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Rheumatoid arthritis (RA) is a daily disease seen in rheumatology clinics. It predominantly involves the appendicular skeleton. The axial skeleton is mostly spared except for the cervical spine where instability can occur and can be carefully assessed with cervical spine radiographs in flexion and extension. Radiographs may show erosion at the C1-C2 level with destruction of the transverse ligament that can result in atlantoaxial subluxation. Diagnosis is based on clinical, laboratory, and radiographic findings. Conventional radiography has been the mainstay for diagnosis of joint damage and subsequent follow-up. Radiography can provide only indirect information on synovial inflammation, however, and the technique is insensitive to early bone damage. Hand radiographs are frequently ordered as the first imaging modality in the assessment of patients presenting with peripheral arthritis. They can provide invaluable information about the bones, joints, mineralization, soft tissues and the distribution of abnormalities. Given the wide spectrum of rheumatic diseases, it might be challenging to make the diagnosis solely based on the clinical findings and imaging plays an important role in narrowing the differential diagnosis. Having the knowledge of the common radiographic manifestations of inflammatory arthritis is of paramount importance for clinicians and radiologists to diagnose the underlying disease in early stages of disease in order to start treatment. The purpose of the article is to review the key radiographic findings of common rheumatic diseases in the hands.

Hypertension is one of the most common chronic diseases encountered in primary healthcare and may lead to serious complications if left uncontrolled. This case report aims to describe the management of a 48-year-old female patient with grade II hypertension through a family medicine approach at Nisam Primary Health Center, North Aceh Regency. The patient presented with intermittent headaches for one week, which worsened after physical activity and were accompanied by numbness in both legs. She had a five-year history of hypertension with poor adherence to antihypertensive medication. Physical examination revealed a blood pressure of 165/70 mmHg, leading to a diagnosis of grade II hypertension. Comprehensive management was conducted using patient-centered and family-centered approaches, including education regarding hypertension, lifestyle modification, DASH diet implementation, physical activity, medication adherence, and family support through home visits and family folders. The interventions were expected to improve blood pressure control, prevent complications, and enhance the patient’s quality of life. A family medicine approach plays an important role in comprehensive hypertension management at the primary healthcare level.

Early detection of a potential heart attack is a crucial step in preventing sudden death from heart disease. This research aims to develop an Internet of Things (IoT)-based health monitoring system capable of measuring vital body data in real time and predicting the likelihood of a heart attack from CSV data obtained from sensors, integrated through RapidMiner as learning data using a machine learning algorithm, the Support Vector Machine (SVM). The system was built using an ESP32 microcontroller connected to a MAX30102 sensor to measure heart rate and finger oxygen levels (SpO₂), as well as a DHT22 sensor to measure temperature and humidity. The resulting data is sent to the Blynk application to display real-time data according to its parameters. The initial prediction logic was developed using a rule-based method based on medical thresholds for four vital parameters. The data was then used to train an SVM model as a classification system to detect potential heart attacks. Test results showed that the system can identify abnormal conditions with a good level of accuracy and provide early warnings based on changes in vital parameters in real time. This system is expected to be an initial solution for personal health monitoring, especially for individuals at risk of heart disease. It can be further developed with cloud integration and automatic notifications to users' devices.

Dengue Hemorrhagic Fever (DHF) remains a major public health problem in Indonesia, particularly in densely populated areas. Control efforts require accurate data and spatial analysis to understand disease distribution patterns. Geographic Information System (GIS) is an effective tool for visualizing case distribution and supporting surveillance and planning of control programs at the primary healthcare level. This study aims to describe the spatial distribution of Dengue cases based on medical record data and produce a geographic distribution map to support Dengue control efforts at the Puskesmas level. This study used a quantitative descriptive design with secondary data from medical records at Karangsari Health Center. The sample consisted of 255 DHF patients in 2025, selected using a total sampling technique. Data were processed through editing, geocoding patient addresses, and spatial analysis using QGIS software.The results showed 255 Dengue  cases in 2025 with fluctuating monthly trends, peaking in April and lowest in December. Case distribution was uneven and tended to cluster. High-risk areas accounted for 15.7%–21.2%, moderate-risk areas 9.8%–15.7%, and low-risk areas 7.1%–9.8%. Megu Cilik Village had the highest proportion of cases, while other villages were categorized as moderate and low risk. This pattern indicates that Dengue incidence is influenced by environmental conditions, vector density, host factors, rainfall, and Aedes aegypti presence. GIS provides clearer spatial visualization, helping identify high-risk areas and supporting targeted public health interventions.

