Bali Medical and Wellness Journal
The Bali Medical and Wellness Journal is an internationally open-access, peer-reviewed journal that aims to disseminate high-quality research and knowledge related to medical sciences and wellness practices fostering a holistic approach to health, integrating physical, mental, and social well-being. The journal accepts manuscript in English. Each manuscript is peer-reviewed by two reviewers independent on each other; the process is double-blind. All articles are published open access. The journal publishes original research articles, review articles, case reports, and clinical studies in all areas of medicine and wellness. It encourages submissions from a wide range of medical and health disciplines, including but not limited to general medicine, public health, traditional medicine, integrative medicine, wellness tourism, health economics, patient care, nursing best practices, midwifery practice, nutrition science, dietetics, population health, health policies, epidemiology, preventive medicine, and environmental health. Journal Insight The subject categories for the Bali Medical and Wellness Journal could encompass a wide range of topics within the medical wellness domain. Here are some categories: Preventive Medicine: Research on health screenings, vaccinations, and lifestyle interventions to prevent disease. Integrative Health Practices: Studies on the integration of traditional medicine with alternative therapies. Nursing in Wellness: This category would cover research on nursing practices that contribute to patient wellness, including preventive care, patient education, and chronic disease management. It would also explore the role of nurses in implementing wellness programs and interventions. Midwifery and Holistic Care: Articles in this category would focus on the holistic approach midwives take in prenatal, childbirth, and postnatal care. It would highlight the importance of midwifery in promoting natural and wellness-oriented childbirth experiences. Nutrition and Dietetics: Articles on the role of nutrition in maintaining health and preventing illness. Physical Activity and Fitness: Insights into exercise regimens and their impact on health and wellness. Mental Health: Exploration of mental health’s influence on physical well-being and vice versa. Environmental Health: Examination of how environmental factors affect health. Healthcare Policy and Management: Discussions on healthcare systems, policies, and their impact on public health. Medical Tourism: Analysis of the growing field of medical tourism and its implications for healthcare delivery. Quality of Life and Wellness: Research on factors that contribute to a high quality of life and overall wellness. Education and Training: This would include advancements in medical and health professional education that align with medical wellness principles, ensuring that future professionals are equipped with the knowledge and skills to support holistic care. These categories reflect the journal’s commitment to a holistic view of health, considering a variety of factors that contribute to medical wellness. Our journal is committed to: Promoting Preventive Healthcare: Encouraging early detection and prevention strategies through regular health screenings and check-ups. Integrating Holistic Practices: Combining traditional medical treatments with wellness therapies such as yoga, meditation, and nutrition to support comprehensive patient care. Advocating Lifestyle Changes: Supporting research on diet, exercise, and stress management to prevent and manage diseases. Fostering Mental and Emotional Well-being: Publishing studies that explore the connection between mental health and physical health, and the impact of emotional well-being on overall health. Understanding Community and Environmental Influences: Recognizing the significance of social and environmental determinants in health outcomes and promoting sustainable healthcare practices. Encouraging Interdisciplinary Collaboration: Bridging various disciplines to provide a multifaceted understanding of health and wellness. Our journal aims to cater to a diverse audience, including healthcare professionals, researchers, policymakers, and educators, who are engaged in the pursuit of enhancing health and wellness at both individual and community levels.
