Healthcare in Low-resource Settings is an open access, peer-reviewed journal which aims to publish high-quality, outcome-based research conducted in or applicable to low-resource settings. Potential topics of interest are also: comparison of different medical procedures in terms of their effects on healthcare resources; education of health professionals in rural areas; strategies to formulate effective health policies in those areas, and guidelines targeted specifically to them; advances in healthcare resource management. Healthcare in Low-resource Settings publishes Research Articles, Reviews (narrative, systematic and meta-analysis), Case Reports, Debate Articles, Short Reports, Letters to the Editor, and Study Protocols. The Journal also publishes thematic issues focusing on a single topic within its scope.
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E-learning health management on behavior to prevent tuberculosis transmission
Inadequate information of pulmonary tuberculosis prevention contributes to poor conduct in controlling its spread. E-learning health management education is an effective way to change individuals' attitudes toward improved health. This study sought to assess the effects of E-learning health management education on behaviors targeted at avoiding the spread of pulmonary tuberculosis. The research design used was pre-experimental, with a one-group pre-post-test procedure. The Wonokromo Community Health Center had a population of 37 patients with pulmonary tuberculosis, and the sample included all 37 respondents chosen using a non-probability sampling approach called total sampling. The independent variable is E-learning health management education, and the dependent variable is behavior aimed at limiting the spread of pulmonary tuberculosis. A Likert scale questionnaire was employed as the study tool. The data was analyzed using a T-test, with significance defined at α = < 0.05. The consequence. The E-learning health management education intervention had a significant impact in preventing tuberculosis transmission (p < 0.001). This demonstrates a link between e-learning health management education and preventative behavior for pulmonary tuberculosis transmission. Prior to administering the E-learning health management education program among patients, the majority of participants had negative attitudes on limiting the spread of pulmonary tuberculosis.
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Loss of confidence: exploring medical health professionals’ perceptions of the Kurdistan Healthcare System
Understanding the Medical Health Professionals’ (MPH) perspectives is valuable in increasing the efficiency of health centres of Iraqi Kurdistan. The aim of this research is to observe and analyse the MPH’s perspectives on key health system challenges in the Iraqi Kurdistan health system. A self-administered questionnaire was developed and distributed electronically and in person to recruit participants in Sulaimani. 170 anonymous responses were received and the data collected and analysed between the 13th of March and the 21st of June 2024 using the Statistical Package for Social Science (SPSS) program version 28.0. The results showed that, majority of MPH expressed a negative perspective on most of the services provided in Public Health Centres. Simultaneously, positive perspectives were also expressed on health indicators in public and private health centres and rated Iraqi Kurdistan and Iraq’s health systems. In conclusion, an overwhelming majority of MPH expressed a negative perspective on the recent health system in Kurdistan.
Correction: Cross-cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations
In response to the reservations raised by the Authors of “Urdu translation and validation of GAD-7: a screening and rating tool for anxiety symptoms in primary health care” (J Pak Med Assoc 2017;67:1536-40), the Authors of the paper “Cross cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations”, published as an Early access on June 4th, 2026, on Healthcare in Low-resource Settings, in accordance with Ahmad et al., the Editor-in-Chief of the Journal, and the Publisher, wish to rephrase the initial paragraph of the Discussion section of their paper, in order to better reflect the work and the contribution of Ahmad et al. The rephrased paragraph will be as follows: The present study is the first comprehensive effort to linguistically translate and psychometrically validate the GAD-7 for clinical use in Pakistan. Despite its widespread international use, the scale has undergone limited cross-cultural validation in the country; prior translations, e.g., Ahmad et al.7 previously conducted a structured Urdu translation and psychometric validation of the GAD-7, reporting exploratory factor analytic evidence, reliability estimates, and convergent and discriminant validity findings. Nevertheless, additional contemporary psychometric evidence testing remained limited, warranting further validation research. The present study sought to further extend previously conducted research by adopting a broader contemporary validation framework and to provide additional evidence regarding the cultural and psychometric performance of the Urdu GAD-7. Specifically, the present study incorporated a multidisciplinary evaluation panel, explicit evaluation of semantic, conceptual, and cultural equivalence, item-level review and refinement, consideration of culturally specific idioms of distress, and detailed documentation of adaptation decisions. In addition, the study extended psychometric evaluation through confirmatory factor analysis, measurement invariance testing, and ROC-based diagnostic accuracy analysis. Accordingly, the present study should be understood as building upon and extending the work of Ahmad et al.,7 rather than replacing it. The definitive version of record of the paper will bear the rephrased paragraph. The paragraph originally featured in the Early access read: The present study is the first comprehensive effort to linguistically translate and psychometrically validate the GAD-7 for clinical use in Pakistan. Despite its widespread international use, the scale has undergone limited cross-cultural validation in the country; prior translations, e.g., Ahmad et al.7 have not systematically examined its psychometric properties. This study addresses this gap by providing a cultural adaption alongside rigorous psychometric validation in a Pakistani clinical population. References Ahmad S, Hussain S, Shah FS, Akhtar F. Urdu translation and validation of GAD-7: a screening and rating tool for anxiety symptoms in primary health care. J Pak Med Assoc 2017;67:1536-40. Khan A, Madihie A, Ali I. Cross-cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations. Healthc Low-resour S doi: 10.4081/hls.2026.14309
