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Chronic pain in older adults causes them to experience disability which causes dependence in fulfilling daily needs (ADL). The family as a caregiver for the elderly is the main support system in the care process at home. An increase in knowledge and skills is needed by caregivers to improve their coping and reduce the burden of care. Community service activities are carried out by providing material such as the concept of chronic pain, training in care skills and accompanying home visits. Participants were families who cared for chronically ill elderly with 36 respondents. Assessment was carried out using pre-test and post-test knowledge and family readiness in caring for the elderly. The results of the assessment of family readiness to care for the elderly found that families who cared for the elderly with chronic pain had readiness in caring for the elderly (mean value = 3.91 ± 0.28), but there was data that families were not prepared to face emergency situations (mean value = 1 .63 ± 0.83). The results of caregiver training activities showed an increase in knowledge with a mean post test = 8.48 ± 1.21, an increase from the mean pre-test = 5.21 ± 1.73 and a difference in value of 3.27. The next suggestion is that there will be training that contains material on elderly care and stress management in the family so that it is able to improve the quality of care provided to the elderly., Sakit kronis pada lansia menyebabkan lansia mengalami dissabilitas yang menyebabkan ketergantungan dalam pemenuhan kebutuhan sehari-hari (ADL). Keluarga sebagai caregiver lansia merupakan sistem pendukung paling besar dalam proses perawatan di rumah. Peningkatan pengetahuan dan keterampilan perawatan dibutuhkan caregiver untuk meningkatkan koping dan menurunkan beban rawat. Kegiatan pengabdian masyarakat dilakukan dengan pemberian materi konsep sakit kronis, pelatihan ketrampilan perawatan pada lansia serta pendampingan kunjungan rumah. Peserta kegiatan merupakan keluarga yang merawat lansia sakit kronis berjumlah 36 orang. Penilaian dilakukan dengan menggunakan pre-test dan post-test pengetahuan serta kesiapan keluarga dalam merawat lansia. Hasil pengkajian kesiapan keluarga merawat lansia didapatkan bahwa keluarga yang merawat lansia dengan sakit kronis memiliki kesiapan dalam merawat lansia (nilai mean=3,91±0,28), namun terdapat data bahwa keluarga tidak siap dalam menghadapi situasi gawat darurat (nilai mean=1,63±0,83). Hasil kegiatan pelatihan caregiver menunjukkan terjadinya peningkatan pengetahuan dengan nilai mean post test=8,48±1,21, meningkat dari nilai mean pre-test=5,21±1,73 dan selisih nilai 3,27. Saran selanjutnya diharapkan adanya pelatihan yang berisi materi perawatan lansia serta manajemen stress pada keluarga agar mampu meningkatkan kualitas perawatan yang diberikan pada lansia.

This study aims to determine the protective cardiovascular effect of aerobic exercise training by measuring cluster of differentiation 146 (CD146), circulating endothelial cell (CEC), and high-density lipoprotein-cholesterol (HDL-C) levels in adults.This study was an experimental pre-post-test without a control group. Forty-five participants were divided into three groups based on aerobic exercise training intensity: low, moderate, and high. Whole blood samples were measured for HDL-C levels. In addition, CEC was isolated from Peripheral Blood Mononuclear Cells (PBMC) samples, then identified by CD146 marker using flow cytometry.CEC percentage and HDL-C increase after aerobic exercise training. There was a significant difference in CEC percentage between the intensity groups. However, there was no difference in HDL-C levels.Aerobic exercise training can protect cardiovascular health by stimulating CEC mobilization, identified by CD146. In addition, an HDL-C level increase also contributes to cardiovascular protection by decreasing inflammation levels, inhibiting low-density lipoprotein-cholesterol oxidation, improving endothelial regeneration capabilities, and lowering blood glucose.تهدف هذه الدراسة إلى تحديد التأثير الوقائي للقلب والأوعية الدموية للتمارين الهوائية المقاسة بواسطة الخلايا البطانية المنتشرة ذات مجموعة التمايز +146وكوليسترول البروتين الدهني عالي الكثافة في البالغين.هذه الدراسة عبارة عن اختبار مسبق تجريبي بدون مجموعة ضابطة. تم تقسيم 45 مشاركا إلى ثلاث مجموعات بناء على كثافة التدريب الهوائي: كثافة منخفضة ومتوسطة وعالية. تم قياس عينات الدم من أجل مجموعة التمايز +146 للخلايا البطانية المنتشرة باستخدام قياس التدفق الخلوي ومستويات كوليسترول البروتين الدهني عالي الكثافة.أظهرت نتائج هذه الدراسة زيادة ذات دلالة إحصائية للخلايا البطانية المنتشرة وكوليسترول البروتين الدهني عالي الكثافة بعد التمرين. كان هناك فرق كبير بين مجموعة الشدة في نسبة الخلايا البطانية المنتشرة، ولكن لم يتم العثور على أي منها في مستويات كوليسترول البروتين الدهني عالي الكثافة.يمكن أن يحمي التدريب الهوائي صحة القلب والأوعية الدموية عن طريق زيادة تكيف الأوعية الدموية عن طريق زيادة الخلايا البطانية المنتشرة ذات مجموعة التمايز +146. تساهم زيادة مستوى كوليسترول البروتين الدهني عالي الكثافة أيضا في حماية القلب والأوعية الدموية عن طريق تقليل مستويات الالتهاب وتثبيط أكسدة كوليسترول البروتين الدهني قليل الكثافة وزيادة القدرة على تجديد البطانة وتقليل نسبة الجلوكوز في الدم.

