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Narra J
Published by PT Narra Sains Indonesia
ISSN : -     EISSN : 28072618     DOI : https://doi.org/10.52225/narraj
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health
Narra J is a multidisciplinary journal and it is published three times (April, August, December) a year. The objective is to promote articles on infection, public health, global health, tropical infection, one health and diseases in tropics. Narra J publishes original research work across all disciplines of medicine and allied sciences, related to infection, public health, global health, tropical infection, one health and diseases in tropics. The journal publishes Original articles, Short Report, Review articles, and Letters to the Editor. All articles published in Narra J are peer-reviewed and published online for immediate access and citation. Narra J publishes the primary research papers, review articles, short communications and letters on topics but not limited to: Public health Global health Infection Tropical diseases One health Biomedical sciences Epidemiology and clinical epidemiology Molecular biology Environmental health Microbiology Pharmacological sciences Diseases in tropics
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 665 Documents
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Impact of a lean management intervention on waiting time and service efficiency in gynecologic oncology surgical services in a national referral hospital in Indonesia: An interrupted time-series study with lean waste analysis Sri DR. Syarief; Sagiran Sagiran; Elsye M. Rosa
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3100

Abstract

Long surgical waiting times in gynecologic oncology reflect operational inefficiencies and limited operating room capacity, compromising timely care and patient outcomes. This study specifically focuses on gynecologic oncology surgical services at Dr. Hasan Sadikin Hospital, Bandung, a major national referral hospital in Indonesia. It evaluated the impact of lean-based dedicated operating slots on surgical waiting times and service efficiency. A mixed-methods explanatory sequential design was applied. Quantitative data comprised 24 monthly time points (12 pre-intervention and 12 post-intervention) and were analyzed using interrupted time series analysis, while qualitative data were obtained through in-depth interviews with seven key informants to explain operational changes after the intervention. The intervention introduced one specialized operating room and nine weekly elective surgery slots dedicated to gynecologic oncology. The results demonstrated a significant reduction in mean waiting time from 8.16 weeks pre-intervention to 3.64 weeks post-intervention. Interrupted Time Series Analysis (ITSA) showed a significant immediate level reduction following implementation, with an estimated change of -2.87 weeks, indicating an immediate reduction in surgical backlog. Trend analysis further demonstrated a significant post-intervention slope change (0.48), reflecting a modification in waiting time trajectory after implementation. Although a slight upward trend was observed afterward due to surgical throughput, waiting times remained substantially lower than in the pre-intervention period. Lean Waste analysis revealed reductions in waiting, overprocessing, and inter-unit coordination inefficiencies. These findings indicate that lean-oriented dedicated operating slots improve operational efficiency, enhance patient access, and minimize systemic waste in high-volume oncology surgical services. The study provides empirical evidence supporting structured scheduling and lean principles as effective strategies for improving time-sensitive surgical care in tertiary hospitals.
Bystander alertness, responsiveness, and barriers to providing first aid for sudden cardiac arrest in Indonesia: A preliminary community-based study Yohanes K. Windi; Loetfia D. Rahariyani; Nikmatul Fadilah; Eko R. Wiyatno
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3105

Abstract

Bystanders can play a critical role in improving survival after sudden cardiac arrest (SCA), yet hesitation and inaction remain common. The aim of this study was to assess bystander alertness, responsiveness, and barriers to providing first aid for SCA in an Indonesian community setting. A cross-sectional survey was conducted among 500 residents attending four Community Health Centers in Sidoarjo District, East Java, Indonesia. A structured, self-administered questionnaire assessed recognition of heart disease, perceptions of life-threatening cardiac conditions, intended responses to SCA, types of medical aid sought, reasons for not providing first aid, and specific first-aid actions. Data were analyzed using descriptive statistics and Chi-squared tests. Overall, respondents showed limited recognition of SCA as a distinct cardiac emergency and were more familiar with heart attack and coronary disease. Although SCA is highly time-critical, it was not commonly perceived as the most life-threatening heart condition. Most respondents preferred to seek medical help rather than provide immediate first aid, while direct bystander intervention was uncommon. Among those who would not intervene, fear of being blamed, lack of knowledge, and perceived incompetence were the main barriers. Among respondents willing to help, intended actions were more commonly directed toward waking the victim or using culturally familiar practices, whereas cardiopulmonary resuscitation (CPR) was rarely reported. Significant differences were observed across all assessed response domains (p<0.001). These findings indicate low community alertness and responsiveness to SCA in this Indonesian setting. Community-based SCA education, hands-only CPR training, clearer emergency response guidance, and culturally sensitive public messaging are needed to improve bystander readiness and reduce delays in first aid.
Compassion imbalance, resilience, and depressive symptoms among older stroke survivors: A moderated–moderated mediation analysis of neuroticism, compassion, and self-compassion Aye M. Thaw; Jiranan Griffiths; Tinakon Wongpakaran; Nahathai Wongpakaran; Joshua Tsoh; Montana Buntragulpoontawee; Kitti Thiankhaw; Nopdanai Sirimaharaj
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3106