Cross-cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations
A Correction has been issued | View Anxiety disorders are a major public health concern in low- and middle-income countries due to the lack of culturally validated screening tools. Although the Generalized Anxiety Disorder Assessment-7 (GAD-7) is widely used, limited research exists on its cross-cultural psychometric validation in Pakistan. This study aimed to translate, culturally adapt, and psychometrically validate the GAD-7 in a Pakistani clinical population. Following a standard forward–reconciliation–backward translation procedure, the GAD-7 was translated into Urdu and reviewed by a multidisciplinary expert panel. The final version was administered to 267 participants. Exploratory and confirmatory factor analyses were conducted. Internal consistency and model fit indices were assessed. Criterion validity was evaluated using Receiver Operating Characteristic analysis. The adapted GAD-7 demonstrated high internal consistency (Cronbach’s α = 0.896). Confirmatory factor analysis indicated both models demonstrated excellent fit; however, one-factor model was retained as the more parsimonious solution. Factor loadings were statistically significant and within acceptable ranges. ROC analysis demonstrated excellent diagnostic accuracy (AUC = 0.970), with an optimal cutoff score of 10 yielding sensitivity of 98.6% and specificity of 81.4%. The Urdu GAD-7 is a reliable, valid, and clinically useful instrument for screening anxiety in Pakistani populations. While multidimensional representations may offer theoretical insight, the scale functions effectively as a unidimensional measure. The findings support its use in both clinical and research settings, particularly for early detection of anxiety in resource-limited contexts.
Prevalence and sociodemographic correlates of physical fighting among Albanian adolescents
This study examined the prevalence and sociodemographic correlates of physical fighting among Albanian adolescents using nationally representative data from the 2022 Health Behaviour in School-aged Children survey. The sample included 5454 schoolchildren aged 11, 13, and 15 years (response rate: 96%). Physical fighting was assessed through a self-administered anonymous questionnaire, with repeated fighting defined as three or more episodes in the past 12 months preceding the survey. Overall, 14% of adolescents reported frequent fighting, with boys significantly more likely than girls to engage in repeated episodes. Prevalence decreased with age, from 17% at 11 years to 10% at 15 years. Logistic regression analysis revealed that male gender, younger age, and higher family affluence were associated with increased odds of frequent fighting. These findings highlight gender and developmental differences in adolescent violence and underscore the need for targeted prevention strategies in Albania and similar settings.
Bullying others and being bullied: findings from the Health Behaviour in School-aged Children (HBSC) study conducted in Albania in 2022
Bullying is a widespread public health concern among adolescents worldwide. Our objective was to assess the prevalence and sociodemographic correlates of bullying others and being bullied among Albanian adolescents. A cross-sectional study conducted in Albania in 2022 included a nationwide representative sample of 5454 schoolchildren aged 11, 13 and 15 years (≈52% girls; response rate: 96%). Data on bullying others and being bullied were gathered, along with sociodemographic factors of adolescents. Binary logistic regression was used to assess the associations of bullying perpetration and victimization with adolescents’ sociodemographic factors. About 7% of adolescents reported bullying others and 8% being bullied at least two or three times a month in the past couple of months preceding the survey. Independent positive correlates were male gender, older age, and higher family affluence (perpetration); age 13, father’s unemployment, and lower family affluence (victimization). Bullying among adolescents in transitional Albania is relatively common, with distinct sociodemographic patterns: perpetration reflects “empowerment”, whereas victimization signals “vulnerability”. These findings highlight the need for targeted prevention in Albania and comparable transitional settings.
Psychometric validation of the EORTC QLQ-PR25 and clinical correlates of quality of life among Albanian men with prostate cancer
Our aim was to assess the psychometric properties of the “EORTC QLQ-PR25” in Albania and to determine the links between disease characteristics and treatment in men with prostate cancer. A study conducted in Tirana during April 2024–December 2025 included 74 consecutive men diagnosed with prostate cancer who completed the EORTC QLQ-PR25 questionnaire (response: ≈94%). The EORTC QLQ-PR25 demonstrated excellent internal consistency across all subscales (Cronbach’s alpha range: 0.85-0.91), with very high reliability for the overall scale (α=0.94). Higher symptom burden and poorer overall quality-of-life were significantly associated with radical prostatectomy, metastatic disease, high Gleason score (9-10), and extracapsular tumour spread (all P<0.05). Patients undergoing radical prostatectomy reported the worst outcomes across all symptom domains, as well as the lowest general quality-of-life and health status scores. Seemingly, the EORTC QLQ-PR25 is a reliable and clinically valid instrument for assessing prostate cancer-specific quality-of-life among Albanian men. Also, symptom burden and quality-of-life impairment were strongly associated with disease severity and invasive treatment. Our findings support the integration of patient-reported outcomes into routine prostate cancer care in Albanian-speaking countries.
