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Diuretic resistance is a serious complication in heart failure patients associated with increased morbidity and mortality. Tolvaptan, a vasopressin V2 receptor antagonist, offers an alternative therapeutic mechanism through aquaresis. This study aims to evaluate the effectiveness and safety of tolvaptan in heart failure patients with diuretic resistance. A retrospective cohort study was conducted on 58 hospitalized patients with NYHA III-IV heart failure and diuretic resistance (urine output <1000 mL/day despite furosemide use ≥80 mg/day) who received tolvaptan 7.5-15 mg/day for 7 days. Variables measured included weight change, urine output, serum sodium, and kidney function. The results showed a significant increase in daily urine output from 820±230 mL to 2180±520 mL (p<0.001), along with an average weight loss of 3.4±1.1 kg (p<0.001). Hypernatremia (>145 mEq/L) occurred in 8.6% of patients. In conclusion, tolvaptan is effective in improving diuresis and reducing congestion in heart failure patients with diuretic resistance, although the risk of hypernatremia should be monitored.

Measles Rubella (MR) immunization coverage in Indonesia remains below the national target of 95%, with coverage in 2024 reaching only 82.3% and showing a decline compared to the previous year. A lower coverage was observed in the working area of Pekanbaru Kota Public Health Center, where only238 out of 547 eligible children (41.3%) received MR immunization. Low immunization coverage may reduce herd immunity and increase the risk of measles and rubella outbreaks. This study aimed to analyze factors influencing MR immunization uptake among children under five in the working area of Pekanbaru Kota Public Health Center in 2025. This quantitative study employed a cross-sectional design involving 40 mothers of children aged 9–60 months selected through accidental sampling. Data were collected using structured questionnaires assessing maternal knowledge, attitudes, family support, support from health workers, and travel time to health facilities. Univariate and bivariate analyses were performed using the Chi-Square test at a 95% confidence level (α = 0.05). The results showed that 67.5% of respondents had provided MR immunization to their  children.  Significant associations  were  found  between  maternal knowledge (p = 0.033), maternal attitudes (p = 0.037), family support (p = 0.002), and health worker support (p = 0.015) with MR immunization uptake, while travel time to health facilities was not significantly associated (p = 0.053). In conclusion, maternal knowledge and attitudes, family support, and health worker support are significant factors influencing MR immunization uptake, highlighting the need to strengthen health education and family involvement to improve MR immunization coverage.

Nosocomial infections, also known as Healthcare-Associated Infections (HAIs), are infections acquired by patients during their stay in healthcare facilities. These infections remain a serious problem because they can increase morbidity and mortality rates, prolong the length of hospital stay, and raise healthcare costs. One classical yet highly relevant approach to preventing nosocomial infections is Florence Nightingale’s Environmental Theory. This theory emphasizes the importance of maintaining a clean environment, adequate ventilation, proper lighting, effective sanitation, and good personal hygiene to support patient recovery and reduce infection risks. Nightingale believed that environmental factors play a crucial role in improving patient health outcomes and preventing disease transmission. In modern nursing practice, the principles of Nightingale’s theory are still widely applied through infection prevention and control programs, environmental cleanliness standards, and patient-centered care. Therefore, understanding and implementing environmental management in healthcare settings remain essential strategies to reduce nosocomial infection rates and improve the overall quality of healthcare services.

Academic stress is a psychological pressure commonly experienced by final-year university students, particularly during the process of completing their undergraduate thesis. High academic demands, limited time, pressure to graduate on schedule, and various obstacles encountered during research may intensify students’ emotional burden. When left unmanaged, academic stress can escalate into more serious psychological problems, including suicidal ideation. This study aims to analyze the relationship between academic stress levels and suicidal ideation among final-year students at Universitas Islam Sultan Agung Semarang. This research employed a quantitative design with a cross-sectional approach. A total of 180 respondents were selected using a simple random sampling technique. The research instruments consisted of the Perceived Academic Stress (PAS) scale to measure academic stress levels and the Adult Suicidal Ideation Questionnaire (ASIQ) to assess suicidal ideation. Data analysis was conducted using the Spearman Rank correlation test. The results showed that the majority of students experienced high (49.4%) and very high (47.8%) levels of academic stress. Meanwhile, suicidal ideation was most commonly found in the mild category (42.8%), followed by the no-risk category (28.9%). The statistical test indicated a significance value of p = 0.021 with a correlation coefficient of r = 0.172, demonstrating a positive and significant relationship between academic stress and suicidal ideation. These findings indicate that higher levels of academic stress are associated with an increased likelihood of suicidal thoughts among final-year students. The study highlights the importance of mental health support, academic guidance, and accessible counseling services to mitigate psychological distress and reduce the risk of suicidal ideation during the thesis completion period.

