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Penyebaran virus Covid-19 yang sangat cepat di seluruh dunia termasuk Indonesia dan penetapan statusnya sebagai pandemi oleh WHO adalah salah satu faktor risiko yang menyebabkan terjadinya peningkatan kecemasan pada ibu hamil terutama pada trimester III yang dapat berpengaruh terhadap kesiapan ibu dalam menghadapi persalinan. Penelitian ini bertujuan untuk menganalisis hubungan tingkat kecemasan ibu hamil trimester III dengan kesiapan menghadapi persalinan di masa pandemi Covid-19. Metode penelitian ini adalah analitik observasional dengan rancangan penelitian cross sectional. Jumlah sampel sebanyak 49 ibu hamil trimester III dengan teknik pengambilan sampel menggunakan purposive sampling. Variabel bebas adalah tingkat kecemasan ibu hamil yang diukur menggunakan kuesioner tingkat kecemasan ZRAS (Zung Self-Rating Anxiety Scale). Variabel terikatnya adalah kesiapan menghadapi persalinan di masa Pandemi Covid-19 yang diukur menggunakan kuesioner kesiapan persalinan. Analisis data menggunakan uji spearman. Hasil penelitian menunjukkan bahwa mayoritas responden tidak ada kecemasan dan 6% kecemasan sedang. Pada variabel kesiapan persalinan mayoritas memiliki kesiapan baik dan 4% kurang. Hasil uji statistik dengan uji spearman didapatkan nilai P = 0,001 (P

Introduction: Stress is an event that places a strain or demand on a person, disrupting the body's balance and physical and psychological conditions. Students often experience stress due to the numerous orders placed on them regarding learning and extracurricular activities on campus. Because medical students are prone to stress due to academic factors and the pressure they face, additional treatment is required to ensure that it does not have a long-term impact. Objective: This study aims to show that vitamin C supplementation can help medical students at Ciputra University feel less stressed. Method: A pre-and post-experimental study and the total sampling technique were used, and the respondents were divided into two groups: treatment and control. The DASS (Depression Anxiety Stress Scale) questionnaire was used in this study as the instrument. After that, the paired t-test was used to examine the data. The findings revealed that 66.6 percent of students in the pre-intervention experimental group experienced mild stress. In comparison, 29.16 percent of students in the pre-intervention control group had a normal pre-experimental score of 17.96. With an average result of 11.58, 95.8% of the participants in the post-intervention experimental group or after vitamin C supplementation were classified as usual. In a comparative test, the average stress score before and after supplementation differed significantly (p = 0.05). It can be concluded that supplementing with vitamin C can help students cope with stress.

ObjectivesHealthcare workers (HCWs) are the front lines during the COVID-19 pandemic. They are more exposed to COVID-19 than other professions. Studies from other countries have shown that the mental health and health-related quality of life (HRQoL) of HCWs were affected during this pandemic. However, studies on mental health in Indonesia remain scarce and no study has evaluated the HRQoL among HCWs. Thus, this study was designed to explore the mental health status and HRQoL among HCWs in Indonesia.DesignThis was a cross-sectional study.SettingThis was an open online survey in Indonesia conducted from December 2020 to February 2021.ParticipantsThis study involved HCWs who worked during the COVID-19 pandemic. Of the 502 respondents who accessed the online questionnaire, 392 were included in the analysis.OutcomesMental health status was measured using the 21-item Depression, Anxiety and Stress Scale and HRQoL was measured using the second version of the 12-item Short-Form Health Survey (SF12v2).ResultsThe prevalence of depression, anxiety and stress among HCWs was 29.4%, 44.9% and 31.8%, respectively. Using the SF12v2 questionnaire, 354 (90.3%) HCWs were found to have impaired physical component and 156 (39.8%) HCWs have impaired mental component.ConclusionThe prevalence of mental health problems among HCWs was high in Indonesia. HRQoL, particularly the physical component, was affected in most HCWs. Thus, policymakers should give more attention to the mental health and HRQoL of HCWs during the COVID-19 pandemic.

