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Recently, the research analyzes the relationship between religion and spirituality has grown rapidly.Many mental health clinics have implemented interventions on religious and spirituality-based mental disorders. This article aimed to examine the effectiveness of handling mental-based mental disorders from various studies that have been conducted. Methods: The articles used in this systematic review were searched in the SCOPUS, PROQUEST, SPRINGERLINK, SAGE and SCIENCEDIRECT databases which is published between 2016-2020. The keyword used were "mental disorders" or "mental illness" and “spiritual” or “religious”, with the use of the phrase Boolean Operators. The articles selected according to the inclusion criteria include articles stating the effectiveness of spiritual healing for mental disorders, articles that analyzed mental illness patients in RCT, case-control studies and experiment. The articles obtained then were analyzed with the DSVIA conclusion table (design, sampling, variables, intervention and analysis). Results: There were 15 articles that meet the criteria as a systematic review.Thestudy result showed that there was a relationship between religious/spiritual involvement and mental disorders (positive). The findings from previous research indicated that religion play an important role in many situations because religious beliefs and rules affect people's lives. Conclusions:The majority of the previous literature stated a significant relationship between religious beliefs and practices and mental health.

Nurses are at the forefront of being directly involved in the care of Covid-19 patients. This can put nurses in a difficult position, especially if they had lack support from the surrounding environment. The society's negative stigma towards nurses can trigger psychological problems for them. Good coping is needed to maintain the work performance of nurses. This study aims to identify the perceived stigma, psychological response, and coping of nurses involved in caring for Covid-19 patients in Indonesia. This research was a cross-sectional study based on an electronic survey, the number of respondents was 509 nurses who came from all regions in Indonesia on 11-20 April 2020. Respondents were nurses who handled Covid-19 patients directly. The data were collected using a modified questionnaire the Berger stigma scale, DASS and Brief of Cope with a total of 27 questions. The questionnaires used have been proven valid and reliable after being tested on 30 nurses treating Covid-19 patients with a Cronbach Alpha value as follows: modified Berger Stigma Scale 0.952; modified DASS 0.928; and modified Brief of Cope 0.753. Most respondents were 26-35 years old (52.1%), female (61.5%), and worked in government-owned hospitals (48.3%). 231 respondents were stigmatized (45.4%), 274 respondents were depressed (46.2%) and 209 respondents were experienced stress (41.1%). The majority of respondents chose problem focused coping (65.8%). This study shows that some respondents feel they were stigmatized by society, but they have good coping (problem focused coping) to reduce their mental burden. Negative stigma against nurses is often difficult to avoid, support from family and colleagues was something that can ease the mental burden of nurses. Support from the government was needed to educate the public so that it does not give negative stigma to nurses and other health workers.

Introduction: Schizophrenia is a serious mental illness that affects the thinking, emotions, relationships, and decision-making. One of the positive effects of treating schizophrenia in patients is family health. The family welfare management strategies provide help for coping, care preparation, organizing meetings, and mentoring. This study focuses on family coping strategies for improving the health of members living with schizophrenia.Methods: A cross-sectional design was used by choosing 160 respondents randomly. The inclusion criteria were family members accompanying control schizophrenia patients to the Public Health Center, with a minimum age of 18. The independent variable was family coping, which consist of two sub-variables (problem-focused coping mechanism and emotion-focused coping mechanism), while the dependent variable was family health, which consists of three sub-variables (efficient, satisfaction, and happiness). The SMART PLS (2.0 Version) was used to prove the impact of the variables.Results: The results indicated that family coping had a significant impact on the health of the family. The hypothesis was taken from the value of the T-test on the structural model analysis, which shows T- statistics (13.966) > T-critical (1.96). The impact of family coping on the health is equal to 0.682 (OR). This means that if family coping is given one-unit value, it will increase the family health by 0.682 times.Conclusion: The implementation of the family coping strategy will improve the capacity of the family to clarify health issues encountered, resolve family behaviors effectively and minimize risk factors. Furthermore, the coping mechanisms chosen by families in facing stress will have an impact on the reduction of illness symptoms in the members with schizophrenia.

Ex-leprosy is a leprosy patient who has undergone treatment and is declared cured from a medical examination. The ex-leprosy have psychological and social problems due to disability and community stigma, caused them difficulty in re-socializing with the community. The aim is to identify the psychosocial experiences of ex leprosy in living their social life. This research is a phenomenological descriptive qualitative research method. The number of participants in this study were twelve using purposive sampling. Data collection using in-depth interviews and field notes, analyzed by the Collaizi method. This study produced six main themes, Social stigma, Support system, Able to do activities, Response to stress, Coping strategies, and Social support. Participants' social activity after recovering from leprosy has increased although there is still a stigma in some communities. Support from family and community is needed as well as good coping mechanisms for ex leprosy patients.

People with severe mental illness have complex disabilities affecting mental functions, daily activities, and social life, thus they need help from others in carrying out daily functional activities. Optimizing the recovery of severe mental illness requires a holistic approach and integration between mental health services and supportive communities so that sufferers can interact with others, have a positive self-concept, and improve their well-being. This study aims to describe a community-based model of recovery for people with severe mental illness. Several literature studies were obtained from 50 reference sources through Science Direct, Google Scholar, Proquest Health and Medical Complete, Proquest Nursing, and Allied Health Sources from 2009 to 2019. Results explain that the community provides an adequate support system in improving the care of people with severe mental illness. Support systems in the community involve social and physical aspects as well as the economic infrastructure through employment opportunities or financial support and a decent living. The interaction between community members and people with severe mental illness could be a positive thing in strengthening the motivation of people with severe mental illness to recover and be able to do their activities independently. The recovery process of severe mental illness requires strong motivation and commitment from the sufferer, the family, all society members, community mental health service team, and related policymakers. It can be concluded that people with severe mental illness need support from various parties in terms of future life planning, identifying strengths and weaknesses that they have, and recognizing multiple obstacles and support so that they recover and live independently.

