The Science Midwifery is a peer-reviewed open access bi-monthly Intitute of Computer Science (IOCS). This journal is published bi-monthly (August, October, December, February, April, June) since August 2022. This professional journal provides a venue for the publication of research relevant to midwifery and reproductive health practice by specialists and researchers in various disciplines including midwifery, reproductive health, maternal and child health, obstetrics and gynecology, sexual health promotion, women's health and nursing. It publishes quantitative and qualitative original articles, review articles, short communications, case reports and letters to the editor in a broad range of clinical and interdisciplinary topics. (Look at the scope)
Nanophytosome delivery system and in vivo test of combination of binahong leaf extract (Andredera cordifolia) and bay leaf (Syzygium polyanthum) as a diabetic wound healer
This study aimed to develop and characterize a nanophytosome system containing combined extracts of bay leaf (Syzygium polyanthum) and binahong leaf (Anredera cordifolia), and to evaluate its wound healing activity through in vivo study. The extracts were prepared by maceration using 96% ethanol and characterized through phytochemical screening and LC-MS/MS analysis. Nanophytosomes were formulated using phospholipid complexes with variations of surfactants, followed by homogenization and sonication. The formulations were evaluated for particle size, polydispersity index, zeta potential, and entrapment efficiency. The results showed that particle size ranged from 16.30 to 927.18 nm, with the smallest size observed in Tween 80-based formulation. The polydispersity index ranged from 0.20 to 0.86, indicating better homogeneity in Tween 80 systems. Zeta potential values ​​were in the range of −6 to −17 mV, suggesting moderate stability. Entrapment efficiency was high in all formulations (92.5–97.3%), with the highest value observed in Cremophor-based formulation. In vivo evaluation demonstrated that the nanophytosome significantly accelerated wound healing compared to control groups, as indicated by faster wound contraction and improved tissue regeneration. In conclusion, the nanophytosome system enhanced the physicochemical properties and delivery of bioactive compounds, showing potential as an effective therapeutic approach for wound healing.
Relationship between stunting status and parental parenting patterns with the incidence of dental caries in toddlers in the working area of the bugel public health center
Stunting and dental caries are two common child health problems that often occur simultaneously and influence each other. Parental care patterns, education level, knowledge, and socioeconomic status play important roles in dental caries occurrence in stunted children. To analyze the relationship between stunting status and parental care patterns with dental caries occurrence in children under five, as well as the factors underlying dental caries. Cross-sectional study on 162 children under five (81 stunted and 81 normal) at Bugel Public Health Center. Data collected through questionnaires and examinations. Analysis used Chi-Square test and multiple logistic regression (α=0.05). Prevalence of stunting and caries were each 90.1%. Significant relationships found between stunting and caries (p=0.001; OR=17.25), parental care and caries (p=0.002; OR=18.61), education and caries (p=0.035; OR=4.42), knowledge and caries (p=0.047; OR=4.30). Socioeconomic status was not significantly associated (p=0.433). Multivariate analysis showed stunting (OR=5.59; p=0.032) and parental care (OR=4.80; p=0.040) as significant factors. Stunting status and parental care are significant factors of dental caries in children under five. Integrated intervention programs are needed to address stunting and dental health, parenting education, and routine monitoring.
Resolving medical malpractice disputes through customary institutions: Between statutory law and local wisdom
The transformation of medical dispute resolution in Indonesia reveals a critical paradox: while Law No. 17 of 2023 on Health mandates non-litigation mechanisms, the existing framework remains entrapped within a state-centric legal paradigm that systematically marginalizes customary institutions which have long served as accessible, socially legitimate, and restoratively-oriented dispute forums across diverse Indonesian communities. A fundamental research gap persists in the prevailing legal monism approach, which creates a normative vacuum by failing to recognize customary institutions operationally within health law, thereby forcing communities to choose between legally certain but inaccessible formal mechanisms and socially accepted but legally uncertain customary processes — a justice gap that disproportionately burdens economically vulnerable populations. This study employs a normative-prescriptive legal methodology integrating legislative, conceptual, and comparative approaches to reconstruct the positional framework of customary institutions within medical dispute resolution. The findings reveal that customary institutions hold strong constitutional legitimacy under Article 18B(2) of the 1945 Constitution yet operate within a normative vacuum in the medical domain, and introduce a Two-Tier Integrative Model positioning customary institutions as relational mediation forums at the first tier and MKDKI as technical verifier at the second tier, connected through a court homologation mechanism. This study provides a strategic normative blueprint recommending explicit revision of Law No. 17 of 2023 to accommodate customary institutions within the national medical dispute resolution system.
