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Sleep disturbances are a common complaint among perimenopausal women due to hormonal, psychological, and physiological changes, which impact their health and quality of life. Safe and easy-to-apply non-pharmacological approaches, such as lemongrass aromatherapy (Cymbopogon citratus), have the potential to be a supportive alternative in overcoming sleep disturbances during this phase. However, empirical evidence regarding the effect of lemongrass aromatherapy on the sleep quality of perimenopausal women is still limited, especially in the context of primary health care in Indonesia. This study aims to analyze the effect of lemongrass aromatherapy on the sleep quality of perimenopausal women. This study used a quantitative approach with a one-group pretest–posttest pre-experimental design. The sample consisted of 30 perimenopausal women selected using total sampling technique in the working area of Pustu Paring Lahung UPT Tumpung Laung. The intervention in the form of lemongrass aromatherapy through inhalation was carried out regularly before bedtime. Sleep quality was measured before and after the intervention using a standardized questionnaire. Data analysis was performed descriptively and bivariately using Fisher's Exact Test. Descriptively, there was an improvement in sleep quality after the administration of lemongrass aromatherapy, marked by a decrease in the proportion of poor sleep quality and an increase in good sleep quality. However, the statistical test results showed that the relationship between sleep quality before and after treatment was not statistically significant (p = 0.515). Lemongrass aromatherapy showed a tendency toward clinically significant improvement in sleep quality, but this was not statistically significant. Further research with a stronger design and longer intervention duration is needed to confirm the effectiveness of lemongrass aromatherapy on the sleep quality of perimenopausal women.

The high cost of colloid fluids and the large number of patients are concerns in determining which treatment standard should be chosen from several treatment alternative, where the total cost for 43 cases with a combination of crystalloid colloid fluids is IDR 209.370.993 while the total cost for 45 cases of crystalloid fluids is only UDR 146.492.268 which causes hospital losses. This study aims to determine the difference in the cost-effectiveness between crystalloid fluids and crystalloid-colloid combinations in hospitalized dengue fever patients without shock at Tangerang City Hospital. The research design used was cross-sectional with a comparative quantitative analysis method, where cost effectiveness was analyzed using the Average Cost Effectiveness Ratios (ACER) method. There were two groups of study samples: the first group, 25 patients who received crystalloid fluids, and the second group, 23 patients who received crystalloid-colloid combination fluids. This study showed a difference in the average hospitalization costs for dengue patients between crystalloid fluid therapy and crystalloid-colloid combination therapy. Hospitalization costs for dengue patients were lower in the crystalloid fluid group, with a significant difference (p=0.000). It was also found that crystalloid fluids were more cost-effective than the crystalloid-colloid combination. The implications of the study results consist of theoretical implications and practical implications. Based on the results of the analysis carried out, the crystalloid solutions are more cost-effective than crystalloid-colloid combinations. This finding can be used as a consideration in making decisions and policies that are in accordance with quality control and cost control for patients covered by the National Health Insurance (BPJS Health insurance).

This meta-review evaluates the effectiveness of diverse mental health programs targeting Syrian refugees in Turkey over the period 2015-2023 through a systematic synthesis of 47 studies involving a total of 12,847 participants. Meta-regression results demonstrate a statistically significant reduction in Post-Traumatic Stress Disorder symptoms, with a large effect size (d = -0.86, 95% CI [-1.02, -0.70], p < .001), as well as a significant reduction in depressive symptoms (d = -0.72, 95% CI [-0.88, -0.56], p < .001) following intervention. Among the therapeutic approaches examined, Cognitive Behavioral Therapy exhibited the strongest therapeutic effect (β = 0.45, p < .001), followed by Eye Movement Desensitization and Reprocessing (β = 0.38, p < .001). Further moderator analysis revealed that group-based interventions were more effective than individual approaches (OR = 1.86, 95% CI [1.42, 2.30]). At the same time, program duration of 12-16 weeks showed a strong correlation with optimal clinical outcomes (r = 0.67, p < .001). These findings extend the results of Acarturk et al. (2022) regarding the effectiveness of CBT and reinforce the argument advanced by Shehadeh et al. (2016) concerning the superiority of group-based approaches, while also indicating a longer optimal intervention duration than previously reported. In contrast to the meta-analysis by Antuña-Camblor & Hernández (2025), which emphasized EMDR, this study identifies CBT as superior to EMDR among Syrian refugees in Turkey. The novelty of this study lies in its comprehensive analysis of program moderator factors and the identification of the most effective intervention duration parameters for the target population.

