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All Journal Journal of Biomedicine and Translational Research JOURNAL OF HEALTHCARE TECHNOLOGY AND MEDICINE The Indonesian Biomedical Journal Jurnal Keperawatan dan Fisioterapi (JKF) Jurnal Kesmas dan Gizi (JKG) JURNAL FARMASIMED (JFM) JURNAL MUTIARA NERS NURSING UPDATE JURNAL ILMIAH ILMU KEPERAWATAN PREPOTIF : Jurnal Kesehatan Masyarakat Excellent Midwifery Journal Jurnal Multidisiplin Madani (MUDIMA) Formosa Journal of Sustainable Research (FJSR) Indonesian Nursing Journal of Education and Clinic (Jurnal Pendidikan dan Praktik Keperawatan Indonesia) Jurnal Pengmas Kestra (JPK) Jurnal ABDIMAS MUTIARA Jurnal Indah Sains dan Klinis Tour Health Journal Medistra Medical Journal (MMJ) JURNAL TEKNOLOGI, KESEHATAN DAN ILMU SOSIAL
Karnirius Harefa
Institut Kesehatan Medistra Lubuk Pakam
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Civil Engineering, Building, Construction & Architecture Computer Science & IT Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Education Engineering Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Physics Public Health Social Sciences Other

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Analysis of the Implementation of Maryam Exercise in Prenatal Classes to Increase the Rate of Normal Deliveries at Fahri Mutiara Clinic, Asahan Regency, in 2025 FAHRI YANTI; Karnirius Harefa; Raisha Octavariny
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/p751aq56

Abstract

Background: The childbirth process is an emotional experience that involves both physical and psychological mechanisms in mothers giving birth. Normal delivery is often a tense event for most women. A mother, especially one experiencing her first pregnancy (primigravida), tends to feel fear when facing childbirth because it is her first experience. When this fear arises, the brain automatically triggers the body to anticipate pain, making the pain during labor feel more intense. Each individual’s anxiety reaction varies depending on personality, emotional condition, level of understanding, cultural background, family support, education, and prior experiences. Objective: This study aims to describe and analyze the implementation of the Maryam exercise in prenatal classes to increase the rate of normal deliveries at the Fahri Mutiara Clinic, Asahan Regency, in 2025. Methods: qualitative with a case study approach, focusing on gathering detailed information. Result: Based on interviews with informants (IF1–IF7), pregnant women’s perceptions of the benefits of the Maryam exercise at Fahri Mutiara Clinic were very positive. This exercise was considered helpful in preparing both physically and mentally for childbirth. The motivation of pregnant women to participate was driven by the desire to give birth normally, reduce anxiety, and maintain the health of both mother and baby, supported by their husbands, healthcare workers, and the surrounding environment. Conclusion: The role of the midwife instructor was highly significant as a guide, motivator, and educator throughout the sessions. Mothers who regularly participated in the exercise reported calmer childbirth experiences, better breath control, and smoother labor without complications, along with increased inner peace and self-confidence.
Impact Analysis of the Tiered Referral System Implementation on Outpatient Visit Reduction at Dr. Ferdinand Lumban Tobing Hospital, Sibolga Sidabutar, Syuryanty; Karnirius Harefa; Tati Murni Karo-Karo
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/aykm3z30

Abstract

Health is a fundamental right and an important indicator of a country’s development. The Indonesian government, through the National Health Insurance (JKN) program administered by BPJS Kesehatan, has implemented a tiered referral system to improve the efficiency and quality of healthcare services. This study aims to analyze the impact of implementing the tiered referral system on outpatient visits at RSUD Dr. Ferdinand Lumban Tobing Sibolga, as well as its implications for hospital services, resources, and management. This study employed a quantitative analytic comparative design using a cross-sectional approach combined with retrospective secondary data analysis from 2013 to 2023. The sample included all outpatient visit data using total sampling. Data analysis was conducted using univariate analysis to describe data distribution and bivariate analysis with a paired t-test to examine differences in visits before and after the implementation of the tiered referral system. The results showed a decrease in outpatient visits by 11.31% (from 74,310 to 65,902 visits), with most mild cases being handled at primary healthcare facilities (FKTP), while the hospital managed more complex cases. Hospital revenue remained stable due to an increase in specialized services. Implementation challenges included inappropriate referrals, patient perceptions of complicated referral procedures, long waiting times, and differences in service between JKN and non-JKN patients, which affected patient satisfaction and healthcare-seeking behavior. In conclusion, the tiered referral system has multidimensional impacts on hospitals and patients. Strengthening coordination among healthcare facilities, enhancing the capacity of healthcare workers, and providing education and socialization to the community are necessary to improve patient understanding, satisfaction, and the effective utilization of healthcare services.
Factors Associated with Husbands' Participation in the Family Planning Program Yustina, Eka; Gurusinga, Rahmad; Raisha Octavariny; Karnirius Harefa; Reni Aprinawaty Sirait
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/wa4z5t57

