Background: Cervical cancer is the fourth most common malignant cancer among women after breast, colorectal, and lung cancers. Pap smear has been recognized as an effective strategy for reducing the incidence and mortality rate of cervical cancer. This study aimed to investigate the determinants of Pap smear utilization for cervical cancer early detection in women of reproductive age using path analysis model. Subjects and Method: This was an analytic observational study with a case-control design. The study was conducted in Cilongok and Ajibarang Sub-districts, Banyumas, Central Java, from January 3 to February 3, 2018. A total sample of 200 women reproductive age was selected for this study by fixed disease sampling. The dependent variable was Pap smear utilization. The independent variables were education level, attitude, perception on the quality health care, access to the health center, family support, peer support, and health personnel support. The data were collected by questionnaire and analyzed by path analysis. Results: Pap smear utilization was positively and directly associated with education (b = 2.63; 95% CI= 1.77 to 3.48 p<0.001), perception on quality of health care (b= 1.04; 95% CI= 0.22 to 1.86; p= 0.012), attitude (b= 1.48; 95% CI= 0.51 to 2.44 p= 0.003), access to health center (b=1.02; 95% CI= 0.20 to 1.84 p= 0.015), family support (b= 1.29; 95% CI= -0.22 to 2.61; p= 0.029), and health personnel support (b= 2.02; 95% CI= 0.60 to 3.45 p= 0.005). Pap smear utilization was indirectly associated with peer support through perception on quality health care (b = 0.66; 95%= -0.01 to 1.33 p = 0.031). Conclusion: Education, perception on quality of health care, attitude, access to health center, family support, and health personnel support are directly associated with Pap smear utilization.

Background: Globally, one in four children under the age of five suffers from stunting. Stunting is associated with an underdeveloped brain, with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood, reduced earnings and increased risks of nutrition-related chronic diseases, such as diabetes, hypertension, and obesity in future. This study aimed to analyze prenatal factors associated with the risk of stunting in Nganjuk, East Java, using a multilevel analysis. Subjects and Method: This was an analytic observational study with a case control design. The study was conducted at 25 posyandus (integrated health posts) in Nganjuk, East Java, from June 03 to July 07, 2018. Posyandu was selected by stratified random sampling. A sample of 225 children under five was selected by fixed disease sampling, consisting of 75 stunted children and 150 normal children. The dependent variable was stunting. The independent variables were birth length, maternal height, and family size. The data were collected by questionnaire and analyzed by a multilevel logistic regression run on Stata 13. Results: The risk of stunting increased with maternal height <150 cm (b= 2.59; 95% CI= -0.75 to 4.42; p= 0.006), birth length <48 cm (b=4.17; 95% CI= 2.19 to 6.15; p<0.001), and large family size (b= 2.31; 95% CI= 0.34 to 4.29; p= 0.022). Posyandu had a contextual effect on stunting with ICC= 63.39%. Conclusion:The risk of stunting increases with maternal height <150 cm, birth length <48 cm, and large family size. Posyandu has a sizeable contextual effect on stunting.

Background: Anxiety and pain are physiologic symptoms experienced by mothers during birth delivery. However, if these symptoms are not well-managed they can cause low birth weight, prematurity, prolonged labor, and postpartum depression. This study aimed to analyze the psychosocial factors associated with anxiety and delivery pain. Subjects and Method: This was an analytical observational study with cross sectional design. The study was conducted at Gajahan community health center, Surakarta Hospital, and Muhammadiyah Hospital, Delanggu, Central Java, from December 2017 to January 2018. A total sample of 166 delivery mothers were selected for this study by purposive sampling. The dependent variables were anxiety and delivery pain. The independent variables were parity, psychological stress, coping mechanism, family income, and family support. The data were collected by questionnaire. Anxiety was measured by modified Pregnancy Related Anxiety Questionaire (PRAQ_R). The data were analyzed by path analysis. Results: Delivery pain increased with higher anxiety (b= 0.30, SE= 0.02, p<0.001). Anxiety decreased with higher delivery pain (b = -1.19, SE= 0.02, p<0.001) and increased with higher stress (b = 0.92, SE= 0.09, p<0.001). Anxiety decreased with coping mechanism (b = -0.31, SE = 0.08, p<0.001) and parity (b= -0.86, SE= 0.37, p<0.001). Stress decreased with better coping mechanism (b= -0.48, SE= 0.08, p<0.001), higher family income (b = -0.16, SE = 0.04, p<0.001), parity (b= -2.13, SE= 0.36, p<0.001), and stronger family support (b = -0.22, SE = 0.06, p=0.007). Coping mechanism increased with parity (b = 1.39, SE = 0.33, p<0.001) and strong family support (b= 0.46, SE= 0.06, p<0.001). Conclusion: Delivery pain increases with higher anxiety. Anxiety associated with delivery pain, stress, and coping mechanism.