The level of patient satisfaction with nurses' caring behavior and influencing factors
The implementation of nurses' caring attitudes and behaviors can improve patient satisfaction. This study analyzed patient satisfaction with nurses’ caring behavior and factors influencing it at the National Brain Centre Hospital. A quantitative, cross-sectional design with descriptive analysis was used. The inclusion criteria included inpatients at the National Brain Centre Hospital Mahar Mardjono who were willing to fill out the patient satisfaction questionnaire. Independent variables included demographic data, age, gender, employment status, insurance, length of stay, functional status, and caring-based nursing care. Patient satisfaction was the dependent variable. The modified Indonesian Caring-Based Stroke Patient Satisfaction Questionnaire (InCa_SPSQ), Barthel Index score, and patient medical records were used as instruments. Descriptive analysis, Paired t Test, and observational analysis were applied to analyze the data. 161 patients participated in the study, with 60.2% very satisfied with caring-based nursing care. No respondents were dissatisfied. Functional status at discharge was significantly associated with satisfaction (p=0.0001), whereas demographic factors showed no significant correlation. Most patients were very satisfied with caring-based nursing care, and functional status at discharge significantly impacted satisfaction.
The impact of vitamin D and vitamin B12 on bone mineral density and musculoskeletal pain in patients with osteoporosis
Osteoporosis is a major cause of bone fragility and musculoskeletal pain, conditions that substantially reduce quality of life. Vitamin D plays a central role in calcium homeostasis and bone mineralization, while Vitamin B12 deficiency has been associated with impaired bone health and neuromuscular symptoms. However, their combined impact on Bone Mineral Density (BMD) and pain remains incompletely understood. We conducted a cross-sectional study at the Rheumatology Clinic of the University Clinical Center of Kosova (January 2022–August 2024). A total of 136 patients (aged 18–75 years) with chronic musculoskeletal pain underwent Dual-Energy X-Ray Absorptiometry (DEXA) to assess BMD in the lumbar spine and femoral neck. Serum 25-hydroxyvitamin D and Vitamin B12 levels were measured, and pain intensity was evaluated using the Visual Analog Scale (VAS). Osteoporosis was highly prevalent, affecting 59.6% of patients in the right femur, 65.4% in the left femur, and all patients in the spine. Patients with lower Vitamin D levels reported significantly higher pain scores (r = -0.55, p < 0.01), while elevated Vitamin B12 levels showed a positive correlation with pain (r = 0.59, p < 0.01). BMD values in all skeletal sites were negatively correlated with pain severity, with the strongest association observed in the spine (r = -0.73, p < 0.01). Vitamin D deficiency was strongly associated with both lower BMD and greater musculoskeletal pain, whereas Vitamin B12 variations showed complex correlations requiring further study. Early detection of osteoporosis and systematic monitoring of vitamin status may support more effective management of pain and bone health in affected patients.
Self-consciousness of health status for type 2 diabetes mellitus with chronic complications: instrument development and psychometric test
Self-consciousness regarding health status is crucial for individuals with Type 2 Diabetes Mellitus (T2DM) to engage actively in lifelong diabetes self-management. However, existing instruments have not fully incorporated aspects of nurse partnership, dialogue, and pattern recognition related to diabetes knowledge, self-management skills, and self-care abilities. This study aimed to develop and validate the Self-Consciousness of Health Status (SCHS) instrument for patients with T2DM and chronic complications. Instrument development occurred in three phases: Phase One involved a literature review and a three-round e-Delphi to generate the item pool. Phase Two tested content validity with five experts, and construct validity with confirmatory factor analysis (CFA) among 602 participants. Internal consistency and test-retest reliability were also assessed. Phase Three finalized the scale and score interpretation. CFA confirmed the SCHS structure, consisting of 77 items across four dimensions. The scale demonstrated strong model fit (Chi Square p > 0.05, RMSEA p > 0.05) and standardized factor loadings between 0.516–0.908 (p < 0.05). SCHS is a valid and reliable tool to measure health self-consciousness in patients with T2DM and chronic complications.