Kumboyono K, Chomsy IN, Iskandar A, Aryati A, Parwati I, Wihastuti TA. Infect Drug Resist. 2022;15:821–829. The authors have advised the author and affiliation list on page 821 is incorrect. The correct author list and affiliations are as follows. Agustin Iskandar,1,2 Khoirunisah Dwi Hartanti,2 Theresia Maharani Sari Nastiti,2 Sandy Wijaya,2 Kumboyono Kumboyono,3 Aryati Aryati,4 Ida Parwati,5 Titin Andri Wihastuti6 1Doctoral Program in Medical Science, Faculty of Medicine, University of Brawijaya, Malang, 65145, Indonesia; 2Department of Clinical Pathology, Faculty of Medicine, University of Brawijaya-Saiful Anwar General Hospital, Malang, 65145, Indonesia; 3Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, 65151, Indonesia; 4Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, 60131, Indonesia; 5Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia; 6Basic Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, 65151, Indonesia Page 823, Ethical Clearance section, the text “The institutional ethics committee of University of Brawijaya approved the study (No. 09/EC/KEPK/07/2021) and also ethical committee of Saiful Anwar General Hospital (No. 4000/011/K.3/302/2021). All of the patients participate in this study provided informed consent that has been accordanced with the Declaration of Helsinki” should read “The institutional ethics committee of Saiful Anwar General Hospital approved the study with reference No. 4000/011/K.3/302/2021 and No. 400/161/K.3/102.7/2022”. Page 828, Acknowledgments section, the text “The authors are thankful for the Ministry of Culture and Education; the Republic of Indonesia sponsored this research financially through “Program Penelitian Kolaborasi Indonesia” World Class University with grant numbers: 342.2/UN10.C10/PN/2021” should read “The authors are thankful for the Ministry of Culture and Education; the Republic of Indonesia sponsored this research financially through “Program Penelitian Kolaborasi Indonesia” World Class University with grant numbers: 342.2/UN10.C10/PN/2021. Thanks to Indah Nur Chomsy for her extensive assistance with formatting, proofreading, and language editing for this publication”. All authors including newly added authors report no conflicts of interest and apologize for these errors.

Teuku Heriansyah,1 Herlina Dimiati,1 Tjut Farahiya Hadi,1 Dimas Arya Umara,1 Lian Varis Riandi,2 Fauzan Fajri,3 Sukmawan Fajar Santosa,4 Titin Andri Wihastuti,5 Kumboyono Kumboyono6 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 2Department of Parasitology, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 3Department of Animal Model, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 4Integrated Research Laboratory, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 5Department of Basic Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Jawa Timur, Indonesia; 6Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, IndonesiaCorrespondence: Tjut Farahiya Hadi, Email tjut@mhs.unsyiah.ac.idIntroduction: Ascorbic acid and calcitriol were frequently utilized in conjunction as therapy during the COVID-19 pandemic, and individuals with minor symptoms had notable improvements. There have been a few studies, often with conflicting findings, that examine the use of them for endothelium restoration and numerous clinical trial studies that failed to establish the efficacy. The aim of this study was to find the efficacy of ascorbic acid compared to calcitriol on the inflammatory markers monocyte chemoattractant protein-1 (MCP-1), nitric oxide (NO), and superoxide dismutase (SOD), as protective agents which play an important role in the early stages of atherosclerosis formation. This study was an experimental in vivo study.Methods: The total of 24 male Rattus norvegicus strain Wistar rats were divided into 4 groups, namely: control/normal group (N), atherosclerosis group (DL) given atherogenic diet, atherosclerosis group given atherogenic diet and ascorbic acid (DLC), and atherosclerosis group given atherogenic diet and calcitriol (DLD) treatment for 30 days.Results: Ascorbic acid and calcitriol treatment was significantly effective (P< 0.05) in lowering expression of MCP-1 and increasing NO and SOD level. Calcitriol was superior to ascorbic acid in increasing SOD (P< 0.05). There was no significant difference between ascorbic acid and calcitriol in decreasing MCP-1 and increasing NO (P> 0.05).Discussion: Both treatments could reduce MCP-1, and increase NO and SOD by increasing antioxidants. In this study calcitriol was superior to ascorbic acid in increasing SOD, but not NO and decreasing MCP-1. According to the theory, it was found that calcitriol through nuclear factor erythroid 2-related factor 2 (Nrf2) causes a direct increase in the amount of SOD. Nrf2 is an emerging regulator of cellular resistance to oxidants.Conclusion: Ascorbic acid and calcitriol treatment was able to reduce MCP-1 and increase NO and SOD in atherosclerosis rat. Calcitriol was significantly superior in increasing SOD levels compared to ascorbic acid.Keywords: ascorbic acid, calcitriol, monocyte chemoattractant protein-1, nitric oxide, superoxide dismutase, atherosclerosis

Latar Belakang: Penerapan sistem informasi kesehatan dan electronic health record (EHR) meningkat secara signifikan di era digital. Perawat sebagai pengguna terbanyak sistem informasi kesehatan memiliki peran penting dalam penerapan sistem.Tujuan: Menggambarkan pengalaman perawat ketika bekerja menggunakan sistem informasi kesehatan dan EHR.Metode: Penelitian menggunakan metode scoping review berdasarkan petunjuk PRISMA dan menelusuri tiga database, yaitu ProQuest, EBSCO, dan ScienceDirect. Pencarian menggunakan kata kunci “nurse”, “experiences”, “health”, “information”, “technology”, “electronic”, dan “record” dikombinasikan dengan kata “AND”, “OR”, dan “NOT”. Artikel dipilih dari publikasi dalam kurun waktu sepuluh tahun terakhir dan menggunakan Bahasa Inggris.Hasil: Didapatkan 17 artikel yang berhubungan dengan pengalaman perawat selama bekerja menggunakan sistem informasi kesehatan dan EHR. Perawat mengalami peningkatan interaksi dengan sistem dan perangkatnya. Kepuasan, kesejahteraan, dan stres kerja perawat dapat dipengaruhi oleh kualitas sistem. Dukungan organisasi berupa pelatihan dan pendampingan diperlukan selama proses adaptasi perawat terhadap penerapan sistem baru. Sistem informasi juga dapat mempermudah komunikasi antar perawat maupun petugas lain.Kesimpulan: Perawat menggambarkan berbagai pengalaman berkaitan dengan penerapan sistem informasi kesehatan dan EHR. Implikasi penelitian ini adalah memberikan wawasan dan masukan bagi organisasi kesehatan yang mengembangkan atau menerapkan sistem baru agar berjalan optimal.Kata kunci: pengalaman, perawat, sistem informasi, EHR.

