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The PESIAR Program (Petakan, Sisir, Advokasi, dan Registrasi Map, Screen, Advocate, and Register) is an operational instrument of BPJS Kesehatan designed to accelerate the achievement of Universal Health Coverage (UHC) by increasing National Health Insurance (JKN) membership at the local level. However, the effectiveness of this program’s implementation is strongly determined by the institutional capacity and configuration that support it. This article aims to reposition institutional determination not only as a factor influencing program effectiveness, but as a model of administrative governance in achieving UHC. The study uses a mixed methods approach with a sequential explanatory design. Quantitative data were obtained through a survey of PESIAR Agents in Semarang City, while qualitative data were collected through open-ended questionnaires and interviews. The results show a strong, positive relationship between institutional determination and the effectiveness of the PESIAR Program. Qualitative findings further clarify that issues of program effectiveness largely originate from institutional capacity, the quality of cross-sector coordination, and the role of PESIAR Agents as field implementers. This study concludes that institutional determination deserves to be positioned as an administrative governance model for the PESIAR Program in promoting the achievement of UHC at the local level.

Abstract: One of the most common harmful bacteria, particularly in hospitals, is Pseudomonasaeruginosa, which is also the most frequent cause of wound infections. Because it leads to antibioticresistance and persistent infections, one of the most significant virulence factors it produces isbiofilm. The goal of the current study is to prevent P. aeruginosa isolates from wound patients fromforming biofilms by using plantaricin, which is a peptide with broad-spectrum antibiotic generated byLactobacillus plantarum. In order to produce plantaricin, so that Lactobacillus plantarum isolates from rawbuffalo milk were screened. The plantaricin was then purified using ammonium salts and a gelfiltration column, with a final 40% recovery. The isolates of P. aeruginosa with more production tobiofilm from wound infections were tested for the inhibitory impact of pure plantaricin. The resultsshowed that the plantaricin reduced the development of biofilms in a dose-dependent manner, with alarger percentage of biofilm inhibition reaching 46–68% at 150 µg/ml.

This study aims to analyze the discretion of family planning counselors in implementing contraceptive policies and the influence of acceptors' socio-demographic characteristics in Demak Regency. Using a mixed-methods approach with a sequential explanatory design, the study included 89 respondents for quantitative analysis and five key informants for in-depth interviews. The results showed a strong positive correlation between counselor discretion and acceptor socio-demographic characteristics (r = 0.646; p < 0.001), which explained 41.7% of the variance in discretionary practices. Counselors adapted communication strategies based on the age, education, geographic location, and culture of acceptors. Policy implementation faced obstacles in the counselor-community ratio (1:23) and the dominance of short-term contraceptive choices due to socio-cultural influences. Theoretical implications enrich the literature on street-level bureaucracy, while practical implications recommend strengthening counselors' capacity, increasing the ideal ratio, and implementing IEC strategies tailored to local culture. Limitations include a single geographic focus and a cross-sectional design. Future research is suggested to use longitudinal designs and multi-regional comparative studies to explore the dynamics of discretion in different socio-cultural contexts.

This meta-analytic study aims to comprehensively examine the relationship between mental health, learning capacity among health education students, and competencies in nosocomial disease risk management through cross-contextual empirical synthesis. An analysis of 47 studies involving 12,847 participants from 15 countries demonstrates a strong, statistically significant association between students' mental health and competencies in nosocomial infection prevention, as reflected by a correlation coefficient of r=0.68 (p<0.001) and a 95% confidence interval of 0.61-0.74. Students with high mental health scores (M=78.4; SD=8.2) exhibited substantially superior understanding of infection prevention protocols, namely 43% higher than the control group (M=54.7; SD=12.1; t(846)=18.42; p<0.001; d=2.31). Structural equation modeling confirmed learning capacity as a significant partial mediator (β=0.52; p<0.001), with an indirect effect reaching 35.4% and a 95% CI range of 28.6-42.1%. Mindfulness-based psychoeducational interventions were shown to enhance nosocomial risk identification abilities by 38.7% (F(2,564)=42.18; p<0.001; η²=0.41) while reducing clinical anxiety by 31.2% (t(382)=9.84; p<0.001). These findings extend the frameworks proposed by Song (2024) and Schutte et al. (2025), which primarily emphasize cognitive aspects, by demonstrating that the integration of psychological dimensions yields a multidimensional predictive model explaining 64.3% of the variance in risk management competence (R²=0.643; F(5,841)=304.76; p<0.001), surpassing conventional models that account for only 38-45% of the variance.