Background: Nowadays juvenile delinquency is increasing in terms of number and type. Delinquency and criminality among teenagers are generally categorized as deviant behavior in society and can be interpreted as a form of teenage resistance to normative rules and values that apply in society. Many risk factors are related to deviant behavior. This study aimed to analyze the risk factors that influence the occurrence of juvenile delinquency.Method: This study used a cross-sectional design and a simple random sampling technique. The calculation results involved 295 samples. The independent variables were individuals, families, school environments, peer groups, coping mechanisms, lifestyles, and technologies. The dependent variable was juvenile delinquency. The data was collected using a questionnaire. The analysis used a multiple linear regression test with a significance level of α≤0.05.Results: Of the seven variables, six of them significantly influence juvenile delinquency. Technology is the variable that has the greatest influence on the occurrence of teenager wear.Conclusion: Technology is the most influential factor. These results indicate a significant shift in the causes of juvenile delinquency from family and peer factors to technological factors. This is quite reasonable because technology is a major need and is a trend for teenagers at this time.

Objective: This study explores the impact of social media on family who live with mentally disordered members in rural areas of Ponorogo, East Java Province. Various efforts have been made to determine whether or not social media can help families in rural areas deal with serious stress because of living with their mentally disordered members. Method: This study involves 160 members with mental disorder and their family. Stress is measured based on Lazarus and Folkman theory. Data are analyzed using the Sperman test with SPSS software. Results: Using Beck criteria, it was found that 60% (N = 160) of families feel stressed. Interestingly, there was a significance difference of stress experienced by the social media users and non-social media users (p value= 0.002). There are 31.3% of social media users who are less stressed while 68.7% non-social media users felt more stressed. Conclusion: This study verifies the stress experienced by familes who live with mentally disordered members. It can be concluded that the families who use social media are less stressed even though they live with mentally disordered members. It means social media can prevent stress. In addition, it is recommended that counseling and psychological training should be designed by considering participants’ gender and level of education.

The elderly pottentially getting multimorbid disease and chronic disease. Chronic disease through the elderly need an end of life care. The purpose of this study was to found the factors related to the perceptions of end of life care using health belief models. Design of these study was explanatory survey with cross sectional approached. The samples were 118 elderlies in Puskesmas Jatikalen area, Nganjuk Regency. Independent variables were demography (age and gender), sosiopsychological (social class), structural (knowledge), perceived susceptibility, perceived seriousness, perceived benefits, and perceived barriers. Dependent variable was end of life care. Data were collected by interview using questionnaire. Data were analyzed using chi square. Factors related to end of life care in the elderly were age (p value = 0.049), gender (p value = 0.001), social class (p value = 0.002), knowledge (p value = 0.0048), perceived susceptibility (p-value = 0.039), perceived seriousness (p-value = 0.025), perceived benefits (p-value = 0.000), and perceived barriers (p-value = 0.000). The factors related to the end of life care are age, gender, social class, knowledge, perceived susceptibility, perceived seriousness, perceived benefits, and perceived barriers. This study was recommended to apply to the elderly with chronic illnesses, especially at community. Keywords: end of life care, elderly, health belief model

Diabetes mellitus is a chronic disease that caused meaning of life disturbance. Logotherapy is an intervention that could affect people life perspective. The purpose of this study was to analyze the effect of logotherapy implementation to the meaning of life in diabetes mellitus client. This study used quasy-experimental pretest-post-test with control group. The dependent variable was meaning of life, and the independent variable was the implementation of logotherapy. Sample in this study was 30 respondents, were taken by using consecutive sampling. The meaning of life were taken by using Purpose in Life Test (PIL Test) then analyzed by using Wilcoxon Sign Rank Test and Mann Witney U statistic test, a= £0.05. The result showed logotherapy had significant effect on meaning of life in the treatment group (p=0,001). Statistical test Mann Whitney U Test showed that there was a difference meaning of life in control group and the treatment group after implementation of logotherapy. It could be concluded that the implementation of logotherapy has an effect to increasing the meaning of life in diabetes mellitus client. Further study was recommended to developing deeper study that related to logotherapy in diabetes mellitus client.

Aim: This study aims to determine the effect of health services on coping mechanisms of families with schizophrenia. Methode: The sample consisted of 260 family carers of individuals with schizophrenia in Ponorogo, East Java, Indonesia. Caregivers of families completed filling in the service factor questionnaire and coping mechanism questionnaire. Results: Community Value for Service Factor 0.662 and Family Coping 0.670 which means valid and strong. Community Value for Service Factor 0.853 and Family Coping 0.800 means Reliability. T-Statistics value of 0.205, which means there is an influence between service factors on family coping. Conclusiaon: Research on improving health services for coping mechanisms in family members of individuals with schizophrenia will help design interventions to improve coping mechanisms.

Introduction: Caregivers provide support for mental disorders in the form of care such as assistance in daily life activities, but during a pandemic it is a challenge in itself. Objective: To explore the caregiver's experience in caring for clients with mental disorders in remote areas during a pandemic. Methods: Using a phenomenological qualitative research design with 25 participants. The sampling technique used was purposive sampling with data collection techniques using in-depth interviews and field notes then analyzed using IPA (Interpretative Phenomenological Analysis). Results: This study found 6 themes, namely: Caregiver Workload and Tension, Threats to Caregivers' Physical and Psychological Well-Being, The Need for a Continuing Family Role, Holistic Care, Coping Strategy, Communication is getting harder.Conclusion: our research provides unique findings about the experience of treating mental disorders needs during the COVID-19 pandemic. Caregivers of mental disorders struggle with parenting difficulties during the pandemic, which poses a threat to their well-being and potential harm to the mental disorder survivor-caregiver relationship.