Introduction Endothelial Progenitor Cells (EPCs) are part of hematopoietic stem cells that differentiate into endothelial cells during their blood vessels’ maturation process. The role of EPCs is widely known to contribute to repair of the vascular wall when endothelial dysfunction occurs. However, various risk factors for cardiovascular disease (CVD) influence EPC performance, leading to endothelial dysfunction. One EPC dysfunction is decreased amount of EPC mobilization to the injured tissue. EPC dysfunction reduces the angiogenetic function of EPCs. The vital maturation process that the EPCs must pass is the late phase. The dysfunction of late EPCs is known as senescence. This study aimed to identify and compare senescence of late EPCs, through CD62E and CD41 markers, in non-smokers and smokers as a risk factor for CVD. Methods EPC collection was from peripheral mononuclear cells (PBMCs) in non-smokers (n=30) and smokers (n=31). The EPCs were then marked by CD62E/CD41 and senescence β-galactosidase assay using FACS. Identification of senescence cells was based on fluorescence with DAPI. Results Positive percentage of late EPCs in non-smokers was not significantly different from that in smokers (p=0.014). The number of senescent late EPCs in smokers was higher than in non-smokers (p

Kumboyono Kumboyono,1 Wiwit Nurwidyaningtyas,2 Indah Nur Chomsy,2 Titin Andri Wihastuti3 1Nursing Department, Faculty of Medicine, University of Brawijaya, Malang, 65145, Indonesia; 2Doctoral Program of Medical Science, Faculty of Medicine, University of Brawijaya, Malang, 65145, Indonesia; 3Department of Biomedicine, Faculty of Medicine, University of Brawijaya, Malang, 65145, IndonesiaCorrespondence: Kumboyono Kumboyono Email publikasikoe@gmail.comIntroduction: Smoking can cause vascular damage in the form of an inflammatory reaction characterized by endothelial activation. Endothelial activation forms a pathological adaptation pattern so that it can induce the atherogenesis process. Several markers, such as E-selectin, platelet-derived micro particles (PMPs) and hematopoietic stem cell (HSC) can identify the activation of endothelial in circulating blood. Therefore, the deviation of vascular adaptation due to smoking can be detected early through the feedback mechanism between E-selectin, PMPs, and HSC.Purpose: This study aims to analyze the initial picture of the negative impact of smoking on vascular adaptation by measuring E-selectin, PMPs, and HSC in the peripheral blood circulation. Participant criteria and methods: Peripheral blood samples (5 mL) were taken from each participant, both the smoking group (n = 30) and the non-smoker group (n = 31) to obtain peripheral blood mononuclear cells (PBMNC). PBMNC was isolated using ficoll-based gradient centrifugation. The flow cytometry assay method used to measure the E-selectin, PMPs and hematopoietic stem cells.Results: The mean of circulating E-selectin in smokers was higher than that of non-smokers. On the other hand, the average number of PMPs and HSCs in smokers was lower than non-smokers.Conclusion: Smoking increases the risk of accelerated vascular block formation, as indicated by an increase in the amount of circulating E-selectin. The increase in E-selectin in the blood vessels mediates the increased adhesion of PMPs in the vascular area so that the number of circulating PMPs in smokers decreases. The decrease in circulating PMPs decreases the signal of vascular repair, which is characterized by a decline in the number of HSCs.Keywords: endothelial injury, cardiovascular disease, atherosclerosis, peripheral blood mononuclear cells, smoker

Kumboyono Kumboyono,1 Indah Nur Chomsy,2 Ardhi Khoirul Hakim,3 Hidayat Sujuti,4,5 Tita Hariyanti,5,6 Arie Srihardyastutie,7 Titin Andri Wihastuti8 1Department of Nursing, Faculty of Health Sciences, University of Brawijaya, Malang, Indonesia; 2Doctoral Program of Medical Science, Faculty of Medicine, University of Brawijaya, Malang, Indonesia; 3Master Program of Biomedical Science, Faculty of Medicine, University of Brawijaya, Malang, Indonesia; 4Department of Biomolecular-Ophtalmology, Faculty of Medicine, University of Brawijaya, Malang, Indonesia; 5Saifur Anwar General Hospital, Malang, Indonesia; 6Department of Public Health, Faculty of Medicine, University of Brawijaya, Malang, Indonesia; 7Department of Chemistry, Faculty of Mathematics and Natural Science, University of Brawijaya, Malang, Indonesia; 8Basic Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, IndonesiaCorrespondence: Titin Andri Wihastuti, Email titinwihastuti@gmail.comPurpose: Smoking is a significant risk factor in developing cardiovascular disease pathogenesis through oxidative stress and inflammation mechanisms. This study used cotinine as a biomarker of nicotine exposure levels in the body, which was associated with levels of Interleukin-6 (IL-6) and Superoxide Dismutase (SOD) as markers of oxidative stress and vascular inflammation. The research aimed to analyze the effect of cotinine levels on the expression of IL-6 and SOD.Methods: This study used a cross-sectional design on 200 subjects, consisting 100 smokers and 100 non-smokers. Cotinine levels, IL-6 expression, and SOD were measured from the blood serum of each subject using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Then the data were analyzed using Generalized Structured Component Analysis (GSCA).Results: There was a significant effect of cotinine levels on the reduction of SOD mediated by IL-6 (CR = 4.006). Cotinine levels also increased IL-6 mediated by SOD (CR = 4.292). The structural model shows that higher cotinine levels will increase IL-6 expression, and conversely, SOD expression will decrease.Conclusion: High cotinine levels cause an increase in the inflammatory process and oxidative stress in the vasculature of smokers, which is characterized by high IL-6 expression and low SOD expression.Keywords: cotinine, IL-6, SOD, oxidative stress, cardiovascular disease, smoking

Background The pathomechanism of CVD is a complex and multifactorial process. The primary mechanism of CVD is atherosclerosis. Inflammation in atherogenesis raises the risk of hypoxia, which will activate hypoxia-inducible factor-1α (HIF1A). Also, together with lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory mediator for atherogenesis. Purpose This study aims to measure the hypoxia-inducible factor-1α (HIF1A) expression and its correlation to Lp-PLA2 expression at low-risk, intermediate, and high-risk CVD populations. Patients and Methods The study used a correlational analysis method with a total sampling technique in 160 individuals in the risk population. The atherosclerosis risk group was analyzed using the Framingham Risk Score and categorized into low, intermediate, and high-risk groups. Venous blood samples taken from respondents were measured using the ELISA method with Lp-PLA2 and HIF-1α as parameters. Data were analyzed using normality test, homogeneity test, one-way ANOVA, post hoc-Tukey HSD, and Pearson correlation. Results The concentration of HIF1A had a very strong correlation with Lp-PLA2 expression, both in the low-risk group (r = 0.512), intermediate (r = 0.512), and high (r = 0.715) (P

