Factors Associated with Delays in Early Stroke Detection among Older Adults

Stroke is a medical emergency caused by disrupted blood circulation to the brain, leading to rapid neurological dysfunction and potentially fatal outcomes if not treated promptly. Optimal management must be initiated within the first three hours after symptom onset, known as the golden period. However, many stroke patients experience delays in receiving treatment, particularly in the prehospital phase, where more than 80% of cases fail to obtain timely medical intervention due to late recognition of stroke signs and symptoms (Satapathy, et al., 2025). Several factors related to early stroke detection require further investigation to determine the most dominant contributors to delayed detection and management. This study aimed to analyze the factors associated with the occurrence of delays stroke detection among older adults in five Banjar in Melinggih Village. A descriptive correlational analytic design with a cross-sectional, conducted over three months from July to September 2025, with 292 respondents were selected proportionally based on inclusion and exclusion criteria. Data were collected from older adult using structured questionnaires from AST (Face, Arm, Speech, Time), the Los Angeles Prehospital Stroke Screen (LAPSS), and PACS (Medic Prehospital Assessment for Code Stroke). Data analysis was performed using spearman rho and multivariable logistic regression. The results demonstrated significant associations between early stroke detection and knowledge (p<0.001; OR=5.702), attitude (p<0.001; OR=4.820), awareness (p<0.001; OR=4.820), assistant support (p<0.001; OR=4.620), information access ((p<0,001; OR=0.474), education background (p<0,001; OR=4.820). Multivariate analysis identified knowledge factor associated early stroke detection occurrence (P<0.001; OR =5.502; 95% CI: 1.938–9.843). In conclusion, delays in early stroke detection among older adults is significantly associated with knowledge, attitudes, awareness, family accompaniment, access to information, and educational background. Enhancing knowledge among older adults, along with strengthening public health programs that provide stroke related education and reinforce the role of elderly health cadres in monitoring older adults’ health, is essential to reduce delays in early stroke detection among this population.            

PENGARUH PENAMBAHAN TEPUNG KACANG MERAH (Phaseolus Vulgaris Latau) TERHADAP DAYA TERIMA STICK IKAN CAKALANG (Katsuwonus Pelamis)