Advancing Nursing Education and Practice for Future Global Health
Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Improving the function of vital lung capacity of post-COVID-19 patients through deep breathing exercises
Prolonged respiratory disorders in post-COVID-19 patients still exist after patients return to the hospital. Deep breathing exercises are recommended that can increase the vital capacity of the lungs. This study aimed to identify the effect of a deep breathing exercise on vital lung capacity in post-COVID-19 patients. The intervention group (20) received deep breathing exercises, and the control group (20) received standard care. The vital lung capacity was evaluated after two weeks. The findings show that there is increased functional capacity for both groups. There is increasing the functional capacity increased in L from a mean of 1.73 with SD 0.38 to 1.87 with SD 0.37 (p=0.000, CI 95%) in the intervention group, and in the control group, it increases from 1.63 with SD 0.21 to 1.73 with SD 0.21 (p=0.008, CI 95%). The finding of the t-test result showed a significant difference in the average value of the vital lung capacity before and after the intervention between the intervention and the control groups (p=0.008; 95% CI=0.02-0.07). A deep breathing exercise improves the vital lung capacity of post-COVID-19 patients.
The mediating effects of leadership, organizational culture, and nurse factors on the relationship between nursing care and patient satisfaction
Effective leadership and a supportive organizational culture play a crucial role in shaping the quality of nursing care, affecting not only the environment but also nurses’ skills and attitudes. This study explores how various factors related to nurses—such as their competence and attitudes—interact with leadership and organizational culture to impact nursing care and patient satisfaction. We aimed to identify previously overlooked connections that can improve patient outcomes. To conduct this research, we analyzed data from 125 nurses working in inpatient wards at an Islamic Hospital in Indonesia using a cross-sectional design. In August, we gathered information through validated questionnaires and examined the data using SmartPLS 3.2.8 with partial least squares structural equation modeling (PLS-SEM). Our results indicate that organizational factors significantly impact nursing practices (p = 0.000) and the quality of nursing care (p = 0.019). Moreover, the work conditions and experiences of nurses were found to greatly influence both the nurses’ competencies (p = 0.000) and the care they provide (p = 0.002). Additionally, factors related to nursing significantly affect both the quality of care (p = 0.004) and patient satisfaction (p = 0.002), with nursing care having a strong positive impact on patient satisfaction (p = 0.000). Interactions among organizational factors, nursing attributes, and care practices, as well as the working conditions of nurses, played significant roles in boosting patient satisfaction (p = 0.039 and p = 0.0016). Leadership, organizational culture, and nurse factors play significant mediating roles in strengthening the relationship between nursing care and patient satisfaction. These findings highlight the importance of strengthening organizational and nurse-related factors to improve nursing care quality and patient satisfaction.
Risk factors for tuberculosis patients with diabetes mellitus in Indonesia: a case control study
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium Tuberculosis (Mtb), and its burden is exacerbated by the increasing prevalence of Non-Insulin-Dependent Diabetes Mellitus (NIDDM). This case-control study aimed to identify risk factors associated with TB among patients with NIDDM in Banjar Regency, Indonesia. A total of 93 respondents with TB or TB with NIDDM were included using a purposive sampling technique. Data were collected via questionnaires and medical records, analyzing demographic characteristics, history of TB exposure, and health parameters. The results showed that gender, education level, smoking history, hospitalization history, and a family history of TB were significantly associated with TB among NIDDM patients. These findings highlight the need for targeted interventions to reduce TB risk among individuals with NIDDM, including enhanced screening, public health education, and lifestyle modifications.
Effectiveness of progressive muscle relaxation on anxiety in community-dwelling older adults in Indonesia
Community-dwelling older adults are a vulnerable group frequently affected by anxiety, which may impair their health, functioning, and quality of life. Progressive Muscle Relaxation (PMR) is a therapeutic method designed to induce relaxation and potentially reduce anxiety. This quasi-experimental study investigated the effect of PMR on anxiety levels among older adults in Pangkalpinang City, Indonesia, conducted from April to May 2020. A total of 138 participants were assigned to intervention (n=67) and non-intervention (n=71) groups. The intervention consisted of ten PMR sessions over five weeks, delivered twice weekly in small groups. Data were collected using the Geriatric Anxiety Inventory and analyzed via Wilcoxon and Mann-Whitney tests. The intervention group exhibited a significant reduction in anxiety from pre-test to post-test (p = 0.0001, p < 0.005), whereas the non-intervention group showed no meaningful change. The between-group comparison indicated a moderate effect (p = 0.0001, p < 0.005). PMR demonstrates beneficial outcomes in reducing anxiety among older adults; however, its implementation should involve trained health professionals and take into account individual conditions.
