Contagion: Scientific Periodical Journal of Public Health and Coastal Health
Journal title CONTAGION: Scientific Periodical Journal of Public Health and Coastal Health Subject Health Sciences. Language English. ISSN 2685-0389 (online) Frequency Four times a year in January-March, April-June, July- September, and october- December. 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 periodical journal of public health published by the Public Health Study Program of the Faculty of Public Health at Universitas Islam Negeri Sumatera Utara Medan, Indonesia. These journals prioritize the collaboration of lecturers and students, with the scope of the discussion being about Public health, midwife, nursing, nutrition science, medicine, mental health, coastal public health, islamic and health sciences in islamic countries and developing countries. The journal is published four times a year in January-March, April-June, July- September, and october- December. Telp:+62895391495346||Email: contagion@uinsu.ac.id ||e-ISSN:2685-0389
Universitas Islam Negeri Sumatera Utara, Medan
COPYRIGHT Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges as well as earlier and greater citation of published work (see The Effect of Open Access). LICENSE CONTAGION (Scientific Periodical Journal of Public Health and Coastal Health) is published under the terms of the Creative Commons Attribution-ShareAlike 4.0 International License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Environmental and Behavioral Factors of “3M Plus” Practices (Cover, Drain and Recycle) Associated with Dengue Fever Incidence in Cilongok District, Banyumas Regency
Dengue hemorrhagic fever has been a public health concern in Cilongok District evident by a sharp increase in its cases in the last two years. This study aims to analyze the relationship between physical, biological, and social environmental factors, as well as the behavior of 3M Plus, with the incidence of dengue hemorrhagic fever in Cilongok District, Banyumas Regency. The research followed a quantitative approach of observational analytics with a case-control design. A total of 60 respondents were involved, consisting of 30 cases and 30 controls that were selected using neighborhood-matched controls based on a residential distance of less than 100 meters. Data analysis was carried out using chi square test and logistic regression. The results of the study show a cumulative increase in dengue cases from 26 cases in 2023 to 126 cases in 2024. Spatial analysis showed an uneven distribution of cases with high concentrations in densely populated areas, especially Langgongsari Village, Pageraji Village, and Panusupan Village. Indoor temperature was significantly associated with the incidence of dengue (p = 0.038; OR = 3.500), as well as air humidity (p = 0.039; OR = 3.455). Biological factors measured through the House Index (p = 0.398; OR = 1.902) and Container Index (p = 0.398; OR = 1.902) do not indicate a meaningful relationship. In social environmental factors, the habit of hanging clothes was significantly related to the incidence of dengue (p = 0.004; OR = 5.675), as well as the absence of gauze wire in house ventilation (p = 0.008; OR = 5,231). The other 3M Plus behavioral variables did not show a significant relationship. This study shows that the incidence of dengue fever in Cilongok District is influenced by microclimatic conditions in the house and specific behaviors that increase the chances of human-vector contact. Efforts to control dengue need to integrate ventilation and humidity management of the house with targeted behavior change interventions, especially reducing clothing storage in the room and increasing household physical protection Keyword: dengue hemorrhagic fever, environmental factors, 3M Plus behavior
Copyright (c) 2026 Lailatul Mardhiyah, Suhartono Suhartono, Mursid Raharjo, Nur Endah Wahyuningsih, Sulistiyani Sulistiyani http://creativecommons.org/licenses/by-sa/4.0
Association Between Home Physical Environment, Individual Characteristics and Personal Hygiene and the Incidence of Leprosy in Cirebon Regency
Leprosy is a contagious disease caused by the bacterium Mycobacterium leprae, which attacks the peripheral nerves and skin. This study aims to analyze whether household ventilation, housing density, window availability, wall and floor conditions, room separation, and personal hygiene behaviors are significantly associated with leprosy incidence in Cirebon regency. This research is an analytical observational study with a case-control design, involving 77 case respondents and 77 controls randomly selected. Data were collected through observation and interviews regarding home conditions and personal habits, and then analyzed using the chi-square test. The results show that the variables of ventilation size (p-value < 0.001 and OR = 5.361), window condition (p-value < 0.001 and OR = 3.640), room separation (p-value < 0.001 and OR = 6.249), and occupancy density (p-value = 0.014 and OR = 2.387) were significantly associated with the incidence of leprosy, while floor type (p-value = 0.297 and OR = 1.539) and wall type (p-value = 0.250 and OR = 1.543) were not associated with leprosy incidence. Regarding personal hygiene factors, knowledge (p-value < 0.001 and OR = 7.125), attitude (p-value < 0.001 and OR = 6.818), shared towel use (p-value < 0.001 and OR = 5.2), and nail-cutting habits (p-value < 0.001 and OR = 3.433) had a significant effect on leprosy, while bathing frequency (p-value = 0.294 and OR = 1.539) did not show a significant relationship. The findings indicate that the physical housing environment and personal hygiene are associated with leprosy occurrence in Cirebon Regency, suggesting that control efforts should prioritize housing improvements and the promotion of proper hygiene practices Keyword: Leprosy, Physical Home Environment, Knowledge, Attitude, Personal hygiene
Copyright (c) 2026 Irene Silitonga http://creativecommons.org/licenses/by-sa/4.0
Prognostic Value of the Neutrophil–Lymphocyte Ratio for 28-Day Mortality in Hospitalized Pulmonary Tuberculosis
Pulmonary tuberculosis (TB) remains a leading cause of infectious mortality. The neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory index that may stratify short-term risk in hospitalized TB. To examine whether admission NLR predicts 28-day mortality in pulmonary TB. We conducted a retrospective cohort at Royal Prima General Hospital, Medan (1 January 2023–31 December 2024), among adults (18–65 years) admitted with active pulmonary TB. Demographics, TB category, day-1 neutrophil and lymphocyte counts (to derive NLR), and 28-day outcomes were abstracted from medical records. NLR was analyzed as a continuous variable and as a binary variable using a receiver operating characteristic (ROC)-derived cut-off. Group comparisons used t/Mann–Whitney tests as appropriate; prognostic performance was assessed by area under the ROC curve (AUC). The results of the analysis show that NLR has a significant ability to identify patients at risk of death during treatment. This finding has important implications for clinical management, where the use of NLR as a routine biological marker can assist medical personnel in triage and more timely therapeutic decision-making. Therefore, the application of this parameter is expected to help reduce mortality rates through closer monitoring of high-risk patient groups. Keywords: Pulmonary Tuberculosis, Neutrophil–Lymphocyte Ratio, 28-Day Mortality, Prognosis, Biomarkers.