Homemade food is increasingly dominating the choices of consumers who are oriented towards a healthy lifestyle. However, the belief that self-cooking is synonymous with food safety is not always supported by scientific evidence. This Narrative Review aims to build an in-depth thematic synthesis of the various dimensions of food safety risks that arise in the process of preparing healthy homemade food, ranging from biological and chemical contamination, to human behavioral factors as the main agents of contamination. The study was conducted against seven reputable sources of scientific literature published between 2010–2025, including observational, experimental, cross-sectional, and review studies. Four main themes were identified: (1) risky behaviors in the household kitchen as the dominant factor; (2) unexpected cross-contamination pathways including table salt as a vector; (3) chemical and biological contaminants hidden in "healthy" materials; and (4) evidence-based interventions that have been proven to be effective. This review confirms that homemade food safety is a behavioral issue, not just a technical one, so the intervention approach must be multidimensional and sustainable.

Bureaucratic rigidity is a form of public administration pathology that remains a serious problem in Indonesian governance. The bureaucracy's rigid, hierarchical nature, slow decision-making, and resistance to change are major obstacles to the government's digital transformation process. Amidst the demands of the digital era, which prioritizes speed, transparency, and efficiency, an unadaptive bureaucracy actually slows down innovation in public services and erodes public trust in the government. This study aims to analyze bureaucratic rigidity as a disease in public administration and its impact on the implementation of digital transformation in Indonesia. The method used is a qualitative approach with a literature review. The results indicate that bureaucratic rigidity is caused by a conservative organizational culture, complicated regulations, and low human resource capacity to adapt to technology. Furthermore, a lack of system integration and weak transformational leadership exacerbate these conditions. Digital transformation is not merely a technological issue, but a paradigm shift in governance. Therefore, comprehensive bureaucratic reform is needed, including simplifying procedures, strengthening the digital competency of civil servants, and shifting the work culture to be more flexible and innovative. Thus, an adaptive and responsive bureaucracy can be realized as the foundation of an effective digital government that is oriented towards public services.

Critically ill patients are individuals with unstable health conditions who require close monitoring of hemodynamic parameters. The high mortality rate among critically ill patients treated in intensive care units reaches 36.5% of 33,148 patients. Hemodynamic instability in critically ill patients can be influenced by underlying diseases, medical interventions, as well as physical and psychological stress responses during treatment. Therefore, in addition to pharmacological therapy, non-pharmacological interventions such as Asmaul Husna dhikr therapy are needed, as they can provide a relaxation effect and help stabilize hemodynamic parameters in critically ill patients. To determine the outcomes of the implementation of Asmaul Husna dhikr therapy. This study used a descriptive case study method involving two critically ill patients with unstable non-invasive hemodynamic parameters. Changes in non-invasive hemodynamic parameters were observed in both respondents after the implementation of Asmaul Husna dhikr therapy. In respondent 1, the hemodynamic status was initially categorized as increased and became stable after the intervention. Similarly, in respondent 2, the hemodynamic status changed from increased before the intervention to stable after the intervention. The implementation of Asmaul Husna dhikr therapy can be used as a complementary therapy to help stabilize hemodynamic parameters in critically ill patients.