Background: One of the efforts made to return people with severe mental illness to the community is to prepare with sufficient skills so then they can return to a productive life. The purpose of this study was to develop a vocational social rehabilitation model to increase the independence of the instrumental activity of daily living (ADL) among people with severe mental illness. Design and Methods: The study was conducted in 2 stages. Phase 1 used an observational design with a cross sectional approach. It was conducted at the Menur Mental Hospital from March to July 2020. The population of this study were all people with severe mental illness with a psychotic degree scoring ≥30. The total sample was 100. The data was analyzed using the Partial Least Square. The second phase was carried out by compiling modules from strategic issues and conducting expert consultations. Results: The results of phase 1 showed that the instrumental ADL independence was directly influenced by perceived behavior, memory phase, motivation phase, skills and intention. Additionally, it is indirectly influenced by socio-demography, mental illness severity, attitude towards behavior, subjective norm, perceived behavioral control, attention, retention, motor reproduction, motivation and skill. The results of the phase 2 carried out were used to compile modules based on the stages of vocational rehabilitation consisting of determining eligibility, preparatory counseling, implementing rehabilitation, evaluation and ongoing support. Conclusion: The vocational social rehabilitation model is related to the independence of the Instrumental ADL among people with severe mental illness. Significance for public health Vocational social rehabilitation is included in prevention level of public health. The aim of vocational social rehabilitation is to increase the independence of the instrumental activity of daily living (ADL) among people with severe mental illness. So, people with mental illness could productively in society and not depend on others. In addition, the vocational social rehabilitation could develop the physical, mental and social abilities among people with mental illness. It is necessary to have rehabilitation institutions that involve the community so people with mental illness can return to normal life.

Background: The growing prevalence of schizophrenia in Indonesia requires the consideration of the families, caregivers, health care professionals, and the entire society, to serve as a support and coping resource for the patients. The process of recovery is rather difficult, especially in the absence of a decent place to live. Hence, there is the need to provide a supportive environment that facilitates recuperation from psychotic symptoms, enhances interaction with others, promotes self-expression of thoughts and feelings, and helps deal with daily stress and challenges. There are currently no studies on the framework of societal adaptation for people with schizophrenia (PWS). The aim of this research, therefore, was to explore the experiences of rural society inhabitants in adapting to PWS in Indonesia. Methods: The study uses a qualitative research design and implements an interpretive phenomenological approach. A total of ten society members were recruited from the community by purposive sampling, and the in-depth interviews conducted were audio-recorded and transcribed. In addition, thematic analysis was carried out using the interpretive phenomenological analysis method. Results: The majority of the participants assumed that PWS prompt the feeling of alertness over fear. In addition, the participants revealed a feeling of indecisiveness in related situations and emphasized the value of keeping up traditional beliefs and practices and the effectiveness of a demonstration of indifference. They explained the need to combine traditional and modern health practices as recommended by the spiritual leaders. Conclusion: Societal adaptation to PWS entails the understanding of how to deal with the disease’s uncertainty and complexity. It is important to create a supportive environment to promote mental health and wellbeing.

Based on the violent behavior, the data obtained in the last 6 months using population of psychiatric inpatients with violent behavior of 64 patients. The purpose of this study was to analyze the effect of forgiveness therapy that focused on emotions of violent behavior in post restrain schizophrenia. This research method used a Quasi-experimental design. The independent variable was forgiveness therapy that focused on emotions. The dependent variable was violent behavior. The populations were 64 patients with violent behavior using a simple random sampling technique and for the sample were 52 patients. Collecting data using general adaptive function response score (GAFR) observation sheets with Wilcoxon and Mann Whitney statistical tests. Wilcoxon test showed (p-value 0.002) after being given forgiveness therapy. The Wilcoxon test showed (p-value 0.513) after being given therapy that focused on emotions it can be concluded that there are differences in violent behavior before and after therapy of forgiveness and therapy that focused on emotions. Mann Whitney test results obtained (p-value 0.016) remission therapy was more effective in reducing the violent behavior of post restrain schizophrenia.

To date, breastfeeding baby in hospitals is still a serious issue. The present study is aimed to investigatenurse-mother interaction in making decision on whether to breastfeed baby with low birth weight in ahospital. This qualitative study administered the grounded theory approach. For data collection, focus groupdiscussion was implemented. Informants were selected with purposive sampling technique from threehospitals located in East Java Province, Indonesia. The validity test was satisfied with triangulation onsources, method and setting. New findings obtained from the study were classified into four categories,such as interaction, decision making, support and obstacles. The four categories form a triangle-shapedmodel of interaction. The first interaction is between nurse and spouse/family. The second one is betweenspouse/family with the mother. The third interaction is between mother and nurse. Support and obstaclesmay happen in every interaction. Decision making of breastfeeding mediated by the triangular interactionindicates that care is centered on infant. Nurses can improve the decision making quality of breastfeeding byminimizing obstacles and optimizing support in every flow of interaction.

Introduction: Mental health knowledge is a substantial part of mental health literacy. Many psychosocial problems are transient and are often not noticed. This study aimed to analyze the factors related to student self-awareness in conducting psychosocial screening. Methods: This study used a descriptive-analytic design with cross-sectional approach. The study was conducted at the Faculty of Nursing, Universitas Airlangga Surabaya. A total of 160 respondents was chosen using simple random sampling techniques. The instrument used was a questionnaire. The dependent variable in this study was students’ awareness in conducting psychosocial problems screening. The independent variables in this study were knowledge, social interaction, family support, perceived vulnerability, perceived severity, perceived benefits, perceived barriers, and self-confidence. Analysis used multiple linear regression statistical tests. Results: The results showed there was a relationship between social interaction (p=0.00), perceived vulnerability (p=0.00), perceived benefits (p=0.001) and self-confidence (p=0,000) with students’ self-awareness in conducting psychosocial screening. There was no relationship between knowledge (p=0.555), family support (p=0.720), perceived severity (p=0.070), perceived barriers (p=0.748) with students’ self-awareness in conducting psychosocial screening. Conclusion: Mental health awareness in nursing student should be enhanced and strengthened with health education. Self-awareness of mental health is important for students. This can prevent mental disorders in the future