Copyright (c) 2026 Ali Napiah Nasution, Perwita Sari Sinaga, Sri Wahyuni Nasution http://creativecommons.org/licenses/by-sa/4.0
The Correlation between Self-Care and Quality of Life in Type 2 Diabetes Mellitus Patients at the Sei Rampa Health Center
Type 2 diabetes mellitus (T2DM) can substantially reduce patients’ quality of life (QoL). Self-care is expected to lessen this burden, but evidence across key self-care domains in primary care is still limited. This study aims to identify how strong and significant the relationship between these two variables is: self-care and quality of life. A sequential explanatory mixed-methods study was conducted at the Sei Rampah Community Health Center. Quantitatively, 136 T2DM patients completed a survey; Pearson’s correlation tested associations between five self-care domains (diet, physical activity, medication therapy, availability of blood-glucose monitoring equipment, and diabetes knowledge) and QoL. Qualitatively, in-depth interviews with eight patients explored daily self-care experiences; transcripts were coded and thematically analyzed using CAQDAS/NVivo following the Miles and Huberman framework. Ethical approval was granted by Universitas Prima Indonesia. All self-care domains were significantly associated with better QoL (p < 0.001). Interview data explained the quantitative patterns: diet adherence was constrained by financial limitations, eating habits, and limited healthy menu variety; physical activity was generally light and inconsistent due to fatigue, age, motivation, and family support; medication adherence was relatively high but lapses occurred without reminders; routine glucose monitoring was uncommon because glucometers and strips were costly and health literacy was limited; and stronger diabetes knowledge, often reinforced by family, supported more consistent self-care behaviors. Programs should strengthen feasible diet and activity routines, support adherence with reminders, expand affordable access to glucometers/strips, and intensify education by engaging family support to improve QoL. Keywords: T2DM, Self-Care, Quality of Life, Medication Adherence, Glucose Monitoring, Primary Care.
Copyright (c) 2026 Sri Lestari Ramadhani Nasution, Winda Adelia Lubis, Ermi Girsang, Abednego Karo Sekali http://creativecommons.org/licenses/by-sa/4.0
Innovation of Prototype of Stunting Health Information System and 3D Pageflip E-Module on Stunting Preventive Knowledge and Attitude in South Tangerang
According to an analysis conducted by the World Bank Group, WHO, and UNICEF, around 144 million children who are under the age of five (21.3%) were affected by stunting worldwide in 2019. By 2022, this figure had risen to an estimated 148.1 million children (22.3%). This study aims to evaluate the health promotion interventions utilizing a prototype of a stunting health information system and a 3D pageflip e-module in enhancing attitudes and knowledge for the prevention of stunting in South Tangerang. This study applied a quantitative approach combined with a quasi-experimental design, utilizing a two-group design with a pretest and post-test measurements framework. A total of 106 individuals surveyed were included, divided equally into two groups: one group received the prototype stunting health information system intervention, and the other was provided with the 3D Pageflip e-module, comprising 53 participants for every group. The Wilcoxon test showed the prototype of the stunting health information system group showed a significant difference for knowledge (p = 0.046) and attitude (p = 0.025), and the 3D pageflip e-module group showed a significant difference in knowledge and attitude (p = 0.000). The Mann-Whitney test showed that there was a significant difference for knowledge (p = 0.000) and for attitude (p = 0.042). The effect size test for knowledge is 1.06 and for attitude 0.27. It can be concluded that the prototype of the stunting health information system and the 3D pageflip e-module effectively increase mothers' knowledge and attitudes regarding stunting prevention. Keywords: Prototype, Stunting Health Information System, 3D Pageflip E Module, Knowledge, Preventive, Attitude
Copyright (c) 2026 Rita Dwi Pratiwi, Riris Andriati, Fenita Purnama Sari Indah http://creativecommons.org/licenses/by-sa/4.0
Patient Safety Attitudes Among Intensive Care Unit Nurses in an Indonesian Islamic Hospital: A Mixed-Methods Study
Patient safety culture plays a crucial role in intensive care units (ICUs), where nurses play a central role in ensuring safe and quality care. Evaluation of patient safety attitudes in nurses is important to reduce medical errors and improve service quality. This study aims to evaluate patient safety attitudes in nurses in the ICU of an Islamic hospital and propose a strategy for improvement based on the Theory of Planned Behavior (TPB). Mixed-methods with a sequential explanatory model approach, using the Safety Attitudes Questionnaire (SAQ-INA). Quantitative data from ICU nurses were complemented by qualitative interviews, analyzed using the TPB framework. The number of respondents in this study was 14 respondents from both quantitative and qualitative research. ICU nurses showed a positive attitude with high scores on the teamwork climate (82.7%), safety climate (76.3%), and job satisfaction (90.4%). However, low scores on stress recognition (61.6%), unit management perception (66.8%), hospital management (68.6%), and working conditions (74.1%) indicate challenges such as high workload, staff shortages, and lack of management support. The qualitative findings emphasize the need for non-punitive reporting and collaboration between professions. ICU nurses are strongly committed to patient safety, but stress and resource limitations hinder them. Recommendations include stress management training, non-punitive reporting systems, management engagement, and resource optimization to strengthen patient safety attitudes Keywords: Patient Safety Attitudes, ICU Nurses, Safety Attitudes Questionnaire, Theory of Planned Behavior
Copyright (c) 2026 Tri Sutopo, Arlina Dewi http://creativecommons.org/licenses/by-sa/4.0
Implementation of the International Patient Safety Goals in Efforts to Reduce the Risk of Patient Falls in Hospitals: A Behavioral Perspective