Background The pathomechanism of CVD is a complex and multifactorial process. The primary mechanism of CVD is atherosclerosis. Inflammation in atherogenesis raises the risk of hypoxia, which will activate hypoxia-inducible factor-1α (HIF1A). Also, together with lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory mediator for atherogenesis. Purpose This study aims to measure the hypoxia-inducible factor-1α (HIF1A) expression and its correlation to Lp-PLA2 expression at low-risk, intermediate, and high-risk CVD populations. Patients and Methods The study used a correlational analysis method with a total sampling technique in 160 individuals in the risk population. The atherosclerosis risk group was analyzed using the Framingham Risk Score and categorized into low, intermediate, and high-risk groups. Venous blood samples taken from respondents were measured using the ELISA method with Lp-PLA2 and HIF-1α as parameters. Data were analyzed using normality test, homogeneity test, one-way ANOVA, post hoc–Tukey HSD, and Pearson correlation. Results The concentration of HIF1A had a very strong correlation with Lp-PLA2 expression, both in the low-risk group (r = 0.512), intermediate (r = 0.512), and high (r = 0.715) (P

This study aims to explore the nature of community response to the initiation of smoking among Indonesian early adolescents. The study was a qualitative survey involving 100 selected participants (early adolescents, parents, teachers of junior high schools, and school nurses with 25 participants in each category) through snowball sampling method. Participants were interviewed with semi-structured open-ended questions. Data analysis was accomplished by the triangulation of data source. Smoking initiation arises reactive and assertive community response in rejecting negative impact of smoking-leading situation. Community response to the initiation of smoking among early adolescents has certain complex characteristics. Health professionals need to actively participate in building smoke-free community by constructing a practical model of public health nursing which is comprehensive to protect Indonesian early adolescents from negative impacts of culturally allowed smoking.

Kumboyono Kumboyono,1 Indah Nur Chomsy,2 Agustin Iskandar,3 Aryati Aryati,4 Ida Parwati,5 Titin Andri Wihastuti6 1Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, 65151, Indonesia; 2Doctoral Program of Medical Science, Faculty of Medicine, University of Brawijaya, Malang, 65145, Indonesia; 3Department of Clinical Pathology, Faculty of Medicine, University of Brawijaya, Malang, 65145, Indonesia; 4Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, 60131, Indonesia; 5Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia; 6Basic Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, 65151, IndonesiaCorrespondence: Titin Andri Wihastuti, Basic Nursing Department, Faculty of Health Sciences, University of Brawijaya, Malang, 65151, Indonesia, Email titinwihastuti@gmail.comBackground: Tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and monocyte chemoattractant protein-1 (MCP-1) are early phase cytokines often encountered when the body is exposed to severe acute respiratory syndrome-associated-coronavirus-2. TNF-α, IL-1β, and MCP-1 are pro-inflammatory cytokines critical in the defence response against systemic infection and injury. Therefore, TNF-α, IL-1β, and MCP-1 are the most aggressive responses to viral infections in the acute phase, so they can be used to determine the survival of coronavirus disease 2019 (COVID-19) patients.Purpose: The study aimed to determine the levels of TNF-α, IL-1β, and MCP-1 as predictors of survival for COVID-19 patients.Patients and Methods: A prospective cohort study was conducted on confirmed COVID-19 by a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) in 84 adults admitted to the hospital in Indonesia. TNF-α, IL-1β, and MCP-1 level were measured from serum subjects using the enzyme-linked immunosorbent assay.Results: The results from logistic regression modelling of the survival status of COVID-19 patients based on TNF-α, IL-1β, and MCP-1 levels were significant (p-value=0.024). The predictors of all cytokines had P Wald < 0.05, so the three cytokines could be used simultaneously to predict the survival status of COVID-19 patients. MCP-1 has the most dominant risk relative value (2.76; 95% CI; 2.53– 4.68) compared to TNF-α and IL-1β in predicting patient survival.Conclusion: TNF-α, IL-1β, and MCP-1 as markers of acute systemic inflammatory cytokines can be measured at the beginning of hospitalisation of COVID-19 patients for early diagnosis of disease severity so that healthcare professionals can determine clinical guidance needs for therapeutic programs.Keywords: cytokine, survival predictors, COVID-19, SARS COV-2

الملخص: أهداف البحث: تهدف هذه الدراسة لتحديد التنبؤات بالسلوكيات التعزيزية عند الأطفال الذين يعانين من اضطراب تجنب تناول الطعام المقيد من منظور إندونيسي. طرق البحث: تم توزيع هذا المسح الوصفي المقطعي على ٢٤٥ من الأمهات اللآتي يقمن برعاية أطفال يعانين من اضطراب تجنب تناول الطعام المقيد. تم تجميع المعلومات بواسطة استبانة تعبأ شخصيا. استخدم اختبار ت- المستقل، واختبار مان-ويتني، وتحليل التباين بطريقة واحدة (أنوفا) كروسكال- والس، والانحدار الخطي المتعدد لتحليل البيانات الوصفية. النتائج: تجسدت العوامل المرتبطة بالسلوكيات التعزيزية في الأبوة والأمومة المتبادلة، خصوصا من حيث رعاية الطفل والتفاعل مع الأطفال. بالإضافة إلى ذلك، أظهر الانحدار الخطي المتعدد أن الأبوة والأمومة المتبادلة استمر في نطاق التواصل، حيث الأطفال هم المتنبئون الرئيسين، بينماعدد الأطفال تتأثر السلوكيات التعزيزية. الاستنتاجات: حددت هذه الدراسة عدد الأطفال والأبوة والأمومة المتبادلة في التفاعل مع الأطفال كعوامل رئيسة تؤثر على السلوك التعويضي للأمومة. نقترح أن الرعاية التداخلية ممكن أن تحسن السلوك التعويضي للأمومة عند الأطفال الذين يعانين من اضطراب تجنب تناول الطعام المقيد. Abstract: Objectives: This study aimed to identify predictors of promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder (ARFID). Methods: A cross-sectional descriptive survey was administered to 245 mothers who were caring for children with ARFID. Data were collected with a self-administered questionnaire. For descriptive data analysis, independent t-test, Mann–Whitney U test, one-way analysis of variance, Kruskal–Wallis, and multiple linear regression were employed. Results: The factors related to promotive behaviours in these mothers were embodied in mutual parenting, especially in terms of childcare (p = 0.001

