress and employee performance at the Health Department of North Sumatra Province in 2025. Using a quantitative cross-sectional design, the study involved 300 employees selected through total sampling. Data were collected via structured questionnaires measuring four dimensions of work stress—task demands, role demands, organizational structure, and organizational leadership—and their association with employee performance. Chi-square tests and binary logistic regression were used for analysis. The results revealed that task demands, organizational structure, and leadership showed significant associations with performance, while role demands did not. In multivariate analysis, organizational leadership emerged as the most influential factor (Exp(B) = 2.470; 95% CI = 1.535–3.975), followed closely by organizational structure (Exp(B) = 2.345; 95% CI = 1.458–3.773). These findings indicate that employees who perceive strong leadership and well-defined organizational systems are significantly more likely to perform well. The results also suggest that unclear structures and rigid bureaucratic leadership styles may hinder performance. This study underscores the importance of organizational reforms that prioritize leadership development, structural clarity, and stress management strategies. It provides valuable empirical evidence for policymakers and health administrators to formulate targeted interventions that enhance employee well-being and institutional effectiveness in Indonesia’s public health sector. Keywords: Work-Related Stress, Employee Performance, Organizational Leadership, Public Health Sector, Organizational Structure.
Copyright (c) 2025 Sri Lestari Ramadhani Nasution, Puji Lestari, Ermi Girsang http://creativecommons.org/licenses/by-sa/4.0
The Effectiveness of Prenatal Yoga on Improving Sleep Quality of Pregnant Women in The Third Trimester: A Quasi Experimental Study at Bah Kapul and Simarimbun Health Centres, Pematangsiantar City
Disturbances in sleep are common among pregnant women, especially in the third trimester, and can negatively impact the health of both the mother and fetus. Non-pharmacological approaches, such as prenatal yoga, offer a safe and effective way to improve sleep quality. This study aims to evaluate the effectiveness of prenatal yoga in enhancing sleep quality, blood pressure, and breathing among pregnant women in the third trimester in the Bah Kapul and Simarimbun Health Centre areas, Pematangsiantar City. A quasi-experimental design was employed, with an intervention group (n = 30) and a control group (n = 30). The intervention group participated in prenatal yoga sessions lasting 60 minutes, three times a week, for eight weeks (minimum 12 sessions). Sleep quality and disturbance were measured using a dedicated assessment tool, and data analysis was conducted with SPSS. Results showed that prior to the intervention, most participants in both groups reported poor sleep quality. After the intervention, significant improvements were observed in the intervention group (p < 0.001), including a reduction in severe sleep disturbances from 6.7% to 0%. The median sleep quality score increased by 1 point in the intervention group, compared to no change in the control group (p = 0.010), while the sleep disturbance score decreased by a median of 4 points in the intervention group (p = 0.019). No significant changes were found in blood pressure or breathing (p > 0.05). The study received ethical approval from the Health Research Ethics Committee of Politeknik Kesehatan Kemenkes Medan (Reference No: 01.26.696 /KEPK/POLTEKKES KEMENKES MEDAN 2024), and written informed consent was obtained from all participants. In conclusion, prenatal yoga significantly improved sleep quality and reduced sleep disturbances in pregnant women in the third trimester and is recommended as part of the antenatal care program at health centers. Keyword: Prenatal Yoga, Pregnant Women, Sleep Disorders, Sleep Quality, Third Trimester.
