Gema Lingkungan Kesehatan (GeLinKes) (e-ISSN: 2407-8948) is a peer-reviewed, open-access scientific journal dedicated to advancing knowledge in health sciences and medicine, with a particular emphasis on environmental health. The journal is published by Politeknik Kesehatan Kemenkes Surabaya and serves as an academic platform for disseminating evidence-based research, applied studies, and policy-relevant findings that contribute to environmental sustainability and population health improvement. Starting in 2025, the journal adopts a quarterly publication schedule, issuing four editions annually to accommodate the growing number of high-quality submissions.
Ethanolic Peel Extract Attenuates Isonazid-induced Hepatic Injury in Rats via Reduced NF-kB, and Caspase 3 Expression
Isoniazid can induce hepatotoxicity and liver fibrosis via oxidative stress, NF-κB, and caspase-3 pathways. Garcinia mangostana L. (mangosteen) peel extract, rich in xanthones, offers anti-inflammatory and anti-apoptotic properties that may mitigate drug-induced liver injury. To evaluate the effects of mangosteen peel ethanol extract on NF-κB p65, caspase-3 expression, and hepatic fibrosis in isoniazid-treated Wistar rats. In this experimental study, 28 male Wistar rats were divided into four groups: negative control (NC), positive control (PC; isoniazid 50 mg/kg), and two treatment groups receiving isoniazid plus mangosteen extract at 250 mg/kg (I1) and 500 mg/kg (I2) for 30 days. Liver tissues were analyzed using immunohistochemistry (NF-κB, caspase-3) and Masson’s trichrome staining (fibrosis). The 500 mg/kg dose significantly reduced NF-κB p65 and caspase-3 expression and mitigated hepatic fibrosis compared to the PC group (p < 0.05). The 250 mg/kg dose showed less pronounced effects. Garcinia mangostana L. peel extract, especially at 500 mg/kg, effectively attenuates isoniazid-induced liver injury by downregulating NF-κB and caspase-3 in isoniazid-induced Wistar rats. These findings suggest its potential as an adjunct in preventing isoniazid-induced hepatic injury in a preclinical setting. Additional translational and clinical investigations are needed to determine its efficacy and safety as a potential hepatoprotective agent in humans.
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Hospital Disaster Resilience in Indonesia: An Evidence-Based Synthesis of Flood and Earthquake Preparedness
Indonesia is one of the most disaster-prone countries in the world due to exposure to earthquakes, floods, tsunamis, volcanic eruptions, and climate-related hazards. Hospitals play a critical role in maintaining healthcare delivery during disasters, yet their resilience capacity varies. This study synthesized evidence on hospital disaster resilience in Indonesia, focusing on preparedness for flood and earthquake hazards. An evidence-based descriptive synthesis was conducted using peer-reviewed studies, national reports, policy documents, and international guidance. Findings were analyzed across four resilience domains the Hospital Safety Index: structural and non-structural safety, emergency management systems, continuity of essential services, and governance and policy integration. The review found that improvements in hospital resilience were most evident in governance, disaster management planning, and policy integration, largely driven by accreditation requirements and national disaster risk reduction initiatives. However, structural resilience remains insufficient in many facilities, particularly regarding seismic preparedness and non-structural mitigation measures. Flood preparedness is more advanced than earthquake preparedness because hydrometeorological hazards occur more frequently. Persistent vulnerabilities were identified in continuity of essential services, including electricity, water supply, sanitation systems, and healthcare waste management. Although disaster preparedness plans are increasingly available, operational readiness through emergency exercises remains inconsistent. Overall, hospital disaster resilience in Indonesia remains uneven, characterized by stronger administrative preparedness than infrastructural and functional resilience. Strengthening disaster-safe hospitals requires integrated resilience frameworks, climate-resilient health infrastructure, sustained investment in emergency preparedness, enhanced workforce capacity, and stronger implementation of disaster risk reduction policies across the healthcare system to ensure service continuity during future emergencies and disasters.
The Hepatoprotective Role of Ethanolic Mangosteen Peel Extract (Garcinia mangostana L.) on MDA, TNF-α, E-Selectin, and SGPT Levels in Isoniazid-Induced Liver Fibrosis Wistar Rats
Isoniazid is a first-line anti-tuberculosis drug known to cause drug-induced liver injury (DILI) through oxidative stress and inflammatory mechanisms that contribute to the development of liver fibrosis. Mangosteen peel (Garcinia mangostana L.) contains xanthone compounds with antioxidant and anti-inflammatory properties, making it a potential hepatoprotective agent. This study aimed to determine the role of ethanol extract of mangosteen peel on malondialdehyde (MDA) levels, tumor necrosis factor-α (TNF-α) expression, E-selectin expression, and SGPT levels in the liver of isoniazid-induced fibrosis Wistar rats. This experimental study used a post-test only control group design. Twenty-eight male Wistar rats were randomly divided into four groups: negative control group, positive control group (isoniazid 50 mg/kgBW/day), treatment group 1 (isoniazid + mangosteen peel ethanol extract 250 mg/kgBW/day), and treatment group 2 (isoniazid + mangosteen peel ethanol extract 500 mg/kgBW/day) for 30 days. MDA and SGPT levels were measured using spectrophotometry, while TNF-α and E-selectin expression were assessed using immunohistochemistry. Administration of mangosteen peel ethanol extract significantly reduced MDA and SGPT levels and decreased TNF-α and E-selectin expression compared to the positive control group. The most significant reduction was observed in the group receiving the extract dose of 500 mg/kgBW. Mangosteen peel ethanol extract reduces MDA, TNF-α, E-selectin, and SGPT levels in isoniazid-induced Wistar rats. These findings demonstrate its hepatoprotective potential in a preclinical setting, further translational and clinical studies are warranted to evaluate its efficacy and safety in humans as potential hepatoprotective agent.