Acute Coronary Syndrome (ACS) is a complex case that requires a collaborative action between the doctors and the nurses. This research aims to explore the collaboration experience between nurses and doctors in the care of ACS patient at Emergency Departments (ED) from the nurses' perspective. This research is a descriptive qualitative phenomenological research which involved 32 nurses who are employed in an ED. The data were collected using semi-structured in-depth interviews for the duration of 30–60 min. The results of the data analysis revealed that there are 3 themes; nurses' perception of independent intervention and collaboration, patients’ handling tasks are predominantly performed by the doctors and a collaboration policy. These 3 themes represent unidirectional communication patterns and the doctor acts as the dominant figure. The pattern concludes implement hierarchical practices. Therefore necessary to develop a collaboration model in handling patients with ACS in the hospitals and build a good collaborative relationship.

Police officers are first responder with special lay category. Police have an additional duty to provide first aid to victims of accidents because medical personnel are still limited to provide help. Certainly the police have their own experience that needs to be explored to find out what expectations are for their daily activities in helping victims of current traffic accidents. This study used a qualitative design of hermeneutic phenomenology to explore and interpret police officers' expectations as first responder in traffic accident victims. The number of participants as many as 5 people who served at the Post Purwodadi Lands Area Pasuruan Police. Instruments in this study that researchers as a core instrument and other supporting tools that is in the form of a netbook equipped with a camtasia studio voice recorder program, ballpoint pen, and paper for field notes. Data collected through indepth interview processed into tranksrip and then analyzed by using method Dikelmann et al (1989). The results of the research are two cross-sectoral cooperation and the need for an award. The theme of cross-sector cooperation is built on two sub themes, namely cooperation with hospitals and cooperation with the community. The theme of need for an award is built by a sub theme that needs rewards. The conclusion of this research is that police officers have big expectation to the related parties to give the best first aid for the safety of traffic accident victims. Thus, it is hoped that the cooperation will be strengthened to support police officers in helping victims of traffic accidents to reduce the mortality and morbidity of traffic accident victims.

Introduction: Acute Coronary Syndrome (ACS) is a cardiovascular disease that is one of the main causes of death worldwide. Nurse collaboration in Indonesia is still very complex and inadequate. Positive collaboration in providing care for patients with ACS is essential in the practice of nursing services. Objective: This study aims to explore the barriers in the implementation of nurses-physicians collaboration for the care of patient with ACS in Emergency Departments (EDs). Method: This research is a qualitative survey using purposive sampling. It was conducted on 16 nurses who worked in emergency departments from four general hospitals in East Java, Indonesia. Research data were collected using open-ended questions in semi-structured interviews. Results: There were three themes obtained from the data analysis, which include the difference of confidence between senior and junior nurses in ACS actions, limitations in performing professional nursing, and unclear job responsibilities. Conclusions: Collaboration of nurses and physicians in emergency departments still faces many problems. It is important to carry out interprofessional education initiations for nursing and medical students, apply peer-mentoring to increase the self-confidence of junior nurse, develop and train the clinical pathway of collaboration between physicians and nurses for the care of ACS patients in EDs.

Objectives This study has aimed at identifying the nature of preconception care delivered by healthcare practitioners toward prospective brides and grooms at primary healthcare in Jakarta. Materials and methods This study used a qualitative design with descriptive analysis. The participants of this study are nine health practitioners, who deliver preconception care to prospective brides and grooms at primary healthcare in Jakarta, involving doctors, nurses, midwives, health analysts, and psychologists. The criteria of the participant were healthcare practitioners who were in charge of delivering healthcare service to prospects from primary healthcare, at least having a year experience at primary healthcare, having at least an associate degree. Participants have selected through purposive sampling in which characteristics suitable to the research objectives. The trustworthiness of the data has met through principles of credibility, conformability, dependability, and transferability. Results The study identified four themes, which include participants’ perspective on prospects preparation, implementation of preconception care to prospects at primary healthcare, obstacles faced during the delivery, and participants’ needs for preconception care services. Conclusion Healthcare practitioners need specialized training and interagency cooperation to enhance professional skill-mix in preconception care to achieve goals for maternal and child health.

Background: WHO declared COVID-19 as a global pandemic due to its rapid spread and has been confirmed worldwide. Preventive efforts are made to minimize the virus spread among the community. Sociodemographicfactors play an integral role in determining the communityknowledge, perception, attitudes, and practice towards COVID-19 prevention protocols. Methods: This review was conducted on various journal articles to see the sociodemographic factors that influence the levels of knowledge, perceptions, attitudes, and practices of the community towardsCOVID-19 prevention protocols. Journal articles were selected under the PRISMA guidelines, from which 28 articles were found to meet the predetermined criteria. Result: Several sociodemographic factors found to affect the levels of knowledge, attitudes, practices, and perceptions of respondents towards the COVID-19 prevention protocols were age, gender, education, marital status, occupation, socio economic status, area of residence, and nationality. Conclusion: Education and socio economic status/monthly income were found to be the main factors that influenced the respondents’ level of knowledge. Individuals with higher education tended to take health problems more seriously, as shown by their better scores of compliance with the COVID-19 prevention protocols, compared to the scores shown by other groups.