Fatmasari Diahpermata Djajaputri Adhimutiahara
Design of an IVA test mannequin model as a learning media for midwifery students at the Tasikmalaya Health Polytechnic, ministry of health
Introduction: Cervical cancer remains one of the leading causes of cancer-related deaths among women in Indonesia, particularly in developing countries. The Visual Inspection with Acetic Acid (IVA Test) is a simple, affordable, and sensitive method recommended by the World Health Organization (WHO) for early detection. However, many healthcare workers, including midwives, still lack sufficient skills in performing the test. This study aims to develop a prototype of an IVA Test manikin as an innovative learning medium to enhance midwifery students’ competencies. Methods: This research employed the Research and Development (R&D) approach through stages including anatomical graphic design of the cervix, prototype fabrication using medical-grade silicone, and simulation of acetic acid application using hypochlorite acid. The cervical part was designed modularly with litmus paper that turns white when applied with hypochlorite, mimicking a positive IVA reaction. Validation and consultation were conducted with material and media experts to assess design accuracy and functionality. A small-scale trial was carried out involving 10 midwifery students from Poltekkes Kemenkes Tasikmalaya. Results: The prototype successfully resembled the realistic shape, color, and texture of the cervix. Expert validation indicated that the manikin met anatomical and functional criteria, while student trials demonstrated that the model was easy to use, improved understanding of procedural steps, and increased confidence in performing the IVA Test. Conclusion: The developed IVA Test manikin serves as an effective, practical, and sustainable learning innovation to enhance midwifery students’ clinical skills in cervical cancer early detection. Further studies with larger samples and expert validation are recommended to optimize its educational model/video.
Review article "antifungal activity of black garlic (allium sativum linn) extract against candida albicans fungus"
This study aims to analyze the effectiveness of black garlic extract (Allium satium Linn) on the growth of candida albicans fungus, which is known as an opportunistic pathogen in humans, black garlic produced through the process of heating garlic contains active compounds such as allicin, saponins, flavonoids and tannins that have the potential as antifungals. The method used in this study is a narrative review based on articles published in the last 10 years. The results show that black garlic extract can inhibit the growth of C. Albicans with a significant inhibition zone diameter at certain concentrations. In addition, black garlic has higher antioxidant activity than fresh garlic, making it a safe and effective alternative in the treatment of fungal infections, especially in the context of increasing antifungal resistance. This study recommends the formulation of black garlic in the form of a gel preparation as a safer and more effective preparation for applications in pharmaceutical preparations.
Nanophytosome delivery model based on a combination of bay leaf (syzygium polyanthum) and binahong (anredera cordifolia) extracts in gel formulation as a therapy for diabetic ulcers
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia and associated with various complications, including diabetic foot ulcer (DFU), which may lead to infection, gangrene, amputation, and even death. Natural-based topical therapies have potential to support DFU healing; however, the limited solubility and permeability of active compounds, particularly polar phytochemicals, often reduce their therapeutic effectiveness. Nanophytosomes, a phospholipid–phytoconstituent complex system, are considered capable of enhancing the stability and penetration of herbal compounds. This study aimed to design and develop nanophytosomes containing a combination of bay leaf extract (Syzygium polyanthum) and binahong leaf extract (Anredera cordifolia), characterize the system, incorporate it into a gel formulation, and evaluate its wound-healing activity in a diabetic wound model. The study involved preparation of nanophytosomes from the combined extracts followed by characterization of particle size, polydispersity index (PDI), zeta potential, entrapment efficiency, and particle morphology. The nanophytosome system was then formulated into a gel and evaluated for physical quality parameters including pH, viscosity, spreadability, and stability. Wound-healing activity was assessed using a diabetic wound model in experimental animals by observing wound closure and histological parameters. The expected results include the formation of nanophytosomes with favorable physicochemical characteristics, a stable gel formulation, and improved diabetic wound healing compared with the control group. It is anticipated that the nanophytosome gel combining S. polyanthum and A. cordifolia extracts may serve as a promising innovative topical therapy for DFU.