Articles
42 Documents
<![CDATA[Effectiveness of Puzzle Therapy as Brain Exercise in Improving Memory Function Among Older Adults with Dementia: A Case Series Study ]]>
<![CDATA[Ni Komang Matalia Gandari]]>;
<![CDATA[Ni Luh Putu Apriliani]]>;
<![CDATA[I Putu Wira Kusuma Putra]]>;
<![CDATA[I Made Rismawan]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 2 No. 3 (2025): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v2i3.49
<![CDATA[Background: Memory impairment significantly impacts the quality of life for older adults living with dementia. Non-pharmacological interventions, such as puzzle therapy, have emerged as promising, low-cost strategies for managing cognitive decline and providing environmental enrichment. Objective: To analyze the effectiveness of puzzle therapy as a brain exercise in improving memory function among older adults with moderate dementia. Methods: This case series involved three older adults (aged 74–84 years) residing at the Tresna Werdha Wana Seraya Social Institution in Bali. Participants engaged in puzzle therapy sessions lasting 10–15 minutes, conducted thrice over one week. Cognitive and memory functions were assessed using the Mini-Mental State Examination (MMSE) before and after the intervention. Results: All participants demonstrated measurable cognitive gains. Baseline MMSE scores ranging from 15 to 16 improved to post-intervention scores of 19 to 21, reflecting a consistent mean improvement of 4.0 points. Notable enhancements were observed specifically in the domains of orientation, immediate recall, and concentration. Conclusion: Puzzle therapy serves as a feasible and effective cognitive stimulation tool for improving memory function in older adults with moderate dementia. These findings support the integration of structured brain exercises into routine geriatric nursing care within institutional settings.]]>
<![CDATA[Gut Microbiota Dysbiosis in Mild Cognitive Impairment: Alzheimer’s Disease Diagnostic Potential and Nutritional Modulation ]]>
<![CDATA[Gabrielle Juliana Hartono]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i1.50
<![CDATA[Background:. Alzheimer’s disease (AD) is a progressively deteriorating neurodegenerative condition that poses a substantial burden on society. Current diagnostic methods of AD are often considered complex and costly. Mild Cognitive Impairment (MCI) is defined as the transitional stage before AD. Alterations in the gut microbiota (dysbiosis) are observed in MCI and preclinical AD and are hypothesized to contribute to disease pathogenesis. Aim: The objective of this review was to evaluate gut microbiota profiles as non-invasive, low-cost indicators and tailor diagnostic biomarkers. The diagnostic potential and the efficacy of nutritional modulation strategies across the AD continuum were assessed. Results: The mechanisms by which dysbiosis promotes neurodegeneration were analyzed, including increased intestinal permeability, Lipopolysaccharide (LPS) leakage, and reduced production of short-chain fatty acids (SCFAs). Taxonomic shifts were summarized, documenting the depletion of SCFA producers (e.g., Firmicutes) and the enrichment of pro-inflammatory genera. The quantitative performance of machine learning models utilizing microbial data for disease classification was reviewed. High predictive accuracy for AD incidence was achieved by machine learning classifiers based solely on gut microbiome profiles, with Area Under the Curve (AU-ROC) values reaching up to 0.927. Nutritional interventions, including probiotics (Lactobacillus, Bifidobacterium) and prebiotics, were found to modulate the gut effectively by enhancing SCFA production, reinforcing intestinal barrier integrity, and suppressing systemic neuroinflammation. Conclusion: Robust potential is demonstrated by gut microbial profiles as high-performance, non-invasive screening tools for early detection in the AD continuum. However, future validation is required through large-scale, long-term randomized controlled trials (RCTs) focusing on establishing causation and developing personalized gut-based therapies.]]>
<![CDATA[Effectiveness of Sandalwood Aromatherapy on Sleep Quality in Elderly Patients with Hypertension: A Gerontological Nursing Case Study at Wanaseraya Social Care Home ]]>
<![CDATA[Ni Komang Matalia Gandari]]>;
<![CDATA[Komang Ayu Widiatrini]]>;
<![CDATA[I Made Rismawan]]>;
<![CDATA[Ni Putu Cyntia Maseni]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i1.53