According to the World Health Organization (WHO), approximately 134 million adverse events occur annually in hospitals in low- and middle-income countries, contributing to an estimated 2.6 million deaths. Patient falls remain one of the most frequent preventable safety incidents in hospital settings. This study aimed to analyze behavioral and organizational factors influencing nurses in implementing the International Patient Safety Goals (IPSG), particularly in fall risk prevention. A quantitative cross-sectional design was employed. The study population consisted of 1,125 nurses at Hospital X, and 290 nurses were selected as the research sample using proportionate stratified random sampling based on the Lemeshow formula. Data were analyzed using Chi-square and multiple logistic regression tests. The results showed significant associations (p < 0.05) between knowledge, attitude, facilities and infrastructure, regulations, coworker support, leadership support, and IPSG implementation. A total of 63.8% of nurses demonstrated good IPSG implementation. Multivariate analysis identified facilities and infrastructure as the most dominant factor (p = 0.0001; OR = 4.562; 95% CI = 2.289–9.094), indicating that adequate facilities increased the likelihood of proper IPSG implementation by 4.562 times compared to inadequate facilities. In conclusion, strengthening structural readiness particularly ensuring adequate safety facilities is essential to improve IPSG implementation in fall risk prevention. However, the cross-sectional design limits causal interpretation, and self-reported data may not fully reflect actual clinical practice Keywords: International Patient Safety Goals Implementation, Fall Risk, Nurse Behaviour
Copyright (c) 2026 indriyani sudarmadi, Zahroh Shaluhiyah, Daru Lestantyo http://creativecommons.org/licenses/by-sa/4.0
The Association Between Preeclampsia and Low Birth Weight in Hospitals in Medan: A Case-Control Study
Preeclampsia is a medical condition that causes increased blood pressure occurring during pregnancy, which significantly contributes to poor prenatal outcomes, such as low birth weight (LBW). In Indonesia, especially in North Sumatra, the prevalence of preeclampsia remains significant; however, data concerning its correlation with low birth weight in hospital environments is still scarce. This research was intended to ascertain the correlation between preeclampsia and the incidence of low birth weight among mothers delivering in hospitals in Medan City. A hospital-based case–control study utilized secondary data from medical records at H. Adam Malik Hospital and Dr. Pirngadi Hospital, Medan, from January 2022 to June 2024. A total of 180 postpartum women participated, comprising 90 cases (women who gave birth to babies with low birth weight) and 90 controls (women who gave birth to babies with normal birth weight). We used multivariable logistic regression and chi-square testing to find adjusted odds ratios (ORs) with 95% confidence intervals (CIs). A strong link existed between low birth weight and preeclampsia. Mothers with preeclampsia exhibited a significantly elevated probability of delivering low birth weight infants in comparison to those without preeclampsia (adjusted OR = 6.21; 95% CI: 3.10–12.30; p < 0.001). Advanced maternal age (>35 years) and preterm gestational age (<37 weeks) were independently correlated with low birth weight (LBW), whereas parity exhibited no significant correlation. Preeclampsia is significantly correlated with the incidence of low birth weight in mothers delivering in hospitals in Medan City. To improve maternal and child health and lower the risk of bad outcomes for newborns, it is important to improve early detection and comprehensive antenatal management of preeclampsia. Keywords: Preeclampsia, Low Birth Weight, Maternal Age, Gestational Age, Case-Control Study.
Copyright (c) 2026 AIDIL AKBAR http://creativecommons.org/licenses/by-sa/4.0
Socioeconomic Gradient and Anthropometric Risk: Central Obesity among Adolescents in Aceh, Indonesia
Central obesity is a critical risk factor for future cardiometabolic disorders in adolescents, particularly in low- and middle-income settings such as Indonesia. This cross-sectional study examined the prevalence and determinants of central obesity among adolescents in Aceh Barat and Nagan Raya, Indonesia. A total of 167 senior high school students were recruited using purposive sampling, which allowed representation from multiple schools but limits generalizability beyond the study population. Data on waist circumference, family income, physical activity, screen time, and body mass index (BMI) were collected using standardized procedures. Central obesity was defined based on age- and gender-specific waist circumference cut-offs according to International Diabetes Federation criteria. Associations were examined using chi-square tests and binary logistic regression. The prevalence of central obesity was 15.0%. In bivariate analysis, adolescents from middle–high income families (OR = 3.23; 95% CI: 1.35–7.75) and those classified as overweight based on BMI (OR = 40.30; 95% CI: 12.69–127.98) had significantly higher odds of central obesity. However, in multivariate analysis, only BMI remained independently associated with central obesity (AOR = 0.02; 95% CI: 0.005–0.083), while socioeconomic status, physical activity, and screen time were no longer statistically significant Keywords: Adolescents, Body Mass Index, Obesity Central, Socioeconomic Status, Screen Time
Copyright (c) 2026 Siti Maisyaroh Fitri Siregar http://creativecommons.org/licenses/by-sa/4.0
Factors Associated with Loss to Follow-Up (LtFU) among People Living with HIV/AIDS
Loss to follow-up (LtFU) among people living with HIV/AIDS (PLWHA) receiving antiretroviral (ARV) therapy remains a significant challenge, contributing to treatment failure, drug resistance, and ongoing HIV transmission. This study aimed to identify factors associated with LtFU among PLWHA on ARV therapy in Demak Regency. Method: A quantitative observational analytic study with a cross-sectional design was conducted among 199 PLWHA meeting inclusion criteria. Data were collected using validated questionnaires addressing knowledge, attitudes, perceptions, family support, peer support, stigma, healthcare worker support, quality of health services, access to services, and health service policies. Data were analyzed using SPSS with univariate analysis, bivariate chi-square tests, and multivariate logistic regression at a 0.05 significance level with 95% confidence intervals (CI). Results in bivariate analysis indicated that all independent variables were significantly associated with LtFU (p < 0.05). Multivariate analysis identified six independent predictors: poor knowledge (OR = 4.68; 95% CI: 1.57–13.94), negative attitude (OR = 5.65; 95% CI: 1.98–16.08), poor perception (OR = 4.95; 95% CI: 1.69–14.45), inadequate family support (OR = 14.40; 95% CI: 3.75–55.37), poor service quality (OR = 4.40; 95% CI: 1.54–12.62), and a weak health service system reflecting limited access and provider support (OR = 5.61; 95% CI: 1.79–17.57). Collectively, these factors explained 72.65% of the variation in LtFU. In conclusion, LtFU is driven by a combination of cognitive, psychosocial, and structural determinants, with family support and health system factors being the most influential. Effective interventions should prioritize enhancing family involvement, patient education, and counselling, as well as improving service accessibility, quality, and responsiveness to ensure sustained retention in HIV care. Keywords: Antiretroviral, HIV/AIDS, Loss to Follow-Up, Risk Factors.