Spatiotemporal Water Quality Assessment of Lake Mahalona via Google Earth Engine
Freshwater lake ecosystems are increasingly recognized as sensitive indicators of environmental health, where shifts in physicochemical water quality parameters reflect broader ecological pressures from anthropogenic activities and climate variability This study aims to map the spatial distribution, analyze temporal trends, and evaluate the water quality status of Lake Mahalona in Towuti Subdistrict, East Luwu Regency, South Sulawesi, based on pH, TSS, BOD, COD, and ammonia parameters. The analysis was conducted using the GEE platform with Sentinel 2 Level-2A imagery data for pH, TSS, BOD, and COD parameters, as well as GEOS-CF data for ammonia, covering the period from January to November 2025. The methods applied included creating an Area of Interest (AOI), using the JRC Global Surface Water Mapping Layers, v1.4, utilizing Harmonized Sentinel-2 MSI Level-2A (SR), atmospheric correction, cloud and water body masking, outlier removal using the inter-quantile range, deriving functional equations for water quality parameters, and exporting the data. Satellite-derived estimates yielded pH values ranging from 6.587 to 7.154; TSS from 17.55 to 19.821 mg/L; BOD from 3.215 to 7.266 mg/L; COD from 2.857 to 6.116 mg/L; and atmospheric ammonia pressure indicators at 0.001 mg/L. Time-series analysis revealed fluctuations in all parameters, with increases in TSS, BOD, and COD from August to October, while ammonia remained stable at very low concentrations. Based on Government Regulation No. 22 of 2021, the pH, TSS, COD, and ammonia parameters still meet Class II and III water quality standards; however, the BOD value has exceeded the 2 mg/L threshold, indicating organic pollution pressure from anthropogenic activities in the watershed. The GEE-based approach demonstrates considerable potential for efficient spatial and temporal monitoring of lake water quality, providing important baseline information for the sustainable management and conservation of Lake Mahalona.
Hydraulic Coagulation–Ultrafiltration for Peat Water in South Kalimantan
Access to safe drinking water remains a critical public health challenge in South Kalimantan, where peat-influenced water sources exhibit high turbidity, elevated iron concentrations, and acidic pH. This experimental study designed, fabricated, and evaluated a Circular Pipe–Synthetic Ultrafiltration (CP-SKU) device a hydraulic coagulation reactor requiring no mechanical energy input — for treatment of peat-influenced dug well water. Five sequential treatment configurations were tested in triplicate using PAC Powder (100 mg/L) as coagulant. The CP-SKU configuration achieved the best performance: turbidity reduction from 19.8 to 0.47 NTU (97.63%), iron below detection limit (<0.1 mg/L), and pH 6.72 — all compliant with Indonesian Ministry of Health Regulation No. 2 of 2023. Extended trials on high-turbidity raw water (83.67 NTU) confirmed 98% turbidity removal and 99.55% MPN Coliform reduction. However, effluent pH (6.39) fell marginally below the 6.5 regulatory threshold, and residual coliform indicators did not meet zero-tolerance standards, necessitating upstream pH correction and downstream disinfection prior to consumption.
Administrative Innovation in the Implementation of the Healthy Indonesia Program with a Family Approach (PIS-PK)
This study aims to analyze the implementation of administrative innovations in the Healthy Indonesia Program with a Family Approach (PIS-PK) and its impact on program effectiveness and family participation. The research method used a qualitative approach with data collection through in-depth interviews, participant observation, and documentation of PIS-PK administration in four community health centers. Data analysis was conducted through data reduction, coding, comparisons between community health centers, and triangulation to ensure the validity of the findings. The results showed that administrative innovations included digitizing family data, standardizing health forms and indicators, digital data-based monitoring, family education and participation, and cross-stakeholder coordination. The implementation of these innovations increased the accuracy and efficiency of data collection, accelerated reporting, facilitated the identification of priority families, and encouraged active family involvement. The main challenges included limited human resources, infrastructure, and community adaptation to the digital system. However, strategies such as routine training, portable hotspots, and cadre mentoring were able to overcome these challenges. This study provides an important contribution to the development of standardized and integrated data-based family health service administration and environmental health management.
The Green Hospital: A Hybrid Systematic Literature Review and Bibliometric Analysis
In recent decades, Green Hospitals have been the subject of numerous studies, yet conceptual fragmentation and ambiguity persist. Thus, the purpose of this study is to address the fragmentation and conceptual ambiguity in green hospital literature by a hybrid approach that integrates a systematic literature review (SLR) and bibliometric analysis. Unlike prior studies, which are predominantly descriptive, this study provides a structured synthesis, identifies theoretical gaps, and develops an integrative framework. A total of 169 Scopus-indexed articles between 2011 and 2025 were systematically identified using an expanded Boolean search strategy ("Green Hospital" OR “sustainable hospital” OR “green healthcare” OR “eco-friendly hospital”) and analyzed following PRISMA guidelines. Bibliometric analysis was conducted using VOSviewer to map intellectual structure, collaboration networks, and thematic evolution. The study findings indicate that the existing study is heavily concentrated on environmental and infrastructure dimensions, while behavioral, governance, and policy aspects remain underexplored. The study also identifies geographic concentration and potential database bias in the global distribution of the study. Importantly, the study develops an integrated Green Hospital Sustainability Framework (IGHSF) based on an inductive thematic approach. This study contributes to the literature by improving methodological rigor in green hospital studies through a hybrid SLR-bibliometric approach, advancing theoretical understanding of sustainability integration in healthcare systems, and providing actionable insights for policymakers and healthcare managers in implementing sustainable hospital practices.