Copyright (c) 2025 Parmiana Bangun, Yeyen Damanik http://creativecommons.org/licenses/by-sa/4.0
The Effect of Antenatal Yoga on Lower Back Pain in Third-Trimester Pregnant Women at Ertitawati Siregar’s Independent Midwifery Practice in Olora Village, Gunungsitoli City
Pregnancy-related low back pain (LBP) is prevalent in late gestation and can negatively affect physical comfort and psychological well-being. Non-pharmacological interventions such as antenatal yoga are increasingly incorporated into routine care; however, pragmatic evidence from community-based settings remains limited. This study examined within-subject changes in LBP severity among third-trimester pregnant women participating in a structured antenatal-yoga program delivered at a community midwifery clinic. Researchers conducted a single-group pre-experimental pretest–posttest study at an independent midwifery clinic in Gunungsitoli, Indonesia. Forty pregnant women ≥28 weeks’ gestation were recruited through purposive sampling. The intervention consisted of supervised prenatal-yoga sessions held three times per week over four weeks. Pain intensity was assessed before and after the program using the Numeric Rating Scale (NRS) and categorical severity bands (mild, moderate, severe). Pre–post differences were analysed using the Wilcoxon signed-rank test. Participation in antenatal yoga was associated with a clinically meaningful reduction in pain severity. Prior to the intervention, 62.5% of participants reported moderate pain and 37.5% reported mild pain; no cases of severe pain were observed. Following the intervention, 82.5% reported mild pain and 17.5% reported moderate pain. The change in NRS scores was statistically significant (p < 0.001). In this pragmatic third-trimester cohort, engagement in a structured antenatal yoga program was linked to reduced LBP severity and a shift toward milder pain categories. These findings support the feasibility of integrating antenatal yoga into routine prenatal care as a non-pharmacological option. Future controlled studies incorporating effect sizes, confidence intervals, functional outcomes, adherence andsafety monitoring, and short-term follow-up are recommended to strengthen casual inference and inform optimal program design. Keywords: Antenatal Yoga, Pregnancy, Third Trimester, Low Back Pain, Non-Pharmacological Intervention, Community Midwifery, Pretest–Post-test.
Copyright (c) 2025 Desi Handayani Lubis, Sri Rezeki, Erin Padilla Siregar, Pratiwi Lumbantobing http://creativecommons.org/licenses/by-sa/4.0
Analysis of Medication Adherence Level and Influencing Factors in Hypertension Patients in Samarinda City
Hypertension is a degenerative condition that significantly contributes to global morbidity and mortality, making medication adherence a critical factor in achieving long-term therapeutic success. This study investigates the relationship between patient-related factors and adherence to antihypertensive medication. A cross-sectional analytical survey was conducted among 195 hypertensive patients in Samarinda, East Kalimantan. Data were collected using a structured questionnaire incorporating the MMAS-8 scale, which categorizes adherence into high (score = 8), moderate (score = 6–7), and low (score < 6), alongside a validated instrument assessing sociodemographic, clinical, and behavioral determinants. Statistical analysis employed chi-square tests and odds ratios (OR) with 95% confidence intervals. The majority of patients demonstrated low adherence (65.6%), followed by moderate (28.7%) and high adherence (5.6%). Significant associations were found between adherence levels and gender (P = 0.033, OR = 0.513, 95% CI: 0.276–0.951), knowledge level (P = 0.013, OR = 2.190, 95% CI: 1.176–4.079), duration of hypertension (P = 0.017, OR = 0.483, 95% CI: 0.265–0.881), and insurance status (P = 0.004, OR = 0.080, 95% CI: 0.009–0.680). Knowledge level emerged as the most influential factor in promoting adherence. These findings highlight the importance of targeted educational interventions and sustained support for patients at risk of poor adherence, aiming to optimize antihypertensive therapy and prevent long-term complications. The study advocates for strengthened evidence-based clinical practices and underscores the need for health policy reforms particularly in patient education and insurance accessibility to improve hypertension management in primary care settings. Keyword: Adherence, Hypertension, Gender, Knowledge
Copyright (c) 2025 Sinta Ratna Dewi, Almahdy Almahdy, Hardisman Dasman, Syofyan Syofyan, Aldyba Syaqilla Hafifah http://creativecommons.org/licenses/by-sa/4.0
The Influence of Environmental Sanitation and Community Behavior on Dengue Fever Incidence: A Case-Control Study in Siantar Utara District
