Health Frontiers: Multidisciplinary Journal for Health Professionals

Waist-to-Hip Ratio and Body Mass Index as Predictors of Blood Pressure Elevation Among Adolescents: A Cross-Sectional Study

2026-04-09T09:33:01+00:00

Hypertension in adolescence is an emerging public health concern, with central and general adiposity recognised as modifiable determinants of elevated blood pressure. This study examined the associations of waist-to-hip ratio (WHR) and body mass index (BMI) with blood pressure and evaluated their relative strength as predictors of elevated blood pressure among senior secondary school students in East Java, Indonesia. A cross-sectional observational study was conducted on 14 February 2025 at SMA Diponegoro Tumpang involving 72 students aged 15–18 years selected through simple random sampling. WHR, BMI, and blood pressure were measured using standardised procedures, and elevated blood pressure was classified according to the 2017 American Academy of Pediatrics guidelines. Chi-square tests and binary logistic regression were used to analyse associations and identify independent predictors after adjustment for age and sex. The participants had a mean age of 16.5 ± 0.9 years, and 58.3% were female. Elevated blood pressure was identified in 30.6% of students. Both WHR (OR = 5.14, 95% CI: 1.89–13.97, p < 0.001) and BMI (OR = 4.73, 95% CI: 1.77–12.64, p < 0.001) were significantly associated with elevated blood pressure. In multivariable analysis, WHR remained an independent predictor (adjusted OR = 4.21, 95% CI: 1.47–12.07, p = 0.007), whereas BMI was no longer significant after adjustment. These findings indicate that central adiposity, as measured by WHR, is a stronger predictor of elevated blood pressure than general adiposity in Indonesian adolescents and supports the inclusion of WHR screening in school-based cardiovascular risk prevention programmes.

Multilevel Determinants of Mental Health: A Systematic Review of Access, Stigma, and Social Inequities

2026-04-30T13:04:40+00:00

Mental health outcomes are increasingly understood as the result of interacting structural, cultural, and individual-level influences that shape patterns of care access, service engagement, and recovery trajectories. This study synthesizes evidence from systematic reviews to examine how key domains including accessibility and equity, cultural sensitivity, stigma and mental health literacy, therapeutic communication, and social determinants collectively influence mental health systems and outcomes. The findings indicate that barriers to care extend beyond service availability, encompassing affordability constraints, institutional limitations, and disparities affecting marginalized populations. Cultural context further mediates how mental health conditions are perceived and managed, influencing both help-seeking behavior and treatment adherence. Stigma remains a critical cross-cutting issue, contributing to delays in accessing care and negatively affecting treatment engagement and quality of life . In parallel, broader social conditions such as socioeconomic disadvantage and social isolation play a significant role in shaping vulnerability and resilience. Taken together, the evidence highlights the importance of adopting a comprehensive perspective that integrates health system improvements with culturally informed and socially responsive approaches to mental health care.

Association Between Basic Immunization Status and Stunting Among Children Under Five: A Multivariate Analysis in a Primary Healthcare Setting

2026-05-06T02:08:42+00:00

Stunting remains a persistent public health challenge driven by multifactorial conditions, including infection exposure and suboptimal caregiving practices. Immunization may contribute to stunting prevention through infection control pathways; however, evidence from primary healthcare settings remains limited and methodologically inconsistent. This study aimed to examine the association between basic immunization status and stunting among children under five using a multivariate approach that accounts for key confounding factors. A cross-sectional study was conducted among 120 mothers with children aged 12–59 months in the Wayabula Primary Health Center area. Data were collected using structured questionnaires, verified child health records, and anthropometric measurements. Basic immunization status was treated as the primary exposure, while exclusive breastfeeding, infection history, and household sanitation were included as covariates. Data were analyzed using chi-square tests and multivariate logistic regression to estimate adjusted associations. Incomplete immunization was significantly associated with stunting in bivariate analysis (p=0.012). After adjusting for covariates, children with incomplete immunization had higher odds of stunting (AOR=2.87; 95% CI: 1.31–6.29). Infection history and poor sanitation were also significantly associated with stunting within the model. These findings indicate that immunization status is independently associated with stunting after controlling for key confounding factors. Strengthening immunization coverage within integrated primary healthcare services may contribute to more effective stunting prevention strategies.