Headache is the most prevailing disorder and the third leading cause of disability worldwide. The prevalence of primary headaches has been reported to increase by 2-4 times in patients with psychiatric comorbidities, including depression. This study sought to assess the correlation between depression level and headache severity among medical students. To the best of our knowledge, this is the first study to evaluate the correlation between depression level and headache severity in Indonesia. A cross-sectional study was conducted among students of Airlangga University in 2021. To evaluate the level of depression and the severity of headache, Depression Anxiety Stress Scales (DASS-42) and Headache Impact Test 6 (HIT-6) were used, respectively. A set of validated questionnaires were used to assess students’ demographic characteristics. A total of 82 medical students were included in this study and most of them were female (86.6%). The third-semester students represented the highest proportion (45.2%) of subjects. The mean age and body mass index (BMI) were 19.88 ± 1.03 and 22.55±4.44, respectively. The average DASS-42 score was 10.98±11.47 which indicated a mild depression level. The average HIT-6 score was 45.74±6.130 which revealed a mild impact. The data of Spearman correlation suggested that headache severity was significantly correlated with depression level (r=0.396, p

Family medicine (FM) is a patient-centered and community-based clinical method. The FM has multiple strengths that are useful for medical students, such as provides continuing care to patients and families. Because of the COVID-19, medical students have been removed entirely from the clinical learning environment. Online teaching has played key roles in medical education by covered key clinical conditions, case studies, and examinations. According to the latest American College of Obstetricians and Gynecologists (ACOG), Hyperemesis Gravidarum (HG) is the term for the most severe form of nausea and vomiting of pregnancy. We used the method to collect data for a case report taken from a web-series review on Netflix, titled “Virgin River”, Season 2, Episode 1 to 3. From the symptoms and physical examination of the patient, Ms. CR was diagnosed with HG complicated by dehydration, cardiac arrhythmia, and hypoglycemia. The treatment that has been given to her includes non-pharmacological and pharmacological therapy. The family medicine approach has an important role because it has a strong mutual trust based on the doctor-patient relationship. Also, the family has a significant role in the treatment of patients since it can provide effective psychological and emotional support.

Introduction. Vitamin D deficiency is a common health problem that occurs in various countries. Vitamin D deficiency is linked to various diseases such as kidney failure, liver damage, atherosclerosis, obesity and psychiatric disorders such as depression and schizophrenia. This study aimed to analyze the correlation between serum vitamin D levels and schizophrenia severity. Methods. Schizophrenia patients who visited the Inpatient and Outpatient Clinic Department of Psychiatry of the Dr. Soetomo Hospital Surabaya. This was a cross-sectional observational study, conducted in December 2017 - April 2018 . The subjects consisted of 53 schizophrenia patients, vitamin D levels < 30 ng /mL (35 (66.04%); > 30 ng/mL (18 (33.96%). Serum vitamin D levels test by enzyme linked fluorescent assay (ELFA) method using Vidas. The severity of schizophrenia was measured using a positive and negative syndrome scale (PANSS) score. Results. Mean serum vitamin D levels in schizophrenia were 23.45 ± 9.16 ng / mL, serum vitamin D levels in males were 24.36 ± 9.80 ng / ml and females 21.96 ± 7.98 ng / ml. The mean serum vitamin D level and PANSS scores of positive symptoms was 16.42 ± 8.50. The mean serum vitamin D level and PANSS scores of negative symptoms was 15.60 ± 6.12. The mean serum vitamin D level and PANSS scores of general psychopathology symptoms was 29.51 ± 10.29. The statistical results showed no association between vitamin D levels and PANSS scores. Conclusion. The results of this study indicated low serum vitamin D levels in schizophrenia. There was no association between serum vitamin D levels and the severity of schizophrenia using PANSS scores.