Severe preeclampsia is a condition characterized by systolic blood pressure exceeding 160 mmHg and diastolic pressure exceeding 110 mmHg, occurring after 20 weeks of gestation and accompanied by edema and proteinuria. One intervention used to save both mother and fetus is a cesarean section. This final nursing scientific paper analyzes the implementation of evidence-based practice, specifically warm foot soak therapy, for mothers with severe preeclampsia during the pre- and postpartum periods who are at risk for ineffective cerebral perfusion. This descriptive case study method used a nursing care approach. Assessment results identified five major nursing problems, including the risk for ineffective cerebral perfusion. After four days of warm foot soak therapy, this problem was resolved, as blood pressure decreased from 147/101 mmHg to 120/88 mmHg. Conclusion: Warm foot soak therapy effectively lowers blood pressure in pre- and postpartum mothers with severe preeclampsia. Recommendation: Nurses can implement warm

Hypertension is a public health problem that requires educational approaches and nonpharmacological interventions. This community service activity aimed to improve knowledge and support community-based hypertension management through health education, hypertension exercise, and cucumber juice therapy in RT 03 RW 08 Lenteng Agung, South Jakarta. The activity was conducted in three stages. The preparation stage included site selection, door-to-door screening of individuals with hypertension, which identified 32 hypertensive residents, obtaining informed consent, and preparing the instruments. The implementation stage consisted of hypertension education with pre-test and post-test knowledge assessments, as well as demonstrations of hypertension exercise and cucumber juice preparation involving 29 participants. Participants were encouraged to perform the exercise and consume cucumber juice regularly for seven days at home. The evaluation stage assessed changes in blood pressure after the intervention. The results showed improved knowledge and reduced blood pressure in most participants. This activity was effective in supporting hypertension management in the community.

Male infertility represents a major global health concern, with oxidative stress playing a central role in the deterioration of sperm quality. In recent years, growing attention has been directed toward herbal medicine as a potential alternative or complementary therapy due to its antioxidant and multi-target properties. However, a comprehensive long-term overview of the global research landscape in this field remains limited. A bibliometric and visualized analysis was conducted using publications indexed in the Scopus database from 2005 to 2025. Eligible peer-reviewed articles were retrieved following PRISMA guidelines. Bibliometric indicators were analyzed using Biblioshiny (R-Bibliometrix) to assess publication trends, leading contributors, and thematic evolution, while VOSviewer was employed to visualize international collaboration networks, co-citation patterns, and keyword co-occurrence clusters. A total of 562 articles were included, revealing a strong upward trend in scientific output, particularly after 2016, with an annual growth rate of 15.78% and a peak in 2025. Iran, China, and Nigeria emerged as the most productive countries, while the Faculty of Veterinary Medicine and several universities in Africa, the Middle East, and Asia were identified as leading institutions. Keyword analysis highlighted three dominant research fronts: semen quality assessment, testicular histopathology, and oxidative stress–related molecular mechanisms. The collaboration network indicated increasing global and South–South research synergy. The field of herbal medicine for male infertility has evolved into a mature and multidisciplinary research domain, increasingly grounded in mechanistic and experimental evidence. These findings provide a strategic overview of research hotspots and emerging trends, offering valuable guidance for future experimental and clinical investigations.