Abstract

Husband participation in family planning (FP) programs is a key factor in the success of population control and the improvement of family reproductive health. However, the level of husband involvement in FP programs in Indonesia remains relatively low and is influenced by various factors. This study aims to analyze the relationship between knowledge, attitudes, the role of health workers, and sociocultural factors with husband participation in family planning programs. This study employs a quantitative research design with a cross-sectional approach. The study population consists of married couples of reproductive age, with the sample selected using purposive sampling. Data collection was conducted using a structured questionnaire. Data analysis was performed using univariate and bivariate methods with the chi-square test, as well as multivariate analysis using multiple logistic regression to identify the dominant factors influencing husbands’ participation in family planning programs. The results indicate a significant relationship between knowledge, attitudes, and sociocultural factors and husbands’ participation in family planning programs (p < 0.05). Meanwhile, health workers did not show a significant association with husbands’ participation (p > 0.05). The knowledge variable was the factor most strongly associated with husbands’ participation in the family planning program, with a 1.65-fold higher likelihood of participating compared to husbands with lower knowledge levels, whereas attitudes and sociocultural factors did not show a significant influence after controlling for other variables. This study indicates that husbands’ participation in family planning programs is influenced by individual and environmental factors, particularly husbands’ knowledge regarding family planning. Therefore, efforts to enhance education and outreach focused on husbands, as well as sociocultural approaches involving families and communities, are needed to increase men’s involvement in family planning programs.
The Role of Management Functions in Enhancing Community Empowerment for Stunting Prevention in Batu Bara District Sianturi, Herlina; Reni Aprinawaty Sirait; Raisha Octavariny; Karnirius Harefa
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/zssjx722

Abstract

A Stunting remains a major public health problem in Indonesia, including in Batu Bara District. The success of stunting reduction is not only determined by technical interventions but is also influenced by the effectiveness of management functions and the level of community empowerment. This study aims to analyze the effect of basic management functions on community empowerment in stunting prevention efforts in the working area of the Batu Bara District Health Office. This study employed an analytical quantitative design with a cross-sectional approach. The population consisted of 250 stunting program implementers and posyandu cadres, with a sample of 167 respondents selected using proportional random sampling. Data were collected through a structured questionnaire that had been tested for validity and reliability. Data analysis was conducted using univariate, bivariate (Chi-square test), and multivariate (logistic regression) analyses. The results showed that all aspects of management functions planning, organizing, actuating, and controlling, had a significant effect on community empowerment (p < 0.001). The most dominant variable was controlling (PR = 5.84), followed by actuating (PR = 5.70), planning (PR = 4.32), and organizing (PR = 3.23). In conclusion, management functions play an important role in enhancing community empowerment in stunting prevention. Therefore, strengthening management functions, particularly in controlling and actuating, is necessary to improve the effectiveness of stunting prevention programs.
The Provision of Communication and Emotional Support by Drug Swallowing Supervisors (DSS) in the Treatment Success of Pulmonary Tuberculosis Nasution, Ferani; Sirait, Reni Aprinawaty; Harefa, Karnirius
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/d73dfk04

