Intraoperative hypothermia and post-anesthetic shivering (PAS) remain frequent complications in oncologic surgery under general anesthesia, yet evidence integrating intraoperative temperature changes with PAS severity in mastectomy patients is limited. This study aimed to evaluate intraoperative temperature profiles, determine the incidence and severity of PAS, and analyze the association between age, body mass index (BMI), and PAS among radical mastectomy patients. A cross-sectional observational study was conducted involving 36 women undergoing radical mastectomy with endotracheal general anesthesia. Core temperature was measured at 30 and 60 minutes intraoperatively, and PAS was assessed using the bedside shivering assessment scale (BSAS) upon admission to the recovery room. Moderate intraoperative hypothermia was observed in 72.2% of patients at 60 minutes, while PAS occurred in 30.6% of cases. Significant associations were identified between PAS and BMI (p = 0.001), as well as age (p = 0.026). Moderate-to-severe shivering (BSAS scores 2-3) was more frequently observed among underweight and elderly patients. This study provides novel evidence by linking intraoperative hypothermia patterns with PAS severity using BSAS in mastectomy patients. Clinically, the findings support structured perioperative temperature monitoring and the implementation of risk-based warming protocols, particularly for patients with low BMI and advanced age.
The surgical safety checklist (SSC) is a recognized tool for enhancing patient safety by reducing surgical complications and mortality. While its benefits are well established, effective implementation depends on consistent adherence by the medical team. This study examined the relationship between surgical procedure type and team compliance with SSC in the central operating room of a maternal and child hospital in Yogyakarta. Using a quantitative cross-sectional design, data were collected from 65 observed operations out of 148 total procedures, including elective and emergency cases. Compliance was evaluated in three SSC phases: sign-in, time-out, and sign-out. Correlation was analyzed using chi-square tests. The results showed no significant relationship in the sign-in phase (p = 0.195), but significant correlations were found in the time-out (p = 0.004) and sign-out (p = 0.011) phases. Overall, a significant association was identified between type of surgery and SSC compliance (p = 0.006). This study concludes that SSC compliance remains suboptimal, particularly in the initial phase. Elective procedures demonstrated higher compliance than emergency cases. Strengthening a culture of safety and promoting interdisciplinary training are essential strategies to improve SSC adherence and elevate surgical care quality.
Iron deficiency anemia (IDA) remains a critical global public health burden, affecting approximately 1.8 billion people worldwide, disproportionately impacting children under five and women of reproductive age in developing countries. Conventional iron supplementation often suffers from low compliance due to gastrointestinal side effects. Thus, food-based interventions utilizing widely accepted bakery products represent a sustainable and culturally appropriate strategy for addressing micronutrient deficiencies. A completely randomized design with five red beet flour proportions(0-40%). In muffin formulations was employed, analyzing proximate, physicochemical, antioxidant, and sensory parameters were analyzed across three replications. Results: increasing red beet flour significantly (p < 0.05) enhanced Fe content (1.42-5.06 mg/100 g), total betalains, total phenolics, and antioxidant activity. Treatment T2 (20%) demonstrated an optimal balance between functional properties and sensory acceptability. The T2 formulation can contribute approximately 28% of the recommended dietary allowance for iron per serving, positioning it as a viable functional food for community nutrition interventions. This product could be integrated into supplementary feeding programs targeting vulnerable populations prone to anemia. The food-based approach offers superior compliance and sustainability compared to conventional tablet supplementation, thereby strengthening population-level strategies for IDA prevention.