Copyright (c) 2026 Dian Widyahandayani Widyahandayani http://creativecommons.org/licenses/by-sa/4.0
The Impact of Instant Noodle Consumption Patterns on Hemoglobin Levels among Medical Laboratory Technology Students at Poltekkes Medan
Instant noodles are widely consumed worldwide due to their convenience, affordability, and long shelf life, particularly among university students. Despite their popularity, these products are nutritionally imbalanced, with high in carbohydrates and sodium, but low in protein, iron, and essential vitamins, raising concerns about their impact on hemoglobin levels and anemia risk. This study specifically examines hemoglobin status in relation to both frequency and duration of instant noodle consumption, while considering gender and sleep duration. A cross-sectional analytical study was conducted among 163 third-year Medical Laboratory Technology students at Poltekkes Kemenkes Medan. Hemoglobin concentration was measured from venous blood samples, while dietary patterns, sleep duration, and instant noodle consumption habits were assessed via structured questionnaires. Associations were analyzed using the Chi-square test (p < 0.05). Most students maintained normal hemoglobin levels regardless of instant noodle consumption frequency or duration. Female students had lower hemoglobin than males, reflecting hormonal and menstrual influences. Sleep duration did not significantly affect hemoglobin. Nearly all students reported adding vegetables and eggs to their noodles, potentially mitigating the adverse effects of sodium and supporting iron absorption. However, this effect was not statistically controlled, rendering the observed maintenance of hemoglobin suggestive rather than definitive. Hemoglobin status in young adults is primarily influenced by gender-related biological factors and overall dietary quality, rather than instant noodle consumption patterns alone. The findings highlight the importance of nutrient-rich complementary foods and warrant longitudinal studies to clarify the causal impact of dietary habits on hematological health Keywords: Noodles, Hemoglobins, Anemia, Sleep, Gender Factors
Copyright (c) 2026 Evi Irianti, Ice Ratnalela Siregar, Elizawarda Elizawarda, Rinson Sitohang http://creativecommons.org/licenses/by-sa/4.0
Risk Factors Associated with Sick Building Syndrome Among Workers in High-Rise Office Buildings
Indoor air quality is one of the crucial aspects of the work environment. Poor workplace conditions not only reduce comfort and job satisfaction but also significantly affect work productivity. One clinical manifestation of poor office environmental quality is the emergence of Sick Building Syndrome (SBS). The etiology of SBS is multifactorial, involving complex interactions between physical environmental factors (temperature, humidity, particulate dust), chemical factors (VOCs, CO₂), and biological agents, as well as individual characteristics and psychosocial conditions. This study aimed to determine the risk factors associated with the occurrence of SBS among employees of the Central Java Provincial Archives and Library Office. This research employed an analytical observational approach with a cross-sectional design involving 93 employees as respondents. The results showed that the average indoor air quality measurements in the work areas were as follows: humidity 56.30%, temperature 27.85oC, lighting intensity 170.04 lux, and air change per hour 3.43 times/hour. The prevalence of SBS among employees was 58.1%. There was not a significant association between temperature (p=0.035; RP=1.840), humidity (p=0.085; RP=0.712), lighting (p=0.121; RP=0.733), and ACH (p=0.791; RP=1.088) with SBS. In conclusion, this study identified no relationship between indoor air quality and the incidence of SBS among employees of the Central Java Provincial Archives and Library Office. Keywords: Indoor Air Quality, Sick Building Syndrome, Risk Factors, Workers.
Copyright (c) 2026 Widya Ayu Oktavia, Onny Setiani, Tri Joko, Sulistiyani Sulistiyani, Suhartono Suhartono http://creativecommons.org/licenses/by-sa/4.0
Effects of Continuing Professional Development on Nurses’ Competence in Chronic Illness Care: A Systematic Review and Meta-Analysis
Chronic illnesses, including diabetes mellitus, hypertension, cardiovascular disease, and cancer, represent major global health challenges requiring sustained nursing competence. Continuing Professional Development (CPD) is promoted to enhance nurses’ knowledge, skills, and professional attitudes; however, its effectiveness in chronic illness care remains inconsistent. This meta-analysis evaluated the impact of CPD on nursing competence in managing chronic illnesses. A systematic search of PubMed, Scopus, CINAHL, and Web of Science was conducted for studies published between January 2019 and January 2025. Eligible studies included randomized controlled trials, quasi-experimental, and cohort designs reporting competence-related outcomes following CPD interventions. Data were synthesized using a random-effects model, and heterogeneity was assessed using the I² statistic. Eleven studies involving 1,362 nurses from Asia, Europe, and the Americas met the inclusion criteria. CPD showed a significant positive effect on nursing competence in chronic illness care (Hedges’ g = 0.47; 95% CI: 0.31–0.63; p < 0.001). E-learning and blended learning approaches were more effective than traditional face-to-face methods, and programs lasting more than six months produced greater improvements. Moderate heterogeneity was observed (I² = 48%), with no evidence of publication bias. The findings indicate that CPD moderately improves nursing competence, particularly when delivered through technology-enhanced and sustained educational strategies. Variations in intervention duration and learning modality may explain differences in effect sizes across studies. CPD is an effective strategy to strengthen nursing competence in chronic illness care, especially when implemented through blended or e-learning formats and extended program duration Keywords: Continuing Professional Development, Nursing, Competence, Chronic Illness Care, Meta-Analysis
Copyright (c) 2026 Miming Oxyandi http://creativecommons.org/licenses/by-sa/4.0
Designing a Medical Records Student Lab Learning Application for Patient Data Management
Electronic medical records (EMR) are mandatory in Indonesian health facilities, yet students often lack access to systems mirroring real-world community health center (Puskesmas) workflows. This study developed SIMETRIK, a simulation-based tool designed to bridge the gap between classroom theory and clinical competency. Using a Research and Development (R&D) approach, the application was built via a waterfall model incorporating needs analysis, UML-based design, and high-fidelity prototyping. Evaluation involved 15 respondents, 10 students, 4 lecturers, and 1 practitioner, who assessed the system using a 1–4 Likert scale across five dimensions: ease of use, navigation clarity, feature alignment, learning utility, and satisfaction. Results indicated that user satisfaction earned the highest mean score (M = 3.33), followed by the application’s utility as a learning medium (M = 3.00). Feature alignment with public health workflows was rated at 2.67. Conversely, ease of use and navigation clarity received lower scores (2.33 and 2.13, respectively), signaling a requirement for interface refinement. Despite navigational hurdles, participants successfully executed registration and clinical documentation tasks. Feedback confirmed that SIMETRIK significantly improved students' understanding of EMR processes and aligned with professional practice requirements. These findings demonstrate that the application serves as a viable simulation platform for laboratory learning, underscores the importance of competency-focused digital tools, and establishes a foundation for future database-driven implementations in health informatics education Keywords: SIMETRIK, Electronic Medical Records, Simulation-Based Learning, Usability Evaluation, Patient Data Management, Competency-Based Education
Copyright (c) 2026 Niska Salsiani http://creativecommons.org/licenses/by-sa/4.0
Digital Transformation of BPJS Primary Healthcare Administration: A Qualitative Study of E-Module Implementation and Service Quality Improvement