Mandibular third molar odontectomy and drug of choice: a case report
Impacted tooth is an abnormal tooth eruption, usually caused by adjacent tooth near it or pathologic tissue. Impacted tooth is partially erupted or cannot be erupted entirely because it is blocked by bone or surrounding soft tissue or even both. The odontectomy procedure performed was the same as in other odontectomy cases. Initially, a flap was made to get a field of view, and division of the tooth structure was carried out in the lower third molar teeth into several parts. The results shown one week after the odontectomy procedure, no abnormalities were found and healing in the bones and soft tissue were seen after the procedure. From this case report, it can be concluded that in post-operative impacted tooth management, a minimum traumatic technique should be applied and the correct drug of choice and time of administration can give a high effective effect of managing patient's discomfort and high yield of infection prevention.
Implementation care nursing child: Hyperbilirubinemia
Hyperbilirubinemia is a condition characterized by elevated bilirubin levels in newborns that clinically appear as jaundice. This study aimed to describe the implementation of nursing care in newborns diagnosed with hyperbilirubinemia in a hospital setting. A descriptive case study approach was used involving three newborns with hyperbilirubinemia treated at Gunung Maria General Hospital, Tomohon, in March 2024. Data were obtained through comprehensive nursing care processes including assessment, nursing diagnosis, planning, implementation, and evaluation. The findings indicated that the infants experienced neonatal jaundice accompanied by hyperthermia, risk of impaired skin integrity, risk of infection, and parental anxiety. Nursing interventions were carried out through phototherapy management, breastfeeding education, hyperthermia management, infection prevention, and maintenance of skin integrity. After four days of nursing care, bilirubin levels decreased and the identified nursing problems showed improvement. The implementation of nursing care, particularly phototherapy combined with supportive interventions, contributed to the improvement of the infants’ condition and reduction of bilirubin levels.
Formulation and antibacterial activity of black mulberry fruit (Morus nigra L.) extract cream against cutibacterium acnes and staphylococcus epidermidis
Acne vulgaris is an inflammatory disorder of the pilosebaceous unit characterized by sebum overproduction, abnormal keratinization, microbial proliferation, and inflammation, with Propionibacterium acnes and Staphylococcus epidermidis as key contributing bacteria. To reduce the side effects associated with conventional acne therapies, natural ingredients have been explored as alternative approaches. Black mulberry (Morus nigra) fruit is one such natural source known to contain bioactive compounds, including flavonoids, tannins, and terpenoids, which possess antibacterial properties. This study aimed to develop and evaluate a topical cream formulation containing ethanolic extract of black mulberry fruit and to assess its antibacterial activity and physicochemical stability. The extract was obtained through 96% ethanol maceration and formulated into creams at concentrations of 1.25%, 2.5%, and 5%. Antibacterial activity was evaluated using the agar well diffusion method, while cream quality was assessed through organoleptic properties, homogeneity, pH, viscosity, spreadability, and centrifugation stability. The results showed that the extract exhibited strong antibacterial activity against both tested bacteria. All concentrations demonstrated inhibition zones categorized as strong, with a concentration-dependent increase in activity. At 1.25% inhibition zones against P. acnes were 11.7 ± 0.25 m, while against S. epidermidis were 11.9 ± 0.20 mm at day 28. All formulations showed acceptable physicochemical characteristics and remained stable during 28 days of storage. The novelty of this study lies in the development of a stable topical cream formulation of M. nigra extract with confirmed antibacterial activity, providing a potential plant-based alternative for anti-acne therapy.
Strategy for enhancing stability and bioavailability of active lipid ingredients through nanoparticle technology: Review
Background: Lipid-based active ingredients have high pharmacological potential, such as anti-inflammatory, antioxidant, and anticancer activities, but often face biopharmaceutical challenges such as low water solubility, poor chemical stability, and limited bioavailability. Objectives: This review article aims to analyze various nanoparticle technology-based formulation strategies to improve the stability and pharmacological activity of lipid active ingredients. Methods: A total of 31 scientific articles published between 2020 and 2025 were systematically analyzed to evaluate the types of lipid nanoparticle systems, production methods, the role of surfactants and additives, and their impact on stability and bioavailability. Commonly used systems include Solid Lipid Nanoparticles (SLN), Nanostructured Lipid Carriers (NLC), and nanoemulsions. Results: The results of the study indicate that encapsulation in a nano lipid matrix can protect the active ingredients from oxidative, photolytic, and enzymatic degradation and increase membrane solubility and permeability. Key factors for successful formulation include the selection of lipid type, production method, and the combination of surfactant and coating polymer. In addition to improving pharmacokinetic parameters, lipid nanoparticle systems also show potential for cost efficiency through dose reduction and increased therapeutic efficacy. Conclusions: Overall lipid nanoparticle technology is an effective, applicable and prospective approach in the development of modern pharmaceutical preparations based on lipophilic active ingredients.