Protein Energy Malnutrition (PEM) remains a major nutritional issue among toddlers and significantly contributes to Protein-Energy Malnutrition (PEM) remains a major nutritional problem among infants and young children and contributes to high child mortality rates. Data from the World Health Organization (WHO) indicates that approximately 54% of child deaths are caused by Protein-Energy Malnutrition. One preventive measure involves utilizing local foods, such as skipjack tuna—which is high in animal protein—and red beans as a source of plant-based protein, by processing them into stick-shaped products. These stick products are designed as snacks weighing 50 grams per serving to help meet the daily nutritional needs of healthy infants and toddlers, supplementing their daily nutritional requirements beyond main meals. The objective of this study is to determine the effect of adding red bean flour on the organoleptic acceptability (color, aroma, taste, and texture) as well as the nutritional value of skipjack tuna sticks. An experimental research method was used with three treatments: the addition of 42% red bean flour (L1), 47% (L2), and 52% (L3). Organoleptic testing was conducted by panelists using the Kruskal-Wallis test, while nutritional value analysis was based on TKPI 2020. The results of the organoleptic test showed no significant differences among the treatments (p > 0.05), but all formulations fell into the “like” category (scores of 3.6–4.0). In terms of color, L1 and L2 were the most preferred; for aroma and texture, L2 and L3 were preferred; while L2 received the highest score for taste. Nutritional analysis showed an increase in energy and protein as the proportion of red beans increased, with the highest values in L3 (Energy 2,413.4 kcal; protein 93.8 g; fat 97.75 g; carbohydrates 293.25 g). Based on the nutritional analysis results, the recommended formulation is skipjack fish sticks with 52% red bean flour added (L3). As a snack, this product has higher energy and protein levels than the other treatments, which can help meet the energy and protein needs of undernourished toddlers. Further research is needed regarding the content or analysis of other micronutrients in the fish stick formulation.    Kekurangan Energi Protein (KEP) masih menjadi masalah gizi utama pada balita dan berkontribusi terhadap tingginya angka kematian anak. Data World Health Organization (WHO) menunjukkan bahwa sekitar 54% angka kematian pada anak disebabkan oleh Kekurangan Energi Protein. Salah satu upaya pencegahan adalah pemanfaatan pangan lokal, seperti ikan cakalang yang tinggi protein hewani dan kacang merah sebagai sumber protein nabati, melalui pengolahan menjadi produk stik. Produk stik ini dirancang sebagai makanan selingan (snack) dengan berat 50 gram per takaran saji untuk membantu memenuhi kebutuhan gizi harian balita.sehat untuk membantu mencukupi kebutuhan gizi harian di luar makanan utama.  Tujuan penelitian ini untuk mengetahui pengaruh penambahan tepung kacang merah terhadap daya terima organoleptik (warna, aroma, rasa, dan tekstur) serta nilai gizi stik ikan cakalang. Menggunakan metode eksperimen atau percobaan (experiment research) dengan tiga perlakuan, yaitu penambahan tepung kacang merah 42% (L1), 47% (L2) dan 52% (L3). Uji organoleptik dilakukan oleh panelis menggunakan Uji Kruskal-Wallis, sedangkan analisis nilai gizi mengacu pada TKPI 2020. Hasil uji organoleptik menunjukkan tidak terdapat perbedaan signifikan antar perlakuan (p> 0,05), namun seluruh formulasi berada pada kategori “suka” (nilai 3,6-4,0). Dari aspek warna paling disukai L1 dan L2, aroma serta tekstur disukai L2 dan L3, sedangkan rasa tertinggi pada L2. Analisis nilai gizi menunjukkan peningkatan energi dan protein seiring peningkatan proporsi kacang merah, dengan nilaii tertinggi pada L3 (Energi 2.413,4 kkal; protein 93,8 gram; lemak 97,75 gram; karbohidrat 293,25 gram). Berdasarkan hasil uji nilai gizi maka formula yang direkomendasikan adalah stik ikan cakalang dengan penambahan 52% tepung kacang merah (L3), sebagai makanan selingan produk ini  memiliki kadar energi dan protein lebih tinggi dari pada perlakuan yang lainnya, yang dapat membantu memenuhi kebutuhan energi dan protein bagi balita KEP. Diharapkan adanya penelitian lanjutan terkait dengan kandungan atau analisis zat gizi mikro lainnya dari formulasi stik ikan

Meta-Analysis Study of Correlation Between Olfactory Dysfunction and Cognitive Impairment in Parkinson\u27s Disease

Disturbance in olfactory perception is commonly identified as a non motor manifestation in Parkinson’s disease and is often interpreted as an early biological signal reflecting ongoing degeneration of neural structures. This study was specifically formulated to conduct an in depth evaluation of the association between reduced smell performance and impaired cognitive functioning in Parkinson’s disease by applying systematic numerical aggregation techniques that adhere to internationally accepted research protocols. A broad and methodologically organized literature exploration was conducted using PubMed Wiley and ScienceDirect to identify empirical studies examining the association linking smell processing ability with mental functioning measures in individuals diagnosed with Parkinson’s disease. The screening process was carried out in accordance with clearly defined inclusion requirements. Assessment of smell function relied on the olfactory recognition assessment developed by the University of Pennsylvania Test UPSIT while evaluation of cognitive condition employed the MMSE alongside the MoCA cognitive screening tools. Pooled odds ratio values along with 95% confidence interval ranges were calculated using a random effects modeling framework. Overall 3 eligible studies comprising 773 individuals conducted in populations from America, Korea, and Britain met the established inclusion standards. Quantitative synthesis revealed a statistically meaningful relationship between impaired olfactory ability and reduced cognitive performance in Parkinson’s disease, with individuals experiencing hyposmia or anosmia showing a markedly increased probability of cognitive impairment compared with participants exhibiting intact smell perception OR 2.57 95% CI 1.15 to 5.74. The results of this analysis suggest a strong and statistically significant relationship between diminished olfactory capacity and cognitive impairment in Parkinson’s disease, highlighting its potential role as an early detectable clinical indicator of progressive cognitive deterioration. Despite the presence of variability among included studies and a relatively small pool of eligible research, the meta analytic evidence supports the usefulness of olfactory assessment as a non invasive and economically efficient approach for identifying cognitive risk in Parkinson’s disease. Additional large scale investigations employing uniform evaluation protocols are necessary to confirm these outcomes and enhance their relevance in clinical practice.            