Indonesia’s National Health Insurance system (BPJS Kesehatan) continues to face persistent administrative challenges in primary healthcare, including limited accessibility, bureaucratic complexity, long waiting times, and patient dissatisfaction. To address these issues, digital transformation initiatives have introduced electronic modules (e-modules) aimed at improving administrative efficiency, service quality, and data accuracy. This qualitative study collected data through in-depth interviews with twenty participants: twelve BPJS beneficiaries and eight primary healthcare officers from four community health centers in Sibolga City, North Sumatra. Participants were purposively selected based on their experience with BPJS e-module services. Interviews were transcribed verbatim and analyzed thematically using NVivo 12 through open coding, categorization, and theme development. Four themes emerged: 1) Administrative accessibility improved as e-modules simplified access to procedural information; 2) Service efficiency increased through shorter waiting times and faster processing; 3) User satisfaction improved, especially among digitally literate participants who perceived greater transparency and predictability, and 4) Administrative accuracy strengthened due to standardized digital documentation, reducing manual errors. Nonetheless, barriers persisted, including limited digital literacy, uneven internet connectivity, and insufficient technical support at facility level. E-modules represent an effective administrative innovation that reduces procedural complexity and enhances service consistency in primary healthcare. However, uneven benefits resulting from infrastructural constraints, organizational inertia, and varying user capacity underscore the need to align technological implementation with institutional readiness and user support to prevent widening service disparities Keywords: BPJS Health, Primary Healthcare, E-Module, Digital Health Administration, Service Quality
Copyright (c) 2026 Benri Situmorang http://creativecommons.org/licenses/by-sa/4.0
Cardiovascular Disease Risk Factors Among Mining Workers at PT. Manggala Alam Lestari
This study aimed to analyze the risk factors associated with cardiovascular disease (CVD) among mining workers at PT Manggala Alam Lestari, Musi Banyuasin, South Sumatra, Indonesia. A retrospective case-control study was conducted using secondary data from routine Medical Check-Up (MCU) records collected between 2022 and 2024. A total of 400 workers were included, comprising 80 CVD cases and 320 controls selected using a 1:4 frequency matching strategy by age group (≤45 and >45 years) and gender. Data analysis involved univariate summaries, bivariate chi-square tests, and multivariate multiple logistic regression to obtain adjusted odds ratios (aOR) and 95% confidence intervals while controlling for potential confounders, including age, gender, and work shift. Five significant modifiable risk factors were identified: obesity, diabetes mellitus, hypertension, dyslipidemia, and smoking. Obesity showed the strongest association with CVD (aOR ≈ 9.4), followed by diabetes mellitus (aOR ≈ 8.4), hypertension (aOR ≈ 7.6), dyslipidemia (aOR ≈ 5.2), and smoking (aOR ≈ 4.0). The final logistic regression model demonstrated good performance, with a Nagelkerke R² value of 0.645, indicating that 64.5% of the variation in CVD status could be explained by these five factors, and acceptable model fit on diagnostic testing. In conclusion, obesity and other metabolic and behavioral factors are strongly associated with CVD among mining workers at this site. Targeted occupational health interventions focusing on weight management, early detection and control of metabolic disorders, and comprehensive smoking cessation programs are essential to reduce the burden of CVD in the mining industry Keywords: Cardiovascular Disease, Mining Industry, Metabolic Risk Factors, Obesity, Occupational Health
Copyright (c) 2026 Jansen Fernando http://creativecommons.org/licenses/by-sa/4.0
Environmental Health Surveillance of Household Drinking Water in Buluh Cina Village, a Riverine Rural Community along the Kampar River, Indonesia
Access to safe household drinking water remains a major environmental health concern in riverine rural communities that rely on untreated groundwater and refill water sources. Buluh Cina Village, located along the Kampar River in Riau Province, depends largely on shallow wells and refilled drinking water stations, many of which lack adequate disinfection and routine monitoring. This study aimed to conduct an integrated environmental health surveillance of household drinking water quality in Buluh Cina Village to identify microbiological and physicochemical risks relevant to local public health action. A cross-sectional surveillance study was conducted by collecting 30 water samples from points of access (supply) and 30 samples from points of use (ready-to-drink) in selected households using stratified random sampling. Laboratory analyses assessed microbiological parameters (Escherichia coli and Total Coliform), physical parameters (turbidity, color, and pH), and chemical parameters (iron, manganese, and residual chlorine), following the Indonesian Ministry of Health Regulation No. 2/2023. Overall, 91.7% of samples did not meet national drinking water quality standards. Microbiological contamination was detected at both sampling points, with Escherichia coli present in 33.3% of PA samples and 46.7% of PU samples, and total coliform contamination in 53.3% of PA samples and 63.3% of PU samples. However, the differences between PA and PU were not statistically significant. Residual chlorine was absent or below the recommended level in 70% of samples, while turbidity, abnormal pH, and elevated iron and manganese were also observed. These findings indicate significant environmental health risks associated with household drinking water in this riverine rural community. Priority public health actions include improving safe household water storage practices, increasing uptake of point-of-use disinfection, strengthening routine monitoring of refill drinking water depots, and integrating drinking water surveillance into primary health care center (puskesmas)-based environmental health workflows. This study provides locally grounded evidence to support targeted interventions for improving drinking water safety in riverine rural settings Keywords: Buluh Cina Village, Drinking Water Quality, Environmental Health Surveillance, Household Water Safety, Kampar River
Copyright (c) 2026 Herniwanti Herniwanti http://creativecommons.org/licenses/by-sa/4.0
Determinant Factors of Early Menarche among Primary School Girls
Early menarche, defined as the onset of menstruation before the age of twelve, has been linked to adverse physical and mental health outcomes and is a key predictor of rapid pubertal growth. Although data at the elementary school level in Indonesia remain limited, recent findings suggest a rising prevalence of early menarche in urban areas. This study provides local evidence from an urban school in Padang City, where early menarche appears to be increasing. This research examined associations between early menarche among elementary school girls in Public Elementary School (SDN) 03 Alai Timur, Padang City, and factors including nutritional status, maternal age at menarche, and exposure to mass media information technology. Statistical analyses were conducted using the Chi-square test and the Fisher Exact Test, with a significance level of p < 0.05. Results showed that three-quarters of the participants experienced early menarche. Overweight-obese nutritional status was significantly associated with higher rates of early menarche (95.2%; p=0.011), as was high exposure to mass media information technology (88.9%; p=0.020). Although not statistically significant (p=0.071), girls whose mothers had experienced early menarche also showed higher rates (90.0%). Overall, early menarche was strongly associated with nutritional status and media exposure, while maternal age at menarche demonstrated a non-significant intergenerational effect. The findings highlight the need for schools to implement programs that educate young girls on proper nutrition, responsible media consumption, and reproductive health from an early age. Keywords: Early Menarche, Elementary School Students, Nutritional Status, Maternal Menarche History, Mass Media Exposure.