Fast and predictable recovery is essential in breast cancer surgery, yet comparative evidence on inhalation anesthetics within Indonesian clinical settings remains limited. This study compared the effectiveness of desflurane and sevoflurane on early recovery time after modified radical mastectomy. A cross-sectional design was applied to 76 ASA I-II female patients who received standardized induction, maintenance, and Aldrete-based recovery assessment. Recovery was categorized as fast (≤10 minutes) or delayed (>10 minutes). Statistical analysis used Chi-square testing, supported by effect size and risk ratio estimation. Desflurane demonstrated significantly faster recovery than sevoflurane (97.4% vs 78.9%, p = 0.014). The association showed a moderate effect size (Cramér’s V = 0.30), and patients receiving sevoflurane were substantially more likely to experience delayed recovery (RR = 8.3). These results align with recent studies highlighting desflurane’s lower blood-gas solubility and faster elimination profile. The homogeneous sample and standardized anesthetic protocol strengthen internal validity. However, the non-randomized design, purposive sampling, and absence of documented adverse events limit generalizability. Desflurane may offer practical benefits in improving post-anesthesia care unit (PACU) efficiency and surgical throughput in high-volume settings. Further multicenter randomized studies are recommended to confirm these findings and explore broader clinical implications.
Emotional intelligence is a key skill influencing adaptation, communication, and personal growth in elementary school-aged children. Emotional card games offer a promising interactive approach to enhance children's emotional competencies. To analyze the effect of emotional card games on the emotional intelligence of elementary school-aged children. A quasi-experimental pretest-posttest control group design was conducted among 77 first-grade students at MI Mambaul Khair NW Bertais Mataram in 2025. The intervention group (n = 39) participated in three sessions of an emotional card game, while the control group (n = 38) received no intervention. Emotional intelligence was measured using a validated 24-item questionnaire. The intervention group demonstrated a significant increase in emotional intelligence scores from pre-test to post-test (p = 0.007), whereas the control group showed no significant change. Between-group comparison confirmed significantly higher post-test scores in the intervention group (p = 0.006). After adjusting for confounding variables and baseline scores, the intervention effect remained statistically significant (p < 0.001). Emotional card games effectively improve emotional intelligence among elementary school-aged children. These findings support the integration of game-based social-emotional learning strategies into elementary school curricula. School health practitioners and educators can utilize this low-cost, engaging intervention to promote children's emotional well-being and support holistic child health development.
Bullying remains a persistent issue in schools and continues to undermine students’ emotional and psychological well-being. This paper introduces a novel conceptual model of an expressive writing program specifically designed for Indonesian schools, addressing the current gap in structured resilience-building interventions. Using a qualitative design based on secondary data from books and journal articles, this study outlines how expressive writing can be systematically integrated into school settings to strengthen students’ mental resilience. The proposed model-illustrated in the program diagram-combines guided writing sessions, emotional literacy activities, and teacher-facilitated support mechanisms. The program also emphasizes teacher preparedness, safe classroom environments, and collaborative involvement from parents and counselors. Additionally, secure digital platforms are recommended to enhance accessibility and ensure confidentiality. This model is intended to guide schools in implementing proactive emotional support systems and to provide a foundation for future empirical evaluation of its effectiveness in reducing bullying and improving students' emotional well-being.
This study evaluated the effectiveness of an empathy-based mental health first aid (MHFA) intervention through structured SUFA mentoring by peer counselors in reducing symptoms of anxiety and depression in adolescents. The design used was a quasi-experimental, one-group pretest-posttest study conducted over two weeks in middle and high schools. A total of 100 students were trained as peer counselors, and each mentored one adolescent (a 1:1 ratio). Symptoms were measured before and after the intervention using the Mini MINDHEAR Youth Scale V.1. Analysis included descriptive statistics (mean pre–post scores and changes in symptom categories of "mild/none" vs. "moderate") and McNemar test (α = 0.05) to assess changes in categories. Respondents were predominantly female (67%), in late adolescence (58.18%), and high school students (55%). The mean anxiety score decreased from 4.92 to 3.50 (Δ = 1.42), while depression decreased from 5.05 to 3.21 (Δ = 1.84). The proportion of mild/none anxiety increased from 13 to 56, and moderate decreased from 87 to 44 (p = 0.003). A similar pattern occurred for depression: mild/none increased from 13 to 61, while moderate decreased (p = 0.001). SUFA-based peer counseling interventions significantly reduce symptoms of anxiety and depression in adolescents. Schools should integrate structured peer counselor training programs into mental health frameworks, establish systematic early detection protocols, and establish clear referral pathways to professional services within school-based support systems. The limitations of this study were no control group and short duration, which must be addressed in subsequent research.