Dengue remains a persistent urban health challenge in Indonesia. Household-level factors, such as physical barriers and daily behaviours, may influence indoor vector–host contact but are inconsistently addressed in routine control programs. We conducted a community-based case–control study in Siantar Utara (Pematang Siantar, North Sumatra) to assess household attributes associated with dengue occurrence. Cases were physician-confirmed dengue patients; controls were neighbourhood peers without recent dengue-compatible illness. A total of 36 case and 36 control households were enrolled. Prespecified exposures included: window/ventilation screening (≥50% of openings with intact mesh), presence of larvae in water-holding containers (WSC) and non-WSC, indoor hanging clothes (≥5 garments visible), and health-officer support within the preceding 3 months. Data were collected through standardized interviews and on-site observations. Associations were analyzed using χ² and Fisher’s exact tests (α = 0.05). Households lacking mesh screening were disproportionately represented among cases, with a statistically significant association between screening and dengue status (p = 0.011). Indoor hanging clothes were more common in case households and significantly associated with dengue incidence (p = 0.016). Health-officer support demonstrated a strong protective effect (p < 0.001). Larval presence in WSC and non-WSC was not statistically significant (p = 0.326 and p = 0.233, respectively These findings support a mechanistic pathway in which intact screening and reduced indoor resting sites lower exposure to day-biting Aedes aegypti. In this urban Indonesian context, window/ventilation screening and clothing-storage practices were associated with dengue occurrence, highlighting modifiable, low-cost targets for the 3M Plus strategy. Programmatic integration should prioritize mesh coverage and integrity checks, counseling to reduce indoor hanging garments, routine container management, and regular cadre visits, with monitoring via ABJ and simple household indicators. Further cluster or stepped-wedge trials are recommended to validate effectiveness and sustainability. Keyword: Dengue, Aedes aegypti, Environmental, Sanitation
Copyright (c) 2025 Deli Syaputri, Samuel Marganda http://creativecommons.org/licenses/by-sa/4.0
Effect of Ankle Strategy Exercise on Balance Improvement and Fall Risk Reduction in the Elderly
Older adults face a heightened risk of falling both indoors and outdoors due to age-related declines in balance. One contributing factor is weakness or instability in the ankle joint, which can significantly impair postural control and lead to limitations in daily activities. As balance deteriorates, functional capacity in the lower limbs declines, further hindering mobility and independence. Enhancing ankle strength and stability is therefore essential to improving balance and reducing fall risk in this population. This study investigates the impact of Strategic Ankle Exercise on balance and falling risk among older adults. Employing a one-group pre-test and post-test experimental design, the study involved 33 participants who met the inclusion criteria and were selected through total sampling. Balance was assessed using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. Paired sample t-tests conducted via SPSS revealed a significant improvement in dynamic balance following the intervention: BBS scores increased from 44 to 50.8, while TUG scores decreased from 15.5 to 10.1 (p < 0.001). A correlation analysis indicated a strong negative relationship between changes in BBS and TUG scores (r = -0.86; p < 0.001), suggesting that improvements in balance were associated with reduced fall risk Strategic Ankle Exercise emerges as an effective, evidence-based intervention for enhancing balance and minimizing fall risk in older adults. These findings support the integration of this program into geriatric care strategies. Future research should explore optimal exercise dosage and customization to maximize benefits across diverse age groups and functional levels. Keyword: Balance, Ankle strategic exercise, BBS, TUG
Copyright (c) 2025 James Manik http://creativecommons.org/licenses/by-sa/4.0
Association Between Age and Cholesterol, Blood Sugar, and Uric Acid Levels in Office Workers
Degenerative conditions related to cholesterol, blood sugar, and uric acid tend to increase with age and lifestyle changes, particularly among office workers in the productive age group. This study investigates the association between age and levels of cholesterol, blood sugar, and uric acid among employees of the Bengkulu Ministry of Health Polytechnic. A descriptive analytical design was employed using medical check-up data from 203 respondents. Data normality was assessed using the Kolmogorov-Smirnov test, and correlations were analyzed using Pearson’s method. The findings revealed significant correlations between age and total cholesterol, HDL, LDL, triglycerides, blood sugar, and uric acid levels, although most correlations were weak in strength. These results suggest that age contributes to elevated biochemical markers associated with degenerative diseases, highlighting the importance of routine health monitoring among office workers as a strategy for early prevention. Keywords: Cholesterol, blood sugar, uric acid, degenerative diseases, office workers
Copyright (c) 2025 Darwis Darwis, Fikitri Marya Sari, Ade Sissca Villia, Ade Febryanti, Nehru Nugroho http://creativecommons.org/licenses/by-sa/4.0
Performance Evaluation of Internal Verifier in Reducing Pending Inpatient Claims of BPJS Kesehatan at Muhammadiyah Hospital North Sumatra 2022