Expressive feelings therapy is a form of mental health nursing modality therapy that aims to help individuals express their thoughts and emotions openly without violating the rights of others. This study aims to explore the effectiveness of cognitive therapy focused on “expressing feelings” in improving emotional expression abilities among female patients in the recovery phase at the Anggrek Ward of the Aceh Government Mental Hospital. This descriptive qualitative study was conducted through group therapy activities with structured stages, using media such as emotion expression picture cards and a spin-the-bottle game as interaction stimuli. The population consisted of 18 patient in the Anggrek ward, with a sample of 12 patients who were cooperative, psychologically stable, able to communicate bidirectionally, and willing to participate in group therapy. The results showed that participants experienced an improvement in their ability to express emotions such as happiness, sadness, anger, and anxiety more openly, accompanied by increased social interaction and reduced emotional tension. The therapy also encouraged greater self-confidence and a sense of emotional relief. These findings support that expressive feelings therapy can be incorporated as part of routine nursing interventions for patients who experience difficulties in emotional regulation. It is recommended that further research be conducted over a longer duration and with a broader scope to strengthen the validity of the findings.

Arrhythmias are generally classified into two groups: disorders of impulse formation and disorders of impulse conduction. Cardiac arrhythmias can also be categorized into three main types: supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias. One of the most commonly encountered arrhythmias in clinical practice is Atrial fibrillation. This study employed a case study method using a nursing process approach. The subjects consisted of two patients: Mrs. S, a 74-year-old female, and Mr. R, a 44-year-old male. The nursing intervention administered was antiarrhythmic therapy using intravenous digoxin. Evaluation was conducted by monitoring the patients’ heart rate and cardiac rhythm using an electrocardiogram (ECG) monitor. The results of the case studies in both patients showed that digoxin therapy produced a positive therapeutic response, as evidenced by a gradual reduction in heart rate. However, ECG monitoring revealed no significant changes in cardiac rhythm. These findings suggest that digoxin is effective for rate control, although it does not restore sinus rhythm.

The increasing number of children with autism spectrum disorder in Indonesia presents new challenges for the inclusive education system, particularly in the development of social skills. This study aims to analyze the impact of floortime therapy on the development of social skills in children with autism at UPTD SMP Negeri 18 Depok City. The study employed a qualitative approach using a case study method, with data collected through observation, interviews, and documentation. The theoretical framework was based on the floortime implementation theory proposed by Greenspan and Wieder (2006) and the social skills theory by Rachmah (2018). The results indicate that floortime therapy has a positive impact on improving the social skills of children with autism, particularly in aspects of attention and engagement, two-way communication, sharing ideas and emotions, and logical thinking. The effectiveness of the therapy is further enhanced by the contribution of the surrounding environment, including family members, teachers, peers, and therapists, who play an important role in supporting the sustainability of the intervention. These findings emphasize that floortime therapy is not only effective as a therapeutic approach but also serves as a supportive strategy in improving the quality of inclusive education services for children with special needs.  

Flood disasters that struck Cikahuripan Village significantly affected the physical, psychological, and learning motivation conditions of elementary school students, particularly at SD N 1 Cikahuripan. In the post-disaster period, students experienced a decline in learning motivation caused by psychological trauma, loss of a sense of security, and limited learning facilities. This Community Service Program (Pengabdian kepada Masyarakat/PkM) aimed to restore students’ psychological conditions while strengthening their learning motivation through an integrated psychosocial and pedagogical approach. The implementation methods included an initial assessment of students’ conditions, trauma healing activities based on play therapy, and the application of Fun Learning methods combined with the “Tree of Dreams” activity to rebuild students’ intrinsic motivation. The program was conducted from 15 to 22 November 2025 and involved 31 elementary school students as well as teachers as sustainability partners. The evaluation results showed significant positive changes, indicated by increased cheerfulness, active participation, confidence in social interaction, and improved learning focus among students. In addition, teachers’ capacity to implement trauma-sensitive teaching practices also improved. This program demonstrates that post-disaster learning motivation recovery requires a holistic approach integrating psychological and academic recovery, and it has the potential to serve as a replicable model for educational interventions in disaster-prone areas.