Smoking remains as a nation-wide health problem in Indonesia. Several measures had been conducted to motivate smoking cessation, among those is the use of pictorial health warnings (PHWs). PHWs have been implemented since 2014, and some of the pictures were revised in 2018. However, there was no evaluation regarding the effectivity to this date. This study compared the effectivity of the old and new versions of PHWs in promoting smoking cessation. This was a cross-sectional study conducted in one of the sub-districts in East Java, Indonesia, in February 2020. Study population were local villagers aged at least 18 years who visited the sub-district’s primary healthcare during the study period. Consecutive sampling was used as the sampling method. Respondents were interviewed using a pre-determined questionnaire. The old and new versions of PHWs were printed and showed to the respondent during the interview. Comparison between groups was analyzed using McNemar test. A total of 103 respondents participated in this study. More respondents agreed that the old version of PHWs was considered more effective to motivate smoking cessation as compared to the newer version (71.84% vs 64.08%), although the significance was marginal (p=0.077). Our study showed that both versions of PHWs were considered effective to promote smoking cessation. However, more respondents agreed that the old version of PHWs were more effective than the new PHWs. We recommend policymaker to conduct a field study to test the effectivity of the proposed PHWs before revising the legal regulation in the future.

Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) using individual participant data meta-analysis we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had “some” influence on their patients’ health (CI95%) (81.8%–84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%–95.5%). Across all samples 649 (16%; 14.9%–17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%–25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.

The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.

Background: Going through college is a stressful life situation. Students are challenged to live independentlyalong with academic challenges. The medicine is known to be more stressful than other professional studyprograms. Objectives: To analyze the depression, anxiety, and stress in medical students of the Faculty ofMedicine, Universitas Airlangga Year Batch 2016, 2017 and 2018. Sampling Methods: This research wasconducted with observational analytic study design, a cross-sectional approach by accidental sampling. Thevariables used are the socio-demographic characteristics of medical students as an independent variable,and the scale of depression, anxiety, and stress as the dependent variable. Data was collected by visitingeach year batch, and giving a questionnaire sheet Depression, Anxiety, Stress Scale - 42 items (DASS42). The results were then processed and analyzed in SPSS 16. Result: Respondents were mostly female(71,0%), Javanese (69,9%), have no history of personal (95,3%) and family mental disorders (94,4%), donot consume alcohol and cigarettes (98,3%), having married parents (91,4%), mean age 19 years, and firstchild. Year batch of 2016 exposed to depression 26.3%, anxiety 51.5%, and stress 32.3%. Year batch of2017 exposed to depression 30.2%, anxiety 60.4%, and stress 37.5%. While the year batch of 2018 which isdepressed 23.2%, anxiety 54.3%, and stress 30.5%. Conclusion: There was correlation between anxiety andstress with gender, which female tend to be more anxious and stressed, there is no difference in depression,anxiety, and stress in the class of 2016, 2017 and 2018.

Gadgets can be interpreted as a tool that can easily be connected to the internet. If the use of gadgets can be done wisely, humans will get many benefits from using gadgets. But if the use of gadgets cannot be controlled, it will have a negative impact. One of the negative effects obtained is dependence or addiction to the gadget itself. Apart from the use of gadgets, bullying is also common today. Approximately three million teenagers become drug abusers in Indonesia. The data was collected using primary data in the form of a questionnaire to collect data on gadget addiction, bullying behavior, and drug abuse among junior high school adolescents at MTs Nahdlatul Wathon Licin. This was a descriptive observational study. The population was students in 8th-9th grades at MTs Nahdlatul Wathon Licin. Sampling was done by total sampling. The number of samples obtained was 93 people. Data were analyzed using descriptive statistical methods which are presented in the form of frequency distribution tables. It was found that 8.6% of respondents had a high risk of gadget addiction, 48.4 % of respondents have a high level of bullying behavior, and 2.2% of respondents are addicted to drugs.

The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.