This study evaluates the effectiveness of internal verifiers at Muhammadiyah Hospital North Sumatra in minimizing delayed inpatient claims submitted to BPJS Kesehatan, Indonesia’s national health insurance agency. A mixed-methods sequential explanatory design was employed, combining quantitative data from 2020 (prior to verifier recruitment) and 2022 (post-recruitment) with qualitative insights from interviews with internal verifiers, coders, and other stakeholders, as well as a review of claim files processed by the hospital’s BPJS Unit. Interview protocols were adapted from a 2018 study at Koja Hospital, North Jakarta, and data were analyzed using the Miles and Huberman approach, with findings integrated across methods. Source triangulation ensured validity and reliability. Results showed that internal verifiers significantly reduced the proportion of delayed claims despite an overall increase in submissions, with the highest rate of pending claims dropping from 25.6% in 2020 to 17.9% in 2022. Of the 2022 delays, 31.2% were due to BPJS Kesehatan system errors or confirmation processes, indicating that only two-thirds stemmed from hospital-related issues. Qualitative analysis identified key contributors to delays, including diagnostic coding errors, inconsistent understanding among BPJS verifiers, incomplete documentation, limited staff knowledge, and human resource inaccuracies. The presence of internal verifiers improved claim management and hospital revenue by increasing eligibility and accelerating approvals. To further optimize claim processing, strategies such as enhancing coding accuracy, improving staff competency, ensuring documentation completeness, and adopting electronic systems with supportive incentives are recommended. Keyword: Internal verifier, pending claims, performance
Copyright (c) 2025 Amalia Hasibuan, Ermi Girsang, Sri Lestari Ramadhani Nasution http://creativecommons.org/licenses/by-sa/4.0
Managing Pregnancy in Autoimmune Disease with Fetal Anomaly: Ethical Challenges and Clinical Decisions in a Case of Multiple Sclerosis
Pregnancy in women with multiple sclerosis (MS) complicated by fetal anomalies presents immediate clinical and ethical challenges. MS, a chronic autoimmune disorder of the central nervous system, commonly affects women of reproductive age and necessitates balancing maternal disease stability with fetal safety. This case report, based on retrospective clinical data and a narrative literature review, highlights the complexities of managing such pregnancies. A 27-year-old G5P2A2 woman at 19 weeks’ gestation with relapsing-remitting MS, previously treated with methotrexate during the first trimester, was referred for high-risk care following the detection of a membranous ventricular septal defect (VSD) via fetal echocardiography. Despite teratogenic concerns, the pregnancy was continued under multidisciplinary management involving obstetrics, neurology, rheumatology, and fetomaternal cardiology. The outcome was a preterm delivery of a neonate with VSD requiring specialized follow-up, while the mother remained clinically stable without MS relapse. This case underscores the ethical tensions between maternal autonomy, beneficence, non-maleficence, and justice, particularly in navigating reproductive choices amid uncertain neonatal outcomes. Shared decision-making, supported by multidisciplinary counseling, proved essential in guiding care. Clinicians managing high-risk pregnancies in women with autoimmune disease must integrate ethical principles within collaborative frameworks to optimize outcomes for both mother and child. Keywords: High-Risk Pregnancy, Congenital Anomaly, Ethical Dilemmas, Patient Autonomy, Shared Decision-Making.
Copyright (c) 2025 Putri Nadya Syahidah, Setyorini Irianti, Aih Cahyani http://creativecommons.org/licenses/by-sa/4.0
Maternal Mortality in Cardiac Pregnancy: Ethical Conflicts in Patient Autonomy and Clinical Decision-Making
Maternal mortality remains a significant concern in pregnancies complicated by heart disease, especially when patient preferences diverge from evidence-based clinical recommendations. These situations present complex clinical and ethical challenges for healthcare providers. This case report illustrates the interplay between patient autonomy, clinical decision-making, and outcomes in high-risk cardiac pregnancy. A 34-year-old multiparous woman with known cardiomegaly and valvular heart disease presented at 37–38 weeks’ gestation with worsening dyspnea, cardiac decompensation, and pulmonary hypertension. Despite medical advice recommending immediate delivery at a tertiary care center, she initially declined intervention. She later returned with severe preeclampsia and pulmonary hypertension. An emergency caesarean section was performed, but her condition deteriorated postoperatively, culminating in cardiac arrest and death. This case underscores the ethical tension between honoring patient autonomy, the right to make informed decisions, and the principle of beneficence, which obligates clinicians to act in the patient’s best interest. Decision-making was shaped by educational background, limited health literacy, cultural norms, family influence, and potential mistrust of the healthcare system, all of which may compromise truly informed consent. Addressing these barriers requires clear, accessible, and culturally attuned communication to ensure patients comprehend the risks and benefits. Integrating structured shared decision-making and early ethics consultation can help resolve conflicts, align care with patient values, and safeguard maternal and fetal outcomes. Ethical management demands a careful balance between respecting autonomy and preventing harm, while advocating for systemic reforms that address the social determinants of maternal health. Timely multidisciplinary care, culturally sensitive counseling, and structured shared decision-making are essential to harmonize patient autonomy with life-saving interventions in high-risk cardiac pregnancies, thereby reducing preventable maternal mortality. Keyword: Ethical Dilemmas, Maternal Mortality, Cardiac Disease In Pregnancy.