Diabetic foot disease (DFD) is a preventable but rapidly growing complication of diabetes in Oman. The individual and societal consequences of DFD are catastrophic; however, best practices in its management remain underreported. This review aimed to identify, appraise, and synthesize the available evidence on DFD in Oman and to map findings onto the capability, opportunity, motivation, behaviour (COM-B) model to guide public health interventions. Five databases (PubMed, Scopus, Cochrane Library, WHO EMRO repository, Google Scholar) and two Omani journal archives were searched from inception to March 2026. Records were screened independently by two reviewers, and methodological quality was appraised using an adapted Newcastle-Ottawa scale. Findings were mapped deductively onto the six COM-B sub-domains and to the behaviour change wheel intervention functions. Ten publications met inclusion criteria. Diabetes related lower limb amputations account for 47% of all amputations nationally. Concurrent deficits were found across capability (55% lacked knowledge of DFD causes), opportunity (no multidisciplinary foot teams outside Muscat; 50 to 54% barefoot walking), and motivation (38% performed regular foot examination). Limitations include lack of interventional studies, urban concentration, and self-reported outcomes. Policy priorities are a national DFD registry, multidisciplinary foot care beyond Muscat, and integration of behaviour change techniques into primary care.
Hospital effluent has the potential to release both chemical substances and pathogenic microorganisms into surrounding water bodies, creating hazards for the environment and human health. There is a scarcity of studies in Indonesia that assess the impact of hospital wastewater on river ecosystems using benchmark regulations. This study measured the quality of wastewater at a point 50 meters before discharge and 50 meters after the wastewater treatment plant by analyzing six main parameters of temperature, potential of hydrogen (pH), Biochemical oxygen demand (BOD), chemical oxygen demand (COD), total dissolved solids (TDS), and total suspended solids (TSS), then compared with the water quality standards according to the Regulation of the Governor of the Special Region of Yogyakarta No. 20/2008. This study found that although temperature and pH remained within acceptable ranges, higher BOD, COD, and TDS levels downstream indicated that hospital wastewater was adding to the river's organic and chemical pollution. Improved wastewater treatment processes and consistent monitoring are essential to protect ecosystem integrity and public health.
Cesarean section is a common surgical procedure often associated with moderate to severe postoperative pain. Hypnotherapy has been proposed as a complementary, non-pharmacological intervention; however, evidence specific to post-cesarean pain management remains limited. The purpose of this PRISMA-based systematic review was to evaluate hypnotherapy as an intervention for reducing postoperative pain associated with cesarean section. Literature searches were conducted in Google Scholar and PubMed for studies published between 2015 and 2024 using predefined inclusion and exclusion criteria. From 326 identified records, four studies met all eligibility criteria and were included in the qualitative synthesis. Despite heterogeneity in study design and intervention protocols, all included studies consistently reported reductions in postoperative pain intensity among participants receiving hypnotherapy compared with standard postoperative care, with pain outcomes primarily measured using validated scales such as the Numerical Rating Scale. These findings suggest that hypnotherapy may support conventional analgesic strategies as an adjunctive intervention during early postoperative recovery. Nevertheless, the scarcity of existing research and the presence of methodological limitations suggest the need for rigorously designed randomized controlled trials to provide more robust evidence.