Orthopedic trauma patients have the risk to experience mental disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and other mental disorders. However, studies that analyze the relationship between mental disorders in orthopedic trauma patients, especially post-operative brachial plexus injury (BPI), are still difficult to find. This study aims to evaluate the relationship between disability and pain to post-traumatic stress disorder, depression, and anxiety in patient with postoperative BPI.It was an observational analysis with cross-sectional design study. Data were collected from July 2019 to September 2019. All subjects were patients of Orthopedics Clinic Dr. Soetomo General Academic Hospital Surabaya. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was used to determine the disability level in patients. Visual Analog Score (VAS) was an instrument for assessing pain scale and mental disorders used Mini International Psychiatry Interview (MINI).There were 41 subjects met the research criteria, consisted of 10 men (24.39%) and 31 women (75.61%), aged 12-63 years. Based on the status of education, most subjects were graduated from junior/senior high school with 28 subjects (68.29%). The most common cause of BPI was traffic accidents as many as 37 people (90.24%). Mental disorders diagnosed from MINI found ten people (24.39%) were diagnosed with major depression; two subjects (4.87%) had generalized anxiety disorder. The average VAS score was 5.15 and the average DASH score was 52.02. There was no significant difference in VAS scores in the major depression group and PTSD group. However, there was an association between DASH score and depression (The level of disability and pain in orthopedic trauma patients with depression tend to more severe than without depression.

Perinatal depression is a mood disorder that occurs in pregnant and postpartum women. To determine the magnitude of the risk of perinatal depression, this study uses the Edinburgh Postnatal Depression Scale (EPDS) screening tool. This study uses primary data in the form of a questionnaire to collect data on screening for depression in pregnant women and postpartum during the last 12 months. This research is an observational descriptive study with cross sectional research design. Sampling was done by cluster random sampling in Segobang Village, Jelun Village, and Banjar Village in Licin District, Banyuwangi Regency. The number of samples obtained was 31 samples. In the EPDS screening results of the pregnant women group, the results showed a very high risk of 18 , 75%. Whereas in the postpartum maternal group, the results showed a high risk of 6 , 67%, and a very high risk of 6 , 67%. Based on the results of the correlation test with Spearman's rho correlation, it can be concluded that there was a significant corellation between maternal age of postpartum with the risk of perinatal depression (α = 0 , 03).

Purpose. To analyze the determinants of tobacco smoking addiction in rural areas. Methods. A cross-sectional study was conducted on February 2020. The self-administered questionnaire (α = 0.908) and Perceived Stress Scale–10 were used as tobacco smoking determinants and the WHO ASSIST questionnaire V3.0 to determine its addiction risk. Their correlations were analyzed by Spearman’s rank-order approach using the SPSS version 23.0. Results. Among 75 male respondents that participated in this study, those on low, moderate, and high addiction risk were 45 (60.00%), 23 (30.67%), and 7 (9.33%), respectively, and significantly correlated with the research questionnaire that consisted three parts: 1. awareness toward the health risk; 2. social control; 3. mass media role in tobacco smoking (p=0.014, 0.004, and 0.009 respectively), but there was no significant correlation with the stress level (p=0.287). Conclusion. Increased awareness toward the health risk, good social control, and mass media reporting the danger of tobacco smoking is significantly in correlation with the decreased addiction in rural areas. However, the high perceived stress has no correlation with its increase.

Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians' right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.

BACKGROUND: Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association.METHODS: Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists.RESULTS: We found 11 eligible surveys from 8 countries (n = 3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48-0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists.CONCLUSIONS: We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine.

Borderline Personality Disorder (BPD) is a condition that is currently commonly found in daily psychiatric practice, and causes serious psychiatric disorders because it has an impact on the emergence of various other comorbid psychiatric disorders. The management of BPD is a challenge, because it is quite difficult and complex. Psychotherapy is an effective first-line therapy for BPD. Transference Focused Psychotherapy (TFP) is psychodynamic based psychotherapy that is specifically designed for BPD and is considered effective based on the specific psychopathology of BPD, namely the lack of identity integration. TFP focuses on the relationship between patient and therapist in sessions which have the aim of facilitating better behavioral control and increasing reflection and influencing regulation so as to produce identity integration that leads to a more coherent identity, better regulatory abilities, less self-destructive behavior. forming a more balanced and constant relationship, and increasing overall functioning.Keywords : Borderline Personality Disorder, Psychodynamic Psychotherapy, Transference Focused Psychotherapy.