Copyright (c) 2025 Hanifan Nugraha, Muhammad Alamsyah Aziz, Dini Pusianawati http://creativecommons.org/licenses/by-sa/4.0
The Influence of Short-Distance Sprint Training on Physical Condition and Speed Performance in Youth Volleyball Players
Volleyball is a sport that requires high levels of speed and endurance, making targeted physical training essential for optimal performance. Sprint training over distances of 50 and 80 meters is one approach that can enhance both attributes. This study investigates the effects of 50-meter and 80-meter sprint training on the speed performance of volleyball players involved in extracurricular activities at MAN 2 Banjarnegara. A quantitative experimental design was employed, utilizing a Two-Group Pretest-Posttest framework. Participants were randomly assigned to two experimental groups: Group A (50-meter sprint training) and Group B (80-meter sprint training). Across 14 training sessions, including pretest and posttest assessments, data were collected using a 60-meter sprint test. Statistical analyses included normality tests (Kolmogorov-Smirnov and Shapiro-Wilk), homogeneity tests, and paired t-tests. Results demonstrated that both sprint training protocols significantly improved sprint performance. Group A exhibited a mean improvement of 0.35 seconds, while Group B showed a greater improvement of 0.77 seconds, with both outcomes achieving statistical significance (p < 0.05). These findings indicate that sprint training over both distances effectively enhances speed performance in volleyball playersThe study concludes that incorporating 50-meter and 80-meter sprint training into volleyball conditioning programs can positively impact players’ physical speed. Coaches and trainers are encouraged to integrate these sprint protocols to improve essential skills such as spiking, passing, and blocking. For comprehensive development, sprint training should be complemented with agility drills and aerobic endurance exercises to meet the multifaceted physical demands of the sport. Keywords: Volleyball, Physical Fitness, Extracurricular, Sports Student, Athletes.
Copyright (c) 2025 Evi Saputri Romandoni, Agung Wahyudi, Yovhandra Ockta http://creativecommons.org/licenses/by-sa/4.0
Wound Patterns in Victims of Physical Abuse: A Retrospective Descriptive Analysis at Bhayangkara Sartika Asih Hospital, Indonesia
Physical violence remains a global public health concern, with limited Indonesia-specific data on non-fatal injuries. This study aims to describe the characteristics of victims of physical abuse based on age, sex, and wound patterns using forensic medical reports to support public health strategies and forensic practices. A retrospective descriptive study was conducted using 150 Visum et Repertum (VeR) reports from living victims of physical violence treated at Bhayangkara Sartika Asih Hospital, Bandung, in 2022. Reports were selected through purposive sampling, including only those with complete documentation; cases involving deceased victims or unrelated to physical violence were excluded. Results showed that the most affected age group was 17–25 years (36.67%). Males represented the majority of victims (95.3%). The most common type of injury was bruises (34.52%), followed by abrasions (33.33%) and lacerations (21.03%). Among males, 83 (58%) sustained bruises, while among females, 5 (71%) had abrasions. Head injuries were predominant, with 30 cases (20%) having single wounds and 89 cases (59.3%) multiple wounds. These findings highlight the importance of targeted interventions for young males and suggest that injury surveillance systems should better capture non-fatal violence trends. The observed patterns may reflect social dynamics and risk behaviors prevalent in this demographic group, warranting further investigation Keyword: Physical Violence, Trauma, Wound Pattern, Forensic Medicine
Copyright (c) 2025 Andri Andrian Rusman, Teja Koswara, Jabal Cahyo Wibowo http://creativecommons.org/licenses/by-sa/4.0