Abstract

Pulmonary tuberculosis (TB) remains a major public health concern, with treatment success rates that have not yet reached optimal levels. The success of TB treatment is not solely determined by the availability of anti-tuberculosis drugs, but is also influenced by the quality of support provided by Drug Swallowing Supervisors (DSS), particularly in terms of communication and emotional support. This study aimed to analyze the effect of DSS communication and emotional support on the success of pulmonary TB treatment at the Simangalam Public Health Center in 2025. This study used an explanatory research design with a cross-sectional approach and was conducted from October to December 2025. The study population consisted of 327 pulmonary TB patients, with a sample of 150 respondents selected through purposive sampling. Data were collected using structured questionnaires and medical records. Data analysis included univariate descriptive analysis, bivariate analysis using the chi-square test, and multivariate analysis using binary logistic regression with a 95% confidence level. The results showed that the treatment success rate of pulmonary TB was 64.0%. DSS communication had a statistically significant effect on treatment success (p-value=0.001; OR=6.644), , indicating that good communication increased the likelihood of successful treatment by approximately seven times. In contrast, emotional support did not show a significant effect. Effective communication plays a crucial role in improving patient adherence, whereas the limited impact of emotional support may be due to the long duration of TB treatment, reducing its effectiveness if not provided consistently. In conclusion, DSS communication is the most influential factor in the success of pulmonary TB treatment. It is recommended that public health centers enhance DSS capacity through training and implement standardized communication procedures.
Analysis of the Leadership Style of the Intensive Care Unit Head Nurse on the Quality of Nursing Services at Grandmed Hospital Lubuk Pakam Syaputra Tarigan, Romi; Karnirius Harefa; Tati Murni Karo Karo
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/gj90sj36

Abstract

Leadership is the process of directing and influencing individuals to enhance motivation in achieving organizational goals; therefore, the role of a leader is a crucial factor in determining the success of service quality. The head nurse of the Intensive Care Unit (ICU) has a strategic responsibility in improving the quality of nursing services through the implementation of various leadership styles, including democratic, authoritarian, laissez-faire, transactional, and transformational styles, as well as through supervisory functions as part of the actuating function to ensure that all programs are carried out effectively and efficiently. This study aimed to analyze the leadership style of the ICU head nurse and its relationship with the quality of nursing services at Grandmed Hospital Lubuk Pakam. This research employed a quantitative non-experimental design with a descriptive correlational approach and a cross-sectional method. The study was conducted at Grandmed Hospital Lubuk Pakam with a total population of 68 respondents, and the sampling technique used was non-probability sampling. The results showed a significant relationship between the leadership styles (democratic, authoritarian, laissez-faire, transactional, and transformational) of the ICU head nurse and the quality of nursing services. It can be concluded that each leadership style has its own strengths and weaknesses; however, the appropriate application of leadership style by the ICU head nurse contributes to improving the quality of nursing care provided to patients.
Analysis of ELSIMIL Service Utilization to Increase Knowledge on Stunting Prevention among Prospective Brides at the Tebing Tinggi Family Planning Extension Center Berutu, Helminawati; Harris Rambey; Raisha Octavariny; Karnirius Harefa; Elvi Era Liesmayani
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/27wen316

Abstract

Poor nutritional status in prospective brides is one of the causes of stunting that needs to be identified early. Therefore, the ELSIMIL application was developed to detect stunting risk factors in prospective brides. This study aims to analyze the utilization of ELSIMIL services to increase knowledge about stunting prevention in prospective brides. This mixed-methods study employed a sequential mixed methods strategy, primarily an explanatory sequential strategy. The study population was 98, and accidental sampling resulted in a sample size of 32. Five informants participated in the study. Data validity was validated through triangulation. Quantitative data collection using questionnaires was analyzed using the chi-square test and logistic regression. Qualitative data collection using in-depth interviews was analyzed and discussed in narrative form. Results showed that of the eight variables, one variable (age) was not significantly related. Through logistic regression testing, the most dominant variable was information, with a p-value of 0.010 and Exp(B) of 28.095. Qualitative results showed that prospective brides and grooms who were introduced to the ELSIMIL app, provided with information on how to use the app, provided educational information within the app, and received ELSIMIL service support increased their knowledge and understanding of stunting prevention. In conclusion, utilizing ELSIMIL services can improve prospective brides and grooms' knowledge of stunting prevention. It is hoped that staff at the Family Planning Extension Center can expand their educational reach through youth social forums to make the delivery process more relaxed and easily understood by young prospective brides and grooms.
The Influence of Knowledge Level, Attitudes, and Socialization on Participation in the Social Security Administering Body (BPJS) in the Working Area of Bandar Jaya Public Health Center, Lahat Regency Hermira Sandirka; Karnirius Harefa; Sri Melda Br. Bangun
JURNAL KESMAS DAN GIZI (JKG) Vol. 8 No. 2 (2026): Jurnal Kesmas dan Gizi (JKG)
Publisher : Fakultas Kesehatan Masyarakat Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/xry59j23