Occupational Pesticide Exposure and Reduced eGFR in Farmers
Pesticides are frequently utilized in modern farming to sustain crop productivity. However, improper use may pose occupational health risks, including chronic renal toxicity. In Indonesia, evidence regarding long-term kidney effects among farmers remains limited. This study aimed to determine the prevalence of reduced estimated glomerular filtration rate (eGFR) and examine its association with pesticide exposure among horticultural farmers in Wanasari District, Brebes Regency. A cross-sectional analytical study was conducted among 367 farmers aged 18-63 years. Data on pesticide use, personal protective equipment (PPE), smoking habits, health complaints, and hypertension were collected through interviews. Serum creatinine levels were measured enzymatically and used to estimate eGFR. Multivariate logistic regression analysis was applied to identify factors associated with reduced renal function. Several variables showed a significant association with decreased renal function, namely smoking status (OR = 2.972; 95% CI: 1.299-6.001; p = 0.009), pesticide dosage (OR = 4.555; 95% CI: 2.415-8.291; p < 0.001), PPE use (OR = 0.383; 95% CI: 0.199-0.737; p = 0.004), health complaints (OR = 2.972; 95% CI: 1.567-5.636; p = 0.001), hypertension (OR = 2.367; 95% CI: 1.278-4.382; p = 0.006), working period (OR = 15.057; 95% CI: 3.510-64.591; p < 0.001). Working period was the dominant factor associated with decreased kidney function in farmers. This indicates the importance of chronic exposure duration in increasing the risk of pesticide-induced nephrotoxicity. Prevention efforts should focus on controlling exposure duration, improving adherence to PPE use, providing education on pesticide use, and regularly monitoring kidney function.
Viral Load, CD4 Count, NLR, SGPT, and eGFR Levels as Factors Associated with Quality of Life in HIV Patients
Human Immunodeficiency Virus (HIV) infection remains a major global health problem and may affect the quality of life of people living with HIV. Quality of life can be assessed using the World Health Organization Quality of Life-Human Immunodeficiency Virus BREF (WHOQOL-HIV BREF) questionnaire. This study aimed to analyze the association of viral load, CD4 count, neutrophil-to-lymphocyte ratio (NLR), serum glutamic pyruvic transaminase (SGPT), and estimated glomerular filtration rate (eGFR) with quality of life among HIV patients. This observational analytic study used a cross-sectional design and was conducted at the Voluntary Counseling and Testing Clinic of Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. A total of 100 HIV patients undergoing antiretroviral therapy were included based on predefined inclusion and exclusion criteria. The independent variables were viral load, CD4 count, NLR, SGPT, and eGFR, while the dependent variable was quality of life assessed using the WHOQOL-HIV BREF questionnaire. Clinical and laboratory data were obtained from medical records. Data were analyzed using univariate analysis, Spearman correlation test, and ordinal logistic regression with SPSS version 29.0. Higher viral load, lower CD4 count, and elevated NLR were significantly associated with poorer quality of life. In contrast, SGPT and eGFR were not significantly associated with quality of life. In the multivariate analysis, CD4 count showed the strongest association with quality-of-life category. These findings suggest that viral load, CD4 count, and NLR are associated with quality of life among HIV patients. The integration of virological, immunological, and inflammatory markers may complement clinical assessment of quality of life in people living with HIV, particularly in the Indonesian clinical setting. Further longitudinal studies are needed to clarify their predictive value.
Association of Environmental Sanitation and Personal Hygiene with Skin Health Complaints among Residents in Ibul Besar II
Skin health problems remain a common public concern, influenced by poor environmental sanitation and inadequate personal hygiene practices. Ibul Besar II Village is a suburban locale traversed by a tributary of the Ogan River. Data from the Pegayut Public Health Center in 2022 shows only 991 residents had access to proper sanitation. Moreover, of the 748 houses surveyed, only 284 were classified as healthy housing. In 2023, skin diseases ranked among the top ten most common illnesses at the Pegayut Public Health Center, with 115 cases reported. This study aimed to examine the association between environmental sanitation, personal hygiene, and skin complaints among residents of Ibul Besar II Village. Using a cross-sectional design with 142 respondents meeting the inclusion criteria, data were analyzed through univariate, bivariate (chi-square test), and multivariate (multiple logistic regression) methods. The bivariate results showed significant associations between skin complaints and factors such as bathing habits (p = 0.001; OR = 3.402; 95% CI: 1.670–6.931), hand and nail hygiene (p = 0.012; OR = 2.532; 95% CI: 1.276–5.027), clothing hygiene (p = 0.021; OR = 3.000; 95% CI: 1.240–7.255), bedding and bed linen hygiene (p = 0.011; OR = 2.548; 95% CI: 1.286–5.047), faeces disposal facilities (p = 0.011; OR = 2.919; 95% CI: 1.331–6.402), and wastewater disposal systems (p = 0.001; OR = 4.067; 95% CI: 1.804–9.167). Multivariate analysis showed that inadequate wastewater disposal systems had the strongest association with skin health complaints (p = 0.003; OR = 3.959; 95% CI: 1.605–9.758). To prevent skin health issues, priorities should include improving wastewater disposal facilities and promoting better hygiene of bedding and linen. Additionally, community members are encouraged to improve personal hygiene and maintain environmental sanitation to reduce the risk of skin disorders.