This study aims to analyze the relationship between public policy paradoxes, healthcare service quality, access to and continuity of postnatal care, and maternal mortality in Pekalongan Regency. A mixed-methods approach with a sequential explanatory design was employed, involving 30 respondents for quantitative analysis using Spearman correlation tests and 5 key informants for in-depth interviews. The results indicate that policy paradoxes are strongly correlated with service quality and with access and continuity of care. Service quality also shows a robust correlation with access and continuity. All variables are significantly associated with maternal mortality, with access and continuity of care demonstrating the strongest correlation. Qualitative findings reveal implementation gaps in Ministry of Health Regulation No. 21 of 2021, where postnatal visits are often conducted only 2–3 times instead of the mandated four visits, with 10 out of 13 maternal deaths occurring during the postnatal period. The persistence of maternal mortality is attributed to inconsistent implementation of standard operating procedures, high workload, and socio-cultural factors. The study highlights the need to strengthen supervision, enhance human resource capacity, and promote cross-sectoral collaboration to optimize postnatal care services.

Hypertension is a major modifiable risk factor contributing to the development of Acute Coronary Syndrome (ACS), which includes STEMI, NSTEMI, and unstable angina. The increasing prevalence of hypertension worldwide raises concern regarding its impact on cardiovascular outcomes. This study aimed to describe the profile of ACS patients with hypertension receiving angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) therapy in the Intensive Coronary Care Unit (ICCU) of RSUD Dr. Soetomo Surabaya. Using a descriptive cross-sectional method, data from 91 patients treated between July 2021 and October 2024 were analyzed. Variables included demographic characteristics, clinical classification of ACS, hypertension degree, comorbidities, types and doses of ACEI/ARB administered. The results showed that most patients were male (73%) and aged over 65 years (40%). Chi-square analysis revealed no significant relationship between hypertension degree, ACS classification, or most comorbidities with drug selection or dosage (p>0.05), except for a significant association between coronary heart disease comorbidity and ARB selection. These findings suggest that in hypertensive ACS patients, the choice between ACEI and ARB therapy is predominantly based on individual comorbidity profiles rather than blood pressure severity or ACS type. The study highlights the importance of personalized treatment approaches considering patient comorbidities to optimize cardiovascular outcomes.

Maternal Mortality Rate (MMR) is a critical indicator for evaluating maternal health programs, and insufficient knowledge of pregnancy danger signs remains a significant factor in preventable maternal complications and mortality. This issue is particularly prevalent among third-trimester pregnant women. Health education has proven to be an effective strategy for enhancing maternal knowledge, promoting early detection of obstetric emergencies, and supporting timely decision-making. This study aimed to evaluate the impact of health education on improving knowledge of pregnancy danger signs among third-trimester pregnant women in Nunkurus Village. A pre-experimental study with a one-group pre-test–post-test design was conducted, involving 42 third-trimester pregnant women, with 40 selected through purposive sampling. Structured questionnaires were used to collect primary data, and the Wilcoxon signed-rank test was employed to analyze the knowledge differences before and after the intervention. Results showed a statistically significant increase in knowledge after the health education intervention (p-value = 0.000; p < 0.05). In conclusion, health education significantly enhances knowledge of pregnancy danger signs among third-trimester pregnant women. Strengthening community-level educational interventions can help in early detection of pregnancy complications and contribute to reducing maternal morbidity and mortality.