<![CDATA[Background: Hypertension is a major public health concern associated with increased risks of cerebrovascular and cardiovascular disease. Elderly patients with hypertension often experience poor sleep quality, which further aggravates their condition. Non-pharmacological interventions, such as aromatherapy, are increasingly recognized as effective adjuncts for improving sleep quality. Objective: This study examined the effectiveness of sandalwood aromatherapy as a non-pharmacological nursing intervention to improve sleep quality among elderly patients with hypertension residing at Wanaseraya Social Care Home, Denpasar, Bali. Methods: A qualitative case study design was employed involving three elderly patients (aged 62–65 years) with hypertension and documented sleep disturbances. The intervention consisted of sandalwood aromatherapy administered via electric vaporizer for 30 minutes nightly over three consecutive nights. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline and post-intervention. Nursing care was documented in accordance with Indonesian Nursing Standards (SDKI, SIKI, SLKI). Results: All three patients demonstrated measurable improvement in sleep quality. PSQI scores decreased from poor (6–7) to good (5) following three sessions of aromatherapy. Subjective reports indicated reduced nocturnal awakenings, faster sleep onset, and greater overall satisfaction with sleep. Conclusion: Sandalwood aromatherapy delivered via electric vaporizer is an effective, safe, and practical non-pharmacological intervention for reducing sleep disturbances in elderly hypertensive patients. Incorporating this approach into routine gerontological nursing care at social care homes is recommended.]]>
<![CDATA[The Effect of Slow Deep Breathing Combined with Classical Music on Anxiety in Elderly Patients with Diabetes Mellitus: A Gerontological Nursing Case Study ]]>
<![CDATA[Ni Putu Dita Wulandari]]>;
<![CDATA[Ni Kadek Nita Lestari]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i1.54
<![CDATA[Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. Global prevalence is rising, with an estimated 589 million cases in 2024 and a projected 853 million by 2050. Beyond physical health, DM often leads to psychological complications. Anxiety is 20% more prevalent in diabetic patients than in the general population, often resulting in poor glycemic control and a cycle of metabolic decline. Objectives: This study aims to analyze the effectiveness of combining slow deep breathing therapy with classical music as a non-pharmacological nursing intervention to manage anxiety in elderly patients with DM at Puskesmas Tabanan I. Method: A descriptive case study design was used, following the five-stage nursing process: assessment, diagnosis, planning, implementation, and evaluation. Three patients (aged 65–79 years) with a nursing diagnosis of Anxiety (SDKI D.0080) participated from December 5–7, 2025. The intervention consisted of a 60-minute session held once daily for three days. Anxiety levels were measured using the Indonesian Nursing Outcome Standard (SLKI L.09093). Results: After three sessions, all patients showed significant reductions in anxiety. Subjective findings included decreased worry and improved relaxation. Objective indicators showed reduced restlessness, less muscle tension, and the normalization of respiratory and heart rates. Additionally, patients reported higher confidence in managing their symptoms. Conclusion: Combining slow deep breathing with classical music is an effective, safe, and feasible non-pharmacological intervention for reducing anxiety in elderly diabetic patients. This approach is recommended as a complementary therapy in routine gerontological nursing care.]]>
<![CDATA[Application of Lean Ergonomics to Reduce Motion Waste, Musculoskeletal Complaints, and Work Fatigue in Tempeh MSMEs ]]>
<![CDATA[Endang Widuri Asih]]>;
<![CDATA[I G. Adiatmika]]>;
<![CDATA[I M. Muliarta]]>;
<![CDATA[I.B. Alit Swamardika]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i1.55
<![CDATA[Background: Tempeh Micro, Small, and Medium Enterprises (MSMEs) are largely home-based industries that rely on manual production processes. These manual tasks often involve inefficient movements, leading to musculoskeletal disorders and significant work fatigue. Objectives: This study aims to implement a Lean Ergonomics approach to reduce motion waste, musculoskeletal complaints, and work fatigue among workers in the tempeh industry. Method: This experimental study used a within-subject design (treatment-by-subject). The research was conducted in two phases: before improvement (P1) and after improvement (P2). Data collection involved identifying waste, analyzing work posture using the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA), measuring musculoskeletal complaints via the Nordic Body Map (NBM), and assessing fatigue levels using the Industrial Fatigue Rating Committee (IFRC) questionnaire. Results: Interventions included redesigning worktables to improve posture, implementing the 5S methodology to refine work methods, and optimizing the facility layout. The results demonstrated a significant reduction in unnecessary movements, decreasing from 15 in P1 to 7 in P2. Work posture scores improved, with RULA and REBA scores decreasing by 1.81 and 2.87, respectively. Furthermore, musculoskeletal complaints decreased by 22.4% (9.31 points), and work fatigue levels were reduced by 22.14%. Conclusion: The application of Lean Ergonomics effectively reduces motion waste, improves work posture, and lowers levels of musculoskeletal pain and fatigue. These improvements enhance overall work comfort and performance within tempeh MSMEs.]]>
<![CDATA[Efficacy of Levothyroxine (LT4) and Liothyronine (T3) Combination Therapy vs. LT4 Monotherapy for Hypothyroidism: A Meta-Analysis ]]>
<![CDATA[Gede Made Cahya Trisna Pratama]]>;
<![CDATA[Dewi Catur Wulandari]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 1 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i1.56