Abstract

Post-stroke depression is a frequent and clinically important complication among stroke survivors, contributing to poorer functional recovery and reduced quality of life. The aim of this study was to examine the interrelationships among neuroticism, resilience, compassion, self-compassion, and depressive symptoms in older stroke survivors. Stroke survivors aged ≥50 years were recruited from outpatient clinics at Chiang Mai University Hospital, Thailand. Participants completed standardized questionnaires assessing neuroticism, resilience, compassion, self-compassion, and depressive symptoms. Pearson correlation, multiple regression, mediation, and moderated–moderated mediation analyses were conducted to examine direct, indirect, and conditional associations among these psychological constructs. A total of 142 patients were included in the final analysis. Neuroticism was positively correlated with depressive symptoms (r=0.412, p<0.01) and negatively correlated with resilience (r=−0.311, p<0.01), whereas resilience was negatively correlated with depressive symptoms (r=−0.400, p<0.01). Mediation analysis showed that resilience partially mediated the association between neuroticism and depressive symptoms (indirect effect of 0.098, 95%CI: 0.029–0.195). This indirect association was conditional on levels of compassion and self-compassion. Compassion significantly moderated the association between resilience and depressive symptoms (B=−0.018, p=0.003), and self-compassion moderated the association between compassion and depressive symptoms (B=−0.072, p=0.019). The moderated–moderated mediation model was significant, as indicated by the index of moderated–moderated mediation (index=−0.0096, 95%CI: −0.0230 to −0.0021). The indirect pathway through resilience was strongest among participants with higher compassion for others but lower self-compassion, suggesting a pattern of compassion imbalance. These findings indicate that resilience functions within a broader emotional context, in which the balance between compassion for others and compassion toward oneself may shape vulnerability to depressive symptoms after stroke. Incorporating self-compassion-based strategies into post-stroke rehabilitation may help strengthen psychological recovery and reduce depressive symptoms among older stroke survivors.
Herbal products for the prevention and management of 5-fluorouracil-induced oral mucositis: A systematic review of preclinical evidence Pocut Astari; Dewi F. Suniarti; Erik Idrus
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3110

Abstract

Oral mucositis is a painful and dose-limiting complication of chemotherapy, particularly in patients receiving 5-fluorouracil (5-FU). Herbal products have attracted increasing interest as supportive care candidates because of their antioxidant, anti-inflammatory, anti-apoptotic, and cytoprotective properties. This systematic review aimed to synthesize preclinical evidence on the effects and mechanisms of herbal products in 5-FU-induced oral mucositis models. A literature search was conducted in PubMed, Scopus, EBSCO, ScienceDirect, and ProQuest for studies published up to March 2026, following PRISMA guidelines. Eligible studies were in vitro studies, or studies with a clearly described in vitro component, that evaluated herbal extracts, multi-herbal formulations, or naturally derived plant-based compounds in 5-FU-induced oral mucositis models. Study reliability was assessed using the ToxRTool. Seven studies were included, comprising three in vitro-only studies and four combined in vitro–in vivo experimental studies published between 2014 and 2025. The evaluated products included Daiokanzoto, Salvia miltiorrhiza, Onchung-eum, anthocyanins from Oryza sativa, FITOPROT, cannabidiol, and Camellia tea saponin. Across the included studies, herbal products were reported to improve cell viability, reduce reactive oxygen species production, suppress inflammatory mediators, inhibit apoptosis, and promote epithelial repair. The main mechanisms involved the modulation of nuclear factor kappa-light-chain-enhancer of activated B cells signaling, caspase-3 activation, the Nrf2/Keap1/ARE pathway, mitochondrial dysfunction, and ferroptosis-related markers. All included studies were classified as reliable without restrictions, with ToxRTool scores ranging from 16 to 18. In conclusion, preclinical evidence suggests that herbal products may have protective effects against 5-FU-induced oral mucositis through antioxidant, anti-inflammatory, and cytoprotective mechanisms. However, standardized in vivo studies and clinical trials are needed before their therapeutic use can be recommended.
Formaldehyde exposure risk assessment among fiberboard furniture manufacturing workers in Thailand: Comparison of TIS 2012 and EPA IRIS standards Anamai Thetkathuek; Wanlop Jaidee
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3026