Development and Preliminary Clinical Validation of the Vitaltrack Early Warning Score Prototype for Integrated Inpatient Monitoring
Early detection of changes in patients' clinical conditions is very important to prevent critical events. The Early Warning Score (EWS) assessment still relies on conventional tools that require multiple devices and time, which reduces efficiency and accuracy. Objective: To develop and evaluate a portable vital sign measurement tool based on EWS (Vitaltrack EWS) to improve the speed and accuracy of assessments compared to conventional methods. Methods: The study used a Research and Development (R&D) design involving 39 inpatients in the neurology and surgery wards of RSUD Dr. Soedarso Pontianak. Five physiological parameters blood pressure, pulse rate, body temperature, respiratory rate, and oxygen saturation were measured using two methods: conventional tools and Vitaltrack EWS. A t test was used to assess the equivalence or differences in results between the two measurement methods. Results: EWS score p = 0.932, systolic blood pressure p = 0.907, body temperature p = 0.584, heart rate p = 0.487, respiratory rate p = 0.083, oxygen saturation p = 0.487, measurement time p = 0.000. Vitaltrack EWS is assessed to be accurate and efficient in monitoring patients' vital signs, comparable to the standard tools that have been used in hospitals. Conclusion: Vitaltrack EWS is capable of improving the efficiency and accuracy of vital sign measurements and supports the effective implementation of EWS in inpatient settings. Optimization of sensors and applications through further research provides a scientific basis for the feasibility of commercializing the tool.
Association Between Nutritional Status and Development of Preschool Children at An-Nizam Kindergarten, North Sumatra: A Cross-Sectional Study
Effectiveness of Virtual Reality-Based Health Promotion and Safety Training in Schools
Health and safety within the school environment are essential to ensuring a secure and sustainable learning process. Data from the Ministry of Health (2022) indicate that only 45% of secondary schools have an established emergency preparedness programme. A preliminary assessment at SMK Atisa Dipamkara also revealed substantial gaps: 73% of students had never participated in a fire simulation, and existing training remained conventional without interactive media. Nutritional issues were similarly prominent, as 60% of students frequently skipped breakfast, potentially impairing concentration and physical endurance. This study examined the effectiveness of a virtual reality (VR)-based training model integrating fire emergency simulation and balanced nutrition education. The study was conducted at SMK Atisa Dipamkara, Tangerang, from May to July 2025. A quasi-experimental design was employed involving 100 respondents assigned to VR and conventional training groups. Data were collected through knowledge tests, skills assessments, and Likert-scale satisfaction questionnaires. The findings demonstrate significant improvements in knowledge and skills among participants receiving VR training (p < 0.001), with outcomes superior to the conventional group. High satisfaction scores (M = 4.36; SD = 0.53) reflected strong perceptions of realism, interactivity, engagement, and active participation. VR-based training effectively addresses critical gaps in school preparedness and represents a strategic approach for strengthening comprehensive safety and health promotion programmes in educational settings.
Determinants of Pneumonia in Toddlers: Multivariate Analysis
Pneumonia remains a leading cause of morbidity and mortality among toddlers aged 12-59 months at Cikande Health Center Serang Regency, with 89 cases reported from January to March 2025. This unmatched case-control study included 118 toddlers (59 pneumonia cases and 59 healthy controls from nearby households, 1:1 ratio, purposive sampling). Pneumonia was defined as cough ≥2 days with rapid breathing or chest indrawing. Data on toddler gender, maternal education/knowledge, bedroom ventilation (≥10% floor area), humidity (40-60% RH), occupancy density (≤2 persons/room) and cigarette smoke exposure were analyzed via Chi-Square (bivariate) and multiple logistic regression (multivariate, stepwise elimination, interaction tests) using SPSS. Bivariate analysis showed significant associations (p < 0.05) for all factors. Multivariate modelling retained maternal education (pv=0.041, OR=2.606, 95% CI: 1.042-6.518), maternal knowledge (pv=0.003, OR=3.916, 95% CI: 1.580-9.708), bedroom ventilation (pv=0.026, OR=2.771, 95% CI: 1.126-6.818), bedroom humidity (pv=0.001, OR=5.360, 95% CI: 2.077-13.835) and occupancy density (pv=0.006, OR=3.676, 95% CI: 1.464-9.228). Bedroom humidity was the most dominant factor. No significant interactions found. Modifiable environmental factors (humidity, density) and maternal factors are key pneumonia determinants. Interventions should target home environmental improvements and maternal education.
Estimated Health Risk of Cadmium and Chromium in Elderly Blood Cockle Consumers, Lantebung
This study assessed the non-carcinogenic health risks of Cadmium (Cd) and Chromium (Cr) exposure through blood cockle (Anadara granosa) consumption among elderly residents in Lantebung, Makassar Strait. Blood cockle samples were collected from six purposively selected points, and Cd and Cr concentrations were analyzed. Health risks were estimated using intake calculations and the Risk Quotient (RQ). Cd and Cr concentrations were generally below national and international food safety limits. However, some elderly individuals, particularly frequent consumers, exceeded the non-carcinogenic risk threshold (RQ > 1). The highest risks were associated with specific sampling points, reflecting localized contamination. Risk factors included high consumption rates, long exposure duration, and lower body weight. These findings suggest that compliance with contaminant limits alone may not ensure safety for vulnerable populations. Regular environmental monitoring, risk communication for high-risk groups, and strengthened pollution control measures are recommended. Public health interventions, including periodic health screening and guidance on safe seafood consumption, are needed to reduce long-term health impacts.