<![CDATA[Background: Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism, using serum thyroid-stimulating hormone (TSH) as the primary indicator of therapeutic adequacy. However, many patients remain symptomatic despite achieving normal TSH levels. Objectives: This meta-analysis evaluates the biochemical and metabolic efficacy of adding liothyronine (T3) to LT4 compared to standard monotherapy. Method: A systematic search was conducted to identify randomized controlled trials (RCTs) comparing LT4+T3 combination therapy with LT4 monotherapy in adults. TSH was the primary outcome, while secondary outcomes included free T4 (fT4), total T3, lipid profiles, and body weight. Results: Seven RCTs involving 355 participants were analyzed. Biochemical outcomes showed no significant difference in TSH suppression (P=0.40) or total T3 levels (P=0.38) between groups. Notably, LT4 monotherapy resulted in significantly higher fT4 levels (MD=0.27; 95%CI: 0.13, 0.40; P=0.0001). Regarding metabolic outcomes, combination therapy significantly improved LDL cholesterol (MD=4.79; 95%CI: 1.63, 7.96; P=0.003) with zero heterogeneity (I2=0%). A borderline significant trend toward weight reduction was also observed in the combination group (MD=-2.26; 95%CI: -4.52, 0.01; P=0.05). Conclusion: Compared to monotherapy, LT4+T3 combination therapy provides significant metabolic advantages, particularly in LDL reduction, while maintaining biochemical euthyroidism.]]>
<![CDATA[A Multisectoral Strategy for Expanding JKN Coverage: Policy Analysis and Implementation Framework ]]>
<![CDATA[Ni Luh Ayu Citra Mutiarahati]]>;
<![CDATA[Luh Verra Sridayantari]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 2 No. 1 (2025): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v2i1.29
<![CDATA[Background: The National Health Insurance (JKN) program aims to achieve universal health coverage (UHC) in Indonesia. Although participation rates have increased from year to year, data shows that around 27.8% of Indonesia's population still do not have valid health insurance. The biggest challenges are faced by areas with difficult geographical conditions such as Papua, Maluku, and parts of Sumatra. Objects: This article analyzes the multisectoral approach as a strategy to expand the coverage of JKN. Method: Using qualitative methods through literature review and policy analysis, findings show that cross-sector engagement including local government, education, social, and community sectors contributes significantly to expanding coverage. Results: The results of the analysis show that an integrated multi-sectoral strategy, adaptive to the local context, and supported by synergistic regulations is the key to accelerating the achievement of Universal Health Coverage (UHC) in Indonesia. Conclusion: Recommendations include administrative strategies in the form of Strengthening cross-sectoral governance and harmonization of regional health insurance policies to facilitate coordination between the central and regional governments. Community-Based Strategy: Involving local communities in socialization and increasing community participation in the JKN program. and Technology Strategy: Data integration and utilization of information technology to facilitate registration and increase access to health services, especially in remote areas.]]>
<![CDATA[Potassium-Competitive Acid Blockers versus Proton Pump Inhibitors for Healing of Erosive Esophagitis: A Systematic Review and Meta-Analysis ]]>
<![CDATA[Gede Made Cahya Trisna Pratama]]>;
<![CDATA[Komang Agus Wira Nugraha]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 2 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i2.59
<![CDATA[Background: Erosive esophagitis (EE) is a prevalent manifestation of gastroesophageal reflux disease that requires potent acid suppression for mucosal recovery. While proton pump inhibitors (PPIs) are the standard therapy, their efficacy is often limited by slow onset and genetic polymorphisms. Potassium-competitive acid blockers (P-CABs) have emerged as a novel alternative with superior pharmacokinetic properties. Objective: This systematic review and meta-analysis aimed to evaluate the comparative efficacy and safety of P-CABs versus PPIs in achieving mucosal healing and symptom relief in patients with EE. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted across major databases for randomized controlled trials (RCTs) published through 2025. Nine RCTs involving 2,927 participants were included. Data on healing rates at weeks 4 and 8, heartburn disappearance, serum gastrin levels, and adverse events were synthesized using fixed and random-effects models. Results: P-CABs demonstrated significant superiority in mucosal healing compared to PPIs at week 4 (OR: 1.47; 95% CI: 1.09–2.00; p=0.01) and week 8 (OR: 2.04; 95% CI: 1.41–2.95; p=0.0002). P-CABs also achieved faster heartburn disappearance (MD: -1.29 days; p=0.01). Although P-CABs resulted in higher serum gastrin levels (MD: 121.74 pg/mL; p=0.0007), safety profiles were comparable between groups with no significant differences in adverse events. Conclusion: P-CABs provide faster and more effective mucosal healing than PPIs with a comparable safety profile, representing a robust breakthrough for the management of erosive esophagitis.]]>