Enhancing Vertical Jump Performance in Adolescent Female Volleyball Athletes: Effects of Squat Jumps and Knee Tuck Jumps for Health Promotion
This experimental study examines the effectiveness of two plyometric training methods, squat jumps and knee tuck jumps, in enhancing vertical jump performance among U-12 female volleyball athletes. Vertical jump ability plays a critical role in executing offensive techniques such as spiking and defensive maneuvers like blocking. Fourteen athletes from the Dissporsa Kendal volleyball club participated in the study and were assigned to two experimental groups through ordinal pairing. Group A underwent squat jump training, while Group B received knee tuck jump training, each over the course of 16 sessions. A pre-test/post-test design was employed to assess changes in vertical jump performance. Descriptive statistics indicated improvements in both groups. Group A’s average jump height increased from 27.83 cm to 31.50 cm (a 13.2% improvement), while Group B’s average rose from 27.17 cm to 30.58 cm (a 12.7% improvement). The mean increase in jump height was 3.67 cm for Group A and 3.41 cm for Group B. However, an independent samples t-test revealed no statistically significant difference between the post-test results of the two groups (p = 0.8306), suggesting that both training methods were equally effective in improving vertical jump performance. These findings support the inclusion of squat jumps and knee tuck jumps in youth training programs aimed at developing lower-body explosive power. Due to their simplicity and accessibility, these exercises offer practical benefits for coaches and trainers working with young athletes. Future research involving larger sample sizes and extended training durations is recommended to further investigate the long-term effects of plyometric training on athletic performance and injury prevention in youth sports. Keywords: Plyometric, Vertical Jump, Volleyball, Youth Athletes, Training.
Copyright (c) 2025 Aprillia Setia Widiyawanti, Agung Wahyudi, Yovhandra Ockta http://creativecommons.org/licenses/by-sa/4.0
The IL-4 Paradox: How an Anti-Inflammatory Cytokine Fuels Prostate Cancer Progression
Prostate cancer is one of the most prevalent malignancies in mern worldwide, with complex immune interactions contributing to tumor progression. In contrast, benig prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate that dos not exhibit malignant behavior. Understanding the molucelur differences between benign and malignant prostate condition is essential, particulary regarding immune escape mechanisms that allow cancer cells to evade the immune system. Interleukin-4 (IL-4), an anti-inflammatory cytokine, has been implicated in modulating immune responses within the Tumor Microenvironment. This study was conducted using a retrospective, observational analytical design with a cross-sectional approach to investigates the relationship between IL-4 expression and apoptosis-associated immune checkpoint receptors (PD-1, CTLA-4) and their ligand (PD-L1, PD-L2) in prostate tissue. A total of 40 formalin-fixed, paraffin-embedded (FFPE) prostate tissue samples collected between 2014 and 2020 were analyzed using quantitive real-time PCR (qRT-PCR). Samples were categorized into four groups: BPH, non-metastatic prostate cancer, metastatic prostate cancer, and controls. Statistical analysis was performed using one-way ANOVA and Pearson correlation. IL-4 expression was significantly higher in prostate cancer tissues (both metastatic and non-metastatic) compares to BPH (p = 0.006). Among the immune checkpoint molecules, IL-4 showed the srongest correlation with PD-L1 (r = 0.919), followed by PD-L2 (r = 0.832) and PD-1 (r = 0.626). In the BPH group, CTLA-4 exhibited the highest ecpression, with IL-4 ranked second. In conclusion, IL-4 expression is closely associated with key immune checkpoint markers in prostate cancer, suggesting a potential role in promoting immune escapen and tumor progression. Keyword: Prostate Cancer, IL-4, PD-1, CTLA-4, PD-L1 and PD-L2.