Sexual assertiveness as a predictor of premarital sexual behavior among female adolescents: a cross-sectional study
Adolescence is a critical phase of life that needs extra attention. One common issue among adolescents is engaging in premarital sex, which can have serious negative effects, especially for girls. Girls need to develop the ability to firmly say no to premarital sexual activity, which is known as sexual assertiveness. This study aimed to examine the influence of sexual assertiveness on premarital sexual behavior in adolescents. This was an observational study using a cross-sectional design. The independent variable was the sexual assertiveness and the dependent variable in this research was premarital sexual behavior. This research was conducted in June – August 2024 in classroom settings at UNUSA. The sample in this study consists of 92 female students who have a boyfriend. The sampling technique used purposive sampling technique. Data collection in this study was carried out face to face through interviews and questionnaires. The instruments used were the sexual behavior scale and the Sexual Assertiveness Questionnaire (SAQ). Analysis used a simple linear regression test. The results of the statistical test show a value of ρ = 0,000 (p < 0,05), which means there is an influence of sexual assertiveness on premarital sexual behavior in adolescents. Adolescents with strong sexual assertiveness are better able to avoid engaging in premarital sexual activities, helping them steer clear of its negative consequences. The results of this study are expected to be the basis for designing interventions or educational programs aimed at improving sexual assertiveness skills as a form of self-protection in maintaining adolescent reproductive and mental health.
The effectiveness of health belief model intervention on tuberculosis medication adherence in rural Indonesia: a pre-experimental study
Tuberculosis treatment non-adherence remains a significant challenge in rural Indonesia, with Kampar District reporting below-target success rates. Therefore, this study aimed to evaluate the effectiveness of a Health Belief Model (HBM) intervention on medication adherence among tuberculosis patients in rural Indonesia. A pre-experimental study with a one-group pretest- posttest design was conducted among 45 purposively sampled TB patients in Kampar District. Data were collected using the validated Health Belief Model Questionnaire and the Medication Adherence Rating Scale. The intervention consisted of a 3-month structured program including weekly sessions in the first month, bi-weekly sessions in the second month, and a monthly follow-up in the third month. Following the HBM intervention, significant improvements were observed in perceived benefits (31.33±4.447 to 32.80±4.341, p<0.001), perceived barriers (22.80±3.286 to 24.38±4.185, p=0.002), and perceived susceptibility (25.64±3.675 to 26.69±3.771, p=0.007). Moreover, medication adherence significantly improved from 5.40±1.156 to 6.20±0.944 (p<0.001). The HBM intervention effectively improved medication adherence through enhanced health beliefs among rural TB patients. Thus, integrating HBM-based interventions into TB treatment programs could improve treatment outcomes in resource-limited settings. However, further research with longer follow-up periods is recommended.
HIV knowledge level, social support, and risk perception on attitudes toward HIV testing among heterosexuals in Indonesia
HIV/AIDS remains a major global health issue, particularly among heterosexual populations. The WHO and UNAIDS aim to end the epidemic by 2030 through the 95-95-95 strategy. In Indonesia, 81% of individuals knew their HIV status, 41% were on treatment, and 19% achieved viral suppression as of 2022. HIV test- ing is vital for identifying those infected. This research examines the relationships between HIV knowledge, social support, and risk perception with attitudes towards HIV testing among heterosexual individuals in Indonesia. Using a descriptive analytical design with a cross-sectional approach, 192 respondents from Bekasi Regional General Hospital, Class 1 Cipinang Prison, Class II A Cipinang Narcotics Prison, and Siloam Mampang Hospital were studied. Multivariate analysis showed that both knowledge (p=0.006, OR=2.205) and social support (p<0.001, OR=3.778) significantly influence attitudes towards HIV testing. Higher HIV knowledge and social support increase the likelihood of individuals supporting and participating in HIV testing, highlighting the importance of initiatives to improve both areas to encourage testing.
Promoting mental and sleep health in menopausal women: the effectiveness of yoga and brain gymnastics interventions
Menopausal women frequently experience anxiety and sleep disturbances, which negatively impact their mental well-being and overall quality of life. Non-pharmacological approaches such as yoga and brain gymnastics offer accessible, safe, and low-cost strategies to address these issues. This study aimed to assess the effectiveness of yoga and brain gymnastics in promoting mental and sleep health among menopausal women. A quasi-experimental pretest-posttest design was conducted involving 100 menopausal women, divided into yoga and brain gymnastics intervention groups. Yoga sessions were held three times a week for 60 minutes over four weeks, while brain gymnastics was conducted for 15–20 minutes at the same frequency. Anxiety and sleep quality were measured using the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using paired and independent t-tests. Both interventions significantly reduced anxiety and improved sleep quality (p<0.05). Yoga showed a greater reduction in STAI (35%) and PSQI (40%) scores compared to brain gymnastics (22% and 25%, respectively). Comparative analysis indicated yoga was significantly more effective (p<0.05). Yoga and brain gymnastics effectively promote mental and sleep health in menopausal women, with yoga demonstrating superior benefits as a holistic intervention.