Preliminary Study of Life Cycle Assessment on Food Surplus Redistribution Compared to Food Waste Management in Surabaya
Food waste accounts for approximately 40% of total waste generation in Indonesia and contributes significantly to national greenhouse gas (GHG) emissions. While most food waste is still disposed of in landfills, food surplus redistribution through food banks has emerged as a potential mitigation strategy. This study evaluates the environmental performance of food surplus redistribution compared to conventional food waste management options using a life cycle assessment (LCA) approach. The analysis was conducted at Garda Pangan, Surabaya, with a functional unit of 1 ton of food surplus and assessed three scenarios: (1) landfill disposal, (2) composting and anaerobic digestion, and (3) food surplus redistribution. The assessment applied the CML IA Baseline method and focused on Global Warming Potential (GWP), using SimaPro 9.0 and the Ecoinvent 3 database. The results show that landfill disposal has the highest GWP at 1,920 kg CO₂-eq per ton of food waste, driven primarily by methane emissions from anaerobic decomposition. Composting and anaerobic digestion result in lower impacts, at 1,503 and 1,730 kg CO₂-eq per ton, respectively. In contrast, food surplus redistribution shows a markedly lower GWP of 1.24 kg CO₂-eq per ton of food surplus, as emissions are dominated by transportation activities within a simplified gate-to-gate system boundary. This preliminary analysis relied on secondary inventory data and excluded potential avoided food production impacts; therefore, the estimated GWP for redistribution may underestimate or overestimate actual emissions. These findings highlight the importance of prioritizing food waste prevention and the benefits of food surplus redistribution within integrated waste management strategies to reduce GHG emissions while delivering social co-benefits.
Mosquito Larvae Identification in Water Storage and Assesment of Worker’s Knowledege, Attitudes, and Practices
Vector-borne diseases remain a major public health concern in tropical regions, with dengue fever continuing to be the predominant vector-borne disease in urban Indonesia. Public tourist areas with high human activity may provide favorable breeding sites, making sanitation workers’ roles crucial. This study aimed to identify mosquito breeding characteristics and larval presence in water-holding containers (WHCs) and to describe the knowledge, attitudes, and practices (KAP) of sanitation workers in a historic public open space in an urban setting. A descriptive cross-sectional study using a mixed-methods approach was conducted, combining quantitative entomological surveys with qualitative in-depth interviews. All accessible WHCs at the study site were inspected for larvae, which were collected and morphologically identified, and Aedes larval indices (ABJ/Angka Bebas Jentik, HI, CI) were calculated. Sanitation workers were selected purposively as qualitative informants, and KAP data were analyzed thematically. Seven WHCs were identified, of which two outdoor natural pools (28.57%) were positive for larvae, yielding 13 larvae, all identified as Culex spp., with no Aedes spp. detected. Consequently, Aedes-specific indices showed an ABJ of 100%, HI of 0%, and CI of 0%, indicating a low risk of dengue transmission according to WHO criteria (HI <4% and CI <3%). Sanitation workers demonstrated generally good knowledge, positive attitudes, and routine preventive practices, although understanding of the full 3M Plus concept varied. In conclusion, despite the presence of non-Aedes larvae in outdoor natural containers, the absence of Aedes breeding sites suggests effective dengue vector control supported by routine sanitation practices in the study area.
The Effectiveness of Rice Straw and Cogongrass Straw Soaked Water Attractants on the Number of Aedes spp. Mosquitoes
Aedes spp. mosquitoes are the main vectors of Dengue Hemorrhagic Fever (DHF), which remains a public health problem in Indonesia. Chemical insecticide-based mosquito control has the potential to cause environmental pollution and vector resistance, so safer and more environmentally friendly control alternatives are needed. This study aimed to analyze the effectiveness of rice straw and cogongrass straw-soaked water attractants in attracting Aedes spp. mosquitoes. Method this study used a pure experimental design with a post-test only control group design. The study was conducted at Muhammadiyah Ahmad Dahlan University, Palembang. Traps were placed purposively with a total of 27 observation units consisting of three treatment groups, namely control (water without attractant), rice straw-soaked water attractant, and cogongrass straw-soaked water attractant, each with nine replications. Traps were set for 5–7 days. Data were analyzed using the Shapiro–Wilk normality test, homogeneity test, One Way ANOVA, and the Least Significant Difference (LSD) test with a significance level of 0.05. The results showed the total number of mosquitoes trapped in the control group was 16, in the rice straw attractant group was 31, and in the cogongrass straw attractant group was 32. The average number of mosquitoes in the control group was 2.00 ± 0.67, in the rice straw group was 3.00 ± 1.13, and in the cogongrass straw group was 4.00 ± 1.13. The results of the One- Way ANOVAanalysis showed a significant difference between the treatment groups (p = 0.01). Further LSD tests showed that both attractant groups were significantly different from the control, but there was no significant difference between the rice straw and cogongrass straw attractants. These findings indicate soaked water from rice straw and cogongrass straw was effective in increasing the number of trapped mosquitoes compared to the controlas a natural attractant to catch Aedes spp. mosquitoes and has the potential to be an alternative vector control that is cheap, easy to apply, and environmentally friendly.