This study examines the experience of access to health services and resilience strategies in adolescents with unplanned pregnancies in Makassar, Indonesia. Access to quality reproductive health services is important for adolescents' well-being, but they often face systemic barriers that affect access to health services and outcomes. The study used an Interpretative Phenomenological Analysis (IPA) approach on seventeen adolescent girls aged 15–19 years who had an unplanned pregnancy between June–November 2023. Data were collected through in-depth semi-structured interviews, recorded, verbatim transcribed, and analyzed by a six-stage science process. Two main themes were found: Navigating Closed Doors: Systematic Barriers to Care and Finding Light in Darkness: Resilience and Agency. Participants faced a variety of layered barriers, including a lack of information about health services and rights, geographical and economic constraints, age-based discrimination, parental notification obligations, fear of legal consequences especially related to abortion, family control over decisions, and limitations in adolescent-friendly services. Nonetheless, adolescents show resilience through seeking strategic help, resistance to pressure, spiritual and religious coping, peer support, gradual acceptance of maternal identity, educational sustainability, and positive meaningfulness of difficult experiences. These findings point to the need for a transformation of the health system that not only improves attitudes of health workers, but also addresses structural barriers such as confidentiality, age discrimination, and service availability, while strengthening agency and adolescent coping strategies.

As HIV transitions into a manageable chronic condition, optimizing lifestyle behaviors is key to achieving long-term health outcomes. This study aims to explore lifestyle behaviors in people with HIV (ODHIV) who participate in peer support groups as well as identify socioeconomic and clinical predictors of healthy lifestyle engagement. The research design was a cross-cutting analysis involving 250 ODHIV registered in a community support group. Lifestyle behavior was measured using  a modified Health-Promoting Lifestyle Profile II (HPLP-II) instrument. Multivariate logistic regression analysis was used to determine independent predictors, with Nagelkerke R² and Hosmer–Lemeshow tests  to assess model suitability. The results showed that 56.2% of respondents had a healthy lifestyle. Factors of higher education (OR = 2.77; p = 0.006), older age (OR = 2.32; p = 0.015), employment status (OR = 2.00; p = 0.029), and longer duration of ART therapy (OR = 1.17 per year; p = 0.003) were significant predictors. The model explains 32% of lifestyle variations, with ART compliance and substance control as the strongest behavioral domains. These findings confirm the role of peer support groups as a behavioural reinforcement environment, but socioeconomic disparities remain influential. The integration of theory-based lifestyle interventions into community-based HIV services is necessary to optimize chronic disease outcomes.

Adolescents require higher levels of nutrients for physical growth and development, but the current trend is for adolescents to prefer instant foods such as junk food, spicy foods and foods containing unhealthy additives. This has led to the emergence of various diseases, one of which is gastritis. This condition is even more risky for female students living in Islamic boarding schools with busy activities and irregular meal schedules, thus requiring efforts to prevent gastritis. This study aims to determine the gastritis prevention behaviour of female students at Ma'had Asy-Syakur MAN 2 Kediri. This study uses a descriptive design with one variable, namely gastritis prevention behaviour. The research population consisted of students living at Ma'had Asy-Syakur MAN 2 Kediri, with a total of 59 respondents. Data collection was conducted using a gastritis prevention behaviour questionnaire. The results showed that almost all respondents (81.36%) had gastritis prevention behaviours in the adequate category, with a small portion in the good category (18.64%). The female students' busy and well-scheduled activities, accompanied by the implementation of discipline, regular meal arrangements, and the provision of stomach-friendly menus, contributed to the formation of gastritis prevention behaviour. The most common preventive behaviour was avoiding spicy foods, due to habits, taste preferences, and socio-cultural factors that had been established. This study recommends the need for health education that not only focuses on increasing knowledge but also changing attitudes and habits so that gastritis prevention behaviour can be further optimised.