Although Bipolar Disorder (BD) is a common mental illness worldwide (1-3%), there was no data about the prevalence of BD or bipolar spectrum disorder in Indonesia. This study aimed to screen bipolar disorders in various communities Surabaya and its variations of symptoms characteristics. Through a cross-sectional design and non-random sampling survey (N = 1,104) was conducted using the Mood Disorder Questionnaire (MDQ), a screening tool for BDs, and validated self-report instrument. The SPSS 17.0 and chi square was used for analysis. Results showed the lifetime proportion of MDQ positive was 10.7% (n = 118). The proportions of MDQ positive by gender were 4.8% males and 5.9% females, no gender (p = .444) and educational background differences (p = .470). The highest proportions of MDQ positive were 4.4% in the 25-60 year group, 4% having an education level of senior high school and 6.7% having unmarried status. Among participants who had MDQ positive, 22% had an awareness of having psychological problems, unfortunately only 5.9% had visited a medical professional. Overall, the lifetime proportion of suspected bipolar disorder spectrum in Surabaya was higher than that reported in other studies. Conducting a periodic research regarding other psychosocial-cultural backgrounds will help clinicians and government identify the exact prevalence of bipolar disorder in the society and their risk factors. Furthermore, it will help to prevent the increased rate of bipolar disorders.

This is the case of a 35-year-old female diagnosed by medical and psychiatric examinations as suffering from bipolar affective disorder and food allergy. Evident characteristic included mood swings. Her main complaint was extensive painful ulcer on the palate and lower lip. Current condition had caused her weight loss. Management included anamnesis, clinical and laboratory examinations, psychometrics, and referral to a psychiatrist. The dentist played an important role in identifying recurrent aphthous stomatitis and in the optimal and comprehensive treatment of the patient through multidisciplinary assessment.

Introduction: Pain is a complex stressor that has a major influence on several aspects of a person's physical, psychological, work and financial functions, especially in the form of chronic pain. The approach to chronic pain medically can sometimes not solve the problem as a whole, so that in its management psychological approaches such as cognitive and behavioral therapy (CBT) are needed.Methods: We searched PubMed, Science Direct, and Google Scholar for search articles in English terms "chronic pain", "cognitive behavioral therapy", "pain management", and "efficacy". Searching using the keywords above showed 40 articles, but which were taken were 8 articles from the last 5 years.Results: The method of intervention was carried out with a cognitive-behavioral approach in the form of traditional CBT, telephone-based CBT, coping skills training, cognitive-behavioral based physical therapy or CBT-based self-management. The research parameters used to measure the success rate of the interventions were pain intensity, physical function, psychological pressure, disability, fatigue, quality of life, coping strategies, catastrophization, and depression. The duration of the study varied from 5 weeks to 10 weeks, with a variation of 20-60 minutes per therapy session, except in studies using group therapy can take up to 5-7 hours per day. Some studies also conducted evaluation at the third and six months after treatment. The aim of the CBT approach was to independently improve self-efficacy in pain management.Conclusion: Cognitive behavioral approaches combined with other therapeutic modalities can improve the physical function of patients with chronic pain.

BACKGROUND:Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design.METHODS:Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders.RESULTS:Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]).CONCLUSIONS:Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice. BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design.METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders.RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]).CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.

Background : Stress is response and acknowledged as a natural respond to problems in daily life. Coping is defined as a process used to confront stress with various degree of effectiveness. Purpose : To correlate cause of stress and coping mechanism based on sex and year of admission among Universitas Airlangga medical students year 2013, 2014, and 2015. Method : This study was observational analytic study. Data were taken by self-administrated questionnaires (demographic, Medical Student Stressor Questionnaire, and BriefCOPE) Result : Respondents were dominated by female (60%) and out of 90 answers, the most frequent stressor was Academic Relater stressor (45.12%) regardless of the gender and admission year, and the most frequent coping mechanism is Planning (79.50%) and Religion for female students (80.75%) and 2013 students (78.75%). There was a significant correlation between stressor Intrapersonal and Interpersonal and Teaching and Learning Related also coping mechanism Planning, Humor, and Religion between male and female participants. There was also significant correlation between different admission year for coping mechanism Denial, Humor, and Self Blame. Conclusion : The most common stressor of the student year 2013, 2014, and 2015 with medical major in Universitas Airlangga is Academic Related and the most common coping mechanism is Planning. Keywords : medical student, academic stressor, coping mechanism, observational analytic study