Abstract

Formaldehyde exposure in medium-density fiberboard furniture manufacturing is an important occupational health concern because formaldehyde-containing resins can release hazardous airborne emissions during production processes. The aim of this study was to evaluate and compare formaldehyde exposure risks among furniture manufacturing workers using the Thai Industrial Standard (TIS) 2012 semi-quantitative model and the United States Environmental Protection Agency Integrated Risk Information System (EPA IRIS) quantitative model, and to examine the concordance between the two frameworks. A cross-sectional study was conducted among 439 workers from ten departments in a medium-density fiberboard furniture factory in Chachoengsao Province, Thailand. Work characteristics and health symptoms were collected using structured questionnaires. Full-shift personal air sampling was performed in accordance with the National Institute for Occupational Safety and Health Method 5700, and samples were analyzed by high-performance liquid chromatography. Risk characterization was conducted using TIS 2012 based on exposure rating × health effect rating, while EPA IRIS was applied to estimate non-cancer risk using the hazard quotient and lifetime cancer risk using the inhalation unit risk. Non-cancer and lifetime cancer risks were assessed using HQ and inhalation unit risk. The mean formaldehyde concentration was 5.47 mg/m³ (0.70–11.55 mg/m³), peaking in the Clearing department (11.55 mg/m³). TIS 2012 classified 80% of departments as very high risk, compared with 50% under the EPA IRIS HQ model. The EPA IRIS model showed hazard quotients ranging from 6.59 to 87.99 and lifetime cancer risks ranging from 7.72×10⁻³ to 1.27×10⁻¹, all exceeding the acceptable cancer risk threshold of 1×10⁻⁶. Concordance between the two models was 73%, with discrepancies observed in the Edging and Drilling departments. All departments had unacceptable cancer risks, indicating the need for immediate exposure-control measures. Integrating semi-quantitative and quantitative assessment frameworks is essential for comprehensive occupational risk management. Departments identified as very high risk by both models require urgent control measures and inclusion of cancer-risk assessment in routine occupational health surveillance.
Comparative study of quality of life between endometriosis patients receiving GnRH agonist and dienogest therapy: A cross-sectional study using Endometriosis Health Profile-30 (EHP-30) Iqbal A. Pravasta; Rajuddin Rajuddin; Cut M. Yeni; Dewi K. Rusly; Niken A. Utami
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3097

Abstract

Endometriosis is a chronic gynecological disease that substantially impairs quality of life. Gonadotropin-releasing hormone (GnRH) agonists and dienogest are commonly used hormonal therapies for endometriosis; however, direct comparisons of their effects on quality of life remain limited. This study aimed to compare quality of life between patients with endometriosis receiving GnRH agonist and dienogest therapy using the Endometriosis Health Profile-30 (EHP-30). A comparative cross-sectional study was conducted among 100 patients with endometriosis at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, comprising 50 patients receiving GnRH agonist therapy and 50 receiving dienogest therapy. Quality of life was assessed using the Indonesian version of the EHP-30, with higher scores indicating poorer quality of life. Between-group comparisons and multiple linear regression were performed. Patients receiving dienogest had significantly lower total EHP-30 scores than those receiving GnRH agonist therapy (20.1±9.6 vs 43.7±14.9; p<0.001). Significantly lower scores were also observed in all EHP-30 core domains and optional modules in the dienogest group (all p<0.001), with the largest differences observed in pain, control and powerlessness, and emotional well-being. In multivariable analysis, dienogest therapy remained independently associated with a lower total EHP-30 score after adjustment for demographic and clinical factors (β=−23.625; 95%CI: −28.803 to −18.447; p<0.001). This study highlights that dienogest therapy was associated with better quality of life than GnRH agonist therapy among patients with endometriosis. These findings support the consideration of dienogest as a patient-centered hormonal option when quality of life is a major treatment priority.
Associations of demographic, anthropometric, and laboratory factors with Korean Thyroid Imaging Reporting and Data System (K-TIRADS) ultrasonographic risk stratification in patients with thyroid nodules Siti Nafisah; Indrita Iqbalawati; Hendra Zufry; Iskandar Zakaria; Rini Safitri
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3102