Dioscorea alata enhances on the corpus luteum histology in an endometriosis mouse model
Endometriosis is a chronic inflammatory disease that causes ovarian damage and infertility. Dioscorea alata contains anti-inflammatory and antioxidant agents. This study examined the effect of ethanol extract of Dioscorea alata (EEDA) on the histology of corpus luteum in an endometriosis mouse model. This research is a quasi-experimental with a post-test-only controlled group design. Twenty-four mice were divided into six groups: control (C), negative control (NC) induced endometriosis model, positive control (PC) induced endometriosis model and letrozole, and three treatment groups induced endometriosis model and EEDA 50, 250, and 500 mg/kg body weight (T1, T2, T3). The number and diameter of corpus luteum analyzed with Kruskal-Wallis test, One-way ANOVA, and Duncan's test. The number of corpus luteum decreased in negative control group and increased significantly in the treatment groups (P = 0.038). The diameter of corpus luteum decreased in the negative control group and increased non-significantly in the treatment groups (P = 0.206). The conclusions of this research prove that EEDA has a positive effect both the number and diameter of corpus luteum in an endometriosis mouse model.
Hybrid mediator panel: A legal pluralism framework for resolving medical disputes under the Indonesian health law
Background The transformation of medical-legal relationships from a paternalistic to a contractual model in Indonesia has triggered complex disputes that conventional, legalistic mechanisms often fail to resolve fairly. While Law No. 17 of 2023 mandates non-litigation resolution, the current mediation framework remains trapped in a state-centric paradigm that marginalizes professional ethics and social norms. Research Gap A critical research gap exists in the prevailing legal monism approach, which creates a "justice gap" by failing to synchronize the disciplinary reviews of Article 308 with criminal judicial processes, thereby leaving healthcare workers vulnerable to criminalization and patients without substantive restoration. Method This study employs a normative-prescriptive research method with a qualitative-synthetic conceptual development design to reconstruct the mediation function. Findings The findings introduce a "Hybrid Mediator Panel" and a "Multi-Layered Screening" mechanism as a functional reconfiguration of Article 310 of Law No. 17 of 2023. This model integrates state law, professional ethics (deontological), and living law (deliberation) into a single convergent system to ensure that settlement agreements are not only legally enforceable but also sociologically valid. Contribution This study provides a strategic blueprint for the Indonesian government to implement restorative justice in health law, ensuring legal certainty for medical professionals while simultaneously achieving holistic justice and therapeutic recovery for patients.
219-13FR Sacha inchi oil-based nanoemulsion of bay leaf (syzygium polyanthum) and binahong leaf (anredera cordifolia) extracts and in vitro release using a dialysis membrane
This study aimed to develop and characterize a nanoemulsion system containing combined extracts of bay leaf (Syzygium polyanthum) and binahong leaf (Anredera cordifolia) using sacha inchi oil, and to evaluate its in vitro release profile using a dialysis membrane method. The extracts were prepared by maceration using 96% ethanol and characterized through physicochemical and phytochemical analyses. Nanoemulsions were formulated using Cremophor RH40 and PEG 400, followed by homogenization and sonication. The formulations were evaluated for particle size, polydispersity index (PDI), zeta potential, and morphology. The results showed that the optimized formulation (NEC5) exhibited the smallest particle size (130.06 ± 56.66 nm), acceptable PDI (0.45 ± 0.12), and moderate zeta potential (−14.15 ± 4.88 mV), indicating good stability. Morphological analysis confirmed spherical and uniformly distributed droplets. In vitro release studies demonstrated an initial burst release followed by a more controlled release pattern, with the nanoemulsion showing more stable release compared to the extract. In conclusion, the nanoemulsion system successfully improved the physicochemical properties and controlled release behavior of the plant extracts, indicating its potential as an effective delivery system for plant-derived bioactive compounds.