Breast cancer is a serious health problem among women, with incidence and mortality rates that continue to rise. The disease is often detected at an advanced stage due to low levels of awareness, knowledge, and skills related to early detection. Among adolescent girls, particularly high school students, knowledge and skills regarding Breast Self-Examination (BSE) remain limited. This is largely due to restricted access to health information, a lack of targeted educational initiatives, and learning methods that are insufficiently engaging. BSE is a simple and effective early detection method that can be performed independently beginning in adolescence. Video-based education is considered an effective tool for enhancing adolescents’ understanding. This study aims to determine the effectiveness of video-based education in improving knowledge and BSE skills among Grade XI female students at MAN (State Islamic Senior High School) 2 Yogyakarta. This study employed a pre-experimental design using a one-group pre-test and post-test approach. The study population consisted of all Grade XI female students at MAN 2 Yogyakarta, with a sample of 59 students selected through purposive sampling on predetermined inclusion criteria. The intervention involved a single session of a BSE educational video lasting approximately seven minutes. It was conducted in 15 groups, with each group accompanied by one facilitator. Data were analyzed using the nonparametric Wilcoxon statistical test. The Wilcoxon test results showed a p-value of 0.000 (p < 0.05) for both knowledge and skills variables, indicating a statistically significant improvement between the pre-test and post-test scores. In conclusion, video-based education was proven effective in improving knowledge and BSE skills among Grade XI female students at MAN 2 Yogyakarta. Future researchers are encouraged to assess BSE skills using a structured checklist based on standardized evaluation criteria.  

Dry eye syndrome (DES) is a common ocular surface disorder that can impair visual function and quality of life, particularly among working-age adults. Although DES has a multifactorial etiology, nutritional factors, such as omega-3 fatty acid intake, have been suggested to modulate inflammation associated with the condition. This study aimed to investigate the association between dietary omega-3 intake and dry eye syndrome in adults. This cross-sectional analytical observational study included 88 participants aged 15-59 years. Participants were selected using consecutive non-random sampling and assessed with a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) to estimate omega-3 intake, while dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI). Statistical analyses included chi-square and Fisher’s exact test. The results showed that 51.1% of the participants had insufficient omega-3 intake (<250 mg/day), and 29.5% experienced dry eye syndrome. No statistically significant association was found between sex or age and DES occurrence. However, a significant association was found between omega-3 intake and dry eye syndrome (p < 0.001), with individuals consuming insufficient omega-3 having a substantially higher risk of developing DES. These findings suggest that adequate omega-3 intake may play a protective role in dry eye syndrome. This study underscores the potential of dietary interventions as a strategy for preventing and managing DES.

Thalassemia is a chronic genetic disease that requires long-term treatment and affects children's quality of life physically, psychologically, socially, and academically due to chronic anemia and regular blood transfusion needs. This study aimed to determine factors influencing the quality of life of children with thalassemia at Rumah Sakit Anak dan Bunda Harapan Kita. A descriptive design with a cross sectional approach was used, involving 41 respondents through total sampling. Data were collected using the Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scale) and respondent characteristics including age, gender, socioeconomic status, parental education, and frequency of blood transfusions. Data were analyzed using univariate and bivariate analysis with the Chi-Square test. The results showed most respondents were under ten years old, female, from families with socioeconomic status below the minimum wage, had parents with high school or higher education, and received blood transfusions every three weeks. Bivariate analysis indicated only the frequency of blood transfusions was significantly associated with quality of life, while other variables were not. Thus, transfusion frequency is the main factor influencing quality of life in children with thalassemia.

Overcapacity in Correctional Institutions is a structural problem that is still a serious challenge in the correctional system in Indonesia. This condition is characterized by the number of inmates that far exceeds the ideal capacity, resulting in a decrease in the quality of coaching, health services, and security. This study aims to analyze the factors that cause overcapacity in prisons and the impact they have on the effectiveness of the correctional system. The method used is a normative juridical approach supported by empirical data from relevant agency reports. The results of the study show that the main factors causing overcapacity include the high crime rate, criminal policies that are still oriented towards prison sentences, and limited correctional facilities and infrastructure. The impact of overcapacity is very felt in the implementation of inmate development. Crowded housing conditions also increase conflicts between inmates, the spread of infectious diseases, and violations of basic rights. In addition, the limited number of correctional officers causes supervision to not run optimally and has the potential to trigger deviant practices in prisons. Therefore, it is necessary to reformulate penal policies through the optimization of non-prison penal alternatives, institutional capacity building, and strengthening rehabilitation and social reintegration programs to realize a more humane and just correctional system.