The Relationship Between Conflict Management and Nurse Performance in a Secondary-Level Hospital: A Cross-Sectional Study

2024-05-30T00:55:36+00:00

Conflict is an inevitable phenomenon in hospital settings where multidisciplinary teams work under high-pressure conditions, making effective conflict management essential for maintaining safe and high-quality nursing care. This study aimed to examine the relationship between conflict management strategies and nurse performance at Lavalette General Hospital. A cross-sectional quantitative descriptive study, conducted in accordance with STROBE guidelines, involved 70 nurses selected through simple random sampling. Data were collected using validated instruments adapted from the Thomas–Kilmann Conflict Mode Instrument and a nurse performance questionnaire. Spearman correlation and hierarchical binary logistic regression analyses were employed to assess the association between conflict management and nurse performance. The results showed that 50% of nurses demonstrated very good conflict management, while 48.6% exhibited good performance. A strong positive and statistically significant correlation was identified between conflict management and nurse performance (r = 0.738, p = 0.001). Multivariate analysis further revealed that the collaborating strategy (aOR = 2.43, 95% CI: 1.58–3.74, p = 0.001) and compromising strategy (aOR = 2.03, 95% CI: 1.27–3.25, p = 0.003) were independent predictors of high nurse performance after adjustment for education level and work experience. These findings indicate that effective conflict management is significantly associated with improved nurse performance. Hospitals should therefore implement structured conflict resolution training programs, with particular emphasis on collaborative and compromising approaches, to strengthen workforce performance and enhance patient safety outcomes.

Caregiver Knowledge and Anti-Tuberculosis Treatment Adherence in Pediatric Patients: A Cross-Sectional Analytic Study at a District Referral Hospital

2026-04-09T12:32:05+00:00

Pediatric tuberculosis (TB) remains a major public health challenge in high-burden settings, where treatment success largely depends on consistent caregiver-mediated adherence to anti-tuberculosis therapy (OAT). However, evidence regarding the relationship between caregiver knowledge and OAT adherence among pediatric TB patients in Indonesian district hospital settings remains limited. This study aimed to examine the association between caregiver knowledge of TB and OAT with treatment adherence among pediatric TB patients attending the outpatient clinic of RSUD Kanjuruhan. A cross-sectional analytic study was conducted among 32 caregiver–patient dyads recruited through total sampling. Caregiver knowledge was assessed using a validated structured questionnaire, while adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS-8). Bivariate analysis employed Spearman’s rank correlation, followed by multivariate logistic regression to identify independent predictors of adherence. Most caregivers demonstrated good knowledge levels (62.5%), and 84.4% of pediatric patients were classified as adherent. Spearman’s analysis showed a strong positive correlation between caregiver knowledge and OAT adherence (r = 0.745; p < 0.001). After adjustment for confounders, good caregiver knowledge remained the strongest independent predictor of adherence (aOR = 6.84; 95% CI: 2.11–22.17; p < 0.001), alongside secondary-level education or above (aOR = 3.12; 95% CI: 1.02–9.55; p = 0.046). These findings highlight the importance of integrating structured, education-tailored caregiver education into routine pediatric TB care to improve treatment adherence and completion rates.

Cardiovascular Morbidity in a Warming Climate: A Systematic Review of Vulnerability and Adaptation

2026-05-01T04:53:22+00:00

Rising global temperatures and increasing frequency of extreme heat events have transformed thermal stress into a critical, systemic driver of cardiovascular and chronic disease burden worldwide. Despite growing recognition of heat-related health risks, substantial gaps remain regarding chronic sub-threshold exposure, morbidity outcomes, and the equity implications of adaptation strategies. This systematic review, conducted according to PRISMA 2020 guidelines, synthesizes contemporary epidemiological evidence from peer-reviewed studies published between 2020 and 2025 to characterize heat-health associations, identify vulnerability determinants, and evaluate policy implementation across diverse geographic and socioeconomic contexts. Following independent screening, quality appraisal, and data extraction, a structured narrative synthesis was performed due to significant methodological heterogeneity in exposure metrics and outcome definitions. The findings demonstrate a robust association between heat exposure and elevated risks of stroke, coronary heart disease, and accelerated progression of metabolic, respiratory, and mental health conditions, with chronic thermal stress emerging as an underrecognized contributor to long-term physiological deterioration. Vulnerability is highly stratified, disproportionately affecting older adults, women, outdoor workers, socioeconomically marginalized communities, and populations in low- and middle-income countries, particularly within urban heat island environments. Current adaptation measures exhibit limited behavioral uptake and insufficient equity-focused design. Addressing these disparities requires standardized exposure metrics, context-sensitive early warning systems, multisectoral policy integration, and targeted research on chronic thermal stress to build inclusive, climate-resilient health systems.