G-valley fusion coffee: The potential of golden valley dates (phoenix dactylifera) as an alternative antihypertensive coffee substitute
Hypertension remains one of the leading global health problems and is strongly associated with excessive caffeine consumption from conventional coffee, creating the need for safer alternative beverages with functional health benefits. This study aimed to analyze the potential of Golden Valley dates (Phoenix dactylifera) as a potassium-rich antihypertensive alternative beverage through the development of G-Valley Fusion Coffee. This experimental study employed laboratory testing and sensory evaluation methods. Laboratory analyses were conducted to determine potassium content, moisture content, ash content, and pH value, while organoleptic testing involved panelists aged 13–40 years to assess color, taste, aroma, and texture preferences across three formulations: 100% date seed (FA), 100% date flesh (FB), and a combination formulation (FC). The results showed that date flesh contained the highest potassium level (2141 ppm), indicating strong potential as a functional antihypertensive beverage ingredient. Sensory evaluation revealed that formulation FA achieved the highest acceptance levels in taste (93%), aroma (90%), texture (87%), and color (68%). These findings suggest that G-Valley Fusion Coffee has promising potential as an alternative functional beverage with antihypertensive benefits and acceptable sensory characteristics for consumers.
Legal liability of nurses in adverse events: A normative-empirical analysis of patient safety governance at RSUD dr. Soeroto Ngawi
Adverse events pose a serious threat to patient safety in hospitals. Data from RSUD Dr. Soeroto Ngawi reveal fluctuations in medical incident cases over 2021–2024 (n=354), with procedural and medication errors dominating patient safety reports. A critical research gap persists regarding inconsistent SOP implementation and a blame culture that suppresses transparent incident reporting — gaps unaddressed through an integrated legal-empirical lens. This study aims to analyze forms of nursing negligence, construct a legal accountability framework, and identify barriers and resolution efforts at a regional public hospital. An empirical legal approach was employed, combining case-based and statutory analysis. Data were collected through in-depth interviews with eight key informants, observation, and document review, then analyzed using descriptive qualitative methods with legal triangulation. Results indicate that nursing negligence primarily occurs in patient identification and clinical communication during handover. Nurses' accountability is manifested through immediate clinical responses, IKP system reporting, and root-cause investigations under Law No. 17 of 2023 on Health. Accountability nonetheless remains hindered by psychological barriers and structural workload imbalances. The scientific contribution of this study is the Dual-Layer Accountability Model, which proportionately assigns legal liability between individual professional conduct and institutional systemic failures — a framework absent from prior Indonesian health law scholarship. It is recommended that hospital management adopt a non-punitive just culture, digitize incident reporting, and strengthen clinical risk management training to ensure legal certainty for nurses while advancing patient safety.
SDS-PAGE characterization of dialyzed protein fractions from mycobacterium tuberculosis isolates for tuberculosis biomarker screening
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, in which the identification of protein profiles serves as an important approach in diagnostic research and specific antigen development. This study aimed to analyze the protein profile of dialyzed fractions from Mycobacterium tuberculosis isolates using the SDS-PAGE (Sodium Dodecyl Sulfate–Polyacrylamide Gel Electrophoresis) method. Protein isolation was carried out through sonication at 4 °C to lyse the cells and release intracellular proteins without causing denaturation. The resulting lysate supernatant was subjected to 30% ammonium sulfate precipitation to separate proteins based on their solubility, followed by dialysis to remove residual salts and unwanted small molecules. The total protein concentration was measured using a photometer with a total protein reagent, showing a relatively low value, indicating that the protein fraction was concentrated on specific molecules with higher purity. The SDS-PAGE analysis revealed the presence of a protein band with an estimated molecular weight of 77,6 kDa, suggesting the successful purification of protein fractions based on molecular weight. Based on these findings, it can be concluded that the combination of sonication, ammonium sulfate precipitation, and dialysis is effective as a preliminary purification method to obtain purer proteins from Mycobacterium tuberculosis isolates and enables more specific characterization of protein profiles through SDS-PAGE.
Short-term care strategy in a cesarean section patient with pulmonary hypertension, EF 25% and intraventricular thrombus: A case report
Cesarean section in patients with pulmonary hypertension and interventricular septal thrombus is a high-risk condition that requires an integrated care strategy and multidisciplinary preparation. The primary goals of care are to ensure hemodynamic stability, control pulmonary artery pressure, and prevent thromboembolic complications during and after surgery. Prior to the procedure, patients are prepared with careful anticoagulation therapy using heparin, strict fluid management, and oxygenation support. The choice of anesthetic is made considering its impact on pulmonary pressure and right heart function. Invasive monitoring, such as arterial lines and central venous pressure (CVP), is used intraoperatively for close monitoring. Collaboration between the obstetrics, anesthesia, cardiology, and intensive care teams is crucial to minimize maternal and fetal risks and ensure a safe cesarean section.