Chronic Obstructive Pulmonary Disease is a chronic respiratory disease characterized by progressive and not fully reversible airflow limitation. Dyspnea is the primary symptom experienced by COPD patients and significantly affects their quality of life, especially among those hospitalized. This condition may lead to activity limitation, psychological distress, and decreased social functioning. This study aimed to determine the relationship between the level of dyspnea and the quality of life of COPD patients in the pulmonary inpatient ward of Cut Nyak Dhien General Hospital Meulaboh. This study employed an analytical design with a cross-sectional approach. The sample consisted of hospitalized COPD patients selected using purposive sampling. Dyspnea severity was measured using the Modified Medical Research Council (mMRC) scale, while quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ). Data were analyzed using the Spearman correlation test to determine the relationship between variables.The results showed that most respondents experienced moderate to severe dyspnea and had poor quality of life. Statistical analysis revealed a significant relationship between dyspnea level and quality of life (p < 0.05) with a negative correlation.In conclusion, there is a significant relationship between dyspnea severity and quality of life in COPD patients, where higher dyspnea levels are associated with lower quality of life.

Dengue remains a major vector-borne disease worldwide, and the increasing resistance of Aedes aegypti to synthetic insecticides has encouraged the exploration of environmentally friendly botanical larvicides. This study aimed to systematically evaluate scientific evidence regarding the larvicidal potential of endemic Kalimantan plants against Aedes aegypti and to identify priority candidates for future research. A systematic literature review was conducted following the PRISMA 2020 guidelines. Literature searches were performed across Scopus, PubMed, ScienceDirect, SpringerLink, Web of Science, MDPI, Wiley Online Library, Garuda, SINTA, and Google Scholar for studies published between January 2016 and January 2026. A total of 925 records were identified, and after duplicate removal, screening, and eligibility assessment, 88 studies were included in the final synthesis. The results showed that botanical larvicides rich in alkaloids, flavonoids, terpenoids, phenolics, limonoids, and sulfur compounds demonstrated significant larvicidal activity against Aedes aegypti. However, no direct larvicidal studies were identified for endemic Kalimantan species, including Fibraurea tinctoria, Arcangelisia flava, Dacrydium beccarii, Agathis borneensis, and Scorodocarpus borneensis. These findings highlight substantial evidence gaps and indicate that Kalimantan biodiversity represents a promising source of novel larvicidal agents for sustainable dengue vector control.

Preeclampsia remains a major contributor to maternal morbidity and mortality, particularly in developing countries such as Indonesia. Early detection and integrated management at the primary healthcare level are essential to prevent disease progression and improve maternal outcomes.  Modifiable risk factors such as maternal obesity, inadequate calcium intake, and poor clinical management contribute significantly to disease progression (WHO, 2021; Zhang et al., 2020). This study aimed to evaluate the effectiveness of an Integrated Maternal Health Model (IMHM) combining risk assessment, nutritional intervention, and clinical management for early prevention and control of preeclampsia in primary healthcare settings. A quasi-experimental cohort study was conducted among 104 pregnant women, consisting of 52 preeclamptic and 52 normotensive participants in community health centers in Medan, Indonesia. Data were collected across four antenatal visits, including blood pressure measurements, proteinuria (dipstick), calcium intake, supplementation adherence, and antihypertensive therapy. Statistical analyses included bivariate and longitudinal tests. The results showed that maternal obesity, history of preeclampsia, and hypertension were significant risk factors. Adequate calcium intake demonstrated a protective effect against preeclampsia (p < 0.05), consistent with recent evidence indicating that calcium supplementation can reduce the risk of preeclampsia by up to 49%. However, calcium supplementation did not significantly influence blood pressure among normotensive pregnant women. Antihypertensive therapy, particularly intensive nifedipine regimens, showed significant differences in blood pressure patterns across visits (p < 0.05). In addition, proteinuria levels significantly decreased over time (p < 0.001), indicating improvement in renal function. In conclusion, the IMHM is effective in improving maternal outcomes through a multi-component approach integrating clinical, nutritional, and monitoring strategies. This model provides a practical and scalable framework for early prevention and management of preeclampsia in primary healthcare settings.