Copyright (c) 2025 Ibnu Widya Argo, Raden Danarto, Tanaya Ghinorawa, Indrawarman Soerohardjo http://creativecommons.org/licenses/by-sa/4.0
Recurrent Pregnancy Loss with Hypertensive Complication, Obesity and Suspected APS: A Case Based Approach to Antenatal Care Challenges
Recurrent miscarriage, defined as the loss of two or more consecutive pregnancies, is a multifactorial condition associated with genetic, hormonal, anatomical, autoimmune, and maternal age–related factors. In Indonesia, data remain limited; however, at Dr. Kariadi Semarang Hospital, 18.7% of recurrent miscarriage cases between 2015 and 2017 were reported as idiopathic. We report a case of a 23-year-old woman, G7P0A6, at 33–34 weeks’ gestation, presenting with elevated blood pressure and a history of chronic hypertension since 2016 with poor medication adherence. Ultrasonography revealed symmetrical fetal growth restriction (FGR) with an estimated fetal weight of 1500–1800 grams, and an obstetric history notable for six first-trimester miscarriages, suggestive of antiphospholipid syndrome (APS). Physical examination showed a blood pressure of 160/110 mmHg and obesity (BMI 32.9 kg/m²) without other features of severe preeclampsia; fetal monitoring and Doppler studies were normal. The patient was diagnosed with chronic hypertension exacerbated by preeclampsia, symmetrical fetal, suspected APS, recurrent miscarriage, and obesity. Management included conservative hospitalization, administration of magnesium sulfate, corticosteroids, and antihypertensive therapy, with cesarean delivery planned after 34 weeks once fetal lung maturation was achieved. This case highlights the challenges of managing high-risk pregnancies complicated by APS, FGR, and hypertensive disorders, emphasizing the importance of adequate antenatal care, multidisciplinary coordination, and appropriate timing of delivery to optimize maternal and fetal outcomes. Keywords: Antenatal Care, Poor Obstetric, Recurrent Pregnancy Loss, Fetal Growth Restriction; Preganancy Termination.
Copyright (c) 2025 Husna Bulkis Dasopang http://creativecommons.org/licenses/by-sa/4.0
Renal Function Improvement Following Bilateral Percutaneous Nephrostomy
Urinary tract blockages caused by urolithiasis, trauma, and tumours that spread to the kidneys, bladder, cervix, uterus, or colon would harm renal function. Percutaneous nephrostomy (PCN) provides an option if immediate decompression is required. It serves as a temporary diversion before more serious treatment, to reduce symptoms and preserve renal function in unilateral. This research is a retrospective cohort study that involved patients with obstructive uropathy for about 128 samples from 2019 to 2022. This study was conducted in 2023. Renal function recovery was evaluated by comparing creatinine levels in each group of obstruction aetiology in two periods, before and after obstruction (3rd and 7th day after decompression). History of haemodialysis procedure and chronic kidney disease were excluded The results showed that there was a significant decrease in creatinine from baseline to day 7 of all samples (p=0.001). In the cancer group, there is a significant mean difference in baseline creatinine level and creatinine level at day 7 after the procedure (p=0.008; p<0.05). There is no significant renal function improvement in the stone group. PCN in patients with obstructive uropathy has a significant effect on improving renal function, especially in patients with cervix cancer. Keyword: Obstructive Uropathy, Percutaneous Nephrostomy, Renal Function Improvement
Copyright (c) 2025 Leonardo Grevi Tamara, Sakti Ronggowardhana Brodjonegoro, Fateh Jamal Nahdi http://creativecommons.org/licenses/by-sa/4.0
Partial Hydatidiform Mole with Subclinical Hyperthyroidism – A Case Report
Partial hydatidiform mole is a rare gestational trophoblastic disease marked by triploid karyotype, fetal abnormalities, and growth disorders, sometimes accompanied by subclinical hyperthyroidism. Diagnosis relies on β-hCG testing, ultrasound, and immunohistochemistry. Management, especially regarding chemotherapy, remains debated due to fertility concerns. This case report presents a rare instance of partial hydatidiform mole with subclinical hyperthyroidism, emphasizing key diagnostic and therapeutic considerations. A case report 22-year-old primigravida at 16 weeks presented with abortion imminens, placentomegaly, anemia, and massive bleeding. Evaluation confirmed a partial mole with subclinical hyperthyroidism. She was stabilized for hemorrhagic shock and IUFD, then underwent molar evacuation and caesarean hysterectomy. Although chemotherapy was initially planned, β-hCG levels normalized within 4 months without it, and follow-up showed no malignant transformation or recurrence. Low-risk partial hydatidiform mole can regress without chemotherapy, but comorbidities like subclinical hyperthyroidism require attention. At least 6 months of β-hCG monitoring is essential to confirm resolution and detect complications. Keyword: Chemotherapy, Hyperthyroid Subclinical, Partial Hydatidiform Mole.
Copyright (c) 2025 R. Fuad Mustaqim, Aditiyono Aditiyono, Gatot N.A. Winarno, Dalri Muhammad Suhartomo http://creativecommons.org/licenses/by-sa/4.0