The interplay of type I interferon, NLRP3 inflammasome, and self-antigen clearance in systemic lupus erythematosus progression
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease driven by impaired cellular debris clearance. While individual inflammatory pathways are well-documented, their synergistic interactions lack comprehensive synthesis, hindering the development of mechanism-based therapeutics. This literature review aims to elucidate the interconnected roles of specific cellular inflammatory pathways and their positive feedback loops in driving the clinical progression of SLE. A comprehensive literature review was conducted by analyzing 35 peer-reviewed scientific studies published between 2015 and 2025, sourced primarily from the PubMed database, focusing on SLE pathogenesis, cellular inflammation, and disease severity. SLE progression is propelled by a mutually reinforcing inflammatory cascade rather than isolated pathways. We identified three primary components establishing a pathological positive feedback loop: (1) Impaired self-antigen clearance, supplying a continuous source of Damage-Associated Molecular Patterns (DAMPs); (2) Type I Interferon (IFN-I) overactivation, acting as the systemic immune response conductor; and (3) The NLRP3 inflammasome, functioning as a local amplifier that induces direct tissue damage. The identification of this synergistic feedback loop demonstrates that single-target interventions may be insufficient. Comprehending this dynamic cascade necessitates a paradigm shift towards precision medicine. Future therapeutic strategies must prioritize multi-target combination therapies, stratifying patients based on their unique biological profiles to disrupt the pathogenic cycle effectively.
Primary tooth extraction with distraction behavior management techniques: A case report
Treatment of primary teeth requires careful extraction and appropriate management to achieve optimal results and reduce the risk of complications. Distraction behavior management has been introduced as an important approach to address anxiety and improve patient cooperation during dental procedures, especially in pediatric patients. This case report describes an 8-year-old girl who underwent an extraction procedure using non-pharmacological distraction behavior management techniques. The results of extraction treatment with distraction behavior management proved to be appropriate, involving diverting the patient's focus from the instruments, the operator, and the procedure during the procedure. The extraction procedure proceeded smoothly from start to finish, despite the difficulty of primary tooth extraction. Primary tooth extraction is one of the most feared dental treatments for children. However, with appropriate behavior management techniques according to the child's behavioral classification, the tooth extraction procedure can proceed smoothly and without problems.
Formulation and characterization of nanostructured lipid carriers of curcumin and their development in topical gel preparations for drug delivery systems
Curcumin is a bioactive compound derived from Curcuma longa with anti-inflammatory and antioxidant activities; however, its topical application is limited due to poor solubility and stability. The development of nanoparticle-based delivery systems such as Nanostructured Lipid Carriers (NLC) can enhance drug stability and skin penetration. This study aimed to formulate curcumin-loaded NLC, evaluate its physicochemical characteristics, and develop a gel dosage form based on the optimized NLC formulation. The research methods included preliminary solubility testing of curcumin in various lipid and surfactant components, compatibility analysis using Differential Scanning Calorimetry (DSC), formulation of five NLC formulations using hot homogenization and probe sonication methods, and characterization including particle size, polydispersity index, zeta potential, entrapment efficiency, and morphology using Transmission Electron Microscopy (TEM). The selected NLC formulation was subsequently incorporated into a gel system and evaluated for pH, viscosity, and spreadability. The results demonstrated that the curcumin NLC exhibited nanoscale particle size with relatively uniform distribution, stable zeta potential values, and high entrapment efficiency. TEM analysis confirmed spherical particle morphology. The NLC-based gel formulation showed acceptable physicochemical properties, including skin-compatible pH, suitable viscosity, and optimal spreadability. In conclusion, curcumin was successfully formulated into an NLC system and further developed into a topical gel formulation with promising physicochemical characteristics as a lipid-based drug delivery system.
Holistic management of a 51-year-old male patient with multibacillary hansen's disease through a family doctor approach
Hansen's disease, or leprosy, is a chronic progressive granulomatous disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nervous system. This disease remains a public health problem in several regions of Indonesia, including Grobogan Regency. The prevalence rate of leprosy in Grobogan Regency in 2022 was 3 per 100,000 population, and the incidence rate of new cases was 0.7 per 100,000 population. This case report aims to apply the principles of family medicine in the holistic and comprehensive management of leprosy patients, with a patient-centered and family-oriented approach, based on evidence-based medicine. This report uses a case study approach. Primary data were obtained through anamnesis, physical examination, and home visits to evaluate the patient's living environment. The evaluation was conducted comprehensively through a holistic diagnostic approach, covering the initial phase (assessment), the intervention process, and the results. The management of leprosy with a holistic and evidence-based family medicine approach can provide more optimal results, not only in clinical aspects but also in improving the understanding and involvement of patients and their families. This approach supports efforts to prevent disability and improve the overall quality of life of patients.