Understanding the Multifaceted Roles of Families in Caring for Palliative Patients in the Community: A Systematic Literature Review

Enhancing family support in community-based palliative care is a growing global priority given the family\u27s role as the primary caregiver for long-term palliative care patients in the community. This is a systematic literature review that aimed to synthesize recent evidence on the roles and contributions of families in caring for palliative patients in the community. A literature search was conducted through PubMed and ScienceDirect databases using the keywords “family role” OR “family support” AND “palliative” OR “palliative care.” The PEO framework guided the selection process, focusing on Population: families of palliative patients; Exposure: family caregiving roles; and Outcome: fulfillment of palliative care needs. Nine articles published between 2020 and 2025 met the inclusion criteria. The review identified diverse and interrelated family roles, including providing emotional and social support, delivering direct care, coordinating with healthcare professionals, engaging in decision-making and communication, and facilitating health education. Families also carried significant social and cultural responsibilities while adopting protective and adaptive coping strategies. The findings highlight that families are not merely companions but act as care managers, communicators, and educators who critically influence the quality of home-based palliative care. A unique insight from this review is the emphasis on the transitional phase from hospital to home as a crucial period requiring enhanced family capacity, structured coordination, and psychosocial support. Strengthening family education, telemedicine-based coordination, and community linkages emerges as a vital strategy to ensure holistic and sustainable palliative care delivery within community settings. Community nurses need to involve and meet the needs of families as clients in a nursing care plan that does not only focus on the needs of palliative patient

Faktor Determinan Kejadian Stunting Pada Balita Usia 12-24 Bulan Di Wilayah Kerjah Puskesmas Oesapa Kota Kupang

Stunting remains a prominent nutritional issue in Indonesia, including in the city of Kupang, where the prevalence reaches 31.9%. Identifying local risk factors is crucial for determining appropriate intervention strategies. This study aims to analyze the relationship between direct breastfeeding, a history of low birth weight (LBW), maternal knowledge level, and family income with the incidence of stunting in toddlers aged 52–104 weeks. This study employed a cross-sectional design. A sample of 76 toddlers was selected from a population of 301 toddlers in the service area of the Oesapa Community Health Center, Kupang City. Data analysis showed no significant association between stunting and direct breastfeeding (p=0.204), a history of LBW (p=0.204), maternal knowledge level (p=0.824), or parental income (p=0.699). These findings indicate that these factors are not the sole determinants in this region, and there is a possibility of influence from other external factors not examined in this study, such as environmental sanitation, access to clean water, or the frequency of infections among toddlers. The internal and socioeconomic factors tested were not found to have a direct effect on stunting at the Oesapa Community Health Center. A more comprehensive approach is needed through nutrition education, improved child-rearing practices, interventions targeting environmental factors, and the strengthening of cross-sectoral health services.Stunting masih menjadi persoalan gizi yang menonjol di Indonesia, termasuk di Kota Kupang yang mencatat prevalensi mencapai 31,9%. Identifikasi faktor risiko lokal sangat penting untuk menentukan strategi intervensi yang tepat. Penelitian ini bertujuan untuk menganalisis hubungan antara pemberian ASI langsung, riwayat Berat Badan Lahir Rendah (BBLR), tingkat pengetahuan ibu, dan pendapatan keluarga dengan kejadian stunting pada balita usia 52–104 minggu. Penelitian ini menggunakan desain studi potong lintang (cross-sectional). Sampel penelitian sebanyak 76 balita dipilih dari populasi 301 balita di wilayah kerja Puskesmas Oesapa, Kota Kupang. Analisis data menunjukkan tidak terdapat hubungan signifikan antara stunting dengan pemberian ASI langsung (p=0,204), riwayat BBLR (p=0,204), tingkat pengetahuan ibu (p=0,824), maupun pendapatan orang tua (p=0,699). Temuan ini mengindikasikan bahwa faktor-faktor tersebut bukan merupakan determinan tunggal di wilayah ini, dan terdapat kemungkinan pengaruh dari faktor eksternal lain yang tidak diteliti, seperti sanitasi lingkungan, akses air bersih, atau frekuensi infeksi pada balita. Faktor internal dan sosio-ekonomi yang diuji tidak terbukti berpengaruh langsung terhadap stunting di Puskesmas Oesapa. Diperlukan pendekatan yang lebih komprehensif melalui edukasi gizi, peningkatan pola pengasuhan, serta intervensi pada faktor lingkungan dan penguatan layanan kesehatan lintas sektor