Background: Curiosity is a personality characteristic, which fits with wellbeing and positive functioning. The objective of this study was to assess the construct validity of the Curiosity and Exploration Inventory II (CEI-II) in Indonesia. Design and Methods: The study included 256 undergraduate students who lived in Indonesia, mean age 19.8 years old. The CEI-II measures stretching and embracing using 11 items. The English version of CEI-II was translated into Bahasa. The Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were addressed to examine internal consistency reliability and the test-retest reliability. To evaluate construct validity, exploratory factor analysis (EFA) was used to assess factor structure and confirmatory factor analysis (CFA) was used to evaluate the structural model fit of the CEI-II Indonesia version. Results: The study showed Cronbach’s alpha for the internal consistency of the overall CEI-II Indonesia version was 0.77. The ICC for the test-retest reliability ranged between 0.753-0.829. EFA showed adequate with the Kaiser-Meyer-Olkin value of 0.86 and the Bartlett’s test of sphericity was statistically significant. CFA tested the second-order model with two-order factors and showed a model fit. Conclusions: The CEI-II Indonesia version indicated acceptable construct validity to evaluate curiosity in Indonesia. Significance for public health Curiosity is associated with higher life satisfaction as well as subjective well-being. The National Prevention, Health Promotion, and Public Health Council, United States mentioned subjective well-being as 1 of 7 priority areas for the National Prevention Strategy to improve physical and mental functioning. Curiosity has been conceptualized as an individual desire to look for something new, cognition, and self-regulation. It is considered as an important role in human development. Furthermore, we need tool to improve understanding and measure curiosity in undergraduate students. A tool is required in clinical and research purpose to rapid screening on a large scale and to provide reliable data, especially considering that curiosity is one of indicator of well-being. This study aimed to assess psychometric of Curiosity and Exploration Inventory II (CEI-II), so the undergraduate students can be aware of their positive emotional- motivational system as well as their personality. The result showed the CEI-II Indonesia version indicated acceptable construct validity to evaluate curiosity in Indonesia.

Introduction : Marriage with a spouse who has a mental disorder is not easy. Many couples divorce when married with mental disorder patients because they feel difficulties in their marital relationships, but some of them can maintain it for years. The purpose of this research is to describe family functioning in mental disorders. Method : The design of this study was cross-sectional. The sample was 31 wives of people with mental disorder and they were obtained using an accidental sampling technique. The instrument of this research are Family Assessment Device and The Investment Model Scale then analyzed with Pearson correlation test (α < 0,05) . Results : There was a significant relationship between family functioning with marital commitment (p = 0,022; r = 0,411). Conclusion: The higher of family functioning then the higher of marital commitment experienced by wives of people with a mental disorder . This finding can be used as a consider in improving mental health nursing services to wives of people with a mental disorder by providing adequate information through counseling about mental disorder and the treatment.

Background: People with severe mental illness have the ability to live a satisfactory and independent life with the help of the community. Their adaptation to life’s challenges is a dynamic process, and the community plays an important role. This research, therefore, aims to address the question of how social capital, demographic factors, and coping strategies affect the community’s ability to adapt to people with severe mental illness. Design and methods: The multi-stage random sampling was used to obtain data from 137 respondents from rural society using an analytic observational design and cross-sectional approach. In addition, the Somers’ D test was used to measure the effect of social capital, demographic factors, and coping strategies on community adaptation. Results: The results showed a significant effect of social capital, demographic factors, and the coping strategy of community adaptation (P

Families who care for schizophrenia suffer stress and lose the ability to treat. Family stress can be mediated by resilience. Objective: This study aimed to develop a family resilience model based on family-centred nursing for persons with schizophrenia. This study used a mixed-method cross-sectional approach. The population was a family of caregivers for persons with schizophrenia at Mental Hospital in Surabaya, Indonesia. The respondents were 137 families recruited by simple random sampling. Variables include family factors, risk factors, protective factors, patient factors, family stress, family resilience and family ability to care for persons with schizophrenia. The data were collected using questionnaires and then analysed with partial least squares. The statistical results afforded material for focus group discussions with six families and 10 health workers (psychiatrists, psychologists and nurses) in order to improve the model. The result showed family stress was influenced by family factors (path coefficient = −0.145; t = 2.26), risk factors (path coefficient = 0.753; t = 16.7) and patient factors (path coefficient = 0.159; t = 3.23). Family resilience is influenced by risk factors (path coefficient = 0.316; t = 2.60), protective factors (path coefficient = 0.176; t = 2.22) and family stress (path coefficient = 0.298; t = 2.54). Family resilience affects the family ability to treat persons with schizophrenia (path coefficient = 0.366; t = 5.36). The family resilience model increases family capability by 13.4%. The model helps families through stress management by controlling the burden and stigma so that families are able to survive, rise, growing stronger and be better at caring for persons with schizophrenia. © 2020 Nordic College of Caring Science

BackgroundTreatment of post-pasung(physical restraint) patients with mental disorders has become a new problem in Indonesia in its effort to free the country from the physical restraint programme. Problems emerge when the patient returns to the family and society at large, and families that refuse to allow the patient to come back home risk the possibility that the patient may eventually become a psychotic vagrant.AimsTo determine the appearance of families taking care of patients with mental disorders post-pasung.MethodThis study was qualitative research using a case study approach. The number of participants from six families was selected by purposive sampling. Collecting data was done by in-depth interview, and analysed thematically using Colaizzi steps.ResultsThe results showed that families coping when taking care of patients with mental disorders post-pasungcomprise seven themes. The seven themes are formed by four categories, 19 sub-themes and 32 sections.DiscussionThe appearance of coping was the overall description of coping in the form of strategic process stages, the support of coping and meaning for what the families feel when they are taking care of a patient with a mental disorder post-pasung. The appearance of coping showed how the family chooses the mechanisms of coping to deal with stress and crisis.ConclusionThe coping mechanisms that families use when taking care of a patient with a mental disorder post-pasungwere formed through stages of a strategic process. Families need coping strengthening interventions to provide optimal care for patients with mental disorders post-pasung.