Copyright (c) 2026 Firdawati - Firdawati http://creativecommons.org/licenses/by-sa/4.0
A Systematic Review of the Kano Model's Utility in Classifying Healthcare Service Attributes and Driving Patient Satisfaction
Patient satisfaction is a key indicator of hospital service quality, closely linked to patient loyalty, clinical outcomes, and the reputation of health institutions. However, identifying specific attributes that determine patient satisfaction and dissatisfaction remains a challenge amid the ever-evolving dynamics of healthcare services. The Kano Model offers a useful framework by categorizing service attributes according to their impact on patient satisfaction. This study presents a systematic literature review of the model’s application in hospitals, conducted using the PRISMA protocol. Searches across PubMed, Scopus, and ProQuest for publications from 2019 to 2024 yielded 17 eligible international journal articles, which were analyzed narratively to identify patterns, methods, and findings. Results consistently revealed a hierarchy of patient needs: clinical competence, safety, and accurate information emerged as Must-be attributes, whose absence leads to strong dissatisfaction. Communication quality, responsiveness, and service efficiency were typically One-dimensional attributes, with satisfaction rising proportionally to performance. Digital innovations such as telehealth and personalized services often appeared as Attractive attributes, delighting patients when present but not causing dissatisfaction when absent. . Attribute classification proved dynamic, shaped by clinical context and patient demographics. Furthermore, integrating the Kano Model with frameworks such as SERVQUAL and the Balanced Scorecard enhances strategic prioritization. Several studies also demonstrated that Kano-based interventions can improve both clinical and psychological patient outcomes. Keywords: Patient Satisfaction, Hospital, Kano Model, Service Quality.
Copyright (c) 2026 Gita Febri Irianti http://creativecommons.org/licenses/by-sa/4.0
An Analysis of Stunting Determinants in North Tapanuli Regency
There has been a decline in stunting prevalence nationally in the last two years, requiring a more specific analysis of local determinants to optimize interventions at the regional level, especially in areas with geographical characteristics such as North Tapanuli Regency. This study aims to analyze the effect of nutritional intake, environmental sanitation, immunization status, and medical history on the incidence of stunting in toddlers. This quantitative study with a cross-sectional design involved 71 stunted toddler respondents in four working areas of the Community Health Center in North Tapanuli Regency. The data were analyzed using the Chi-Square test for bivariate analysis and Path Analysis to see the direct and indirect effects. The path analysis results showed that nutritional intake (0.365), sanitation (0.146), and immunization status (0.141) had a significant direct effect on stunting. Nutritional intake was the most dominant determining factor (p=0.010). Conversely, medical history (p=0.485) did not show a significant relationship and did not play a strong mediating role in this model. Nutritional intake is a key factor in determining the severity of stunting. Intervention strategies should focus on meeting the specific nutritional needs of toddlers in addition to improving sanitation and basic immunization coverage Keywords: Stunting, Nutritional Intake, Infectious Diseases, Sanitation, Immunization
Copyright (c) 2026 Emilia Silvana Sitompul http://creativecommons.org/licenses/by-sa/4.0
Factors Influencing Health Practices Among Mothers with Children Aged 0–5 Years in the Working Area of Sirait Public Health Center, Nainggolan District, Samosir Regency
Maternal and child health is an important indicator in assessing the degree of public health. The toddler period (0–5 years) is a critical period that determines the quality of life of children in the future. Samosir Regency still faces various challenges in maternal health practices, especially related to low exclusive breastfeeding coverage and posyandu visits. This study aims to analyze the factors that influence health practices among mothers with toddlers in the working area of the Sirait Community Health Center in Nainggolan District. This study is an analytical survey with a cross-sectional study design. This study was conducted in the working area of the Sirait Community Health Center in Nainggolan District, from August to September 2025. The study population consisted of all mothers with children aged 0-5 years. The study sample consisted of 120 pregnant women, as the sampling technique used was purposive sampling. Data analysis consisted of three stages, namely univariate analysis, bivariate analysis using chi-square, and multivariate analysis using multiple logistic regression with a significance level of 95% (a=0.05). The results showed that the level of mothers knowledge about the concept of health (p=0.001; Exp.B=28.842), mothers perceptions of health and disease (p=0.012; Exp.B=11.184), access to health services (p=0.003; Exp.B=0.409, 95% CI: 1.323-2.445) together influence health practices among mothers with children aged 0-5 years in the working area of the Sirait Community Health Center, Nainggolan District, Samosir Regency. It can be concluded that knowledge, perception, and access to health services play an important role in shaping the health practices of mothers with young children. It is recommended that the Community Health Center and the Health Office improve maternal and child health education, expand access to services, and strengthen communication between health workers and the community to encourage the implementation of innovative health practices at the family level. Keywords: Health Practices, Knowledge, Perception, Access
Copyright (c) 2026 Dewi R. Bancin, Friska Megawati Sitorus, Sharfina - Haslin, Muhammad Syafii http://creativecommons.org/licenses/by-sa/4.0
The Effect of Tea (Camellia Sinensis) Consumption as a Chinese Cultural Practice on the Cognitive Function: A Quasi-Experimental Study
Cognitive decline is an increasing public health concern among older people, particularly those residing in nursing homes where structured preventive interventions are limited. Non-pharmacological approaches such as tea consumption have been associated with cognitive benefits; however, experimental evidence in institutionalized populations remains scarce. This study aims to examine the effect of structured daily tea (Camellia sinensis) consumption on cognitive function among older people in nursing homes in North Sumatra, Indonesia. A quasi-experimental design was conducted involving 60 participants aged 60–80 years, allocated into an intervention group (n = 30) and a control group (n = 30) using purposive sampling. The intervention group received 200 mL of supervised tea (Camellia sinensis) daily for four months, while the control group received a cognitive health information leaflet. Cognitive function was assessed using the Montreal Cognitive Assessment – Indonesian Version (MoCA-INA) at baseline and post-intervention. Data were analyzed using paired and independent t-tests. The intervention group showed a significant improvement in cognitive scores from 17.60 ± 4.32 to 21.93 ± 4.03 (p < 0.001), with a large within-group effect size (Cohen’s d =1.04). Post-intervention cognitive scores were significantly higher in the intervention group compared to the control group (p < 0.001), indicating a large between-group effect (Cohen’s d = 1.20). Structured tea (Camellia sinensis) consumption may represent a culturally relevant, low-cost strategy to support cognitive health among institutionalized older people. Further randomized controlled trials with longer follow-up are warranted Keywords: Dementia, Older People, Cognitive Function, Tea Consumption, Nursing Home
Copyright (c) 2026 Kesaktian Manurung http://creativecommons.org/licenses/by-sa/4.0
Mapping Risk Factors Associated with Breast Engorgement Among Postpartum Mothers: A Scoping Review