Hubungan Tingkat Stres dan Asupan Zat Gizi Makro dengan Status Gizi pada Mahasiswa Tingkat Akhir Jurusan Gizi Kemenkes Poltekkes Kupang Tahun 2025

The final year of college is a transitional period prone to high stress, which theoretically can affect eating behavior and macronutrient intake, thereby impacting nutritional status. Nutrition students are expected to have better self-control; however, the pressure of final projects remains a risk factor for psychological well-being and dietary management. This study aims to analyze the relationship between stress levels and macronutrient intake (protein, fat, carbohydrates) with nutritional status among final-year students in the Department of Nutrition at the Kupang Ministry of Health Polytechnic in 2025. This is an analytical observational study with a cross-sectional design. The study was conducted in May–June 2025 at the Department of Nutrition, Kupang Public Health Polytechnic. The sample consisted of 100 final-year students selected using purposive sampling. Data were statistically analyzed using the Chi-Square test. The majority of respondents experienced very severe stress (89.0%). Most respondents had an inadequate intake of macronutrients, including protein (70.0%), fat (93.0%), and carbohydrates (92.0%). The distribution of nutritional status based on BMI showed the following categories: severely underweight (18.0%), underweight (19.0%), overweight (12.0%), and obese (1.0%). Statistical test results showed no significant association between stress levels (p=0.111), protein intake (p=0.396), fat intake (p=0.582), and carbohydrate intake (p=0.616) and nutritional status. Conclusion: There was no significant association between stress levels and macronutrient intake and nutritional status among senior college students. High stress levels and low macronutrient intake did not directly reflect the nutritional status of the respondents in this study, which was likely influenced by other factors such as the duration of stress or physical activity.Masa perkuliahan tingkat akhir merupakan periode transisi yang rentan memicu stres tinggi, yang secara teoritis dapat memengaruhi perilaku makan dan asupan zat gizi makro, sehingga berdampak pada status gizi. Mahasiswa gizi diharapkan memiliki kontrol yang lebih baik, namun tekanan tugas akhir tetap menjadi faktor risiko psikologis dan manajemen asupan. Penelitian ini bertujuan untuk menganalisis hubungan antara tingkat stres dan asupan zat gizi makro (protein, lemak, karbohidrat) dengan status gizi pada mahasiswa tingkat akhir Jurusan Gizi Poltekkes Kemenkes Kupang tahun 2025. Jenis penelitian ini adalah observasional analitik dengan rancangan cross-sectional. Penelitian dilaksanakan pada Mei–Juni 2025 di Jurusan Gizi Poltekkes Kemenkes Kupang. Sampel berjumlah 100 mahasiswa tingkat akhir yang dipilih menggunakan metode purposive sampling. Data dianalisis secara statistik menggunakan uji Chi-Square. Mayoritas responden mengalami stres kategori sangat berat (89,0%). Sebagian besar responden memiliki asupan zat gizi makro kategori kurang, meliputi protein (70,0%), lemak (93,0%), dan karbohidrat (92,0%). Sebaran status gizi berdasarkan IMT menunjukkan kategori sangat kurus (18,0%), kurus (19,0%), gemuk (12,0%), dan obesitas (1,0%). Hasil uji statistik menunjukkan tidak terdapat hubungan yang signifikan antara tingkat stres (p=0,111), asupan protein (p=0,396), asupan lemak (p=0,582), dan asupan karbohidrat (p=0,616) dengan status gizi.kesimpulan: Tidak terdapat hubungan yang signifikan antara tingkat stres dan asupan zat gizi makro dengan status gizi pada mahasiswa tingkat akhir. Tingginya angka stres dan rendahnya asupan makro tidak secara langsung merefleksikan status gizi responden dalam penelitian ini, yang kemungkinan dipengaruhi oleh faktor lain seperti durasi stres atau aktivitas fisik