Teuku Heriansyah,1 Indah Nur Chomsy,2 Kumboyono Kumboyono,3 Pinandita Annisa Pratiwi,4 Titin Andri Wihastuti5 1Department of Cardiology and Vascular Medicine, Syiah Kuala University, Banda Aceh 23111, Indonesia; 2Master Program in Biomedical Science, Faculty of Medicine, Brawijaya University, Malang 65145, Indonesia; 3Nursing Department, Faculty of Medicine, University of Brawijaya, Malang 65145, Indonesia; 4Medical Study Program, Faculty of Medicine, Brawijaya University, Malang 65145, Indonesia; 5Department of Biomedicine, Faculty of Medicine, Brawijaya University, Malang 65145, IndonesiaCorrespondence: Teuku HeriansyahDepartment of Cardiology and Vascular Medicine, Syiah Kuala University, Banda Aceh 23111, IndonesiaEmail teuku_hery@unsyiah.ac.idBackground: The pathomechanism of CVD is a complex and multifactorial process. The primary mechanism of CVD is atherosclerosis. Inflammation in atherogenesis raises the risk of hypoxia, which will activate hypoxia-inducible factor-1α (HIF1A). Also, together with lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory mediator for atherogenesis.Purpose: This study aims to measure the hypoxia-inducible factor-1α (HIF1A) expression and its correlation to Lp-PLA2 expression at low-risk, intermediate, and high-risk CVD populations.Patients and Methods: The study used a correlational analysis method with a total sampling technique in 160 individuals in the risk population. The atherosclerosis risk group was analyzed using the Framingham Risk Score and categorized into low, intermediate, and high-risk groups. Venous blood samples taken from respondents were measured using the ELISA method with Lp-PLA2 and HIF-1α as parameters. Data were analyzed using normality test, homogeneity test, one-way ANOVA, post hoc–Tukey HSD, and Pearson correlation.Results: The concentration of HIF1A had a very strong correlation with Lp-PLA2 expression, both in the low-risk group (r = 0.512), intermediate (r = 0.512), and high (r = 0.715) (P < 0.05). However, the concentrations of Lp-PLA2 did not match the FRS.Conclusion: HIF1A expression increased with increasing risk, while Lp-PLA2 expression decreased with increasing risk of atherosclerosis based on the FRS category. There is a significant correlation between HIF1A expression and Lp-PLA2 expression based on FRS.Keywords: cardiovascular disease, atherosclerosis, HIF1A, Lp-PLA2, Framingham Risk Score

Objective: The purpose of this study was to analyze the relationship between psychological distress and CHD risk in the next ten years. Methodology: This research was a cross-sectional study carried out on 73 participants in Malang City, Indonesia, from December 2019 to January 2020. The psychological distress assessment was carried out using the DASS 42 instrument. Meanwhile, the assessment of CHD risk was carried out using the Framingham score instrument. Data analysis used the Spearmen Rank Analysis in the SPSS version 16.0 software with a level of significance at p ≤0.05. Results: Most participants had normal psychological distress (56.2%) and a low Framingham score (75.3%). Spearmen correlation between psychological distress and Framingham scores showed a coefficient value of 0.177 with a p-value of 0.134 (p>0.05). This study showed that there was a positive but not significant relationship between psychological distress and Framingham scores. Conclusion: This study shows that psychological distress influences the risk of developing CHD 10 years later. Psychological conditions that are not good can affect physical conditions as well as cardiovascular health. This can provide new insights into the importance of paying attention to a psychological condition. Keywords: cardiovascular disease, coronary heart disease, Framingham risk score, psychological distress, the risk factor

Background: Initiation of smoking habit often occurs in early teens due to the interaction of teenagers with the social environment. The community has an important role in protecting teenagers from the habit of smoking. Objective: The research was aimed to explore the experience of the community in protecting the early-teenagers from smoking habit from the perspective of Indonesian people. Materials and Methods: The qualitative study used the descriptive phenomenology approach on 100 participants (early-teenagers, parents, teachers, and school nurses) who were selected through snowball sampling method. Data collection was carried out through in-depth interviews using open-ended questions. The data were analysed manually using the data source triangulation method. Results: Six research topics were concluded: 1) screening of habits related to health, 2) smoking bans, 3) punishment for smoking habit, 4) smoke-free counseling, 5) evaluation of efforts done, and 6) follow-up of smoking-free programs. Conclusion: The results of the study indicated the importance of consistent efforts to prevent the initiation of smoking habit in early-teenagers both at school and at home. The communities around them at school and home need to have people with healthy non-smoking habit as good role models for the teens.

Introduction: A nurse who experience burnout feelings will influence their motivation, and quality performance. This situation is probably affecting a decline in work quality towards the caring behaviour demonstrated by nurses to their patiens, particularly for a nurse who are working in the long-stay installation room facing directly to patient's problems. The purpose of this research is to identify the work stress level of nurse towards the nurse's caring behaviour in the long-stay installation room (IRNA) in general hospital in Malang.Method: This research used descriptive – correlational, the sampling was Non Probability Purposive Sampling with 93 nurses as the corresponds. The data was analyzed by operating Correlation Pearson, with a significance of p < 0.05.Result: The result found that there was a substantial correlation between the work stress level and the nurse's caring behaviour with p = 0.008 and r = -0.274, and it was a negative correlation.Discussion: It means that when the stress level of nurses will declined, the nurse's caring behavior automatically will beamplified. Conversely, if the stess level of nurses intensively increased, the nurse's caring behaviour become decreased. Thus, this research is needed to be analyzed further in order to asses the quality of caring behaviour by expanding the connected indicator and variable. It is aimed to improve the professionalism and quality of nurses in giving the best service to patients this research need to be continued further in order to asses the quality of nurse's caring behavior by expanding the variable, which is related to internal factors, such as knowledge, perception, emotion, ect and also connected to external factors, such as environment, both physically and non physically like: climate, human being, social economic, culture and ect.

Introduction: Patient acceptance to diet in fl uences patient intake during the hospitalization. Patient acceptance on meals provided by the hospital can be seen from the left over. Whilst factors which in fl uences patient motivation to finish their meals including addtional food, taste, and adaptation level to the hospital, the aim of this research was to identify factors that related to patient acceptance on meals provided by the hospital in class three ward dr. Soepraoen Hospital, Malang. Method: Descriptive analitic was used as research design with cross-sectional approach. As many as 51 samples were chosen with purposive sampling. Data was analyzed with chi square with 95%signi fi cance. Results: The results showed a signi fi cant relation between additional food and the leftover (p-Value = 0,018). There is signi fi cant relation on the taste and the leftover (p-Value = 0.032) and adaptation level and leftover (p-Value = 0.026). Discussion: It can be concluded that additional food, taste, and adaptation level to the hospital have signi fi cant relation with hospitalized patient acceptance on their diet. It is suggested that nurse pay more attention on these factors to fulfi ll patient nutrition needs during hospitalization.