Objective: Autoimmune diseases are complex disorders that arise when the immune system loses tolerance to self-antigens, leading to chronic inflammation and tissue damage. To understand disease pathogenesis and to evaluate therapeutic efficacy, animal models are widely used in autoimmune research. This review aims to analyze various types of animal models employed in studies of autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), type 1 diabetes mellitus (T1DM), and multiple sclerosis (MS), with a particular focus on reproducibility and clinical applicability. Methods: This study was conducted through the selection and analysis of scientific literature published over the last ten years (2015–2025), using specific keywords including “clinical application,” “autoimmunity,” “animal models,” “humanized mice,” “lupus,” “rheumatoid arthritis,” “reproducibility,” and “translational research.” Literature searches were performed in major databases such as Google Scholar, PubMed, ScienceDirect, and Scopus. Results: Spontaneous models, such as NOD and MRL/lpr mice, exhibit close resemblance to human disease pathogenesis but are influenced by strain variability and environmental factors. Induced models, including collagen-induced arthritis (CIA) and experimental autoimmune encephalomyelitis (EAE), allow greater control over disease onset but do not fully capture the clinical complexity observed in humans. Humanized models demonstrate high translational relevance; however, their use is constrained by high costs and technical limitations. Conclusion: No single animal model is universally ideal for studying autoimmune diseases. Model selection should be based on biological relevance, reproducibility of outcomes, and the potential for clinical translation in autoimmune disease research.

Surveillance for diarrhea at the district level in Indonesia is still affected by the fragmented nature of the District Health Information System (DHIS) and Early Warning and Response System (EWARS), inconsistent reporting, patchy data interoperability, and the resulting public health delays. Although there are systems in place like the DHIS and EWARS, the persistent use of hybrid systems that combine manual and digital data entry, as well as the different skill levels of users, continues to produce issues of incompleteness, untimely reporting, and inaccurate data. The present study investigated the deficiencies in surveillance reporting of diarrhea cases, the surveillance data to determine the degree of integration and also investigated the health workers perceptions of the barriers to effective reporting. A mixed methods approach was adopted in this study where we investigated quantitatively the DHIS and routine diarrhea reports submitted for the entire year of 2023, and combined that with qualitative, in-depth interviews with the relevant surveillance officers, program managers, and district staff. The quantitative analysis indicated gaps in reporting about 55% in terms of completeness, and consistency of reporting and also significant differences were found between the manual register, DHIS, and EWARS whereby the integration of these systems was found to be low. The qualitative analysis pointed to the combination of disconnected workflows, limited cross-system interoperability, inadequate system training, excessive workloads, and weak organizational feedback, as the main barriers to effective reporting. The combination of these two datasets illustrates the fact that both system deficiencies and organizational factors are primary drivers of the reporting. Closing the gaps will require system level changes in the interoperability of reporting systems, simplified reporting workflows, training, reporting, and reporting feedback loops.

Non-health facility deliveries remain a significant maternal health problem in rural areas, increasing the risk of complications for both mothers and newborns. Cigobang Village, Karang Tengah, Babakan Madang District, is one of the areas where home deliveries assisted by non-health personnel are still practiced. This community service activity was conducted through the Village Community Health Development (PKMD) program involving 103 respondents, there were 8 pregnant women (100%) who still planned to give birth at home assisted by non-health personnel. The objective of this activity was to improve community awareness and knowledge regarding safe delivery practices in health facilities. The methods included a community health assessment using questionnaires, maternal health education sessions, and interactive discussions with pregnant women, families, and community health cadres. The results showed that despite the implementation of health education, some pregnant women still planned home deliveries assisted by non-health personnel due to cultural beliefs, accessibility issues, and financial considerations. The PKMD activities contributed to increased community knowledge; however, continuous education and multisectoral collaboration are required to promote safer delivery practices.