Hyperemesis gravidarum is excessive vomiting which can cause dehydration, lack of carbohydrate and fat reserves in the body, and Mallary Weiss syndrome due to gastrointestinal bleeding. Boiled ginger and honey were administered as an initial complementary treatment to reduce nausea and vomiting in pregnant women with hyperemesis gravidarum. This study aims to determine the effect of giving ginger and honey decoction on the frequency of hyperemesis gravidarum in pregnant women. This study employed a quasi-experimental design with a one-group pretest-posttest approach. The population was all pregnant women who experienced nausea and vomiting, outpatients, and inpatients at Inche Abdoel Moeis Hospital. The sample consisted of 18 people using consecutive sampling technique. The severity of nausea and vomiting was measured using the pregnancy-unique quantification of emesis and nausea (PUQE) questionnaire. Statistical analysis was performed using the Wilcoxon signed-rank test to compare pretest and posttest scores. The Wilcoxon Test results obtained a significance value of 0.000 < 0.05. There is an effect of giving ginger and honey decoction on the frequency of hyperemesis gravidarum. Pregnant women are advised to use a decoction of ginger and honey, apart from that, other researchers are advised to use a control group in subsequent studies.
Malaria remains endemic in eastern Indonesia, and resistance to conventional antimalarial drugs necessitates alternative treatments. Black pule (Alstonia spectabilis) is one of the plants that has been researched and claimed to be a natural ingredient that can treat malaria. Black pule prototype has been prepared for the downstream stage through commercialization. Before that, it is necessary to conduct marketing research to ensure the success of the marketing. Therefore, this study evaluates consumer preferences and formulates marketing strategies for black pule antimalarial tablets. This study involved 100 respondents selected using cluster and purposive sampling across three malaria-endemic sub-districts in South Central Timor Regency. Using a quantitative-descriptive approach, data were collected through questionnaires and analyzed with descriptive statistics. The results show that most consumer targets stated that the antimalarial tablet prototype of black pule has a good impression and characteristics. Approximately 69-77% of respondents rated the product positively across shape, color, taste, aroma, size, and overall organoleptic attributes. The results indicate that the majority of respondents gave positive evaluations and expressed a preference for the product’s shape, color, taste, aroma, size, and overall organoleptic characteristics. Findings support aggressive marketing strategies for herbal antimalarial tablets in endemic regions. Based on these findings, an aggressive S-O marketing strategy is recommended, emphasizing product promotion, participation in health-related expos, strengthened digital outreach, and concise educational initiatives to improve public acceptance of the herbal antimalarial tablet.
Shallot production in Indonesia, particularly in Brebes Regency, generates substantial agricultural by-product waste that poses significant environmental and public health risks due to inadequate community-level management. This cross-sectional quantitative study investigated the influence of government role, infrastructure availability, and public knowledge on perceptions of shallot by-product waste management among 180 respondents selected through proportional random sampling. Data were collected using structured Likert-scale questionnaires and analyzed through multiple linear regression, Spearman's rank correlation, and gap analysis. Gap analysis revealed critical deficiencies in public knowledge (50.6-76.1%) and infrastructure (69.2%), despite universally positive perceptions toward waste management. Multiple linear regression demonstrated that government role (β = 0.342, p < 0.001), infrastructure availability (β = 0.298, p < 0.001), and public knowledge (β = 0.152, p = 0.007) significantly predicted waste management perceptions, collectively explaining 37.8% of the variance (Adj. R² = 0.378). The government's role contributed the largest effective contribution at 18.74%. These findings carry substantial public health implications, as improved waste management can reduce disease vectors, minimize environmental contamination, and enable by-product valorization for nutritional supplementation. The study recommends strengthening government intervention, expanding waste infrastructure, and enhancing community health literacy as integrated policy strategies to optimize agricultural by-product management and safeguard community nutritional well-being in shallot production centers.
Diabetes mellitus (DM) is a major non-communicable disease among older adults and a growing public health problem in Indonesia. Older people often have limited health literacy, which may affect their knowledge and self-management of DM. This study aimed to analyze the relationship between education level and knowledge about DM among the elderly in Bandung City, West Java. A descriptive cross-sectional study was conducted on 150 elderlies with type 2 DM using purposive sampling at primary health care facilities with high DM cases. Data were collected through structured interviews using a demographic questionnaire and a 15-item multiple-choice questionnaire on DM knowledge that had been tested for validity and reliability previously, adapted from an Indonesian diabetes self-management instrument. Knowledge scores were categorized into good and poor. Data were analyzed using the Chi-square test. Most respondents had an elementary or high-school education. The majority of the elderly with higher education levels had good knowledge about DM, while those with lower education levels tended to have poorer knowledge. There was a statistically significant association between education level and elderly knowledge about DM (p<0.001). Education level is significantly associated with DM knowledge among the elderly in Bandung. These findings highlight the need for a tailored continuity of care diabetes program, especially for the elderly with lower educational attainment, in order to improve self-management and glycemic control.