Students who are working on their undergraduate thesis often experience stress due to academic workload, pressure to graduate on time, and anxiety regarding their academic performance. Spirituality is considered one of the coping mechanisms that may help individuals achieve emotional calmness, life meaning, and self-acceptance, which potentially reduces stress. This study aims to determine the relationship between the level of spirituality and stress among students working on their thesis. This research used a quantitative method with a cross-sectional approach. A total of 134 students were selected using simple random sampling. The instruments used were the Daily Spiritual Experience Scale (DSES) to measure spirituality and the Perceived Stress Scale (PSS-10) to measure stress levels. Data analysis was performed using the Spearman Rank correlation test. The findings indicate a significant correlation between spirituality and stress levels with a p-value of 0,002. The Spearman correlation coefficient (r = -0,264) indicates a negative correlation, meaning that higher levels of spirituality are associated with lower stress levels among thesis-writing students. There is a significant negative relationship between spirituality and stress among students working on their undergraduate thesis. Increasing spirituality may serve as an effective coping strategy to reduce stress during the thesis completion process.

Unhealthy dietary patterns are usually associated with the consumption of purine-rich foods. These foods can increase blood uric acid levels because dietary purines are metabolized into uric acid. This study aims to examine the relationship between dietary patterns and uric acid levels among community members in Baitussalam Health Center, Aceh Besar. This research employed a quantitative, analytical-descriptive design and a cross-sectional method. The study consisted of individuals diagnosed with gout at Baitussalam Health Center. The population consisted of 453 patients. The sample was 81 patients selected using accidental sampling technique. The data were collected using a Food Frequency Questionnaire (FFQ. The uric acid levels were measured using an Auto-check device. Univariate and bivariate analyses were performed, with the Chi-square test used to determine the association between variables. The findings showed that 35 respondents with good dietary patterns (85.4%), 6 respondents had normal uric acid levels (14.6%) and 35 repsondent had abnormal levels (87.5). In contrast, among those with poor dietary patterns had bad dietary intake 40 respondents with 5 respondents (12.5%) had normal uric acid levels, while 35 respondents (87.5%) had abnormal level. Bivariate analysis revealed a p-value of 0.000 (p < 0.05), indicating that the alternative hypothesis (Ha) was accepted and the null hypothesis (Ho) was rejected. These results prove a significant relationship between dietary patterns and uric acid levels. This study recommends that community members improve their dietary habits by consuming low-purine foods such as fruits, green vegetables, eggs, low-fat milk, and carbohydrate sources (e.g., rice and potatoes). Increasing water consumption is highly recommended to help reduce uric acid levels. 

Anxiety is a prevalent mental health issue that affects psychological well-being and daily functioning. In Muslim communities, Islamic spiritual practices are commonly used as coping strategies, yet empirical evidence regarding their effectiveness in reducing anxiety has not been systematically consolidated. This study aimed to synthesize scientific evidence on Islamic spiritual interventions for anxiety reduction. A systematic literature review was conducted in accordance with PRISMA guidelines by searching Google Scholar, PubMed, ScienceDirect, and Elsevier. Observational studies published between 2019 and 2026 that examined Islamic spiritual interventions and reported anxiety outcomes were included and analyzed narratively. Ten eligible articles were identified. The review demonstrates that Islamic spiritual interventions, such as dhikr, prayer, Qur’an recitation, and Islamic spiritual counseling, are consistently associated with reductions in anxiety across diverse populations and settings. Although the magnitude of effects varied, the overall findings indicate a beneficial role of Islamic spiritual practices in anxiety management. These results suggest that Islamic spiritual interventions may be integrated as complementary approaches within mental health and public health services for Muslim populations, while further methodologically rigorous studies are required to strengthen the evidence base.