Background: Globally, pneumonia is an infectious disease with high morbidity and mortality rates. It causes one of five deaths in children under five years old worldwide. Approximately 61 million new cases of pneumonia in Sout East Asia occur annually. This study aimed to examine risk factors of pneumonia among children under five in Karanganyar, Central Java. Subjects and Method: This was an analytic observational study with case control design. The study was conducted in Karanganyar District, Central Java, from October to November, 2017. Study subjects were selected by fixed disease sampling consisting of 68 children under five years old with pneumonia and 136 without pneumonia. The dependent variable was pneumonia. The independent variables were nutritional status, exclusive breastfeeding, maternal stress, type of labour, maternal education, maternal job status, family income, number of children, quality of house, quality of environment, and indoor smoke exposure. The data was collected by questionnaire and analyzed by path analysis. Results: The risk of pneumonia increased with indoor smoke exposure (b= 2.57; 95% CI= 1.54 to 3.60; p< 0.001), number of children ≥3 (b= 1.34; 95% CI= 0.45 to 2.24; p= 0.003), and maternal stres during pregnancy (b= 1.02; 95% CI= 0.16 to 1.88; p= 0.019). The risk of pneumonia decreased with good house environment (b= −0.95; 95% CI= −1.80 to -0.09; p= 0.030), healthy behavior (b= −1.21; 95% CI= −2.09 to −0.33; p= 0.007), and good nutritional status (b= −1.91; 95% CI= −2.92 to −0.90; p<0.001). The risk of pneumonia was indirectly affected by exclusive breastfeding, history of Caesarean section , maternal education, maternal working outside the house, family income, and good quality of house. Conclusion: The risk of pneumonia increases with indoor smoke exposure, but decreases with good house environment, healthy behavior, and good nutritional status.

Background: Stunting is a condition where children under five have a low height for their age. Stunted children under five have a nutritional deficiency (malnutrition), thus affecting the maturity of nerve cells. In addition, they are susceptible to developmental delays such as slow motor movements, lack of intelligence, and slow social response. This study aimed to analyze the effect of stunting on child development based on the results of previous studies. Subjects and Method: This study was a systematic review and a meta-analysis. The articles were searched systematically and comprehensively through several databases including Pubmed, Science Direct, and Google Scholar published from 2010 to 2020. It aimed to ensure the relevance of current findings in the health context and the possibilities for what would happen ahead. Eligibility criteria were used to select studies included in a systematic review/a metaanalysis. The researcher provided eligibility criteria using the PICO model. The population of this study was children. The intervention was stunting. The comparison was non-stunting. The outcome was child development. The article search was carried out for 2 weeks. The keywords were "Association between stunting and delayed development regression", "the effect of stunting on development", "the relationship of stunting to development", "stunting and development", "stunted and development". The articles were collected using PRISMA flow diagrams. The data were analyzed using Review Manager (RevMan) 5 software. Results: This study reviewed 5 articles. The results showed that stunting increased the risk of abnormal development in children (aOR=3.71; 95%CI=2.35 to 5.86; p=0.760). Conclusion: Stunting increases the risk of abnormal development in children. Keywords: stunting, development, child development Correspondence: Milatur Rosyidah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: milatur387@gmail.com. HP: 089620575849.

Increasing the earth’s temperature is one of the impacts of climate change that happened in Indonesia, which can increase the risk of fire disasters that can be happened in the workplace. Hospitals have high fire risk from varied medical activities, the use of electrical equipment, kitchen parts, electricity tools, flammable, explosive, and oxidation chemicals. Nurses play an important role in the event of a disaster as an educator and responsible for the evacuation of victims, emergency relief providers to patients and visitors. This study aims to determine the correlation of fire knowledge with disaster response and preparedness practice among hospital nurses. This research is an observational analytic study with cross-sectional approaches. Respondents in this study were adult inpatient nurses in the X hospital located in Klaten, Central Java. The study used simple random sampling to select 71 respondents. This study uses questionnaires to measure nurses’ knowledge and disaster response and preparedness practice. Sommers’ D correlation test showed a significant correlation between fire knowledge and disaster response and preparedness practice with p-value=0.037 and r=0.283.

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Background: Primary prevention of breast cancer is still not available, so efforts to promote early detection continue to be the major focus in fighting breast cancer. Since early detection is associated with decreased mortality, it is important to minimize delays in detection and diagnosis.The purpose of this study was to examine factors associated with late detection of breast cancer in Surakarta, Central Java, using Health Belief Model. Subjects and Method: A cross sectional study was carried out at Dr. Moewardi Hospital, Surakarta, from October to December 2018. A sample of 200 breast cancer patients was selected by fixed disease sampling. The dependent variable was late detection of breast cancer. The independent variables were perceived susceptibility, threat, benefit, barrier, self-efficacy, family support, breast cancer detection, and family income. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results: Late detection of breast cancer decreased with perceived susceptibility (b= -1.49; 95% CI= -2.55 to -0.42; p= 0.006), perceived threat b= -1.87; 95% CI= -3.05 to -0.69; p= 0.002), perceived benefit (b= -3.27; 95% CI= -4.54 to -2.00; p<0.001), self-efficacy (b= -1.49; 95% CI= -2.52 to -0.46; p= 0.004), family support (b= -1.44; 95% CI= -2.49 to -0.39; p= 0.007), early breast cancer detection (b=-2.21; 95% CI= -3.33 to -1.09; p<0.001), and income (b= -1.75; 95% CI= -2.92 to -0.59; p= 0.003). It increased with perceived barrier (b= 1.64; 95% CI= 0.49 to 2.80; p= 0.005). Conclusion:Late detection of breast cancer decreases with perceived susceptibility, perceived threat, perceived benefit, self-efficacy, family support, early breast cancer detection, and income. It increases with perceived barrier.