Urinary incontinence (UI) affects millions globally, predominantly women, significantly impacting quality of life. This study evaluated Afigel as a novel intervention for reducing UI symptoms. A quasi-experimental pre-posttest design was employed with 93 premenopausal women randomly assigned to intervention (n = 31) and control (n = 62) groups. Data collection utilized personal data sheets, Afigel therapy standard operating procedures, observation sheets, and the questionnaire for urinary incontinence diagnosis (QUID). Dependent and independent t-tests analyzed the data. Among participants, 43% experienced stress incontinence, 47% experienced urge incontinence, and 10% mixed incontinence. Severity was mild (41%), moderate (45%), and severe (14%). The intervention group demonstrated a significant reduction in incontinence scores from 6.30 to 1.53 (p = 0.000), while the control group showed minimal change from 6.30 to 6.18 (p = 0.21). Afigel demonstrates potential as an effective UI management therapy. These findings suggest Afigel could substantially improve quality of life by reducing UI-related social embarrassment, activity limitations, and psychological distress. For primary health care settings, Afigel offers a potentially accessible, non-invasive treatment option that community health nurses and primary care providers could implement, reducing referral burdens on specialist services while addressing this prevalent yet often underreported condition.
Prediabetes prevalence among adolescents has increased substantially worldwide, with estimates indicating that approximately 18-20% of adolescents in certain populations exhibit impaired glucose metabolism, paralleling the global rise in adolescent obesity. In Indonesia, the prevalence of diabetes mellitus continues to escalate, with North Kalimantan representing an underserved region where adolescent metabolic health remains poorly characterized. Identifying modifiable factors associated with prediabetes prevention behavior is essential for developing targeted interventions. To analyze factors associated with prediabetes prevention behavior in adolescents, focusing on nutritional status and knowledge about diabetes mellitus. A cross-sectional analytical design was employed among 316 adolescents aged 13-15 years in Tarakan City, North Kalimantan, Indonesia, selected through proportional stratified random sampling. Data were collected using a demographic questionnaire, an adapted diabetes knowledge questionnaire (DKQ-24), and a prediabetes prevention behavior questionnaire. Chi-square tests and binary logistic regression were performed. Most respondents (53.2%) demonstrated positive prevention behavior, and 70.9% had high knowledge. Nutritional status (p = 0.000) and knowledge (p = 0.033) were significantly associated with prevention behavior. Multivariate analysis confirmed nutritional status (Exp(B) = 1.320; 95% CI: 1.017-1.714) and knowledge (Exp(B) = 0.583; 95% CI: 0.352-0.965) as significant predictors (Nagelkerke R² = 0.052). Nutritional status and diabetes knowledge significantly predict prediabetes prevention behavior, although their contributions remain relatively small.
The increasing number of homebound and bedridden patients in Indonesia illustrates the importance of effective hospital-based telehomecare. While telehomecare can improve access and continuity of care, its implementation depends on alignment with user needs. This study aimed to identify user-centered socio-technical requirements for telehomecare in hospital-based homecare services in Indonesia. A qualitative descriptive study was conducted using in-depth interviews and a focus group discussion with 12 purposively selected stakeholders. A telemonitoring device was used as a contextual probe. Data were analyzed using inductive thematic analysis with stakeholder triangulation. Three main areas of needs were identified: i) functional needs, which include constant monitoring, settings for specific diseases, early warning alerts, organized communication, and access to long-term data; ii) technical needs, like ease of use for older people, access through mobile devices, support for location tracking, easy-to-read dashboards, and compatibility with hospital information systems; and iii) data security, privacy, and making sure everyone can use the system, which involves dealing with. These findings help shape the design and growth of fair telehomecare systems in health settings with limited resources and provide real-world evidence from a low- and middle-income country.