Predictive Value of Neutrophil-to-Limphocyte Ratio for Detecting Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus Patients
Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by insulin resistance, leading to increased blood glucose levels (hyperglycemia). Insulin resistance is a key factor in the development of nonalcoholic fatty liver disease (NAFLD), a condition defined by excessive hepatic fat accumulation that is not caused by alcohol consumption. NAFLD can progress from simple steatosis to hepatic inflammation and fibrosis. The neutrophil-to-lymphocyte ratio (NLR) is a simple biomarker for systemic inflammation. Elevated NLR values may indicate increased inflammation, such as that observed in NAFLD. This study aimed to determine differences in NLR values in T2DM patients with NAFLD and without NAFLD. This cross-sectional study used secondary data from the medical records of 88 T2DM patients from 2022 to 2024, divided into groups without NAFLD (n=45) and with NAFLD (n=43) based on ultrasonographic liver findings. The Welch t-test was applied to compare NLR values, and receiver operating characteristic (ROC) analysis was used to identify the optimal cut-off value for NLR. The NAFLD group had significantly higher NLR values (mean difference = 3.80; 95% CI: 2.75–5.24; p<0.001), with an AUC of 0.962 (95% CI: 0.915–1.000; p<0.001) and an optimal cut-off value of ≥3.1964 (sensitivity 90.7%; specificity 100%). In conclusion, NLR is significantly elevated in T2DM patients with NAFLD and demonstrates strong discriminatory ability, indicating its potential use as a simple inflammatory biomarker in T2DM managements.
Correlation Between TNF-α Levels and APRI Score with Ejection in Hepatic Cirrhosis
Cirrhotic cardiomyopathy is a condition of heart dysfunction characterized by impaired myocardial contractility, left ventricular hypertrophy, diastolic dysfunction, chronotropic dysfunction, and electrophysiological disturbances of the heart. One of the complications in patients with hepatic cirrhosis is influenced by several factors, particularly TNF-α levels and the APRI score. This study aimed to analyze the effect of TNF-α and APRI score on ejection fraction in Child-Pugh C hepatic cirrhosis. Methods: This study employed an analytical observational design with a cross-sectional approach. The sample consisted of 40 inpatients with Child-Pugh C hepatic cirrhosis at the dr. Moewardi Surakarta Regional General Hospital. Samples were selected using consecutive sampling. Data analysis was performed using Spearman’s correlation test and linear regression. Results: The correlation between TNF-α levels and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.559, p<0.001 (moderate correlation). The correlation between APRI score and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.445, p<0.001 (moderate correlation). There is a significant correlation between TNF-α levels and APRI score with ejection fraction in Child-Pugh C hepatic cirrhosis. The implication is that clinicians may incorporate TNF-α levels and the APRI score into clinical algorithms to monitor cirrhotic patients who are at high risk of developing cardiovascular complications.
Integrating Hospital Safety Index and HRM to Enhance Disaster Preparedness
Flooding is a catastrophic environmental health risk in Bekasi Regency and has continually posed adverse impacts on hospital operation interruptions and patient safety. These effects highlight the importance of environmentally literate and people-focused preparedness. The purpose of this study was to evaluate a combined model for managing the hospital safety and human resource planning which introduced the Hospital Safety Index (HSI) and human resource management into a competency-based approach, aiming that hospitals be able to provide their essential services throughout environmental events. This was a qualitative case study on Bekasi Regional General Hospital in flood-prone area. Three in-depth interviews were conducted with hospital decision makers, doctors and nurses as well as K3RS staff; two Focus Group Discussions; questionnaires and document analysis. Based on a modified HSI instrument (40 HOSDIP items), SWOT-TOWS matrices, and Balanced Scorecard (BSC) indicators, environmental safety readiness and HRM-driven response mechanisms were evaluated in this research. The results reveal that the HSI of the hospital is in Category B (moderate safe) mainly due to important gaps in Staff training, Emergency operations coordination and Logistic which directly impacts on the capacity of the facility to manage environmental health risks during flooding. The embedding of HRM in HSI-based assessments enhanced strategic fit and facilitated the development of more flexible preparedness capabilities aligned with BSC themes. The results show that HSI-HRM-BSC composes an evidential model for enhancing hospital resilience to environmental hazards. That preparedness is not only based on safe infrastructure, but also involves the management of competent, coordinated and adaptable human resources which stresses the centrality of people‐centred approaches for mitigating health impacts from environmental disasters.
Platelet to cholesterol ratio of high density lipoprotein cholesterol is associated with diabetes and comorbidity risk
This study aims to analyze the relationship between platelet to HDL cholesterol (Platelet to HDL Ratio / PHR) ratio and the presence of type 2 diabetes mellitus, as well as evaluate the ability of PHR as a predictor of comorbidity risk. Multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% CI. The discriminatory ability of the model is evaluated with the receiver operating characteristic curve (ROC), with the area under the curve (AUC) used to measure the model's performance. Sensitivity and specificity. This study used a cross-sectional observational design with 220 participants (110 type 2 diabetes patients and 110 non-diabetic controls) from the Southeast Sulawesi Provincial General Hospital. Samples were selected based on inclusion criteria (age 30–70 years, for the diabetes group) and exclusion (such as anemia or use of anticoagulant drugs). Data were collected through clinical examinations (age, BMI, blood pressure, platelet count, HDL). PHR is calculated as the number of platelets (per μL) divided by HDL levels (mg/dL). Statistical analysis was performed using independent t-test, multivariate logistic regression, and ROC curve with SPSS software (p < 0.05). The results showed that PHR was significantly higher in the diabetes group with comorbidities (mean 5.49±2.10) than in healthy individuals (4.25±2.39; p < 0.001). The ROC curve shows an AUC of 0.70 for PHR in predicting comorbidity risk, better than HDL alone (AUC 0.55). This study shows that platelet-to-HDL ratio (PHR) is proven to be a simple and economical potential biomarker for detecting an association with diabetes and predicting the risk of vascular comorbidities. These findings support the use of PHR in routine clinical practice, especially in developing countries such as Indonesia. This research contributes to the strategy for the early prevention of diabetes complications through easily accessible hematological parameters.