Abstract

Active participation in BPJS is an important indicator of the successful implementation of the National Health Insurance (JKN) program. Although membership coverage is relatively high, inactive participants are still identified. This study aimed to analyze the influence of knowledge level, attitudes, and socialization on BPJS participation in the working area of Bandar Jaya Public Health Center, Lahat Regency.This study employed a quantitative approach with an analytical observational design and a cross-sectional method. The study population consisted of 9,400 household heads, with a sample of 97 respondents selected using simple random sampling. Data were collected through questionnaires and analyzed using the Chi-Square test and multiple logistic regression at a significance level of 0.05.The results showed that knowledge level was significantly associated with BPJS participation (p = 0.002), attitudes were significantly associated with BPJS participation (p = 0.001), and socialization was significantly associated with BPJS participation (p = 0.000). Multivariate analysis revealed that socialization was the most dominant factor influencing active BPJS participation (OR = 5.12; 95% CI = 1.89–13.86; p = 0.001), followed by attitudes (OR = 4.38; p = 0.004) and knowledge level (OR = 3.96; p = 0.011).It can be concluded that knowledge level, attitudes, and socialization significantly influence BPJS participation, with socialization as the most dominant factor. Therefore, strengthening sustainable and community-based socialization strategies is necessary to increase active BPJS participation.
Anti-Inflammatory Potential of Combined Turmeric Rhizome Extract (Curcuma longa L.) and Hydroxyapatite in Male White Mice (Mus musculus) Ritonga, Ahmad Hafizullah; Amelia, Fatma; Herlina, Herlina; Aritonang, Barita; Harefa, Karnirius
Jurnal FARMASIMED (JFM) Vol 8 No 2 (2026): Jurnal Farmasimed (JFM)
Publisher : Fakultas Farmasi Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/garnbm90

Abstract

Inflammation is a protective response of the body to tissue injury that needs to be controlled to prevent further damage. The use of nonsteroidal anti-inflammatory drugs is effective; however, it has the potential to cause side effects, so safer alternatives are needed. Turmeric rhizome (Curcuma longa L.) is known to have anti-inflammatory activity, while hydroxyapatite (HA) is biocompatible and has the potential to enhance the effectiveness of the combination. This study aims to evaluate the anti-inflammatory potential of the combination of turmeric rhizome ethanolic extract and HA in male white mice (Mus musculus). This research method uses an experimental design with an acute inflammation model induced by intraplanar injection of 1% carrageenan. A total of 25 mice were divided into five groups: negative control (0.5% Na-CMC), positive control (diclofenac sodium), and three treatment groups at 0.5%, 1%, and 1.5%. Edema volume was measured every 1 hour for 6 hours and analyzed using the Kruskal-Wallis test followed by a post hoc test. The results of this study showed that all treatment groups exerted anti-inflammatory effects compared to the negative control, as indicated by decreases in edema volume and the percentage of inflammation and increases in the percentage of inhibition of inflammation, with the 1.5% concentration showing the most optimal effect. These findings indicate that the combination of turmeric rhizome ethanolic extract and HA has potential as an effective anti-inflammatory agent in male white mice.
The Influence of Activated Carbon Produced from Duck Eggshells as an Adsorbent for Free Fatty Acid Content of Used Cooking Oilc Aritonang, Barita; Ritonga, Ahmad Hafizullah; Harefa, Karnirius; Herlina, Herlina; Wiratma, Dicky Yuswardi
Jurnal FARMASIMED (JFM) Vol 8 No 2 (2026): Jurnal Farmasimed (JFM)
Publisher : Fakultas Farmasi Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/r6vzyw08