Analysis of factors influencing personal protective equipment use behavior among students in vocational high school engineering workshops
Background: The behavior of using Personal Protective Equipment (PPE) among technical workshop students plays an important role in preventing workplace accidents and injury risks during practical activities. However, students’ compliance levels in using PPE vary and are influenced by various individual and environmental factors. Purpose: To analyze the factors influencing PPE usage behavior among students in the Technical Workshop of Vocational High School. Methods: This study used a quantitative approach with a cross-sectional design. The population consisted of 1,981 students, with a sample of 205 students selected using stratified random sampling. Data were collected using validated and reliable questionnaires, as well as primary and secondary data sources. The analyses conducted included univariate, bivariate, and multivariate analyses. Results: The results showed that 39.5% of students demonstrated compliant PPE usage behavior, while 60.5% were non-compliant. Bivariate analysis indicated significant relationships between attitude (p-value = 0.016; OR = 0.016) and motivation (p-value = 0.008; OR = 0.008) with PPE usage behavior. No significant relationship was found between knowledge (p-value = 0.644), PPE availability (p-value = 0.113), training (p-value = 0.537), supervision (p-value = 1.00), and peer influence (p-value = 0.570) with PPE usage behavior. Multivariate analysis showed that motivation (p-value = 0.006 < 0.05) was the most influential variable affecting PPE usage behavior among students in the workshop (OR = 2.381). Conclusion: Motivation is the dominant factor influencing PPE usage behavior among workshop students.
Legal pluralism in the practice of informed consent among indigenous communities
The transformation of individual autonomy standards in modern health law often creates a conflict of norms when implemented within the communal social structures of indigenous peoples. This research aims to analyze the dialectics of legal pluralism in the practice of medical informed consent to find a middle ground between centralistic state regulations and the "living law" within indigenous communities. This study employs an empirical legal research method with a socio-legal approach using a descriptive-qualitative design. The results reveal the phenomenon of "collective autonomy," where the validity of medical consent does not merely rely on individual will but is significantly determined by the legitimacy of customary authority and family deliberation mechanisms. Findings indicate that current informed consent practices tend to be legalistic-formal and fail to translate medical risks into local cultural logic, thereby creating judicial vulnerability for both medical personnel and indigenous patients. It is concluded that a reconstruction of the informed consent model based on "Integrative Legal Pluralism" is required, which accommodates communal consent and the use of cultural mediators as a legitimate part of medico-legal procedures. This model offers a strategic solution to achieve a more inclusive healthcare service, respecting the constitutional rights of indigenous peoples while ensuring equitable legal certainty in Indonesia.
Formulation and characterization of nanoparticles combination of binahong leaves and bay leaves as a thin oral herbal preparation for diabetes prevention
Diabetes mellitus is a chronic metabolic disease with a steadily increasing prevalence globally. Binahong leaves (Anrederacordifolia) and bay leaves (Syzygiumpolyanthum) contains flavonoids, such as kaempferol, which have the potential as antidiabetics, but its use is limited by the low solubility, stability, and bioavailability of the active compounds. This study aims to formulate and characterize a nanoparticle herbal medicine combining the two leaves using PlantCrystal technology, and develop it into an oral thin herbal preparation. The simplicia was processed through sorting, washing, drying, grinding, and sieving, then characterized and screened for phytochemicals. The nanoparticle herbal medicine was evaluated based on particle size, polydispersity index, zeta potential, and particle morphology. The membrane lysis release test showed an increase in the release of active substances compared to the simplicia. Furthermore, the formulation was developed into an oral thin herbal and evaluated for its physical properties, including organoleptic, water content, pH, film thickness, fold resistance, weight uniformity, and disintegration time.