Background: Family’s ability to care for children with avoidant restrictive food intake disorder (ARFID) is a central indicator in preventing the children from worse nutritional disorders. Environmental factor, child factor, caregiving behavioral systems, and beliefs can improve the family’s ability to care for children. The aim of this research was to analyze the effect of environmental factor, child factor, caregiving behavioral systems, and beliefs on the family’s ability to care for children with ARFID. Design and Methods: This cross-sectional research was carried out on 245 families with children suffering from ARFID in Malang Regency, in the working area of the Health Office of Malang Regency. The population of this research was families with children suffering from ARFID within the working area of the Health Office of Malang Regency. The research sample size was computed using the rule of thumb in structural equation modeling (SEM), the sample size used was 245. Results: Results showed that the family’s ability to care for children with ARFID was highly influenced by the caregiver’s belief (t = 21.796; β = 0.713). Caregiver’s belief became a dominant factor in the promotion of the family’s ability to care for children with ARFID. A caregiver’s belief was influenced by his/her behavior. Conclusions: It was concluded that the caregiver’s belief serves as a primary factor in the promotion of the family’s ability to care for children with ARFID. A caregiver’s behavior holds a prominent role in influencing his/her belief in providing care for children suffering from ARFID. Significance for public health The results of this research will be useful for the fostering of family’s ability to provide care for children with ARFID. Improved family’s ability to provide care for children with ARFID will prevent nutritional disorders in children like stunting and wasting.

Dyslipidemia is a risk factor for cardiovascular disease through atherogenesis induction. The productive age of early adulthood today has different eating habits in relation to increasing culinary lifestyles and food hunter habits. In general, dyslipidemia rarely causes early phase symptoms. We suspect that there is an increase in the group with impaired lipid profiles related to dietary habits that do not pay attention to the essential needs of eating. The collected serum was carried out using a venous puncture procedure on 45 early adult subjects (men n = 9; women n = 36) aged 19-27 years in Malang City. The lipids were analysed for lipid profiles including TC, TG, HDL-c, and LDL-c. The results of men respondents showed higher differences in the lipid profiles of TC (p = 0.000), TG (p = 0.001), and LDL (p = 0.000) than women while HDL-c levels (p = 0.010) in women had higher differences than men. Dumpling (contains noodles and beef) has positive correlation with TG, TC, and LDL. At least in this study, we found that men in early adult had a higher lipid profile compared to women. This is of course related to diet have an impact on increasing lipid levels. For this reason, it is advisable to maintain a more productive eating habits to reduce the risk of dyslipidemia.

IntroductionAcute Coronary Syndrome (ACS) is a life-threatening condition. Immediate and proper treatment will decrease mortality rate. Patient awareness on ACS is still lacking and as the consequence, ACS patients do not seek immediate help.ProblemThe patients’ efforts to get rid of ACS symptoms.MethodsThe study was a descriptive, qualitative study in which a semi-structured, in-depth interview became the instrument. The respondents were 34 participants (including 17 ACS patients and 17 family caregivers). Data analysis was done by triangulation of data sources.ResultsThree themes were obtained, namely: (1) prefer traditional and self-treatment, for example (a) traditional medicine, (b) taking non-prescription drugs to overcome ACS symptoms, and (c) spontaneous action; (2) using available health resources and facilities that consisted of (a) getting initial treatment at home by nurses, (b) visiting a health center to take care of the symptoms, and (c) using non-ambulance service to visit the health centers; and (3) expectations on health care services to patients composed by sub-themes such as (a) the expectation to get information that supports the healing, and (b) the caring attitude of the heath professional.Conclusions:The results showed that in the prehospital setting when experiencing ACS symptoms, the patients try to overcome the symptoms independently. However, as the symptoms get worse, they utilize health facilities in different ways. At the time of obtaining health services, patients are satisfied with health professionals who show caring attitudes, explain the results of the examination, and provide health education on health care efforts. Thus, to prevent mortality and morbidity, it is important for a health professional to educate the public about ACS, including topics about ACS healthy lifestyles and potential threats if it is too late to get treatment. Furthermore, it is also important for the government to implement prehospital emergency services nation-wide.KumboyonoK,RefialdinataJ,WihastutiTA,RachmawatiSD,AzizAN.Health-seeking behavior of patients with Acute Coronary Syndrome and their family caregivers.Prehosp Disaster Med.2018;33(6):614–620.

Physical changes make elderly limited in performing activities of daily living (ADL) and tend to depend on the family cause the closest has an important role in maintaining the health of the elderly. It can be seen from the implementation of family task in health. The purpose of this study was to determine the correlation implementation of family task in health with independence of elderly in ADL compliance using cross sectional method. Samples were selected by purposive sampling technique with the inclusion criteria and obtained a sample of 40 people. The results showed the number of families who carry out the task of the family in good health with the independence of the elderly category independent category as many as 22 people (55%). While on a family who carry out tasks in the family health category with the independence of the elderly poor are as many categories 1 (2.5%). Based on using the Spearman rank test p-value 0.000

Sex education is a process to express message that one of the purpose is to create adolescense positive attitude avoiding incorrect sex behavior. The method used to create adolescensepositive attitude in order to avoid the incorrect  sex behavior are group discussion method, demonstration, playing role or simulation method. The purpose of this study was to  find out the differences between the influence of giving sex education with simulation method and group discussion of adolescense attitude changes to avoid incorrect sex behavior, and to find out a method that give the biggest score of attitude changes amongthem. The design of this study was quasi experimental pretest posttest design. While the way to collect samples using multi stage random sampling technique with the number of 90 samples divided into 30 groups of  control, 30 groups using simulation method of treatment and 30 groups using discussion group method of treatment. The result from showed that there was difference between score of pretest attitude and score of posttest attitude in the group of simulation treatment (t-test p = 0.644) and the discussion group of treatment (t-test p = 0.000), but there was no difference between score of pretest attitude and score of posttest in control group (t-test p = 0.000)  α = 0.05. Another finding that there was difference attitude among control group, group of simulation treatment, and group of discussion treatment (anova p = 0.000)  α = 0.05.