Introduction: Smartphone addiction often occurs in adolescents. The purpose of this systematic review was to identify the predictors of smartphone addiction in adolescents. Methods: The method used in this systematic review consisted of 5 stages: (1) the identification of the instruments used in the literature (database search); (2) the identification of the relevant literature based on the title and abstract; (3) the inclusion and exclusion criteria; (4) getting the full-text literature and (5) grading based on the literature component and the analysis of the selected instruments. The databases used in the literature search were Scopus, PubMed, Science Direct and Springer Link from 2013 - 2018. The criteria for the included articles were that they used a cross-sectional design and involved adolescents as the sample. Results: 17 of 829 articles met the inclusion criteria. The predictors of smartphone addiction were broadly divided into 3, namely personal factors, interpersonal factors and behavioral factors. These 3 factors are related to one another. Conclusion: It is necessary to do further research within a case-control study to strengthen this systematic review.

Objectives:The study was conducted to illustrate the risk factors of family resilience when taking care ofpatients with schizophrenia.Methods:The research used qualitative design with an interpretive phenomenology approach, with in-depth interviews. The subjects were 15 family members who cared for patients with schizophrenia at theMenur Mental Hospital, Surabaya, Indonesia. The samples were obtained by purposive sampling tech-nique. The data was collected by interview and usingfield notes, then analyzed by Collaizi technique.Results: This research produced two themes, they were care burden and stigma. Care burdens felt byfamilies were confusion about the illness, emotional, physical, time,financial and social burdens, whichleads to decrease in family quality of life. Families also experienced stigma called labeling, stereotyping,separation and discrimination. Stigmas meant that families faced psychological, social and intrapersonalconsequences. This decreased the family quality of life and functionality of the family, and there wereopportunities for negative results to family resilience. Health workers, especially psychiatric nurses,should review care burdens and stigma to develop nursing interventions so families are able to achieveresilience.Conclusions:This research explained how care burden and stigma are risk factors that must be managedby families to survive, rise up, and become better in caring for patients with schizophrenia. Nurses have acentral role in assessing the level of care burdens and stigma in order to help families achieve resilience.Further research may focus on family-based nursing interventions to lower care burden, and community-based interventions to reduce stigma.©2018 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access articleunder the CC BY-NC-ND license

Introduction: Autism is social interaction disorder in children. They were seemingly living in their own world. ABA method was a technique to decrease behaviour disorder or social interaction in autism children. The aimed of this research was to evaluate correlation between ABA method implementation and parents role with social interaction development in children with autism.Methods: This research was used a cross sectional with purposive sampling. There were 22 respondents who met to the inclusion criteria. The independent variable was ABA methode and the dependent variable was social interaction development. Data were collected by using questionnaire and observation, then analyzed by using Spearman Rho Correlation with significance level α≤0.05.Results: The result showed that there was a correlation between ABA method and social interaction development in autism children with p

Introduction: Menopause woman has higher depression level than pre and postmenopause woman. Many woman who are getting menopause will feel lonely and don’t have any friends to talk, if this situation continue it can cause menopausal depression. Peer group support is one of group therapy which gives opportunity to menopause woman to get mutual support and help them to face the problem. This aimed of this study was to analyze the effect of peer group support in the menopause woman depression level.Methods: A quasy experimental pre-post test design was used in this study. There were 16 menopause women taken from Cepokomulyo Kepanjen. The independent variable was peer group support and the dependent variable was the depression level. Data were analyzed by Wilcoxon Signed Rank Test and Mann Whitney U Test with the significance level α

Introduction: Psychological well-being is one of an important part on the positive aging process for elderly. Many older people face stressful situation such as death of family, deterioration of health, decrease of physical ability and psychological problem like loneliness, low self esteem, useless, isolation or difficulty in relationship. Religious relaxation: dzikir is one of the group therapy to fill up psychological necessary by filled up spiritual necessary so they could say thanks to God for everything what they have had now. The aimed of this study was to analyze the effect of religious relaxation: dzikir to increase the level of psychological well being of the elderly.Methods: This study was used a quasy experimental pre post test design. There were 20 respondents which taken by using purposive sampling. The independent variable was religious relaxation: dzikir and the dependent variable was elderly psychological well being. Data were analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U-Test with significance level a≤0.05.Results: The result showed that religious relaxation: dzikir has an effect on increasing the level of psychological well being of the elderly with Wilcoxon Signed Rank Test p=0.004 in treatment group, p=1.000 in control group and the result of Mann Whitney U-Test revealed p=0.000.Conclusion: It can be concluded that religious relaxation: dzikir can increase psychological well-being. Religious relaxation: dzikir help the elderly to develop self acceptance, autonomy, positive relation with others, environmental mastery, purposive in life and personal growth. Researcher suggests the institutional to practice relaxation religious: dzikir to help elderly people to raise psychological well-being.

Introduction: The main problem that experienced by child of mental retardation was slowness development of socialization ability especially the ability to cooperate. This disability happened because less of stimulation activity and because of the extraordinary school give more lessons to increase intelligence ability. Group Activity Therapy (GAT) Socialization is a therapy given to child of mental retardation to train their cooperate in playing group and increased their socialization ability (cooperate). Method: This study used Quasy Experimental design. The population was the students of 1-5 class at Karya Bhakti extraordinary school. The sample was recruited with purposive sampling consist of 20 respondents according the inclusions criteria and divided into treatment and control groups. The Independent variable was GAT Socialization session 6 and the dependent variable was the increased of socialization ability (cooperate). Data were collected with observation sheet and analyzed with Wilcoxon Signed Rank Test and Mann Whitney U Test with level of significance p

Introduction: Scizophrenia is a disease which affect of brain, causing impaired perception, thought, emotion, movement, and behavior, such as self care deficit. Self-care deficit is an impaired ability to bathing, dressing, eating and toileting. Modeling participant is a technique required to address the problem of self-care deficit where clients are taught and trained to meet the needs of self-care. The purpose of this study was to analyze the influence of participants modeling on self-care ability in schizophrenic clients with self-care deficit.Method: This study used quasi experimental design. Sampling was carried out with total sampling to all affordable population comprising 20 respondents in Dr Radjiman Wediodiningrat Mental Hospital, Lawang. This study analyzed by Wilcoxon Signed Rank Test and Mann-Whitney Test with significance level of p < 0.05.Result: The results showed the influence of participants modeling on self-care ability in schizophrenic clients with self-care deficit. Wilcoxon Signed Rank Test in treatment group showed p = 0.005 and control group showed p = 0,206. Mann-Whitney Test showed p = 0.030. Modeling participant improved self-care ability in schizophrenic clients with self-care deficit.Analysis: Modeling participant will improve cognitive, self-confidence and motivation of schizophrenic clients so that their ability to bathing, dressing, eating and toileting will increase.Discussion: Modeling participant can be applied as a technique to improve self-care ability in schizophrenic clients with self-care deficit. For further research can be explored further implementation of the modeling of participants in the group activity theraphy.