Outpatient satisfaction with the integration of primary health care services: A comparative study in Gowa Regency
The implementation of Primary Healthcare Integration aimed to address service fragmentation and improve the quality of health services in Indonesia. This study evaluated outpatient satisfaction with the integrated system compared to a conventional service model in Gowa Regency. A quantitative comparative research design was employed, involving 100 respondents from a health center implementing the integration and 97 respondents from a health center using the conventional model. Data were collected through questionnaires measuring five dimensions of service quality: reliability, responsiveness, assurance, empathy, and tangibles. Statistical analysis using the Mann-Whitney U test revealed a significant difference in satisfaction levels between the two groups (p < 0.001). The integrated system group showed a substantially higher mean rank of 144.08 compared to 52.53 in the conventional group. High satisfaction levels were observed across all dimensions in the integrated system, particularly in the empathy and tangible aspects. It was concluded that the lifecycle-based cluster approach within the integrated system significantly enhanced patient experience and satisfaction. These findings suggested that the transformation of primary health services effectively met community expectations and provided a more structured healthcare delivery model.
The relationship between nutritional status and knowledge with HB levels in adolescent girls
Anemia remains a significant public health problem among Indonesian adolescent girls, as evidenced by prevalence data reaching 32% according to a national health survey. This study aims to analyze the relationship between nutritional status and knowledge with hemoglobin levels in adolescent girls at SMK NU Muara Padang. This study used a quantitative method with a cross-sectional design conducted on 52 adolescent girls selected through a purposive sampling technique. Data collection included a structured questionnaire to measure nutritional knowledge, anthropometric measurements to determine Body Mass Index, and hemoglobin level examination using a digital hemoglobinometer. Statistical analysis was performed using the Statistical Package for the Social Sciences version 26 with a chi-square test at a significance level of 0.05. The results showed that 67.3% of respondents had insufficient nutritional knowledge, data showed that 55.8% had abnormal nutritional status, and 32.7% had anemia. Chi-square analysis revealed no significant relationship between nutritional knowledge and hemoglobin levels (p = 0.51), and no significant relationship between nutritional status and hemoglobin levels (p = 0.14). Although there was no statistically significant relationship, the high prevalence of anemia and low nutritional knowledge indicate the need for comprehensive interventions. Schools and health facilities should collaborate to implement regular nutrition education programs, anemia screening, and iron supplementation to prevent and manage anemia in adolescent girls.
Level of adolescent behavior towards noise-induced hearing loss
Noise-induced hearing loss (NIHL) is a permanent health problem caused by continuous exposure to high-intensity sounds. In Indonesia, the prevalence of noise-induced hearing loss is 4.6%, one of the highest in Southeast Asia. NIHL can be prevented, but many adolescents still do not have appropriate preventive behaviors. This study aims to determine the relationships among adolescents' knowledge, attitudes, and actions regarding NIHL prevention in Aceh Province. The study used a cross-sectional analytical design with a sample of 143 adolescents aged 10–24 years, selected by consecutive sampling. The analysis results showed that the majority of respondents had good knowledge (78.8%) and good attitudes (86.1%). Still, there was no significant relationship between knowledge and actions (p = 0.361), attitudes and actions (p = 0.204), or knowledge and attitudes (p = 0.726). These findings indicate that good knowledge and attitudes do not necessarily promote effective preventive actions. Therefore, a more appropriate intervention approach is needed to encourage behavioral change among adolescents in preventing noise-induced hearing loss.
Suspected chikungunya outbreak in Klungkung, Bali: Environmental and behavioral risk factors
Chikungunya outbreaks in communities with no prior recorded transmission history remain poorly studied in Indonesia, where delayed case detection and low community health literacy present distinct epidemiological challenges. This study investigated a suspected chikungunya extraordinary event in Banjar Jumpai Kangin, Desa Jumpai, Kabupaten Klungkung, Bali, between April and May 2025, with the aim of describing the epidemiological characteristics of the outbreak and identifying the environmental and behavioral risk factors associated with transmission. A case-control design was employed, with data collected through structured interviews, direct environmental observation, and secondary data review. A total of 36 suspected cases were identified, peaking at 8 cases on 8 May 2025, with the majority being female (58.3%) and aged 5 to 14 years (33.3%). All cases presented with fever (100%), followed by arthralgia (91.7%) and rash (83.3%). Bivariate analysis identified four significant risk factors, including the absence of routine water storage container draining (p less than 0.001), the absence of mosquito nest eradication practices (p = 0.046), the presence of mosquito larvae in the household (p = 0.032), and the lack of personal protective behavior against mosquito bites (p = 0.018). Community knowledge of chikungunya was uniformly poor across both case and control groups. Delayed case reporting substantially prolonged the period before any public health response was initiated. These findings underscore the need for proactive community-based surveillance in areas with no prior chikungunya history, and support policy interventions targeting household vector control practices and health literacy as the primary levers for outbreak prevention.