Entrepreneurial leadership has become a crucial competency in higher education institutions seeking to adapt to rapid environmental changes and increasing global competition. This study explores how innovation behavior and dynamic capabilities among lecturers contribute to fostering entrepreneurial leadership within universities. Specifically, it investigates the mediating role of dynamic capabilities in the relationship between innovation behaviour and entrepreneurial leadership. Using a quantitative research design, data were collected through a cross-sectional survey of 85 lecturers at Universitas Duta Bangsa Surakarta. Path analysis and the Sobel test were used to examine both direct and indirect effects. The results reveal that innovation behaviour significantly influences both dynamic capabilities and entrepreneurial leadership. Moreover, dynamic capabilities partially mediate the relationship between innovation behaviour  and entrepreneurial leadership, highlighting their strategic role in enhancing institutional adaptability and innovation. These findings underscore the importance of cultivating innovation behaviour and developing dynamic capabilities among academic staff to promote entrepreneurial leadership. This research provides theoretical, managerial, and policy implications for university governance, emphasizing the need for supportive environments that encourage innovation and continuous development of academic competencies

Non-hemorrhagic stroke occurs due to blockage of blood flow to the brain by a thrombus or embolus. The blockage results in focal neurological disorders that affect the musculoskeletal system, namely weakness in the extremities, which gives rise to nursing problems of impaired physical mobility. To overcome the problem of impaired physical mobility, rubber ball grip exercises (ball squeezing) are given. These exercises have been shown to increase muscle strength, prevent joint stiffness, and improve blood circulation. This scientific paper was conducted to determine the description of nursing care for non-hemorrhagic stroke patients with nursing problems of impaired physical mobility. During the meeting, the nurse provided rubber ball grip exercises (ball squeezing) for 10-15 minutes for 3 times in 24 hours. Evaluation of these actions showed that the patient who initially experienced weakness in the upper extremities with muscle strength 2-3 and after being given rubber ball grip exercises (ball squeezing), the problem of impaired physical mobility was resolved, as evidenced by the patient being able to perform therapy, the extremities feeling slightly lighter, and muscle strength 4. Therefore, it is recommended that non-hemorrhagic stroke patients be given rubber ball grip exercises (ball squeezing) to overcome impaired physical mobility.

Compliance with taking medication is very important for pulmonary tuberculosis patients because it can ensure that the tuberculosis infection is controlled and does not spread to other people. Motivational interviewing counseling can help tuberculosis patients increase medication adherence with an empathetic and supportive approach to providing information. Through this technique, counselors can foster the patient's internal motivation to overcome obstacles that arise related to taking medication regularly. This research has gone through an ethical process with No. 000.9/002/KEPKRSUDBTG/1/2025. This type of research is quantitative, a quasi-experimental method with a one group pretest-posttest without control design. The sampling technique in this research used purposive sampling of 30 respondents. Data analysis used univariate and bivariate analysis with the Wilcoxon rank test. The research results show: The patient's level of compliance with taking TB medication before Motivational Interviewing counseling is in the medium category and the low category. The level of patient compliance in taking TB medication after Motivational Interviewing counseling has increased, namely the high category and the medium category. There is an influence of motivational interviewing counseling on medication adherence in pulmonary tuberculosis patients at Batang Regional Hospital. There is a significant difference between the results of compliance with taking TB medication before and after counseling motivational interviewing at Batang Regional Hospital.