Malnutrition and stunting among children under five remain major public health challenges in developing countries, including Indonesia. These conditions are associated with increased morbidity, mortality, impaired cognitive development, and reduced productivity in adulthood. Stunting reflects chronic nutritional deficiencies, while severe malnutrition indicates acute or prolonged inadequate nutrient intake, often exacerbated by infections, poor caregiving practices, and unfavorable socioeconomic conditions. This case report aims to describe the clinical condition, contributing factors, management, and outcomes of a 14-month-old female toddler diagnosed with severe malnutrition and stunting without complications in Blang Dalam Geuteung Village, Nisam Subdistrict, North Aceh Regency. The assessment was conducted using a family medicine approach, incorporating detailed history taking, physical examination, anthropometric measurements, and nutritional status evaluation based on World Health Organization Z-score indicators. Interventions included nutritional rehabilitation through appropriate dietary intake, family education on balanced nutrition and proper feeding practices, routine growth monitoring, and optimization of primary healthcare services. The results showed gradual improvement in the child’s nutritional status, evidenced by weight gain, better appetite, and improved feeding patterns following the intervention. This case highlights the importance of early detection, comprehensive family-centered management, and continuous monitoring in addressing malnutrition and stunting at the primary care level. Strengthening community-based interventions, improving caregiver knowledge, and enhancing collaboration between healthcare providers and families are essential to reduce the burden of malnutrition and support optimal child growth and development.

Ideally, final-year undergraduates are expected to demonstrate psychological maturity and a clear sense of future direction. However, the pressure of academic demands and social expectations often precipitates a "quarter-life crisis," triggering profound anxiety during this transitional phase. This study investigates the relationship between religiosity and the quarter life crisis among final-year students at Universitas Ibrahimy Situbondo. Employing a quantitative correlational design, the study involved 149 students selected via convenience sampling from a population of 237. Data were collected using the Religiosity Scale and the Quarter-Life Crisis Scale, then analyzed using simple linear regression with JASP version 0.19.1.0. Contrary to common assumptions in religious settings, the findings revealed that religiosity was not significantly associated with the quarter life crisis (p = .105 > .05). The effective contribution of religiosity in explaining the variance of the crisis was minimal (R2 = 0.018 or 1.8%), indicating that 98.2% of the phenomenon is driven by factors outside the scope of this study. These results suggest that religiosity is not a sole predictor capable of buffering against quarter life crisis. Consequently, further research should explore other potential mitigating variables, such as social support, self-efficacy, or career adaptability, particularly within Islamic boarding school-based university environments.

Type 2 diabetes mellitus (T2DM) requires comprehensive management beyond pharmacological therapy, including sustainable lifestyle-based interventions. Yoga asana, as a form of mind–body intervention, integrates physical postures, breathing techniques, and relaxation practices that may influence metabolic and psychosocial pathways relevant to T2DM. This article aimed to synthesize evidence regarding the physiological mechanisms, clinical effectiveness, and healthcare implementation context of yoga asana in T2DM management, as well as to discuss the role of physicians in integrating this complementary therapy, including within health tourism settings. A narrative literature review was conducted using scientific databases, focusing on publications addressing yoga asana, mind–body interventions, T2DM, and clinical integration. The findings indicate that yoga asana is associated with improved glycemic control, including reductions in fasting blood glucose, postprandial glucose, and HbA1c, alongside modulation of stress-related physiological parameters and psychological well-being. Beyond clinical outcomes, yoga asana shows potential for community-based and health tourism contexts as part of chronic disease lifestyle management. Physicians play a central role in clinical assessment, patient education, coordination with complementary therapy providers, and ongoing monitoring to ensure safe, evidence-based integration. Although current evidence suggests consistent beneficial trends, methodological heterogeneity highlights the need for more standardized and mechanistic research.  

Japanese kale (Brassica oleracea) is a leafy vegetable with high nutritional and economic value and strong potential for development through intensive cultivation systems, including polybag-based cultivation. Fertilization is an important factor determining plant growth success. This study aimed to analyze differences in the effects of cattle-manure compost fertilizer and NPK Mutiara fertilizer on the vegetative growth of Japanese kale, as well as to evaluate their roles in maintaining growing media fertility. The research employed a quantitative experimental approach using a single-factor Completely Randomized Design (CRD), namely fertilizer type. Treatments consisted of cattle-manure compost fertilizer and NPK Mutiara fertilizer, each with twelve replications, resulting in twenty-four experimental units. Observed parameters included plant height, leaf width, and growing media pH. The results showed that NPK Mutiara fertilizer produced better plant height and leaf width than compost fertilizer, particularly during the vegetative phase. This advantage was associated with the rapid availability of macronutrients such as nitrogen, phosphorus, and potassium for plant uptake. Meanwhile, cattle-manure compost fertilizer contributed to stabilizing growing media pH and improving soil physical and biological conditions. pH values in both treatments remained within the optimal range and did not limit plant growth. Therefore, NPK Mutiara fertilizer is more effective for short-term vegetative growth enhancement, whereas compost fertilizer supports sustainable growing media fertility.