The Role of Mothers in the High Prevelance of Early Childhood Dental Caries: A Atudy Among Toddlers in the Peatland Areas of West Kalimantan
Peatland environments often rely on groundwater with low mineral content, which may increase children’s vulnerability to dental caries. This study examined whether family factors parental education, occupation, economic status, and parenting practices are associated with dental caries among young children. This descriptive cross-sectional study used a mixed-methods approach. The study was conducted at PAUD Dzafira, East Pontianak, West Kalimantan, and included 45 parent–child pairs selected through total sampling. Data on parental characteristics, parenting practices, and children’s caries status were collected. Quantitative data were analyzed using Spearman’s correlation, and qualitative data were analyzed using NVivo. The mean dental caries score was 3.91 ± 3.21, ranging from 0 to 14 decayed teeth. Significant correlations were observed between children’s caries and maternal education (r = −0.452; p = 0.002), family economic status (r = −0.300; p = 0.045), and maternal occupation (r = −0.535; p < 0.001). Caries-free children were generally characterized by early habit formation, active parental supervision, and consistent motivation. In contrast, inconsistent routines, inappropriate toothbrushing times, and limited parental ability to teach toothbrushing behaviors were more common among children with caries. Higher maternal education, stable employment, and better economic conditions are associated with lower dental caries among children. Strengthening oral health education, especially for mothers as primary caregivers, and improving access to affordable dental care are essential to reduce caries risk in peatland communities.
Health Risk Assessment of Lead (Pb) and Copper (Cu) Contamination in Sediments of Palu Bay, Indonesia
Heavy metals are persistent environmental pollutants that tend to accumulate in coastal sediments and may pose long-term ecological and human health risks. This study evaluated the concentrations of lead (Pb) and copper (Cu) in surface sediments of Palu Bay, Central Sulawesi, Indonesia, and assessed potential non-carcinogenic and carcinogenic health risks through dermal exposure. Sediment samples were collected from ten stations representing residential areas, ports, river estuaries, and relatively open zones. Concentrations of Pb and Cu were analyzed using Atomic Absorption Spectrophotometry (AAS) after acid digestion. Sediment contamination was evaluated using the contamination factor (CF) and geoaccumulation index (Igeo), while human health risk assessment (HRA) followed U.S. EPA guidelines. Mean concentrations of Pb and Cu were 6.61 ± 3.64 mg/kg and 20.70 ± 8.83 mg/kg, respectively, and were below international sediment quality guidelines (CCME and ANZECC). CF values (<1) and negative Igeo values indicated low contamination levels. The hazard quotient (HQ) and hazard index (HI) for dermal exposure were below the threshold of concern (HI < 1), suggesting no significant non-carcinogenic risk. Carcinogenic risk (CR) for Pb was within the acceptable range (10⁻⁶–10⁻⁴). Overall, surface sediments in Palu Bay show low levels of Pb and Cu contamination and currently pose minimal health risk through dermal contact. The results provide baseline data to support future monitoring and coastal management strategies.
Flood Preparedness in Urban Areas: An Analysis of the Role of Households in Disaster Risk Mitigation
Flooding is one of the most frequent disasters in urban areas of Indonesia, including Makassar City, which experiences major floods almost every year. Households are a critical unit of analysis because they are directly affected and serve as the first line of response during flood events. This study aimed to assess household flood preparedness using the Community Preparedness Index (CPI), which consists of four components: Knowledge and Attitudes toward Preparedness (KAP), Emergency Planning (EP), Warning System (WS), and Resource Mobilization Capacity (RMC). A quantitative cross-sectional design was used with purposive sampling of 100 households in Manggala District, Makassar City. Data were collected using a standardized 17 item flood preparedness questionnaire. The results showed that 53% of respondents had low preparedness, indicated by CPI scores below 60%. Distance of the house from rivers or water channels was the most significant factor associated with flood preparedness (p = 0.006). 76% respondents lived within 500 meters of a river or water source and generally demonstrated higher preparedness than those living farther away, likely due to higher risk awareness. Household preparedness is influenced by both internal and external factors. Strengthening disaster education, early warning systems, evacuation planning, and resource mobilization especially for high risk households is essential. These findings support the development of evidence based, community level flood mitigation policies.
Community-Based Sanitation Risk Model to Reduce Childhood Diarrhea in Flood-Prone Urban Settlements
Childhood diarrhea remains a major public health concern in flood-prone urban settlements, where inadequate sanitation and environmental contamination are common. This study aimed to develop and validate a community-based sanitation risk model to identify key environmental and behavioral factors associated with childhood diarrhea. An analytical cross-sectional design was conducted among 240 households with children under five years of age. Data were collected through structured interviews, household sanitation observations, and environmental assessments, covering variables such as water source, latrine condition, waste disposal, drainage, handwashing practices, and flood exposure. Bivariate analysis was used to assess associations between sanitation variables and diarrhea, followed by multivariable logistic regression to determine independent predictors and construct the risk model. The results showed that The two-week prevalence of childhood diarrhea was 27.5%. Multivariable analysis identified contaminated water sources (AOR = 3.42; 95% CI: 1.95–5.99), clogged or non-functional drainage (AOR = 3.85; 95% CI: 2.12–6.97), improper solid waste disposal (AOR = 2.67; 95% CI: 1.56–4.61), unimproved latrines (AOR = 2.11; 95% CI: 1.25–3.58), and inadequate handwashing behavior (AOR = 2.48; 95% CI: 1.40–4.38) as significant predictors of diarrhea. The model demonstrated good discrimination in identifying high-risk households. In conclusion, the The developed community-based sanitation risk model provides a simple, evidence-based tool for identifying households at high risk of childhood diarrhea in flood-prone urban settlements. This model can support targeted sanitation interventions and strengthen community-level disease prevention programs.