Effectiveness of Spotify-Based Health Podcast Intervention on Reproductive Health Perceptions Among Female Vocational School Adolescents: A Pre-Experimental Study

2026-05-26T01:15:48+00:00

This study investigated the effectiveness of a Spotify-based health education podcast in improving reproductive health perceptions among adolescent girls at a vocational secondary school in Surabaya, Indonesia. Adolescent girls frequently rely on peers as their primary source of reproductive health information, increasing their vulnerability to misinformation and adverse health outcomes. A pre-experimental one-group pre-test–post-test design was conducted involving 42 female students enrolled in the Culinary Arts programme at SMK Kartika IV, selected through total sampling. Participants completed a validated reproductive health perception questionnaire before and 14 days after exposure to a standardized five-episode podcast series delivered via Spotify, covering menstrual health, personal hygiene, sexually transmitted infections, and adolescent reproductive rights. Changes in perception scores were analyzed using the Wilcoxon signed-rank test, while logistic regression was used for subgroup analyses. The mean perception score increased substantially from 61.4 (SD 8.3) at baseline to 86.8 (SD 5.1) following the intervention, representing a mean improvement of 25.4 points (Z = ?5.68; p < 0.001; effect size r = 0.88). The proportion of participants demonstrating positive reproductive health perceptions increased from 90.4% at baseline to 100% after the intervention. Significant improvements were observed across all age groups and information-source categories. These findings indicate that a short-term reproductive health education intervention delivered through a widely accessible digital audio platform can significantly enhance reproductive health perceptions among adolescent girls and may represent a scalable strategy for strengthening adolescent reproductive health promotion programs in Indonesia.

Online Gaming Addiction and Emotional Disorders Among Adolescents: A Cross-Sectional Study in a Public Junior Secondary School

2026-04-09T09:34:29+00:00

The rapid global expansion of online gaming has raised increasing concerns regarding gaming addiction and its psychological consequences among adolescents, particularly in low- and middle-income countries where evidence remains limited. This study aimed to examine the association between online gaming addiction and emotional disorders among adolescents attending a public junior secondary school in East Java, Indonesia. A cross-sectional study with stratified random sampling was conducted among 142 students (mean age 13.1 years; 61.3% male). Data were collected using the Internet Gaming Disorder Scale-20 (IGDS9-SF) and the Strengths and Difficulties Questionnaire (SDQ), then analysed using Spearman’s rank correlation and multivariate ordinal regression. Most respondents demonstrated moderate gaming addiction (55.6%), while 2.1% met criteria for high addiction. Emotional disorders were identified in 51.4% of participants, consisting primarily of behavioural disorders (42.5%), depression (34.3%), and anxiety (23.2%). Spearman’s analysis revealed a significant positive correlation between gaming addiction and emotional disorders (r = 0.41, p = 0.001). Multivariate analysis further showed that gaming addiction independently predicted emotional disorders after adjustment for age and sex (adjusted OR = 3.12; 95% CI: 1.68–5.79; p < 0.001). Behavioural disturbance emerged as the most prominent emotional manifestation. These findings highlight the importance of integrating school-based mental health screening and preventive interventions into adolescent health policies in Indonesia.

Knowledge and Awareness of Radiation Protection Among Healthcare Workers: A Cross-Sectional Study