This study aims to determine the relationship between low self-acceptance and the level of self-efficacy in prisoners, as well as its implications on social life after prisoners are released from punishment. The systematic review method  is used with the SPIDER approach to formulate research questions and select relevant articles. The search was conducted through the Publish or Perish, Google Scholar, and Scopus databases with keywords related to self-acceptance, self-efficacy, and inmates. Of the 100 articles identified, 13 studies met the inclusion criteria. The results of the review showed that low self-acceptance was consistently negatively associated with self-efficacy in prisoners, which had an impact on low self-confidence to face social challenges, reintegration, and overcome societal stigma. Psychological factors such as guilt, anxiety, depression, and insecurity can exacerbate low self-acceptance, especially in female inmates. In addition, social support from family, the environment, and psychological interventions have been shown to play an important role in improving self-acceptance and self-efficacy. Interventions such as expressive art therapy, psychoeducation, counseling, skills training, and religious activities have shown effectiveness in improving psychological well-being. These findings underscore the importance of systematic efforts to improve self-acceptance and self-efficacy to support the successful social reintegration of prisoners.

Academic stress is a common type of stress experienced by students, which greatly affects their self-esteem. This study aims to determine the relationship between self-esteem and academic stress levels among students. This study used a quantitative design with a cross-sectional approach and probability sampling technique. The sample consisted of 101 respondents from a total of 132 students. Data analysis was performed using Spearman's rank correlation test. The results showed a weak and negative relationship between self-esteem and academic stress levels with a p-value of 0.000 (p˂ 0.05) and a correlation coefficient (r) = -0.385. There is a relationship between self-esteem and academic stress levels in students, where low self-esteem is associated with higher academic stress levels.

Menopause is a natural phase marked by the cessation of menstruation for 12 months due to estrogen deficiency, which is often accompanied by challenging physical and emotional symptoms. With the increasing population of women aged over 50 years (reaching 26% in 2021), challenges related to access to information and awareness of menopausal changes have become crucial to ensure that quality of life is maintained. Objective: This community service activity aimed to improve knowledge and prepare mothers from an early stage to face menopausal changes and manage the associated discomfort. Methods: The activity was conducted at SDN 9 SP I Pandan and involved nine participants. The educational intervention was carried out in three stages: introduction and pre-test, delivery of material using PowerPoint and leaflets, and an interactive discussion session. The materials covered the definition of menopause, its stages, common symptoms, health risks, and preparation strategies through healthy lifestyles and medical check-ups. Results: The counseling session was conducted smoothly in the hall of SDN 9 SP I Pandan. Participants showed high enthusiasm, with five out of nine actively asking in-depth questions related to preparing for the menopausal transition. Through this educational activity, participants gained a comprehensive understanding of symptom management, including hot flashes, sleep disturbances, and mental health. Conclusion: This community service activity successfully provided new insights for mothers regarding the importance of preparing for menopause. The positive response from participants indicates the need for similar educational activities to be carried out regularly to build a sustainable support system for women during perimenopause and menopause.

The development of automotive technology continuously seeks solutions to improve human mobility and address environmental concerns. This study focuses on the Hydrogen Reactor (HHO) technology as an alternative solution for fuel efficiency and emission reduction, specifically examining the legal protection of consumers utilizing this technology at Bengkel Karya Gemilang. The research aims to analyze the legal framework of consumer protection in the context of new energy-saving technologies and to identify the legal responsibilities of business actors (workshops) and the rights of consumers. Employing a normative legal research method with a case study approach, the study analyzes the implementation of Law No. 8 of 1999 concerning Consumer Protection (UUPK) in the utilization of HHO reactors. The findings indicate that while the HHO reactor technology offers a potential 5-15% increase in fuel efficiency and CO emission reduction, its implementation introduces new legal challenges, particularly regarding product safety, standardization, and the obligation for periodic servicing. Consumer protection is primarily ensured through the workshop’s obligation to provide clear product explanations, guarantee product safety, and fulfill the periodic service commitment. The study concludes that the existing UUPK provides a sufficient legal basis, but its implementation requires clear and transparent agreements, especially concerning the technical specifications and long-term maintenance of the HHO reactor, to ensure consumer rights are fully protected against potential risks associated with new, non-standardized automotive technologies.

Bitter melon (Momordica charantia) is a medicinal plant traditionally used to control blood glucose levels and improve digestive health. These benefits are closely associated with its bioactive metabolite content. This article aims to characterize the bioactive metabolites of bitter melon and to review their potential bioactivity in glycemic control and digestive function. The method employed includes a literature-based characterization of metabolites, identification of major classes of active compounds, and evaluation of analytical techniques commonly applied in natural product research, such as phytochemical screening, chromatography, and spectroscopic analysis. The results indicate that bitter melon contains various bioactive metabolites, including flavonoids, alkaloids, saponins, triterpenoids, and polyphenols, which contribute to blood glucose reduction by enhancing insulin sensitivity and inhibiting glucose absorption. Furthermore, these compounds support digestive health by improving digestive enzyme activity, exhibiting anti-inflammatory effects, and maintaining gut microbial balance. In conclusion, bitter melon represents a promising source of natural bioactive compounds with significant potential for application in health and pharmaceutical development.