Abstract

Thyroid nodules are commonly detected by ultrasonography and require standardized imaging-based risk stratification. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) classifies thyroid nodules according to ultrasonographic features associated with suspected malignancy; however, factors associated with higher K-TIRADS classification remain incompletely understood. The aim of this study was to evaluate the associations of demographic, anthropometric, and laboratory factors with K-TIRADS ultrasonographic risk stratification in patients with thyroid nodules. A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Adult patients with clinically suspected thyroid nodules were included using total sampling. Thyroid ultrasonography was performed using a standardized protocol, and nodules were classified according to the 2021 K-TIRADS. Demographic, anthropometric, and laboratory factors included age, sex, body mass index (BMI), and serum thyroid-stimulating hormone (TSH) level. Generalized estimating equations (GEE) were used to assess associations while accounting for clustering of multiple nodules within the same patient. A total of 109 patients with 171 thyroid nodules were included. Most patients were female (81.7%), with a median age of 46 years (IQR 34–59). Most nodules were classified as K-TIRADS 3 (48.0%) or K-TIRADS 4 (35.7%). Univariate analyses suggested that age was significantly associated with higher K-TIRADS classification (β=0.010; 95%CI: 0.003–0.018; p=0.008), whereas sex, BMI, and serum TSH level were not significant. In multivariable analysis, increasing age (β=0.010; 95%CI: 0.002–0.018; p=0.012) and higher serum TSH level (β=0.007; 95%CI: 0.002–0.011; p=0.002) were independently associated with higher K-TIRADS classification. No significant associations were observed for sex or BMI. The findings highlight that increasing age and higher serum TSH level were independently associated with higher K-TIRADS ultrasonographic risk stratification in patients with thyroid nodules. Selected demographic and laboratory factors may complement the ultrasonography-based classification system.
Positive self-talk as a protective factor in the relationship between perceived stress and depressive symptoms among Myanmar migrant workers: A cross-sectional study Mi M. Maung; Tinakon Wongpakaran; Peerasak Lerttrakarnnon; Shirley Worland; Nahathai Wongpakaran; Justin DeMaranville
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3111

Abstract

Myanmar migrant workers in Thailand experience multiple migration-related stressors that may increase their vulnerability to depressive symptoms. Positive self-talk may support coping and has been associated with lower depressive symptoms, but evidence on the role of self-talk loudness remains limited. This study examined whether positive self-talk frequency and loudness were associated with depressive symptoms among Myanmar migrant workers in Chiang Mai, Thailand, after accounting for sociodemographic factors, perceived stress, and personality traits. A cross-sectional study was conducted among Myanmar migrant workers aged 20–58 years. Participants completed validated self-report measures of depressive symptoms, perceived stress, personality traits, and positive self-talk frequency and loudness. Hierarchical multiple regression was conducted in four blocks: sociodemographic variables, perceived stress, personality traits, and positive self-talk frequency and loudness. A total of 204 migrant workers were included. Sociodemographic variables explained 8.1% of the variance in depressive symptoms (R²=0.081, p=0.008). The addition of perceived stress significantly improved the model (ΔR²=0.213, p<0.001), followed by personality traits (ΔR²=0.106, p<0.001). Positive self-talk frequency and loudness contributed further incremental variance (ΔR²=0.107, p<0.001), resulting in a final model that explained 50.7% of the variance in depressive symptoms (R²=0.507, adjusted R²=0.471). In the final model, perceived stress (β=0.226, p=0.001) and neuroticism (β=0.340, p<0.001) were positively associated with depressive symptoms, whereas positive self-talk frequency (β=−0.292, p<0.001) and self-talk loudness (β=−0.152, p=0.011) were negatively associated with depressive symptoms. These findings suggest that positive self-talk frequency and loudness provide additional explanatory value beyond perceived stress and personality traits and may represent relevant cognitive correlates of depressive symptoms among Myanmar migrant workers.
Real-world effectiveness of a topical dihydroavenanthramide D formulation for chronic pruritus: A multicenter clinical study with molecular evidence of pruritogenic pathway modulation Simone Ribero; Mario Vaccaro; Francesco Borgia; Carlo Mattozzi; Edoardo Zattra; Alessandra Mattiucci; Piercarlo Minoretti
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3116