Introduction: Medical students are experiencing uncertainty in finding the appropriate help for their mental health problems. When they finally decide to seek help, some of them are already in a mental crisis. The suitable indicator for early identification of mental disorder is mental health literacy. Mental health literacy also functions as a tool to decrease stigma towards people with mental illness and to improve help-seeking behavior. The purpose of this study is to determine the influence of mental health literacy to help-seeking behavior and to describe mental health literacy and help-seeking behavior of the medical students.Methods: The study design was observational analytical. Participants filled demographic data and answered questionnaire via an online file sharing platform. The questionnaires used in this study were Mental Health Literacy Scale (MHLS) and Attitudes Toward Seeking Professional Psychological Help Short Form (ATSPPH-SF). The influence of mental health literacy to help-seeking behavior was analyzed using logistic regression analysis. Results: The respondents were 60 medical students. No differences of literacy and attitude were found across the admission years. Overall, the students had good literacy and attitude. Students showed lower scores in the MHLS attributes containing ideas about self-treatments, confidentiality, social distance, and reliance on self. Being literate in the total score of MHLS did not influence on having a good attitude in ATSPPH-SF (p=0.303). Only by being literate in attitudes that promote recognition and help-seeking, the students showed a good attitude in ATSPPH-SF (p-value=0.027). Conclusion: There was no influence on mental health literacy to help-seeking behavior.

Akuaponik adalah suatu integrasi dari budidaya hewan akuatik dan tanaman hidroponik dengan sistem resirkulasi air. Sistem produksi ini diharapkan dapat mengurangi masalah lingkungan dari limbah air budidaya ikan. Penelitian ini bertujuan untuk melihat pengaruh dari penerapan sistem akuaponik terhadap kualitas air antara lain kandungan logam berat (Cu, Fe, Zn), pH, dan COD dalam air. Sampel air diambil dari tiga lokasi yaitu tangki kolam ikan (TK), tangki setelah biofilter (TSB), dan tangki setelah hidroponik (TSH). Pengambilan sampel dilakukan sebanyak 4 kali selama satu bulan yaitu pada 0 hari, 10 hari, 20 hari, dan 30 hari. Konsentrasi COD ditentukan melalui metoda titrasi dengan penambahan zat oksidator KMnO4. Sedangkan kandungan logam berat Cu, Fe, dan Zn dalam air dianalisis menggunakan spektrofotometer serapan atom nyala (SSA). Hasil penelitian menunjukkan konsentrasi logam berat Cu, Fe, dan Zn yang diperoleh paling tinggi pada hari ke-10. Data konsentrasi COD maksimum didapat setelah 20 hari, baik pada sampel air TK, TSB, TSH, dan untuk penerapan sistem akuaponik ini tidak terlalu berpengaruh terhadap kondisi pH yang diperoleh. Menurut PP RI No 82 tahun 2001 untuk klasifikasi air kelas II dalam budidaya ikan dan tanaman, dari hasil parameter yang dianalisis untuk konsentrasi COD, kandungan logam berat Cu, dan pH telah memenuhi standar baku mutu air, untuk kandungan logam berat Zn belum memenuhi standar baku mutu air, sedangkan untuk kandungan logam Fe tidak dipersyaratkan. Kata kunci : Akuaponik, Kualitas air, Logam berat (Cu, Fe, Zn), pH, COD

One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. The present study aims to compare physicians’ perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians’ attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians’ responses in each country were examined using chi-squared, ANOVA, and MANCOVA. A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients’ health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.