Work motivation is one of the important factors influencing time management and nurses’ performance in providing nursing care. Good time management enables nurses to complete tasks in a timely, efficient, and effective manner. This study was conducted to determine the relationship between work motivation and time management among staff nurses at ML Hospital in 2025. This research used a quantitative approach with a cross-sectional design. A total of 40 staff nurses were selected using a total sampling technique. The instruments used were questionnaires on work motivation and time management. Data were analyzed using the Spearman Rank statistical test with a significance level of < 0.05. The results showed that most respondents had good work motivation (62.5%), while the majority demonstrated a moderate level of time management (75%). The Spearman Rank test yielded a p-value of 0.005, indicating a significant relationship between work motivation and time management among staff nurses. In conclusion, there is a significant relationship between nurses’ work motivation and time management, in which higher work motivation is associated with better time management. It is recommended that hospitals enhance nurses’ motivation through managerial support and a positive work environment.

The advancement of social media platforms, especially TikTok, has drastically changed the behavioral patterns and lifestyles of Generation Z. One psychological impact of intensive social media use is Fear of Missing Out (FoMO), which is the worry of missing out on news, trends, or viral social activities. This study aims to reveal how FoMO affects the lifestyle of Generation Z active on TikTok, focusing on aspects of mental health, shopping habits, and the balance of social interactions. This research uses a literature study approach with a qualitative descriptive method, through in-depth analysis of 21 scientific articles published between 2019 and 2025. The findings show that FoMO is associated with increased anxiety, depression, personal dissatisfaction, and excessive social media use among Generation Z. Furthermore, FoMO also drives impulsive consumption patterns and purchases triggered by online trends as well as the desire for social approval. On the other hand, internal factors such as self-confidence and self-control ability have proven to reduce the level of FoMO and its negative effects. This study concludes that FoMO is a complex phenomenon that impacts the mental health and lifestyle of Generation Z, thus requiring measures such as increasing digital literacy, strengthening self-control, and using social media wisely to reduce the negative impacts of FoMO in the long term.

Mental health among Generation Z university students has become an increasingly important issue amid rising academic demands and the rapid development of digital life. Students today face various academic pressures, including competition for achievement, heavy coursework, and performance targets, which may negatively affect their psychological well-being. In addition, advances in digital technology have reshaped students’ daily lives, particularly through intensified information exposure and social comparison. This study aims to examine the influence of academic competition and digital dynamics on the mental health of Generation Z students using a literature review approach. The research employs a descriptive qualitative literature review method by analyzing 20 relevant scholarly articles published in national and international journals between 2018 and 2024. The findings indicate that academic competition is closely associated with increased levels of stress, anxiety, and emotional exhaustion among students. Prolonged academic pressure without adequate psychological support may lead to a decline in students’ psychological well-being. Furthermore, digital life reinforces psychological pressure through mechanisms of social comparison and self-presentation demands. However, several studies also identify protective factors, such as social support, mental health literacy, and emotional regulation skills, which help students manage academic and digital pressures more adaptively. Therefore, the mental health of Generation Z students is shaped by a complex interaction between academic competition and digital life, highlighting the need for comprehensive efforts from both individuals and educational institutions to promote students’ psychological well-being.

The Emergency Room (ER) is a hospital service unit that plays a strategic role in treating patients with critical and emergency conditions. The high number of patient visits and limited resources require an effective triage system to ensure quality of service and patient safety. The Emergency Severity Index (ESI) is a five-level triage system that classifies patients based on the level of severity and resource requirements. This study aims to analyze the relationship between the implementation of triage based on the Emergency Severity Index and the improvement of EAD service quality at Sari Asih Cipondoh Hospital. This study used a quantitative design with a cross-sectional approach. The study sample consisted of EAD patients who met the inclusion criteria. Data were collected through observation of triage implementation and patient satisfaction questionnaires, then analyzed using univariate and bivariate analysis. The results showed that the proper implementation of ESI triage was significantly associated with improved quality of ED services, particularly in terms of speed of service and patient satisfaction. The conclusion of this study confirms that the implementation of ESI triage is an important factor in efforts to improve the quality of ED services.