<![CDATA[Phenotypic Heterogeneity of Familial Hypertriglyceridemia: A Case Series of a Mother and Three Siblings with Diverse Clinical Outcomes ]]>
<![CDATA[Anak Agung Ngurah Adhipa Prasada]]>;
<![CDATA[Cyndiana Widia Dewi Sinardja]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 2 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i2.60
<![CDATA[Background: Familial hypertriglyceridemia (FHTG) is a common autosomal dominant lipid disorder characterized by elevated plasma triglycerides (TG). According to the AHA/ACC 2018 and ESC/EAS 2019 guidelines, TG levels are classified as borderline high (150–199 mg/dL), high (200–499 mg/dL), severe (500–999 mg/dL), or very severe (≥1000 mg/dL). Its clinical expression is highly variable even within the same family, influenced by secondary factors including diet, obesity, diabetes, alcohol intake, and medications. Case Description: We present a case series of four family members — a 63-year-old mother (proband) and her three children aged 28, 33, and 41 years — all exhibiting hypertriglyceridemia with markedly different TG levels (118–1061 mg/dL), comorbidity burden, and clinical outcomes. Target TG levels for therapy are <150 mg/dL (normal), or <500 mg/dL as an urgent target to prevent acute pancreatitis in patients with severe hypertriglyceridemia. All family members are currently managed with fenofibrate, with variable degrees of TG control: the mother has achieved the therapeutic target (<150 mg/dL), the first daughter and brother demonstrate persistent elevation above target despite pharmacotherapy, and the youngest daughter exhibits persistent severe hypertriglyceridemia despite pharmacotherapy (TG 1061 mg/dL, far exceeding the ≥1000 mg/dL very-severe threshold). Discussion: This family illustrates the remarkable phenotypic heterogeneity of FHTG. The proband has achieved good TG control despite significant cardiovascular comorbidities, while the youngest sibling presented with persistent severe hypertriglyceridemia complicated by pregnancy, necessitating substitution of fenofibrate with omega-3 fatty acids and lifestyle modification. The 33-year-old male sibling developed premature cardiovascular disease (microvascular dysfunction) and type 2 diabetes mellitus (T2DM) at a young age, underscoring the metabolic risks associated with persistent severe hypertriglyceridemia despite pharmacotherapy. Analysis of extended family lipid profiles — including LDL-cholesterol, HbA1c, HDL-cholesterol, and uric acid — further reveals the spectrum of atherogenic dyslipidemia within these kindred. Conclusion: Cascade screening of first-degree relatives of patients with FHTG is critical, with particular urgency in Asian populations given distinct dietary patterns and genetic predispositions to hypertriglyceridemia. Management must be individualized, particularly in special populations such as pregnant women. This case series highlights the necessity of long-term, family-centered approaches to lipid management.]]>
<![CDATA[Clinical Effectiveness of Ashwagandha in Menopause: A Systematic Review ]]>
<![CDATA[Frederick Wirawan]]>;
<![CDATA[Putu Enrico Pramana Okaniawan]]>;
<![CDATA[Isharyah Sunarno]]>
<![CDATA[ Bali Medical and Wellness Journal Vol. 3 No. 2 (2026): Bali Medical and Wellness Journal ]]>
Publisher : <![CDATA[PT BMW Journal Sejahtera ]]>
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DOI: 10.71341/bmwj.v3i2.61
<![CDATA[Background: Menopause is the natural and permanent cessation of menses, often accompanied by vasomotor symptoms that can impact a person's quality of life. Ashwagandha (Withania somnifera), also known as Indian ginseng, has been shown to ameliorate some of the symptoms associated with menopause in women, particularly climacteric symptoms. Objective: This study aimed to evaluate Ashwagandha (Withania somnifera) in reducing menopausal symptoms and improving quality of life, as measured by the Menopause Rating Scale (MRS) and the Menopause-Specific Quality of Life (MENQOL) questionnaire. Methods: A systematic review was conducted following the PRISMA guidelines, with pre-defined keywords and pre-determined inclusion and exclusion criteria. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. Results: Based on the inclusion criteria, 7 studies were identified: 4 randomized controlled trials (RCTs) and 3 non-randomized trials. The RCTs were judged to have low risk of bias, while the non-randomized trials were judged to have high (serious) risk of bias. Menopausal symptom outcomes were measured using MRS (2 studies), MENQOL (2 studies), both MRS and MENQOL (2 studies), and MENQOL with SGA (1 study). Six of the 7 studies showed significant improvement in menopausal symptoms and quality of life with the use of Ashwagandha (Withania somnifera), while the remaining study observed a tendency toward improvement but lacked a control group. Conclusion: Ashwagandha (Withania somnifera) shows potential in alleviating menopausal symptoms and improving quality of life. These findings suggest that Ashwagandha may serve as a promising non-hormonal option to support integrative healthcare for women during the menopausal stage.]]>