Health issues are complex and require new ideas for their resolution. Public health focuses on disease prevention, health promotion, and physical, mental, and social therapy. Maternal and Child Health (MCH) and women’s health throughout their life cycle are crucial public health issues as they have a significant impact on the quality of human resources in a generation. In Pukdale Village, East Kupang District, Kupang Regency, problems such as the lack of knowledge among pregnant women about Chronic Energy Deficiency (CED), pregnancy anemia, Exclusive Breastfeeding (EBF), balanced nutrition, and weaning have been identified. To address these issues, a Community Midwifery Care program based on community service was carried out, which included counseling, training, demonstrations, and simulations. The results of this activity showed a positive response and active participation from the community in Pukdale Village in the programs implemented by the students. There was a significant improvement in the knowledge of pregnant women about CED, pregnancy anemia, EBF, as well as the knowledge of mothers of infants about balanced nutrition and weaning. This is expected to improve the overall health status of the community in the village.

Background: Dental caries is a major problem in orodental health, especially in children. The primary cause of caries is the activity of cariogenic microorganisms. Unbalanced remineralization of dental tissue followed by destruction of organic matters may cause cumulative and progressive damage to the tooth structure. Extensive caries lesions that have reached the pulp are an indication for pulp therapy with appropriate crown restoration. Case Report: A 10-year-old boy came with a complaint of a painful cavity in his upper right front tooth. The patient was considered communicative and cooperative. The patient also had a habit of consuming sweets. An intraoral examination revealed extensive caries on the entire surface of 53. A periapical radiograph showed a radiolucent area reaching the pulp cavity on the occlusal surface of 53 with resorption of the apical one-third of the root. Based on the examination results, reversible pulpitis was established as the primary diagnosis. The treatment plan was pulpotomy with a dental crown restoration. Treatment was carried out over four visits. First visit included complete examination, periapical radiography, and pulpotomy. The second visit included core buildup, tooth preparation, and dental impressions. The third visit included try-in and crown insertion, followed by a final follow-up visit. Conclusion: Pulpotomy with dental crown restoration can be an effective clinical approach to restore the function and aesthetics of anterior deciduous teeth, especially in cases that consider aesthetics and cost limitations.

Antibiotics are one of the main pillars in the treatment of bacterial infections and have contributed significantly to increasing human life expectancy. However, long-term use of antibiotics has serious consequences for the balance of the body's microbiome, especially the gut microbiome which plays an important role in maintaining homeostasis through the regulation of the immune system, metabolism, and protection against pathogens. This literature review aims to comprehensively analyze the impact of long-term antibiotic use on the structure, diversity, and function of the human microbiome. The scientific articles reviewed were obtained from PubMed, Scopus, ScienceDirect, and Google Scholar databases, including empirical research, systematic review, and meta-analysis published in the last ten years. The results showed that prolonged exposure to antibiotics consistently decreased microbiota diversity, altered the composition of bacterial communities, and triggered dysbiosis, which is often persistent even when therapy is stopped. Dysbiosis is associated with impaired immune system function, increased systemic inflammation, risk of allergic and metabolic diseases, and potential disorders on the intestinal-brain axis. This impact is more pronounced in vulnerable groups such as neonates and children, especially when exposure occurs during a critical period of development. In conclusion, long-term antibiotic use has broad systemic implications, so a more rational, prudent, and sustainable use strategy is needed to maintain the health of the human microbiome.