Abstract

Chronic pruritus is a prevalent and clinically burdensome condition that substantially impairs quality of life and is sustained by complex interactions between neuro-immune signaling and epidermal barrier dysfunction. Central mediators implicated in this pruritogenic network include interleukin-4 (IL-4), interleukin-13 (IL-13), interleukin-31 (IL-31), substance P encoded by TAC1, and nerve growth factor (NGF). The aim of this study was to evaluate the real-world effectiveness of a topical formulation containing dihydroavenanthramide D (DHAvD), a neurokinin-1 receptor inhibitor, in combination with barrier-repairing agents for reducing pruritus severity in patients with chronic pruritus of diverse etiologies. A supportive molecular sub-study was also performed to determine whether clinical improvement was accompanied by modulation of cutaneous pruritogenic gene expression. A prospective, single-arm, multicenter clinical study was conducted in 1,000 patients with chronic pruritus of diverse etiologies. The formulation was applied twice daily for 14 days, and pruritus severity was assessed using the 12-Item Pruritus Severity Scale (12-PSS; range 3–22). In a molecular sub-study, 20 patients with chronic idiopathic pruritus underwent paired skin biopsies from symptomatic areas before and after treatment, and cutaneous mRNA expression of IL4, IL13, IL31, TAC1, and NGF was quantified by qRT-PCR. The mean 12-PSS score decreased from 11.37±3.71 at baseline to 5.64±2.87 at day 14 (d=−1.72; p<0.001), and 55.4% of participants achieved a ≥50% reduction in pruritus severity. The reduction in symptom severity was consistent across etiological subgroups (p=0.787). A clinically meaningful reduction was also observed among patients treated with the cream as monotherapy, with 12-PSS scores decreasing from 10.44±3.78 to 5.06±2.62 (d=−1.53; p<0.001). In the molecular sub-study, significant downregulation of all five target genes was observed, with effect sizes ranging from d=−0.62 for IL4 (p=0.013) to d=−2.64 for NGF (p<0.001). In conclusion, topical DHAvD combined with barrier-repairing agents was associated with clinically meaningful real-world reduction in chronic pruritus severity and supportive molecular evidence of multi-target pruritogenic pathway modulation. These findings warrant confirmation in randomized vehicle-controlled trials.
Development and preclinical evaluation of an Aceh kelulut honey-based hydrocolloid dressing for wound healing Muhammad IA. Putra; Khairan Khairan; Izza Chairani; Binawati Ginting; Kartini Hasballah; Reno K. Kamarlis; Mudatsir Mudatsir; Syamsul Rizal; Mirnasari Amirsyah; Muhammad Diah
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3121

Abstract

Honey has long been used in wound care because of its antibacterial and anti-inflammatory properties, while hydrocolloid dressings provide a moist and protective environment that supports tissue repair. This study aimed to evaluate the macroscopic and microscopic effects of an Aceh kelulut honey–based hydrocolloid dressing on wound healing in mice. Twenty-seven healthy male mice (Mus musculus) were assigned to three groups: control treated with 0.9% NaCl, pure Aceh kelulut honey (KH), and Aceh kelulut honey–based hydrocolloid (KHHC). Two full-thickness excisional wounds, each 4 mm in diameter, were created on the dorsal skin of each mouse. Wound diameter was measured daily for 14 days. Histopathological evaluation was performed on days 3, 7, and 14 to assess neutrophil and macrophage counts, epithelialization ratio, myofibroblast ratio, and collagen fiber density. The KHHC group showed faster macroscopic wound closure than the KH and control groups. Significant differences were observed among groups in neutrophil count, macrophage count, epithelialization ratio, myofibroblast ratio, and collagen fiber density. KHHC reduced inflammatory cell infiltration, increased myofibroblast ratio, and enhanced collagen fiber density, suggesting accelerated wound contraction and tissue remodeling. However, epithelialization was lower in the KHHC group during the early healing phase. These findings indicate that Aceh kelulut honey–based hydrocolloid dressing may improve several key aspects of wound healing, particularly inflammation control, wound contraction, and collagen deposition. Further studies are required to optimize the formulation and clarify its effect on reepithelialization.

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