The effect of 96% ethanol extract of turmeric (Curcuma longa L. syn. Curcuma domestica Val.) on estrogen hormone levels
Estrogen is essential for maintaining the structure and function of the female reproductive system, and its decline during menopause triggers various symptoms. While Hormone Replacement Therapy (HRT) is commonly used, long-term use increases the risk of certain cancers. Consequently, natural alternatives like turmeric (Curcuma longa L. syn. Curcuma domestica Val.) are being investigated for their phytoestrogenic potential. This study aimed to investigate the effect of 96% ethanol extract of turmeric on estrogen hormone levels in female rats. An experimental study was conducted using 15 female Sprague-Dawley rats over 30 days, divided into five groups: control (0 mg/kg BW), contraceptive pill (10 mg/kg BW), and turmeric extract at doses of 25, 50, and 100 mg/kg BW. The extract was administered orally. On day 31, blood serum was collected, and estrogen levels were measured using the Enzyme-Linked Immunosorbent Assay (ELISA). Estrogen levels increased in all treatment groups compared to the control (647 ng/L), with levels of 691 ng/L (25 mg/kg), 709 ng/L (50 mg/kg), and 617 ng/L (100 mg/kg). However, these differences were not statistically significant. Turmeric extract showed a dose-dependent effect, with moderate doses indicating phytoestrogenic benefits. The decline at high doses suggests a dual action—beneficial at moderate levels, inhibitory at excess. Despite non-significant results, the trends support turmeric’s potential as a natural HRT alternative, warranting further studies with larger cohorts and mechanistic evaluations to define optimal dosage, safety, and reproductive implications.
Using animated health promotion videos to reduce smoking and anxiety in hypertensive patients: a quasi-experimental study
Smoking and anxiety are significant modifiable risk factors that contribute to the worsening of hypertension. Health promotion using engaging media such as animated videos has the potential to enhance patients’ understanding and motivation to change risky behaviors. This study aimed to examine the effectiveness of animated health promotion videos in reducing smoking behavior and anxiety levels among patients with hypertension. A quasiexperimental study was conducted from March to June 2024 at Ar- Rasyid General Hospital, Palembang. A total of 110 hypertensive patients who smoked were selected using purposive sampling and divided into intervention and control groups. The intervention group received animated video-based health education sessions focusing on smoking cessation and anxiety management, delivered over four weeks. The control group received standard care. Smoking behavior was assessed using a structured smoking behavior questionnaire, while anxiety levels were measured using the Hamilton Anxiety Rating Scale (HARS). Data were analyzed using paired and independent t-tests. The intervention group showed a significant reduction in both smoking behavior scores and anxiety levels compared to the control group (p<0.05). The mean reduction in anxiety scores was greater in the intervention group, indicating the effectiveness of animated videos in promoting behavioral and psychological improvements. Animated health promotion videos are effective in reducing smoking and anxiety among hypertensive patients. This approach can be considered an innovative and accessible health education strategy to support hypertension management.
Novel clinical findings of neurodevelopmental disorder linked to HPDL gene mutation: a case report from Saudi Arabia
HPDL gene mutations have recently been linked to neurodevelopmental disorders with variable presentations, ranging from mild hereditary spastic paraplegia to severe infantile neurodegeneration. While the HPDL protein’s role is unknown, it is highly expressed in brain mitochondria. Here we report a case of a 19- month-old male with a homozygous HPDL gene mutation presented with global developmental delay, epilepsy, laryngomalacia post-arytenoidectomy, swallowing dysfunction, and spasticity. He exhibited significant dysmorphic features and recurrent convulsions, and required nasogastric feeding due to oral feeding difficulties.
Effects of oxytocin massage and moringa cookie consumption on colostrum excretion time in postpartum women
Delayed colostrum secretion can hinder the success of exclusive breastfeeding, often due to insufficient stimulation of prolactin and oxytocin. This study aimed to examine the effect of oxytocin massage and Moringa oleifera cookie consumption on accelerating colostrum excretion. A quasi-experimental post-test-only design with a control group was employed. The study involved 40 primigravida women in their third trimester, selected through purposive sampling and divided into an intervention group and a control group. The intervention group received oxytocin massage and consumed moringa cookies from the 38th week of gestation until postpartum colostrum release, while the control group received standard care. Data were collected through observation, and analysis was conducted using the independent t-test. Results showed a significant reduction in colostrum excretion time in the intervention group (mean=5.95 hours) compared to the control group (mean=9.00 hours) with a mean difference of 3.05 hours. The difference was statistically significant (p=0.001; α=0.05). These findings suggest that oxytocin massage combined with moringa cookie consumption may effectively stimulate earlier colostrum release. Implementing such interventions during late pregnancy could support early breastfeeding initiation and improve neonatal health outcomes.