enIntroduction: Community's Perception and enthusiasm toward homecare services becomes challenge to find out for homecare agency. An easy and effective strategy to find out is using technology information system. Methods: This study employed descriptive analysis design, in which perception and enthusiasm community were measured by completing questionnaire (r = 0.367 validity and reliability = 0.734–0.777), while data analysis uses correlation product moment and T-test. Results: Univariat analysis show perception toward homecare services within internal community results in:mean = 19.8; range 17–24, while within external community results in: mean = 19.53; range = 15–24. In other hand, enthusiasm toward homecare services within internal community results in: mean = 31.33; range= 28-36, while within external community results in: mean = 31.27; range = 26–36. Bivariat analysis result, first: Perceptions and enthusiasm internal community was associated toward homecare services (p = 0.001; r = 0.778). Second, Perceptions and enthusiasm external community was associated with homecare services (p = 0.010, r = 0.754). Thereby, no difference between internal community perception and external community perception toward homecare services (p = 0.778). Discussion: In conclusion, this study concludes that community's perception and enthusiasm was considered related to homecare services. This study provides information for homecare management that community needs homecare services to address health improvement among patients with chronic diseases.Keywords: community's perceptions and enthusiasm, homecare services, marketing strategy

Introduction: Acute Coronary Syndrome (ACS) is the leading cause of mortality in the world. Primary prevention strategy focuses on reducing the risk of disease spread. At the same time, curative strategy aims at reducing the risk of disability and mortality. Initial therapy should be considering early stabilization and immediate advanced care to reduce the risk of complication. Therefore, it is important to improve guidelines, the medical referral system, and family consent procedure to save patients with ACS. Aim: This research aimed at exploring the barriers faced by nurses in treating patients with ACS in Primary Health Care (PHC). Method: This research employed a qualitative research method using descriptive phenomenology.This study involving 16 subjects of nurses working in PHC with indepth interview . The data analysis procedure proposed by Clark and Brown 2013. Result: Three main themes were pointed out by 16 participants; 1) Update Guidlines, 2) Inefficient referral process to other health centers, 3) Consent making process by the family. Dicussion: Barriers in performing health care for patients with ACS in the emergency unit of PHC needs updating guidline to be enhanced by engaging the advancement of technology and communication using electronic medical record system, family education, and fulfillment of better medical facilities to make the process more efficient. At the same time, also improves the management service for patients with ACS and making it possible for PHC to provide reliable health care as the first health care provider for the society. Keywords: Barriers to care, Health Care Referral, Acute Coronary Syndrome, Emergency Nursing, Primary Health Care

Kehadiran rokok rendah tar dan nikotin (mild) menimbulkan asumsi bahwa rokok jenis ini lebih ramah terhadap kesehatan. Penelitian ini bertujuan mendeskripsikan makna pengalaman perokok dalam mengkonsumsi rokok mild di Kota Malang. Penelitian dilakukan dengan desain fenomenologi pada tujuh partisipan. Penelitian menghasilkan empat tema yaitu: alasan mengkonsumsi rokok mild ; perubahan yang terjadi setelah menjadi perokok mild ; makna mengkonsumsi rokok mild; jenis layanan dan strategi yang dibutuhkan untuk berhenti merokok. Kesimpulan penelitian ini ialah perokok menilai rokok rendah tar dan nikotin merupakan rokok ringan sehingga memacunya untuk terus menerus merokok dengan hisapan yang lebih dalam atau lebih banyak. Pemerintah disarankan untuk melarang pencantuman label mild dan sejenisnya yang dapat dipersepsikan secara keliru oleh perokok. Abstract The mild cigarette led to the assumption that this cigarette has a lower risk for health. This phenomenological study was aimed to describe the meanings of smoker’s experiences regarding the mild cigarettes consumption in Malang. Seven participants were selected. The results showed four themes: reasons of smoking mild cigarettes; changes that happen after smoking mild cigarettes; meanings of smoking mild cigarettes; health care and strategies needed to stop smoking. This study concluded that smokers believed the mild cigarretes have low tar and niccotine cigarettes so they continue to smoke more and deeply. The government is suggested to stop putting the label of mild/other similar labels in a cigarettes pack which could be perceived incorrectly by smokers .

Adaptasi adalah menyesuaikan diri dengan kebutuhan atau tuntutan baru yaitu usaha untuk mencari keseimbangan kembali kedalam keadaan normal. Sedangakan dukungan keluarga adalah bantuan yang diberikan oleh anggota keluarga yang dapat diandalakan yang berupa informasi verbal atau non verbal dan tingkah laku yang memberi keuntungan emosional. Penelitian ini bertujuan untuk mengetahui pengaruh dukungan keluarga dengan adaptasi pasien skizophrenia. Desain penelitian yang digunakan adalah obsevasional analitik dengan pendekatan cross sectional.Sampel sejumlah 63 pasien skizophrenia yang menjalani rawat inap di Rumah Sakit Jiwa, diambil melalui teknik Simple Random sampling. Varibel yang diukur meliputi tingkat dukungan keluarga dan tingkat adaptasi pasien skizophrenia. Pengukuran tingkat dukungan keluarga menggunakan kuesioner dan pengukuran tingkat adaptasi dilakukan dengan cara observasi langsung. Dari analisis data menggunakan uji korelasi Rank Spearman diperoleh koefisien korelasi sebesar 0.427 dengan probabilitas (sign) sebesar (0.000) dan tingkat signifikasi 95% ( = 0.05). Nilai koefisien korelasi lebih besar dari nilai tabel. Hal ini menunjukkan terjadi hubungan yang signifikan antara dukungan keluarga pesien Skizophrenia dengan peningkatan adaptasi pasien Skizoprenia. Tingkat adaptasi yang baik dapat menunjang pancapaian remisi pasien yang lebih baik. Perlu diadakan penelitian lebih lanjut dengan meneliti faktor regulator dan kognator yang mempengaruhi adaptasi, memperbaiki instrument penelitian dan metode pengambilan data.