Cognitive decline is an increasing public health concern among older people, particularly Breast engorgement is one of the most common postpartum breastfeeding problems and may increase the risk of mastitis, maternal discomfort, and early breastfeeding discontinuation. This scoping review aimed to map and synthesize existing evidence regarding risk factors associated with breast engorgement in postpartum women. The review followed the PRISMA-ScR guidelines. A systematic search of Google Scholar, ScienceDirect, Wiley Online Library, and PubMed was conducted for articles published between 2015 and 2025. Studies examining factors associated with breast engorgement among postpartum mothers were eligible. Two independent reviewers performed study screening and selection, and data were charted using a standardized extraction form. A total of 11 articles met the inclusion criteria and were included in the final analysis. The findings indicate that breast engorgement is a multifactorial condition influenced by maternal characteristics, socioeconomic and environmental factors, infant-related factors, breastfeeding practices, maternal knowledge and perceptions, family and social support, healthcare system support, and cultural practices. The themes were generated through inductive thematic analysis of the included studies. Recurrent patterns across studies suggest that inadequate milk removal, delayed breastfeeding initiation, limited maternal knowledge, and insufficient professional support are frequently reported factors associated with breast engorgement. This review highlights the complexity of breast engorgement and the broad range of factors discussed in the literature. The findings provide an evidence map that may inform future research, clinical practice, and supportive breastfeeding interventions, while acknowledging that scoping reviews are designed to explore and map evidence rather than determine causal relationships Keywords: Breast engorgement, postpartum mothers, breastfeeding, risk factors, scoping review
Copyright (c) 2026 Neng Resi Fitriani http://creativecommons.org/licenses/by-sa/4.0
Family Empowerment Using Moringa Leaf Nuggets to Improve Dietary Adequacy Among Stunted Children: A Quasi-Experimental Study
Family empowerment through the utilization of local food resources is a strategic approach to improving dietary adequacy among children with stunting. Moringa leaves are nutrient-dense local foods that remain underutilized. This study aimed to examine the effect of family empowerment through the use of moringa leaf nuggets on energy intake adequacy among stunted children. This study employed a quasi-experimental pretest–posttest design with a control group. A total of 40 stunted children were assigned to an intervention group (n = 20) and a control group (n = 20). The intervention was conducted over three months and consisted of four empowerment stages (knowledge enhancement, self-efficacy strengthening, training, and evaluation), along with one month of moringa leaf nugget supplementation. The primary outcome was energy intake (kcal), assessed using food records and analyzed with dependent and independent t-tests. showed a significant increase in energy intake within the intervention group, from 886.13 ± 336.49 kcal at baseline to 1063.99 ± 208.04 kcal post-intervention (Δ = +177.86 kcal; p = 0.012). No significant change was observed in the control group (1117.69 ± 647.86 kcal to 1028.43 ± 251.53 kcal; p = 0.289). However, post-test comparison between the intervention and control groups revealed no statistically significant difference (1063.99 ± 208.04 vs. 1028.43 ± 251.53 kcal; p=0.324). Secondary outcomes demonstrated significant improvements in maternal knowledge and psychomotor skills, but not in attitudes. Family empowerment through moringa leaf nugget utilization significantly improved energy intake within the intervention group. However, the absence of a significant between-group difference suggests that the intervention’s effectiveness relative to the control remains inconclusive and warrants further investigation using larger samples and more rigorous designs Keywords: family empowerment, Moringa oleifera, Dietary intake, nutrient adequacy, child stunting, quasi-experimental study
Copyright (c) 2026 Herlina herlina, titih huriah http://creativecommons.org/licenses/by-sa/4.0
Improving Environmental Health Awareness through the PHAST Method for Household Sanitation Intervention in the Belawan Coastal Region
Coastal areas are often faced with complex public health challenges due to environmental vulnerability and limited access to sanitation facilities. Poor sanitation contributes to a high prevalence of environment-related diseases such as diarrhea and malnutrition among children under five. This quasi-experimental study included 30 households with toddlers in Medan Belawan, Medan City. The Participatory Hygiene and Sanitation Transformation (PHAST) method was implemented to empower families in managing sanitation and hygiene practices. Data were collected through observation and assessment of household sanitation conditions before and after the intervention. Analysis was conducted using the Wilcoxon Signed Rank test at a 95% confidence interval due to non-normal data distribution. The results showed a significant improvement in household sanitation scores after the PHAST intervention (Z = -3.905; p < 0.05). Approximately 63.3% of households had increased scores, particularly in handwashing at critical times, waste management, as well as water and food storage practices, signifying a meaningful magnitude of behavioral change. However, this study was limited by its small sample size, absence of a control group, and short observation period, which hindered causal inference and generalizability. Despite the limitations, the evidences suggest that PHAST is a promising method for improving household sanitation management and hygiene behavior in coastal settings. Future studies with larger samples and controlled designs are recommended to assess sustainability and long-term health outcomes Keywords: Household Sanitation, Environmental Diseases, Coastal Area, PHAST
Copyright (c) 2026 Evi Naria, Indra Chahaya, Rusmalawaty Rusmalawaty, Diza Fathamira Hamzah, Anggraini Anggraini, Tamia Sakinah Adjani http://creativecommons.org/licenses/by-sa/4.0
An Aggressive Management Strategies for Acute Kidney Transplant Rejection: An Indonesian Tertiary Center Experience
Acute kidney transplant rejection remains a major cause of early graft malfunction worldwide especially in low- and middle-income countries where diagnostic and treatment resources are limited. Global data indicate that 10–20% of recipients experience acute rejection within the first year, with higher rates reported in developing regions. This study examined the clinical attributes and outcomes of intensive therapy approaches for acute graft malfunction at Dr. Sardjito General Hospital in Yogyakarta, Indonesia. A retrospective case series included four adult kidney transplant recipients who developed acute graft malfunction within 30 days of transplantation (2024 - 2025), defined as a >25% rise in serum creatinine and/or oliguria. Demographic data, Doppler ultrasound resistive index (RI), immunosuppressive therapy, therapeutic plasma exchange (TPE), and short-term outcomes were analyzed descriptively. The study comprised three males and one female (aged 23 – 54 years old). All patients showed elevated RI (>0.75). TPE was performed in three cases (75%), resulting in two full recoveries, one partial recovery, and one persistent dysfunction due to combined immunological and surgical complications. Higher RI values were associated with more intensive treatment. These findings suggest that personalized aggressive therapies, such as TPE and intravenous immunoglobulin, may serve as viable salvage options for severe early graft malfunction. In resource-limited settings, Doppler ultrasound provides valuable non-invasive support when biopsy is unvailable. Larger multicenter studies are needed to confirm long-term efficacy and generalizability. Keywords: Kidney Transplantation, Acute Rejection, Therapeutic Plasma Exchange, Doppler Ultrasound, Immunosuppression.