This research aims to analyze the implementation of the Protection and Rehabilitation Service Program for Juvenile Delinquents in Surabaya City, conducted by the Social Service of East Java Province. Juvenile delinquency remains a significant social problem requiring comprehensive intervention through protection and rehabilitation approaches rather than punitive measures. Drawing on George C. Edward III's policy implementation theory, this study examines four critical factors: communication, resources, disposition, and bureaucratic structure. This qualitative research employs a descriptive approach, with data collected through in-depth interviews, observation, and documentation at the Social Service of East Java Province during June-August 2025. Informants include program managers, social workers, psychologists, beneficiaries of the juvenile delinquency program, and their families. The results indicate that the program has successfully served 1,247 juvenile delinquents through integrated services, including psychological counseling, skills training, family therapy, and social reintegration support. The communication dimension shows effective coordination between provincial and city-level agencies, though information dissemination to communities needs improvement. Resource adequacy is generally sufficient with 35 certified social workers, adequate facilities, and an annual budget of Rp 3.2 billion. The disposition of implementers demonstrates a strong commitment to child-centered approaches. Clear SOPs and inter-agency collaboration protocols support the bureaucratic structure. The program achieves 72% successful rehabilitation rate with 68% of beneficiaries returning to formal education or productive activities. Challenges remain in stigma reduction, family involvement, and post-rehabilitation monitoring. This study recommends strengthening community-based prevention, expanding vocational training options, developing peer support networks, and establishing sustainable aftercare mechanisms.

Hypertension is a chronic condition that requires long-term management due to its strong association with an increased risk of serious complications when blood pressure is not adequately controlled. One of the key factors influencing the success of hypertension management is patient adherence to antihypertensive medication. However, suboptimal adherence remains a common problem and may lead to poor therapeutic outcomes. This literature review aimed to examine the relationship between adherence to antihypertensive medication and blood pressure control among patients with hypertension. A systematic search of the literature was conducted using the PubMed and Google Scholar databases with relevant keywords combined through Boolean operators. The selected articles were screened based on predefined inclusion and exclusion criteria, including original research articles published within the last ten years, accessible in full text, and addressing the association between medication adherence and blood pressure in hypertensive patients. The findings of the reviewed studies indicate that most articles reported a significant relationship between medication adherence and blood pressure levels. Patients with higher adherence to antihypertensive therapy tended to achieve better blood pressure control compared to those with lower adherence. Although variations in the strength of the reported associations were observed across studies, the overall direction of the relationship was consistent. These results suggest that adherence to antihypertensive medication plays an essential role in achieving optimal blood pressure control. Therefore, this review highlights the importance of continuous efforts to improve patient adherence as part of effective hypertension management strategies aimed at reducing the risk of long-term complications.

Osteoarthritis is a progressive degenerative joint disease characterized by cartilage damage, chronic inflammation, and functional limitation. Current treatments mainly focus on symptom relief and mechanical correction, with limited ability to restore the biological environment of the joint. Recently, mesenchymal stem cell derived secretome has emerged as a promising cell free regenerative therapy with anti-inflammatory and tissue-repair potential. This study aimed to systematically review the role of mesenchymal stem cell secretome in osteoarthritis management, both as an intra-articular therapy and as an adjuvant following surgical intervention. A literature review was conducted on relevant preclinical and early clinical studies published over the past decade. The selected articles were analyzed to evaluate therapeutic mechanisms and clinical implications. The findings indicate that intra articular administration of secretome reduces inflammatory mediators, suppresses catabolic enzyme activity, and improves cartilage integrity in various osteoarthritis models. Early clinical evidence also suggests improvements in pain and joint function, especially in patients with mild to moderate disease. Furthermore, secretome shows potential as an adjuvant therapy after surgery by supporting biological recovery of joint tissues. Overall, mesenchymal stem cell secretome represents a promising component of a multimodal strategy for osteoarthritis management, although further clinical trials are required to confirm its efficacy and safety.

Nephrotic syndrome (NS) is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, and hypercholesterolemia, most commonly occurring in children. This disease can be caused by various conditions, such as minimal change disease, FSGS, or lupus nephritis. This case report discusses a 16-year-old boy who experienced nephrotic syndrome with symptoms of swelling throughout his body, accompanied by decreased appetite and a productive cough. The patient presented with complaints of swelling throughout his body that began 7 days after hospitalization and was accompanied by coughing and shortness of breath. A physical examination revealed massive edema, abdominal hypertympany, and shifting dullness. Laboratory tests revealed proteinuria, hypoalbuminemia, and decreased serum albumin. Other supporting tests confirmed nephrotic syndrome. The patient received medication therapy including diuretics, corticosteroids in the form of methylprednisolone, and albumin. Nephrotic syndrome in children can develop gradually and requires management that includes steroids, diuretics, and close monitoring of kidney function and electrolytes. Early detection and appropriate treatment can help improve the patient's prognosis.