Abstract

The repeated use of cooking oil can lead to a decline in oil quality and an increase in free fatty acid (FFA) levels, which may pose adverse health effects when consumed continuously. Therefore, an effective, safe, and sustainable purification method is required to improve the quality of used cooking oil. This study aims to evaluate the effectiveness of activated carbon derived from duck eggshell waste in reducing FFA levels in used cooking oil. The research employed a laboratory experimental method with a post-test only control group design. Samples of used cooking oil were selected purposively based on a level of degradation representative of real conditions. The preparation of activated carbon began with the carbonisation of duck eggshells, followed by chemical activation using a 3 M phosphoric acid (H₃PO₄) solution to enhance surface area and adsorbent porosity. The resulting activated carbon was then applied in the adsorption process of used cooking oil. FFA levels were analysed using the alkalimetric titration method. The results showed that the activated carbon significantly reduced FFA levels from 1.57% to 0.22%, with a reduction efficiency of 75%. This final value complies with the quality standard for cooking oil according to SNI 3741:2013 (≤0.3%). Furthermore, the produced activated carbon exhibited favourable characteristics, as indicated by a high iodine adsorption capacity and well-developed pore structure. In conclusion, activated carbon derived from duck eggshells is effective as an adsorbent for reducing FFA levels in used cooking oil and shows strong potential as an environmentally friendly and economically valuable solution.
Co-Authors A.Dachi, Rahmat Abdi Lestari Sitepu Agnes Silvina Marbun Ahmad Hafizullah Ritonga Amelia, Fatma Andriani Harianja, Bulan Annisa Nabila Ardianto Saputra Aritonang, Barita Bahdin Nur Tanjung Bancin, Dewi R. Berampu, Sabirin Berutu, Helminawati Bintang, Siti Sarah Bintang, Siti Sarah Bintang Sarah Br Siagian, Khairunnisa Brahmana, Netti Etalia Br. Cahayani Zebua, Kristian Chatarina Umbul Wahyuni CHRESNANDO GINTING, JOE Christiani N Daely, Ruth Cut Nurjulianti Dani Hafiz Utomo Daniel Ginting Debi Meilani Desideria Yosepha Ginting Dian Christy Rahayu Dicky Yuswardi Wiratma Dwi Handayani Elisabeth Purba, Ivan Elvida Rahmi Elvida Rahmi Zein Emi Juniarita Br. Barus Evawani Martalena Silitonga Evi Martina, Siska FAHRI YANTI Fikrih Utama, Rezza Frida Lina Tarigan Gandaria Purba, Anita Sri Ginting, Raynald Ignasius Ginting, Rosita Gultom, Rumondang Handayani, Diah Tri Harahap, Fitri Ramadani Harahap, Hasni Yaturramadhan Hariyati Wahyuni Harris Rambey Hasibuan, Eva Kartika Helvi Herlina Herlina . Herlina H Herlina Herlina Hermira Sandirka Hestina Hutajulu, Johansen Ihsan Ihsan Ika Nursaputri Irmayani Irmayani Jehaman, Isidorus Junita Karokaro, Tati Murni Kesaktian Manurung Ketaren, Otniel Khairil Akbar Liesmayani, Elvi Era Lukman Hakim Manik, Tumpak Rudi Aman Manurung, Tetty Grace Manurung Marbun, Agnes Silvina Marlindawani, Jenny Mestika Lumbantoruan MHD Yoppy Monika Helen Sinaga Myrnawati N.C Sitanggang, Margaretha Nababan, Donal Nasution, Ferani Novita Br. Ginting Munthe Purba, Kristin Eliana Purba, Novandi Rahmad Gurusinga Rahmat Alyakin Dakhi Raisha Octavariny Ramadani Sitepu Reni Aprinawaty Sirait Rinco Siregar Riri Safitri Ritonga, Tintin Insani Hartuti Rizka Mutiara Rohana, Taruli Romi Syahputra Tarigan Roslianizar, Syarifah Rotua Sumihar Sitorus Rumapea, Fina Sabirin Berampu Sagala, Erlina Bernadet Sari, Yuli Permata Siagian, Mindo Tua Siahaan, Marlinewati Sianturi, Herlina Sianturi, Theodora R. Sidabutar, Syuryanty Silitonga, Evani Martalena SILITONGA, EVAWANI Simamora, Artha Simarmata, Pratiwi Simson Sinuhaji Sinabutar, Theresia Yuni Florensia Sinaga, Arman Bemby Sirait, Reni Aprinawaty Siregar, Hesti Despita Siti Sarah Bintang Sitorus, Binsar Sitorus, Mido Ester Sri Melda Br. Bangun Sri Wulan, Sri Suharyanisa Sumarjon Syamsudin Syaputra Tarigan, Romi Syara, Arfah May Tati Murni Karo Karo Teja Kesuma Theresia Yuni Florensia Sinabutar Titin Novayanti Dey Togatorop, Lamtiar Betty Ulina Purba, Sri Vierto Winda Alfiana Yosepha Ginting, Desideria Yulia Mehatte Yustina, Eka