Food consumption habits nowadays are diverse, particularly the many choices of processed and quick food at low prices, which, including among students, are unhealthy and unsafe, with unbalanced nutritional levels that can cause a variety of degenerative diseases. This study aimed to describe students' intentions to stop consuming risky foods, grounded in the theory of planned behaviour (TPB). This study is a quantitative descriptive study conducted with second- and fourth-semester students in the public health study program. The sample was selected using accidental sampling, resulting in 87 students participating in the questionnaire. The data were analyzed descriptively and presented in tables and narratives. The study shows that fatty meat/offal, canned foods, pickled foods, and dried sweets are consumed frequently. The non-intentional group comprised processed cheese, frozen sweets and ice cream, quick noodles, and fried foods. Among 10 dangerous foods, fried foods, processed cheese, pickles, and frozen desserts are the least likely to be substituted. Most responders were unsure of the quitting time. Students did not plan to quit unhealthy foods. Students did not have a firm intention to stop consuming hazardous foods such as processed cheese, frozen sweets, instant noodles, and fried foods.
Wound management remains a significant global public health challenge, contributing to substantial morbidity, mortality, and healthcare costs. Honey has been increasingly investigated as a complementary wound care agent due to its antimicrobial, anti-inflammatory, and wound-healing properties. This systematic review aimed to synthesize and critically evaluate the current evidence on the use of honey as an alternative wound treatment. A systematic review was conducted following PRISMA guidelines. Six electronic databases (Scopus, Nature, ProQuest, EBSCO, SpringerLink, and ScienceDirect) were searched using predefined search terms for studies published between 2020 and 2024. Inclusion criteria encompassed human studies, mixed-methods or quantitative designs, and interventions using honey for wound care. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. From 302 initially identified articles, 16 studies met the inclusion criteria after removing duplicates and screening. The included studies comprised randomized controlled trials, prospective controlled studies, case series, and in vitro investigations. Three themes emerged: i) Honey as a wound-healing therapy, demonstrating antimicrobial, anti-inflammatory, and biofilm-inhibiting properties; ii) Benefits of medical-grade honey (MGH), including accelerated epithelialization, reduced infection rates, and shorter recovery times; and iii) Recommendations for honey as a cost-effective, accessible alternative treatment. The evidence supports honey as a promising adjunctive therapy for wound management, particularly in resource-limited settings. However, the heterogeneity in study designs, honey types, and wound categories limits definitive conclusions. Future large-scale randomized controlled trials with standardized outcomes are needed to establish clinical guidelines for honey-based wound care.
In Indonesia, osteoarthritis affects about 7.30% of the population, with its occurrence rising markedly as people age. The condition is found in 11.08% of individuals aged 45-54 years and increases to 18.85% among those older than 75 years. A large proportion of individuals with knee osteoarthritis (KOA) lead inactive lifestyles and often lack adequate encouragement to engage in physical activity. Exercise is known to be beneficial, as it helps regulate cytokine activity in synovial fluid while reducing inflammation and oxidative stress. This research aimed to evaluate the comparative effectiveness of telerehabilitation and home-based exercise interventions for individuals with KOA. A quasi-experimental approach with pre- and post-intervention assessments and a control group was applied. The study involved 120 participants diagnosed with osteoarthritis, who were assigned to either an intervention group receiving an 8-week telerehabilitation program or a control group performing standard exercises independently. Outcome measures: 30-CST, pain intensity, physical activity levels assessed using IPAQ, fear of movement measured by the Tampa Kinesiophobia Scale, and FSS. These variables were assessed before and after the intervention. Additionally, adherence to exercise (EARS) and patient satisfaction were recorded. Statistical analysis was conducted using the Mann-Whitney test and the Wilcoxon signed-rank test.