Anxiety in third-trimester pregnant women is a common condition that may negatively affect psychological readiness for childbirth. One effective non-pharmacological intervention to reduce anxiety is progressive muscle relaxation therapy. This community service activity aimed to reduce anxiety levels among third-trimester pregnant women through health education and practical training on progressive muscle relaxation therapy. The activity was conducted at PMB Lina Contesa and involved 25 third-trimester pregnant women. The intervention consisted of health education sessions, demonstrations, and guided practice of progressive muscle relaxation therapy. Anxiety levels were measured using the Hamilton Anxiety Rating Scale (HARS) before and after the intervention. The results showed a decrease in the mean anxiety scores after the intervention, shifting from moderate anxiety to mild anxiety levels. These findings indicate that progressive muscle relaxation therapy is effective in reducing anxiety among third-trimester pregnant women. In conclusion, health education combined with progressive muscle relaxation therapy is a safe, simple, and effective non-pharmacological approach to reduce maternal anxiety and is recommended to be integrated into antenatal care services at midwifery private practices.

Hemangioma is the most common benign vascular tumor in infancy and is generally characterized by a proliferative phase followed by spontaneous involution. Although most cases resolve without intervention, treatment is required when hemangiomas cause functional impairment, ulceration, or life-threatening complications. Lingual hemangioma is a rare presentation and may result in significant feeding difficulties and airway compromise, requiring prompt and multidisciplinary management. This study aims to report the comprehensive management of a refractory lingual hemangioma in an infant, emphasizing diagnostic evaluation, therapeutic strategy, and nutritional support. A six-month-old female infant presented with a lingual hemangioma associated with progressive feeding difficulties. Prior to initiating therapy, a thorough diagnostic workup was performed, including echocardiography to assess cardiac function, magnetic resonance imaging (MRI) to evaluate lesion extent, and computed tomography angiography (CT-angiography) to delineate vascular anatomy. The patient initially received oral propranolol as first-line therapy; however, due to an inadequate response, combination chemotherapy with Bleomycin–Vincristine (BV) was initiated. To minimize the risk of toxicity, a 50% dose reduction was applied. Clinical evaluation demonstrated a favorable therapeutic response, with a reduction in lesion size and improvement in feeding ability after 10 weeks of treatment. No severe adverse effects were observed during the treatment period. To ensure adequate nutritional intake and support growth, enteral nutrition via a nasogastric tube (NGT) was provided throughout the course of therapy. This case highlights the importance of comprehensive diagnostic assessment, individualized treatment planning, and close monitoring in refractory hemangioma. In addition, optimal nutritional support plays a crucial role in overall patient outcomes. A multidisciplinary approach is essential for the successful management of complex infantile hemangiomas with functional complications.

Hospitalization often triggers anxiety in children because of unfamiliar environments, invasive procedures, and disruption of daily routines. Pediatric nurses are expected to implement atraumatic care through developmentally appropriate, non‑pharmacological interventions. This community service program aimed to strengthen nurses’ and families’ skills in delivering puzzle‑based play therapy and to evaluate short‑term changes in children’s anxiety responses in the pediatric ward of Awal Bros Hospital, Batam. The program was conducted in December 2025 using an action-based approach: coordination with the ward team, preparation of graded puzzle sets and education media, bedside education for parents, and supervised play sessions. Four hospitalized children with different diagnoses (chemotherapy, childhood‑onset lupus erythematosus, febrile illness, and stoma care) participated. Anxiety was assessed before and after the session using an observation sheet and a faces anxiety scale adapted for clinical use. After a 20–30 minute session adjusted to the child’s developmental stage, all participants demonstrated lower anxiety scores and better cooperative behaviors. Caregivers also reported increased understanding of play therapy as part of holistic nursing care. Puzzle play therapy is feasible, low‑cost, and can be integrated into routine pediatric nursing to support coping during hospitalization.