Introduction: Schizophrenia is a severe mental disorder that is characterized by impaired reality (hallucinations and delusions), inability to communicate, affect unnatural or blunt, cognitive disorders (not capable of abstract thinking) and had difficulty doing daily activities. Normally, the family is most affected by the presence of people with schizophrenia in their families. The purpose of this study was to develop an adaptation model of the caregiver in caring for family members with schizophrenia in Kediri.Methods: This study used cross-sectional design with nature explanatory research. Data were collected using a questionnaire on 135 respondents in nine health centers in the city of Kediri region. The sampling technique used simple random sampling. For data analysis and test, the feasibility used a test model of SEM with AMOS program 19.Results: The results showed self esteem caregiver (-0.25 0.05) , caregiver coping effort (12:17

Introduction: Schizophrenia is the problem with kognitive, mal-adaptive thought and behavior. Family who have a member with mental disorder can experience serious conflict, become an objective and subjective burden, blame each other, get involved in hostility among family members. Various negative effect faced by family can caused by wrong family’s health belief model about Schizophrenia, hence the failure on choosing the treatment and taking care of patient at home. Someone with severe stress will seek comfort and strength from God. But so far, the most effective spiritual models to improve the health belief model of the family in caring for patients with schizophrenia has not been found.Methods: Design used in this study was experimental (pre post test control group design). The population was every family of patient with mental disorder in Menur Mental Hospital along the year of 2010, chosen by alocation simple random. Samples were 13 persons in each treatment and control group. The intervention was given in 60–120 minute in 8 times meeting with average interval about 1 week. Data analysis was done using paired t-test and independent t-test.Results: There were significant changes in total of family’s health belief model (p=0,004), there was significantly change in aspects of (1) perceptions about bene fi ts (p=0,009), (2) perception about barriers (p=0,035) and perception about self efficacy (p=0,002). There were no significant changing in perception about susceptibility and severity (p=0,052).Conclusion: Family believes that all events experienced by the patient and the family is God's will, hoping the patient can be more independent, and believe mental disorders can be changed for the better. The conclusion of this study is that family therapy with a spiritual approach can improve the health belief model of the family in caring for patients with mental disorders.

Anxiety is common among adolescents. Self-report anxiety scales are needed to screen and prevent adolescents sinking into worse mental health. The purpose of this study was to assess the psychometric properties of Indonesia Zung Self-rating Anxiety Scale (SAS), including translation, validity, reliability and receiver operating characteristics (ROC). We used cross-sectional study and correlational design in this study. Total sample was 1,000 adolescents in junior and senior high school. The SAS was translated into Bahasa Indonesia based on World Health Organization guidelines. SAS and the Indonesia version of Beck Depression Inventori-(BDI) II questionnaires were used to develop construct validity. Correlation between item score and total score was used to establish convergent validity. Cronbach’s alpha was used to calculate reliability and ROC curves were used to examine cut-off point of SAS. Construct validity showed positive correlation between the SAS and Indonesia version of BDI II scores. Convergent validity showed positive correlation between each item and total score. Cronbach’s alpha 0.691 and the ROC 36.5. Thus, the Indonesia version of SAS provides a reliable and valid tool to screen anxiety among adolescents.

Introduction Violence against adolescents is prevalent in the world, yet this issue is neglected especially in developing countries. Bullying among adolescents negatively affects the victims in relation to emotional, physical, social and overall health status. This study was conducted to understand bullying and its associated factors in school-going adolescents in Indonesia. Methods This study was a correlational design with a cross-sectional approach. Data were obtained from the 2015 Indonesia Global School-based Health Survey (GSHS). As many as 9969 adolescents in schools were selected by probability proportional to size method and systematic sampling. Variables analyzed on this study were age, sex, smoking behavior, alcohol consumption, close friends and feeling of loneliness. The research instrument used the GSHS 2015 questionnaire. Chi-square (χ2) analysis and multiple logistic regression tests were conducted to determine the significance of each variable. Results A total of 19.9% of adolescents in Indonesian schools were victims of being bullied. Being bullied was associated with ≤14 years old [adjusted odds ratio (AOR) 1.30, 95% confidence interval (CI) 1.17–1.45], being male (AOR 1.43, 95% CI 1.28–1.59), being a smoker (AOR 1.46, 95% CI 1.23–1.73), consuming alcohol (AOR 2.07, 95% CI 1.64–2.62), having no close friends (AOR 1.27, 95% CI 0.95–1.70) and feeling lonely (AOR 2.29, 95% CI 2.05–2.55). Conclusion Indonesian in-school adolescents report a relatively high prevalence of having been bullied. Being bullied is related to various factors depending on personal and environmental factors. School communities and health professionals’ attention to adolescents should be sensitized and this issue discussed, developing strategies and minimizing the negative effect on the adolescents. Policy makers need to consider developing a social platform among adolescents to facilitate students’ interaction.

Introduction: The high stigma in the community towards mental disorders does not only affect families and mental disorders patients but also on the patterns of care and care, for example, mental disorders patients are isolated so they do not interact with the community with shackles. The purpose of this research is perceptions in the community about how to treat patients with mental disorders.Method: This study used a qualitative research design with a phenomenological approach with ten participants. The technique of selecting participants was purposive sampling with the criteria of men and women aged > 17 years, living around halfway house and who had interacted with mental patients at halfway house. Retrieval of data on ten participants with in-depth interviews and field notes were then analyzed using the Colaizzi method.Results: In this study, 8 themes were identified, namely 5 themes (community understanding of mental disorders, community stigma, community response, community expectations and community experiences with mental patients) for the first specific purpose and 3 themes (treatment, form of care and caregiver factors nurse) for the second special purpose.Conclusion: Community perception is influenced by several factors including the factor of maintaining distance from mental patients, tolerance and support factors, social limitation factors, and factors of prejudice and misunderstanding. Future research can explore in-depth people's perceptions about the treatment of mental disorders patients, more specifically, for example, the care of mental patients in hospitals and at home.