2026-04-28T00:17:40+00:00

Ionising radiation from diagnostic procedures poses significant occupational risks to healthcare workers (HCWs), yet awareness remains suboptimal in many settings, particularly in low- and middle-income countries. This cross-sectional study assessed radiation protection knowledge and awareness among 140 HCWs from inpatient, intensive care, and emergency units in Indonesia, identifying independent predictors of awareness. Knowledge was evaluated using a validated 15-item instrument (categorized as poor, acceptable, or good), while awareness was measured as a binary outcome. Data were analyzed using Pearson’s chi-square test and multivariable binary logistic regression, adhering to STROBE guidelines. The sample was predominantly female (69.3%) with bachelor’s degrees (57.1%). Overall, 46.4% demonstrated good knowledge, 48.6% acceptable, and 5.0% poor, while 68.6% were classified as aware. Multivariable analysis revealed that knowledge level was the sole independent predictor of awareness: compared to poor knowledge, acceptable knowledge significantly increased awareness odds (aOR = 3.48; 95% CI: 1.12–10.80; p = 0.031), as did good knowledge (aOR = 8.65; 95% CI: 2.10–35.60; p = 0.003). These findings confirm that radiation protection knowledge strongly and independently drives awareness among clinical staff. Consequently, healthcare institutions must prioritize continuous, evidence-based radiation safety education—particularly for personnel in high-exposure units—as the foundational strategy to effectively bridge the knowledge–awareness gap and mitigate occupational radiation risks.

Beyond Technological Fixes: Plastic Pollution Pathways, Recycling Inovtions, and Governance

2026-05-01T05:28:33+00:00

The exponential growth in global plastic production over the past half-century has transformed synthetic polymers from industrial conveniences into one of the most pervasive anthropogenic pollutants on Earth. This study conducts a cross-domain systematic synthesis to evaluate the current state of plastic pollution research and recycling innovations, identifying critical knowledge gaps and strategic pathways for scalable mitigation. Following PRISMA guidelines, we systematically appraised 442 peer-reviewed systematic, scoping, and bibliometric reviews published between 1999 and 2026 across five thematic domains: Amazonian ecosystem contamination, recycling technologies, coastal tourism impacts, pyrolysis-based fuel conversion, and recycled plastics in construction. Results demonstrate widespread microplastic infiltration across remote environments alongside measurable improvements in mechanical and chemical recycling efficiency. However, commercial scalability remains constrained by feedstock heterogeneity, high capital expenditures, fragmented market demand, and a pronounced geographic imbalance in research capacity. The synthesis reveals that technological advancement alone is insufficient to resolve the crisis. Effective mitigation requires integrated governance frameworks, standardized material certifications, extended producer responsibility policies, and equity-centered implementation strategies that prioritize vulnerable communities. By consolidating fragmented evidence into a unified analytical framework, this study provides actionable insights for policymakers, industry stakeholders, and researchers. Aligning future research trajectories with global sustainability commitments is essential to transition from diagnostic awareness to measurable, systemic environmental outcomes.

Beyond Fluid Overload: Reassessing the Role of Interdialytic Weight Gain in Intradialytic Blood Pressure Dynamics

2026-06-29T09:40:22+00:00

Background: Interdialytic weight gain (IDWG) is hypothesized to drive intradialytic blood pressure instability in hemodialysis patients, yet evidence remains contradictory, particularly in low-income and middle-income countries (LMICs) bearing the highest end-stage renal disease (ESRD) burden. We evaluated the association between IDWG and intradialytic blood pressure changes in an Indonesian cohort.

Methods: In this cross-sectional study at Lavalette Hospital, Indonesia (May 2025), we enrolled 83 ESRD patients undergoing maintenance hemodialysis. IDWG was calculated as the percentage weight gain between consecutive sessions. Intradialytic blood pressure change was defined as the difference in systolic blood pressure pre- and post-dialysis. Associations were analyzed using Pearson correlation and stratified analyses.

Results: The mean age was 52·4 years (SD 12·3), with 43 (52%) women. Most participants (62 [75%]) achieved mild IDWG (<4%), while 37 (45%) maintained stable intradialytic blood pressure, 31 (37%) experienced hypertension, and 15 (18%) hypotension. Despite progressive increases in ultrafiltration rates across IDWG categories (245 to 578 mL/h; p<0·0001), mean blood pressure changes did not differ significantly (p=0·89). Crucially, Pearson analysis revealed no significant linear association between IDWG and intradialytic blood pressure changes (r=–0·209; p=0·057), with IDWG explaining only 4·4% of hemodynamic variance.

Conclusion: IDWG alone is an insufficient predictor of intradialytic hemodynamic instability. These findings challenge weight-centric monitoring paradigms, advocating for multifactorial management incorporating ultrafiltration optimization and dialysate profiling. This underscores the urgent need for context-specific, comprehensive hemodialysis quality indicators to advance Sustainable Development Goal targets in resource-constrained settings.