Copyright (c) 2026 Yudriawan Annas, Trisula Utomo, Tanaya Ghinorawa http://creativecommons.org/licenses/by-sa/4.0
Profile of Comorbidities and Length of Hospital Stay Among Stroke Patient at Dr. Gunawan Mangunkusumo Hospital Semarang Regency
Stroke remains a leading cause of morbidity and hospitalization worldwide. Comorbid conditions can significantly influence the length of stay (LOS) among stroke patients. As a catastrophic disease requiring prolong and costly medical care, stroke demands optimized hospital services through strengthened resource capacity, management and referral systems. This study aims to analyze the comorbidity profile of stroke patients and its association with prolonged LOS. A retrospective analytical design was applied, reviewing medical records of all new stroke inpatients at Dr. Gunawan Mangunkusumo Regional General Hospital between January and June 2025, (n = 404). Data were collected using structured research sheets and analyzed with univariate descriptive statistics, chi-square tests, and multivariate and multivariate logistic regression to identify factors associated with prolonged LOS. Among 404 patients, 26 (6.4%) experienced extended hospitalization. Significant factors associated with prolonged LOS included a history of hypertension (p = 0.038) and coronary heart disease (p = 0.037). Coronary heart disease emerged as the strongest predictor of prolonged LOS (OR = 0.192; 95% CI: 0.068–0.539; p = 0.002), highlighting its impact on inpatient management and discharge processes. These findings suggest that integrated cardiovascular and stroke care may improve hospital efficiency. Future prospective studies incorporating measures of stroke severity are recommended. Keywords: Stroke, Length of Hospitalization, Comorbidity, Patients, Indonesia
Copyright (c) 2026 Sudrisman - Sudrisman http://creativecommons.org/licenses/by-sa/4.0
Bladder Tumor Cases with History of Bladder Stones: Disparity in Histopathological Findings at RSUP Dr. Sardjito Yogyakarta
Bladder cancer remains a major cause of morbidity and hospitalization worldwide. Bladder stones have long been linked to squamous cell carcinoma (SCC) as a result of persistent irritation and inflammation. Nevertheless, modern histopathological patterns may diverge from this traditional framework. This study aims to delineate the histopathological distribution of bladder tumors in patients with a history of bladder stones and to investigate the divergence between predicted and actual tumor subtypes. A retrospective descriptive study was performed at RSUP Dr. Sardjito Yogyakarta from January 2018 to June 2025. We looked at medical records of patients who had bladder tumors that were confirmed by histopathology and bladder stones that were documented. A descriptive univariate analysis was conducted. There were 29 patients in all, and their average age was 59.7 ± 11.8 years. Of these, 26 (89.6%) were men. Eighteen patients (62.1%) had urothelial carcinoma/transitional cell carcinoma (UC/TCC), ten patients (34.5%) had SCC, and one patient (3.4%) had adenocarcinoma. The majority of UC cases exhibited high-grade squamous differentiation (12/18; 66.7%). Even though there were a lot of big stones and people were exposed to them for a long time, UC was still more common than SCC. These results show that bladder tumors linked to stones have different types of histopathology and that SCC may not always be the most common type in cases of chronic irritation. Additional multicenter and molecular investigations are necessary to elucidate the biological mechanisms driving this distribution. Keywords: Bladder Tumor, Bladder Stones, Squamous Cell Carcinoma, Urothelial Carcinoma, Histopathology.
Copyright (c) 2026 Nikko Caesario Mauldy Susilo, Indrawarman Soero Hardjo http://creativecommons.org/licenses/by-sa/4.0
Correlations of Social Interaction and Digital Media Use With Mental Health Among Urban Adolescents: A Cross-sectional Study
Digital platforms are now central to adolescents' daily routines, yet their mental-health implications may reflect both online engagement and offline relationships. This cross-sectional study examined associations between social interaction, digital media use, and symptoms of depression, anxiety, and stress among urban adolescents in Jakarta, Indonesia. One hundred high-school students (13-18 years) were recruited purposively and completed structured Likert-type measures of social interaction and digital media indicators; mental health was assessed using DASS-21. Pearson correlation was applied (α=0.05). Nearly half of participants (48%) reported social media use exceeding five hours/day, and TikTok was the most frequently used platform (58%). At least moderate symptoms were reported by 64% for depression, 80% for anxiety, and 46% for stress. Longer daily use and higher perceived media pressure/self-perception influence were positively associated with higher DASS-21 scores (p<0.01 for duration). Conclusion: Offline social interaction and digital media engagement were both statistically related to adolescent mental-health symptoms, highlighting the need for school- and family-based support, digital literacy, and healthier online habits. Keyword: Adolescents Mental health, Social Interaction, Digital media, Social media
Copyright (c) 2026 Siti Jumhati http://creativecommons.org/licenses/by-sa/4.0