Bullying is a form of aggressive behavior commonly experienced by adolescents and has significant impacts on both physical and mental health. Schools, as primary social environments for teenagers, often become settings where bullying occurs. Several factors contribute to this behavior, particularly peer influence, family roles, and social media use. This study aimed to analyze factors related to bullying behavior among adolescents in a junior high school, including respondent characteristics, peer influence, family roles, and social media usage, as well as their relationships with bullying behavior. This research used a quantitative approach with a cross-sectional design involving 71 eighth-grade students as respondents. Data were collected using structured questionnaires and analyzed with the Chi-Square test. The results showed significant relationships between peer factors (p=0.003), family roles (p<0.001), and social media use (p=0.001) with bullying behavior. A large proportion of respondents reported high social media usage (45.1%) and low family involvement (45.1%), while more than half (53.5%) were categorized as being at risk of engaging in bullying behavior. These findings indicate that adolescents are strongly influenced by their social environment, both offline and online. Negative peer interactions and limited family supervision can increase the likelihood of bullying behavior. In conclusion, peer factors, family roles, and social media use are significantly associated with bullying among adolescents. Therefore, collaboration between families, schools, and communities is essential through psychosocial assessments, increased family involvement, and character education programs to prevent and reduce bullying behavior.

Stunting is a major public health problem that reflects chronic malnutrition and adversely affects children’s physical growth, cognitive development, and future productivity. The first 1,000 days of life represent a critical window during which stunting develops and determines long-term health outcomes. This study aims to review evidence on the determinants of childhood stunting and the effectiveness of prevention interventions within public health policy frameworks in Indonesia.A literature review was conducted using peer-reviewed articles, policy documents, and national reports published in the last decade. The literature was analyzed to identify key risk factors, intervention strategies, and policy impacts on stunting reduc-tion.The findings show that stunting is primarily driven by inadequate dietary intake, low socioeconomic status, limited caregiver nutrition knowledge, and poor access to health and sanitation services. National data indicate a decline in stunting prevalence in Indonesia from 24.4% in 2021 to 21.6% in 2022. Evidence consistently highlights that integrated interventions targeting the first 1,000 days of life, including maternal nutrition improvement, breastfeeding promotion, appropriate complementary feeding, and multisectoral collaboration, are effective in reducing stunting.In conclusion, reducing childhood stunting requires sustained, integrated, and policy-based interventions that prioritize early-life nutrition to improve human capital and support long-term national development.

Pregnancy complications remain a major health problem contributing to high maternal morbidity and mortality rates in Indonesia. Factors influencing the occurrence of pregnancy complications include the level of maternal knowledge and advanced maternal age. Advanced age increases the risk of pregnancy disorders due to decreased reproductive function, while low knowledge limits a mother’s ability to recognize danger signs and take appropriate preventive measures. This study aimed to determine the relationship between knowledge level and advanced maternal age and the occurrence of pregnancy complications in the working area of Bonebobakal Public Health Center, Banggai Regency. This study employed a quantitative analytic design with a cross-sectional approach involving 41 pregnant women selected through total sampling. Data were collected using questionnaires and interviews and analyzed using the Chi-Square test. The results showed a significant relationship between maternal knowledge level and maternal age with the occurrence of pregnancy complications. Health education and regular pregnancy monitoring are necessary to reduce the risk of complications and improve maternal and fetal safety..

Background: Comprehensive midwifery care is essential for early detection of complications and reducing maternal and infant mortality rates. In Sleman Regency, despite high access to health services, continuous monitoring remains crucial for ensuring maternal and fetal safety. Objective: To provide comprehensive midwifery care for Mrs. M at Klinik Pratama Shaqi, Sleman, from the third trimester of pregnancy through the postpartum and neonatal periods. Methods: This is a descriptive qualitative study using a case study approach based on Varney's seven-step midwifery management and SOAP documentation. Findings: During pregnancy (37 weeks 6 days), the mother experienced physiological complaints of back pain and shortness of breath, managed through posture education and pregnancy exercises. Labor proceeded normally and spontaneously on October 6, 2024, utilizing "gentle birth" practices such as endorphin massage to reduce pain. A second-degree perineal tear occurred and was treated according to procedure. The baby was born healthy, weighing 3100 grams, with successful Early Initiation of Breastfeeding (EIB). During the postpartum and neonatal periods, uterine involution was normal, breast milk production was adequate, and the infant's growth met standards with no danger signs. Implications: Continuous assistance improves the mother's physical and psychological readiness and ensures a healthy neonatal transition.