Effectiveness of guidance on feeding rules by Posyandu Pintar application on eating behavior in toddlers: a quasi-experimental study
Collaboration is required among various stakeholders to address stunting, starting with monitoring the nutritional status of children through assistance with feeding rules. In this context, Health Service Integrated Post Cadres should enhance service delivery supported by digitalization. Therefore, this research aimed to analyze the effectiveness of guidance on feeding rules by Posyandu Pintar application on eating behavior in toddlers supports Forming SIGAP (Siaga Gagal Pertumbuhan) Villages toward a stunting-free Indonesia. The study employed a quasi- experimental with repeated treatment research design. The sub- jects in this study were toddlers aged 6-72 months in Karangasem Regency of Bali from July to September 2024. The number of respondents was 160 toddler, selected by Stratified Random Sampling. feeding rules mentoring were analyzed using Repeated Measures Analysis Of Variance (ANOVA). Based on the results of the ANOVA repeated measure test, showed that there was an improvement in good feeding behavior between the intervention group from the first to the fifth measurement p<0.001, which means it is less than 0.05. This indicates that H0 is rejected. Then it can be concluded that the guidance on feeding rules by Posyandu Pintar application has been proven to have an effect on toddlers eating behavior. Based on the description, this research could assist healthcare professionals, and policymakers in adap- ting prevention and treatment efforts for stunting.
Quality of life of burn patients after burn
Burn injuries are among the most traumatic types of injuries, often resulting in long-term physical, psychological, and social consequences. Understanding the Quality Of Life (QoL) of burn patients is essential for delivering comprehensive care and effective rehabilitation. This study aimed to assess The Health-Related Quality Of Life (HRQoL) of burn patients and to examine the relationship between QoL domains and patients’ demographic, psychological, and clinical characteristics. A descriptive cross-sectional study was conducted among 150 burn patients attending several hospitals in Palestine. Data were collected using the World Health Organization Quality of Life Questionnaire (WHOQOLBREF), which measures four domains: physical health, psychological health, social relationships, and environment. Structured interviews were used for data collection, and statistical analysis was performed using SPSS software. The sample consisted of 65% males and 35% females, with 66% aged between 30 and 49 years. The most affected areas were the lower limbs (88%) and upper limbs (80%), with varying burn depths and Total Body Surface Area (TBSA) percentages. Patients reported low levels of satisfaction in areas such as happiness, healthcare services, and dietary adherence. Moderate impairments were observed across all QoL domains: physical (mean = 3.20), role (3.05), cognitive (3.18), social (3.35), and emotional (3.45). A statistically significant correlation was found between TBSA and the physical (p=0.033) and cognitive (p=0.035) domains. However, age showed no significant correlation with any QoL domain. Burn injuries significantly affect multiple aspects of patients’ quality of life, particularly the physical and emotional domains. The extent of burn injury (TBSA) plays a crucial role in determining the level of impairment. These findings emphasize the need for multidisciplinary rehabilitation programs focusing on physical recovery, psychological support, and social reintegration.
Prevalence and determinants of scabies among children in Ethiopia: a systematic review and meta-analysis
Scabies is a major neglected tropical disease affecting children in deprived communities like Ethiopia. This study aims to evaluate the prevalence and determinants of Sarcoptes scabiei infestation among Ethiopian children under 15 years. Studies were sourced from PubMed, Scopus, ScienceDirect, and African Journals Online through a systematic search, following PRISMA- 2020 guidelines. The Joanna Briggs Institute’s tool was used to appraise study quality. A random-effects model was used for analysis. Subgroup and sensitivity analyses were conducted to assess heterogeneity using I² statistics. Publication bias was assessed using a funnel plot and Egger’s test. A total of 9,126 children from 14 studies were included, with a pooled prevalence of 14.94% (95% CI: 11.32-18.57). Being male, having a family size of more than five members, children with an education level below grade five, history of sharing clothes within the family, infrequent washing of clothes, lack of formal family education, poor family wealth or income status, using unimproved water sources, personal hygiene issues like untrimmed fingernails, sharing clothes with individuals diagnosed with scabies, poor knowledge about scabies among family members or caregivers, history of contact with individuals experiencing skin itching or scabies, sharing common sleeping beds or fomites, washing hands with water only, having family members with signs of itching or scabies, and infrequent bathing were factors significantly associated with Sarcoptes scabiei infestation among children under the age of 15 in Ethiopia. Therefore, policymakers and health planners should put a great deal of emphasis on the implementation of relevant prevention and control measures.