A Normocytic normochromic anemia is one of the most common types of anemia found in geriatric patients with chronic diseases or acute bleeding. Upper gastrointestinal bleeding (UGIB) may cause continuous blood loss resulting in decreased hemoglobin levels. This case report discusses a 72-year-old woman who presented to the Emergency Department of Cut Meutia Regional General Hospital with complaints of black stools for four days prior to admission accompanied by epigastric pain, nausea, weakness, and pallor. The patient had a history of long-term use of analgesic and anti-gout medications due to chronic joint pain, which was suspected to be a risk factor for UGIB. Physical examination revealed pale conjunctiva and tachycardia, while laboratory findings showed hemoglobin of 7.1 g/dL, hematocrit of 23.3%, MCV of 82 fL, MCH of 29 pg, and uric acid level of 11.56 mg/dL, leading to the diagnosis of normocytic normochromic anemia caused by UGIB accompanied by gout arthritis. The patient received intravenous fluid therapy, proton pump inhibitors, antifibrinolytic agents, gastroprotective therapy, packed red cell transfusion, and other supportive treatments. During hospitalization, clinical improvement was observed, including cessation of gastrointestinal bleeding, reduced epigastric pain, and increased hemoglobin level to 8.6 g/dL. This case highlights the importance of early diagnosis and comprehensive management in geriatric patients with anemia caused by UGIB and comorbid gout arthritis.

Atrophic rhinitis or ozena is a chronic infection of the nasal cavity characterized by progressive atrophy of the nasal mucosa and turbinate bones accompanied by the formation of foul-smelling nasal crusts. This condition is more commonly found in females, particularly during puberty, and is frequently associated with populations of low socioeconomic status and poor environmental sanitation. The exact etiology of atrophic rhinitis remains unclear; however, several factors are believed to contribute, including chronic infection by *Klebsiella ozaenae*, vitamin A and iron deficiency, chronic sinusitis, hormonal imbalance, collagen diseases, trauma, and genetic predisposition. Common clinical manifestations include nasal obstruction, thick greenish nasal discharge, crust formation, epistaxis, anosmia, and *foetor ex nasi*, which is often more noticeable to people around the patient. Anterior rhinoscopy typically reveals widened nasal cavities, turbinate atrophy, thin and dry nasal mucosa, as well as purulent secretions and greenish crusts. Diagnosis is established through history taking, ENT physical examination, and supporting investigations such as microbiological culture, histopathological examination, radiological imaging, and paranasal sinus CT-scan. Management may be conservative with antibiotics, nasal irrigation, nasal drops, vitamin A supplementation, and iron preparations, or surgical in severe cases or those unresponsive to conservative therapy.

This reflective autoethnographic study explores the lived experience of being an only child caring for an elderly mother with Parkinson's disease while working as a full-time lecturer. The research aims to understand how this dual role affects the caregiver's mental health, work productivity, and relationship with the mother. Using a reflective autoethnographic approach based on Ellis, data were collected through three techniques: autobiographical narratives and memos, analysis of personal artifacts (work schedules, medical records, photographs), and an integrated self-interview. Thematic-reflective analysis revealed three main themes. First, structural loneliness describes the profound isolation resulting from having no sibling to share physical, emotional, and decisional responsibilities, which informal support cannot easily remedy. Second, stealth strategies at work refer to hidden tactics such as leaving early without disclosure, using breaks to check on the mother, and concealing caregiving struggles to avoid being perceived as less committed or losing professional opportunities. Third, fought for bonds shows that despite exhaustion and initial frustration, the caregiver’s relationship with her mother deepened through daily effort, patience, and reframing caregiving as meaningful devotion, a process aligned with filial maturity. The findings highlight the unique pressures faced by only-child working caregivers, including invisible productivity loss and the inadequacy of general social support. Practical implications for employers, social workers, and policymakers are discussed. This study contributes a rich first-person account to the underexplored area of only-child caregiving and offers recommendations for workplace cultural change, targeted support groups, and subsidized respite services.