The Effect of Sansevieria Extract on Indoor Carbon Monoxide from Cigarette Smoke
Air quality degradation can occur through changes in physical or chemical properties. Biodiversity in Indonesia can be a solution to the increasingly concerning air pollution problem. There are many types of plants that have the potential to absorb cigarette smoke air pollution, including sansevieria. Sansevieria plants can reduce both indoor and outdoor air pollution, particularly CO from cigarette smoke. Furthermore, NASA research has found evidence that this plant naturally absorbs toxic materials such as carbon dioxide, benzene, and formaldehyde. Purpose The purpose of this study was to determine the effectiveness of Sansevieria plant extract in absorbing cigarette smoke pollution, specifically CO gas. The study compared indoor CO levels from cigarette smoke with and without snake plant extract, using three replicates (or trials). Sensitivity tests showed that 1.5 grams of snake plant ethanol extract reduced carbon monoxide levels by 89.5 ppm within 15 minutes per cigarette. So it can be concluded that the extracts of the Sansevieria masoniana and trifasciata laurentii plants are useful as a solution to air pollution.
System Dynamics Modelling of Population Growth and Waste Management Landfill Capacity Sustainability in Palangka Raya
This study analyzes the growing challenges of municipal solid waste management in Palangka Raya, driven by rapid population growth and limited landfill capacity. The research aims to develop an integrated dynamic system model combining population dynamics and waste management performance to project future conditions and evaluate policy interventions. Using a system dynamics approach, the study models population growth, household waste generation, landfill accumulation, and waste reduction strategies. Primary data were collected through field measurements of existing waste volumes and landfill capacities, while secondary data were obtained from official statistics and relevant reports. Model validation demonstrates high accuracy in projecting population growth, a key driver of increasing waste generation. Simulation results indicate that, under the current conditions, the Bukit Tunggal landfill will reach overload in 2018, revealing an unsustainable system. Moderate interventions produce minimal improvement, while an optimistic scenario delays landfill overload only until 2026. The findings demonstrate that achieving long-term landfill sustainability requires an extreme waste reduction strategy of at least 85% through significant enhancement of recycling, composting, and waste diversion efforts. The study concludes that incremental policies are inadequate to address the worsening waste crisis. Instead, a transformative shift toward high-performance waste processing and decisive policy intervention is essential to maintain landfill functionality and support sustainable urban development. The integrated model developed in this research provides a valuable tool for policymakers to design effective and long-term waste management strategies.
Review of Individual, Organizational, and Technological Factors Influencing Knowledge Management Implementatin in Healthcare: A 2019 – 2024 Analysis
Comprehending the influencing factors for the implementation of knowledge management in healthcare services is crucial for effectively managing and making use of knowledge to support innovation, decision-making, and improvements in healthcare quality. The purpose of this study is to analyze the key factors influencing the implementation of knowledge management in healthcare services, with the purpose of enhancing service efficiency, accelerating knowledge-based decision-making, and ensuring the quality of patient care. This review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was limited to full-text articles published in English between 2019 and 2024 in Scopus and PubMed. A total of 131 articles were initially identified from the databases, including research articles examining factors related to the application of knowledge management. There were data extraction, quality assessment, and the analysis of the data that were conducted for all included studies. A manual content analysis was employed to classify and categorize the identified factors. There were 11 research articles in total that were used in the final review. Content analysis yielded three main groups of factors: (1) individual-related factors, (2) organizational-related factors, and (3) technology-related factors. Conclusion: Healthcare requires robust knowledge management (KM) to support medical team collaboration, best practice sharing, and innovation in patient care.
Individual Characteristics and Compliance with Personal Hygiene and PPE Use among Waste Pickers at Putri Cempo Landfill, Surakarta
Waste pickers face a high risk of disease due to continuous exposure to waste; however, adherence to personal hygiene and the use of personal protective equipment (PPE) remain suboptimal. This study aimed to analyze the relationship between individual characteristics and compliance with personal hygiene and PPE use among waste pickers at the Putri Cempo Landfill, Surakarta. An analytical observational study with a cross-sectional design was conducted among 46 waste pickers, selected through purposive sampling. The dependent variables were compliance with personal hygiene and PPE use, while the independent variables included age, gender, and education level. Data were collected using a structured questionnaire and analyzed using Fisher’s exact test. Most respondents demonstrated moderate compliance with personal hygiene and PPE practices. Statistical analysis indicated no significant association between gender (p = 0.182), age (p = 0.564), or education level (p = 0.602) and compliance behavior. Individual characteristics such as age, gender, and education were not significantly related to compliance with personal hygiene and PPE use. Therefore, interventions to improve compliance should prioritise organisational support and behavioral approaches, including education, training, and facility improvement, rather than focusing solely on demographic factors.