Social needs and resilience of post-stroke patients: an exploratory case study
Stroke recovery is a long-term process where resilience proves to be a very important factor in the stroke recovery process. This study aimed to investigate the existence of social needs in undergoing resilience in post-stroke patients, which can be used as basic data for designing intervention strategies to increase the resilience of post-stroke patients. This research was an applied qualitative study with an exploratory case studies type of research. Participants were selected using the purposive sampling method. Semi-structured in-depth interviews and field notes during the interview process were conducted with 9 informants. The data analysis used in this research was thematic analysis. There were three themes found in this research, including the need for a support system, the need for assistance in accessing health facilities, and the need for information on the whereabouts and assistance of social worker. The improvement of post-stroke patients’ resilience cannot be separated from meeting the patient’s social needs from family, peers, and the surrounding community, including social workers. Collaboration between various parties including the local community needs to be carried out as an effort to improve poststroke patients’ resilience.
An unusual case of multivalvular infective endocarditis complicated by staphylococcal pneumonia in an intravenous drug user: a case report
Infective Endocarditis (IE) is a rare but potentially lethal infection of the endocardium and heart valves, native or prosthetic. Staphylococcus aureus-associated IE was identified as the most common cause of IE and is an independent predictor of mortality. Most cases of IE are left-sided and involve a single valve. Here we report a case of Staphylococcus aureus bivalvular endocarditis (MVE) in a patient with a history of intravenous drug use and provide a literature review of MVE identification, treatment, and prognosis. Our patient underwent a 4-week course of intravenous antibiotic therapy for infective endocarditis. Serial Transthoracic Echocardiography (TTE) during hospitalization demonstrated a reduction in the size of the vegetations on both the mitral and tricuspid valves. Upon clinical stabilization, the patient was transitioned to oral antibiotic therapy for an additional two weeks. At discharge, the patient was in stable condition and was advised to continue outpatient follow-up. Routine surveillance with TTE every three months was recommended to monitor for recurrence or progression.
Health education and interprofessional collaboration to improve maternal knowledge on stunting prevention
Stunting is characterized by growth failure due to chronic malnutrition. A health education initiative utilizing an interprofessional collaboration approach is needed to decrease incidents of stunting. This study aimed to analyze the impact of health education with interprofessional collaboration on mothers’ knowledge about stunting. It used a quasi-experimental design with a pretestposttest control design. The research was conducted at a public health center, involving 230 mothers with children aged 0-24 months. Data analysis was performed using the Wilcoxon test. According to the findings, the majority of mothers lacked knowledge before the IPC intervention, accounting for 83.5%. However, this improved significantly afterward, with 70.4% demonstrating good knowledge. Statistical analysis revealed a significant increase in maternal knowledge (p=0.000). The IPC program positively influenced maternal knowledge about stunting. It is hoped that policymakers will collaborate with health workers through IPC programs to reduce the prevalence of stunting.
Factors correlated with burnout syndrome among nursing staff
Burnout syndrome is a psychological condition characterized by prolonged emotional, mental, and physical exhaustion, often resulting in decreased motivation, reduced professional efficacy, and impaired work performance. Among healthcare professionals, particularly nurses, burnout can significantly compromise the quality and safety of patient care. This study aimed to find the relationship between age and educational background and the prevalence of burnout syndrome among nurses working in the inpatient ward in a hospital in Riau Province, Indonesia. A cross-sectional research design was employed, involving a total of 120 inpatient nurses selected through random sampling. Data collection was conducted using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), which measures three key dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Statistical analysis was performed using the chi-square test to determine the association between demographic variables and burnout levels. The findings revealed a significant correlation between age and educational background with the occurrence of burnout syndrome. Specifically, nurses with higher educational attainment and those within certain age groups demonstrated increased vulnerability to emotional exhaustion and reduced personal accomplishment. These results underscore the importance of integrating individual demographic factors into the development of targeted strategies and institutional support systems to prevent and manage burnout. Enhancing such interventions is essential to safeguarding the well-being of nursing staff and ensuring the delivery of safe, effective, and sustainable patient care.
Evaluating the sensitivity and specificity of symptom-based screening for soil-transmitted helminth infections in children in coastal areas of Indonesia
Soil-transmitted helminth (STH) infection is a neglected tropical disease prevalent in many low-income, developing countries with poor environmental sanitation. Children of preschool and school age are particularly vulnerable to STH infection. This study aimed to evaluate the sensitivity and specificity of clinical complaints in detecting STH infection among elementary school-aged children living in coastal areas of Indonesia. A descriptive, observational design was employed, involving 64 children. Data were collected through a structured questionnaire that assessed respondent characteristics and symptoms, followed by a stool examination using the Kato-Katz method to confirm the status of STH infection. The findings revealed a prevalence rate of 21.9% for STH infection. Among the reported complaints, diarrhea demonstrated the highest sensitivity (78.6%). In terms of specificity, complaints of itching around the anus and frequent diarrhea yielded the highest specificity values, at 82% and 74%, respectively. These results highlight key symptomatic indicators that could support early detection and targeted interventions for STH infections in coastal regions.