Pendahuluan : Proses perubahan seseorang menjadi remaja merupakan proses yang sangat penting dimana pada usia remaja, merupakan proses pencarian jati diri seorang remaja sedang berlangsung, mencari identitas diri, mencoba hal-hal baru, dan proses sosial seperti memiliki sekelompok teman yang menurutnya memiliki satu hobby dengannya, yang biasa disebut dengan “geng”, karakteristik remaja yang sedang berproses untuk mencari identitas diri ini juga sering menimbulkan masalah negatif di lingkungan sekitarnya, diantaranya adalah cyberbullying.Metode : Rancangan penelitian ini adalah cross sectional. Sampel sejumlah 262 siswa siswi kelas xi dan didapatkan dengan menggunakan teknik simple random sampling. Data diperoleh dari kuesioner Cyberbullying and Online Aggression Survey Instrument dan The Social and Emotional Competences Evaluation Questionnaire (QACSE) kemudian dianalisis dengan uji statistic korelasi Spearman Rho.Hasil : Hasil penelitian ini menunjukkan bahwa ada hubungan Cyberbullying dengan kecemasan sosial pada remaja didapatkan bahwa semakin tinggi Cyberbullying yang diperoleh maka semakin tinggi kecemasan sosial yang dialami oleh remaja dengan nilai p = 0,000; r =0,225 nilai normal p= 0.05 , r=1. Ada hubungan antara cyberbullying dengan penarikan sosial pada remaja dengan nilai p = 0,009; r = 0,161 dengan nilai normal p = 0,05 dan r = 1.Kesimpulan : Cyberbullying terhadap kecemasan sosial terdapat hubungan rendah dan bermakna dengan arah negatif dimana semakin tinggi membuat keterlibatan remaja dengan cyberbullying semakin rendah dan Cyberbullying terhadap penarikan sosial terdapat hubungan rendah dan bermakna dengan arah negatif dimana semakin tinggi membuat keterlibatan remaja dengan cyberbullyingsemakin rendah.

Introduction : The stigma that people with ODGJ get from society is also felt by their families, they will feel sad, ashamed, afraid, and feel that they are not free to do many outside activities. The psychological burden felt by the caring family can affect the adequacy of self-efficacy in carrying out daily activities. The purpose of this study is to describe the self-efficacy of families experiencing stigma while caring for people with disorders in Buduran District, Sidoarjo. Method : This type of research design used is a phenomenological method with 15 participants who have family members with ODGJ through purposive sampling technique. The data collection technique used was in-depth interview. The data were analyzed using the Colaizi technique. Results : This study resulted in several themes, namely, 1) community stigma, 2) perception of family members, 3) treatment received by family members, 4) selfacceptance of family members, 5) social support, 6) coping mechanisms, 7) patient health conditions, and 8) mental strength of family members. The self-efficacy picture of family members caring for ODGJ sufferers is based on the perceived problem magnitude in the form of community stigma on the magnitude dimension, so that adaptive or maladaptive coping mechanisms are formed on the strength dimension, resulting in a fairly limited range of behavior on the generality dimension, and expectations of family members healing of sufferers and meaning of conditions. This condition can affect the self-efficacy picture of family members who care for people with ODGJ. Conclusion : a family whose relatives as ODGJ sufferers are prone to inadequate selfefficacy due to the patient's abnormal behavior. The family stigma that develops is also felt by the family and becomes a psychological burden.

Background: Sleep is associated with some behavioral factors such as maladaptive, which tend to disrupt its normal mechanism, therefore, a tool is needed to measure maladaptive sleep hygiene. This study aims to assess the psychometric properties of sleep hygiene index (SHI), translation, factor structure, validity, and reliability. Design and Methods: Data were collected from 101 Indonesia adolescents in junior high school, with SHI-Indonesia translated based on WHO guideline. The obtained data were analyzed using varimax rotation, while the convergent validity was evaluated by calculating the correlation between the item and total score. In addition, the Cronbach’s alpha was computed to investigate internal consistency, and two-week interval test-retest was conducted to assess reliability. Results: SHI is a unidimensional factor structure with an excellent test-retest reliability of P

Introduction: Adolescents living in orphanages experience a lack of self-confidence, withdrawal, lack of interest in learning, lack of communication, and a closed attitude so that it will have a negative impact on cognitive, emotional, and social development. This study aims to determine the effect of Therapeutic Group Therapy (TKT) on the development of adolescent self-identity in orphanages. Methods : The study design was a Quasy experimental pre-post test control group design. The population was 104 children living in orphanages A and B. The research sample was 30 intervention groups and 32 control groups that met the inclusion criteria obtained through purposive sampling. The independent variable is Therapeutic Group Therapy while the dependent variable is self-identity. Data obtained using a questionnaire and analyzed using the Wilcoxon Sign Ranks Test and Mann-Whitney U Test with a significance level ∝

Introduction: Leprosy is an infectious disease that still causes complex problems. The problem in question is not only in medical and physical terms, such as disability, but extends to social, economic, and cultural problems. This study aims to explore the experience of leprosy sufferers with disabilities to achieve resilience. Methods: A descriptive qualitative research design with a phenomenological approach was used. The number of participants was eleven people affected by leprosy with grade 1 and 2 disabilities in Sumenep Regency obtained by a purposive sampling technique. Data collection used in-depth interviews with interview guides and field notes; the results of data collection were analyzed with theme analysis. Results: This study produced five main themes about the experience of leprosy patients in the process of achieving resilience, namely: 1) self-stigma as a stressor experienced by lepers, 2) psychosocial problems that arise in response to stressors, 3) active coping as a method of resolving stress, 4) positive adaptation as a form of self-adjustment, 5) characteristics of strong individuals. Conclusion: Lepers with disabilities identify self-stigma as a stressor that triggers the emergence of psychosocial problems. Individuals can form tough characteristics, such as responding positively to unexpected conditions, becoming more productive, and showing helping others behavior after overcoming stressors through the stages of active coping and positive adaptation.