EFEK ACUPRESSURE TERHADAP NYERI PENYAKIT KANKER: A SCOPING REVIEW: Effects Of Acupressure On Cancer Pain: A Scoping Review

Nyeri merupakan salah satu tanda utama yang dirasakan oleh penderita penyakit kronis termasuk kanker, kajianpenangan nyeri non farmakologis khususnya acupressure telah banyak dilakukan, namun, kajian review yang dapat digunakan sebagai landasan pemikiran intervensi ini masih terbatas. Tujuan dari review ini adalah untuk melihat gambaran dari scoping review tentang efek acupressure terhadap nyeri pada pasien kanker. Review ini menggunakan pendekatan scoping review, dengan menggunakan databased Pubmed, Cohrane, Proquest, Wiley Library dengan menggunakan kata kunci “Acupressure” AND “Pain” AND “Cancer” OR “Cronic” OR “Cronic diases”. Pada pencarian tersebut dilakukan penyaringan data dengan filter awal ceklist”free full text”, “Publication from 2020-2025”, “Randomized Controlled Trial”.Analisis review dilakukan dengan menggunakan pendekatan teori Arksey dan O’Malley. Hasil 5 artikel yang di review menunjukan bahwa acupressure memiliki efek positif dalam mengurangi danmengatasi nyeri pada penyakit kanker, diantaranya mengurangi nyeri pasien kanker payudara, kanker kolorektal, leukimia, kanker paru-paru, kanker lambung, kanker pancreas, kanker tulang, kanker yang sudah metastasis dan kanker yang lainnya. Penelitian selanjutnya dapat melakukan review artikel terakit acupressure dengan metode yang lain dalam mengatasi gejala pada penyakit kanker.Nyeri merupakan salah satu tanda utama yang dirasakan oleh penderita penyakit kronis termasuk kanker, kajian penangan nyeri non farmakologis khususnya acupressure telah banyak dilakukan, namun, kajian review yang dapat digunakan sebagai landasan pemikiran intervensi ini masih terbatas. Tujuan dari review ini adalah untuk melihat efek dari acupressure terhadap nyeri pada penyakit kanker. Review ini menggunakan pendekatan scoping review, dengan menggunakan databased Pubmed, Cohrane, Proquest, Wiley Library dengan menggunakan kata kunci “Acupressure” AND “Pain” AND “Cancer” OR “Cronic” OR “Cronic diases”. Pada pencarian tersebut dilakukan penyaringan data dengan filter awal ceklist”free full text”, “Publication from 2020-2025”, “Randomized Controlled Trial”.Analisis review dilakukan dengan menggunakan pendekatan teori Arksey dan O’Malley. Hasil review menunjukan bahwa acupressure memiliki efek positif dalam mengurangi dan mengatasi nyeri pada penyakit kanker, diantaranya mengurangi nyeri pasien kanker payudara, kanker kolorektal, leukimia, kanker paru-paru, kanker lambung, kanker pancreas, kanker tulang, kanker yang sudah metastasis dan kanker yang lainnya. Penelitian selanjutnya dapat melakukan review artikel terakit acupressure dengan metode yang lain dalam mengatasi gejala pada penyakit kanker Kata kunci: Penyakit kanker, Nyeri, Acupressure, Nyeri kanke

Synergistic Impacts of Water Hyacinth Bloom and Organic Pollution on Water Quality and Public Health Risk