Hypertension is a non-communicable disease often referred to as a silent killer because it generally does not present noticeable symptoms. Several risk factors contribute to the development of hypertension, including high body mass index (BMI) and low levels of physical activity. However, data regarding the association between BMI, physical activity, and hypertension at Pakuan Baru Public Health Center, Jambi City, remain limited. Therefore, this study aimed to determine the relationship between body mass index and physical activity with hypertension among adults at Pakuan Baru Public Health Center, Jambi City. This study employed a quantitative approach with a cross-sectional design. The research was conducted at Pakuan Baru Public Health Center, Jambi City, from November 19 to December 6, 2025. The study population consisted of all adult patients with hypertension at Pakuan Baru Public Health Center, totaling 2,797 individuals. A sample of 93 respondents was selected using an accidental sampling technique. Data were collected using observation sheets through measurements of height and weight to calculate BMI, as well as the Global Physical Activity Questionnaire (GPAQ). Data analysis was performed using univariate and bivariate analyses with the chi-square statistical test. The univariate analysis showed that 27 respondents (29.0%) were classified as severely obese, 42 respondents (45.2%) had a low level of physical activity, and 28 respondents (30.1%) were categorized as having stage 2 hypertension at Pakuan Baru Public Health Center, Jambi City. The bivariate analysis revealed a significant relationship between body mass index and physical activity with blood pressure among patients with hypertension (p = 0.000). It is expected that healthcare providers at Pakuan Baru Public Health Center will continue to provide education regarding the importance of controlling body mass index and engaging in regular physical activity, as these factors contribute to increased blood pressure among patients with hypertension.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an obligate intracellular bacterium that affects the skin, peripheral nerves, upper respiratory mucosa, and eyes. Type 2 diabetes mellitus (T2DM) is a comorbidity that can worsen the course of leprosy. The female patient, Mrs. D, aged 55 years came to the emergency room of Cut Meutia Hospital with the main complaint of red bumps accompanied by pain on the face, hands, chest, and back since 3 days ago and additional complaints such as fever, joint pain, and numbness and loss of feeling in the legs, weakness, frequent thirst, and frequent urination. Dermatologic status is obtained in the facial region in the form of erythema nodules with firm boundaries with numular size, multiple. Laboratory examination showed anemia and leukocytosis. The therapy given was MDT MB package, ferrous sulfate 1x325 mg and PRC transfusion 3 kolf. Complaints arose acutely after the patient resumed taking MDT (multidrug therapy) leprosy drugs which had previously been stopped for more than 3 months. Based on the time of onset of symptoms, history of leprosy treatment, and the manifestation of systemic inflammatory lesions with signs of neurotropism, it can be suspected that the patient is experiencing a type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL).

Hypertension is one of the most common chronic diseases among the elderly and is often accompanied by insomnia. This condition can increase anxiety and reduce quality of life. Progressive Muscle Relaxation (PMR) is an effective non-pharmacological therapy to lower blood pressure and improve sleep quality. This paper describes nursing care for elderly patients with hypertension and insomnia through PMR application at RSUD Embung Fatimah Batam City in 2025. A case study approach was used through the nursing process, including assessment, nursing diagnosis, intervention, implementation, and evaluation. The main nursing diagnosis was sleep pattern disturbance related to physical discomfort and anxiety. Interventions included education and PMR exercises for six consecutive days. Results showed blood pressure decreased from 180/100 mmHg to 130/80 mmHg, sleep quality improved from difficulty sleeping to 6–7 hours per night, and anxiety levels reduced. Progressive muscle relaxation therapy proved effective as an independent nursing intervention to reduce blood pressure and improve sleep quality in elderly patients with hypertension and insomnia. Nurses should use this therapy as a routine non-pharmacological intervention in gerontological nursing practice.