Multifunctional tropical reservoirs face increasing threats from water quality degradation due to anthropogenic activities, posing significant risks to both the ecosystem and public health. This study evaluates the synergistic impacts of water hyacinth (Eichhornia crassipes) bloom and organic pollution on Cengklik Reservoir. It assessed the combined effect of these factors on oxygen dynamics and inferred the potential risks to human health for communities reliant on the reservoir. The research utilized historical data (2020-2024) for Biochemical Oxygen Demand (BOD) and Dissolved Oxygen (DO) from the official BBWS Surakarta website. Standard test methods (SNI 6989.72.2009 for BOD and APHA 2017 for DO) were used to ensure data quality. This study indicates a synergistic interaction between organic pollution and water hyacinth proliferation that contributes to water quality degradation and conditions favorable for pathogen and toxin occurrence. A temporal trend analysis and a comparison with national water quality standards were performed. The analysis revealed a significant increase in average BOD concentrations (4.3-7.9 mg/L) and a decrease in average DO (3.78 mg/L) throughout the study period. These values exceeded the Class II water quality standard for BOD (3 mg/L) and did not comply with the DO standard (>4 mg/L) as per PP RI No. 22 of 2021. Linier regression= 0.820 (Not statistically significant. Simultaneously, BOD does not have a significant effect on DO. This indicates that the BOD variable is not an effective predictor of the DO variable). These findings indicate a high organic load and widespread oxygen depletion. This highlights the urgent need for an integrated management strategy to protect the reservoir’s ecological sustainability and the health of the surrounding community.     

Survivorship Care Effects on Gynecological and Breast Cancer Survivors: A Systematic Review and Meta-Analysis

Survivorship care aims to address the long-term physical and psychosocial needs of cancer survivors, yet evidence regarding its effectiveness and optimal components remains inconsistent. This study aimed to evaluate the effectiveness of survivorship care interventions on quality of life and related outcomes among gynecological and breast cancer survivors and explored intervention components associated with improved outcomes with PRISMA guidelines. Seven databases were searched for English-language studies involving adult gynecological and/or breast cancer survivors who had completed primary treatment and received survivorship care interventions compared with usual care. A random-effects model was used to estimate pooled effects. Heterogeneity was assessed using the I² statistic, and subgroup analyses and meta-regression were performed. Risk of bias was evaluated using the Cochrane Risk of Bias tool. The review was registered in PROSPERO (CRD42023402234). Eight randomized controlled trials comprising 1,464 participants were included. Survivorship care interventions significantly improved overall quality of life (SMD = 0.26; 95% CI: 0.08–0.44), physical well-being (SMD = 0.26; 95% CI: 0.12–0.41), mental well-being (SMD = 0.17; 95% CI: 0.03–0.31), and reduced depressive symptoms (SMD = 0.20; 95% CI: 0.00–0.41), with low to moderate heterogeneity across outcomes. Subgroup analyses indicated that multimodal interventions incorporating lectures, discussions, consultations, and online coaching particularly those supported by mobile health applications were associated with greater benefits, especially in physical well-being. Several studies demonstrated moderate risk of bias, mainly related to randomization and reporting. Survivorship care interventions provide small to moderate clinically meaningful improvements in quality of life and psychosocial outcomes among gynecological and breast cancer survivors. These findings support the integration of structured, multidisciplinary, and technology assisted survivorship care into routine oncology practice, while highlighting the need for higher quality, context sensitive trials.       

Spirituality, Social Support, and Quality of Life: A Study of Indonesian Christian Patients with End-Stage Renal Undergoing Haemodialysis Treatment

Spirituality and social support are recognized as important determinants of quality of life (QoL) among patients with chronic illness. In Indonesia, where religious values are deeply embedded in daily life, understanding these factors is essential for developing culturally appropriate care for Christian patients with end-stage renal disease (ESRD). This study aimed to examine the relationship between spirituality, social support, and QoL among Indonesian Christian ESRD patients undergoing hemodialysis at Prof. Dr. W.Z. Johannes Hospital, Kupang, East Nusa Tenggara. A cross-sectional design was employed involving 176 participants. Social support, spirituality, and QoL were measured using the Multidimensional Scale of Perceived Social Support (MSPSS), the Daily Spiritual Experiences Scale (DSES), and the WHOQOL-BREF, respectively. Data were analyzed using multiple linear regression to obtain adjusted β coefficients and 95% confidence intervals (CI). The results showed that spirituality was significantly associated with QoL (β = 0.29; 95% CI: 0.22–0.36). Social support also demonstrated a significant positive relationship with QoL after adjustment for confounding variables (β = 0.42; 95% CI: 0.34–0.50). In conclusion, higher levels of spirituality and social support are associated with better QoL among Christian ESRD patients undergoing hemodialysis. These findings highlight the importance of integrating spiritual care and strengthening social support systems in the management of ESRD patients.