Loneliness is a feelings of isolation where people felling lonely. All the elderly certainly desire to prosper in his old age but the fact isn’t all the elderly can reach it due to various reasons such as poverty, currently didn’t have offspring or family who can care for the elderly and the inability of the family in providing care to the elderly, so many elderly people become homeless. In This results used pre-experimental one-group pre-post test design. The population in this research is elderly with amount 76 people. Sample was 12 people taken by purposive sampling technique. Collected data conducted by using a questionnaire and analyzed used the Wilcoxon Signed Rank Test with significance α = 0.05. The results of research concluded that millieu therapy methods the creation of art made bracelet could be decreased loneliness of life of the elderly it can stimulate the cognitive, affective, psychomotor, sosio-emotional and self-esteem. Further research is expected to use control groups and researching other factors that influence loneliness the elderly. Researcher can use millieu therapy in supporting and helping the elderly yo live a best quality.

Keperawatan gawat darurat merupakan bagian kompetensi pendidikan profesi yang bertujuan agar mahasiswa mampu berpikir kritis untuk mengatasi masalah keperawatan klien yang mengancam kehidupan. Metode pembelajaran yang digunakan pada tahap ini adalah pembelajaran klinik eksperiential. Namun saat ini masih banyak dijumpai hambatan dalam mencapai tujuan pembelajaran tersebut sehingga berdampak pada rendahnya capaian pembelajaran klinik. Penelitian ini menggunakan metode eksplanatif karena bertujuan menjelaskan hubungan kausal antar variabel. Populasi penelitian ini seluruh mahasiswa Ners Fakultas Keperawatan dan Kebidanan Unusa. Pengambilan sampel menggunakan tehnik simple random sampling sebesar 72 mahasiswa. Variabel endogen adalah karakteristik peserta didik, pengamatan, proses berpikir, perilaku belajar, pembelajaran klinik experiential, dan variabel eksogennya capaian pembelajaran klinik keperawatan gawat darurat mahasiswa ners. Hasil uji statistic menggunakan Partial Least Square didapatkan semua indikator dan variabel konstruk valid dan signifikan. Sedangkan uji signifikansi jalur model struktural nilai t hitung > 1,96, menunjukkan bahwa ada pengaruh signifikan variabel karakteristik peserta didik terhadap pengamatan, proses berpikir, pembelajaran klinik experiential, variabel pengamatan terhadap proses berpikir, dan perilaku belajar, variabel proses berpikir terhadap perilaku belajar, variabel perilaku belajar terhadap pembelajaran klinik experiential, dan variabel pembelajaran klinik experiential terhadap capaian pembelajaran klinik keperawatan gawat darurat mahasiswa ners. Model pembelajaran klinik experiential ini dikategorikan model yang baik dan memiliki nilai prediksi apabila diaplikasikan dapat meningkatkan capaian pembelajaran klinik keperawatan gawat darurat mahasiswa ners. Faktor dominan keberhasilan pembelajaran klinik experiential tergantung pada karakteristik peserta didik dan perilaku belajar mahasiswa ners.

Schizophrenia is a chronic brain disorder that affects about one percent of the population which is also commonly found in Indonesia. Based on the medical records taken from Surabaya Menur Mental Hospital in July until September 2016, the number of patients diagnosed with this disease is 439 patients. The increasing case of schizophrenia is resulted from the lack of support and role of family and their ability in taking care of patients with schizophrenia. This study used quasi-experimental design (pre-post test control group design),purposed to prove the effects of video-based discharge planning using family-centered nursing on the ability of family in taking care of patients with schizophrenia. This study involved the family members of schizophrenic clients as the population in which half of them were taken as the samples: 15 repondents were chosen as the control group, whereas 15 respondents were taken as the treatment group using consecutive random sampling technique. The independent 205 Jurnal Ilmiah Kesehatan, Vol. 10, No. 2, Agustus 2017, Hal 204-213 variable was the video-based discharge planning using family-centered nursing, whereas the dependent variable was the cognitive, affective, and psychomotor ability of the family. Moreover, the data were analyzed by using Mann-Whitney and Wilxocon signed rank test. Mann Whitney test analysis obtained on cognitive ability P value 0.013

Indonesia bebas pasung bagi pasien gangguan jiwa merupakan program prioritas yang harus dicapai pemerintah pada tahun 2019. Saat ini upaya bebas pasung telah dilaksanakan dengan baik, permasalahan baru muncul setelah masa pengobatan selesai dan harus kembali kepada keluarga dan masyarakat. Keluarga tidak menghendaki pasien kembali kepada keluarga, diabaikan, kembali kambuh atau menjadi gelandangan psikotik. Penelitian ini bertujuan untuk memperoleh gambaran dukungan keluarga terhadap pasien gangguan jiwa pasca pasung. Penelitian ini menggunakan desain kualitatif fenomenologi, jumlah partisipan sebesar 9 orang dipilih dengan purposive sampling, pengumpulan data dilakukan dengan wawancara mendalam, data dianalisis secara tematik. Hasil penelitian menunjukkan dukungan keluarga terhadap pasien gangguan jiwa pasca pasung diperoleh 2 (dua) tema besar yaitu; fenomena pasung terhadap pasien gangguan jiwa dan dukungan keluarga. Fenomena pasung meliputi; alasan, keputusan, metode, pembebasan dan dampak pemasungan. Dukungan keluarga meliputi; dukungan penilaian, instrumental, informasional dan dukungan emosional. Dukungan keluarga dibutuhkan pasien untuk dapat mencapai penyembuhan dan mencegah kekambuhan. Pengetahuan yang kurang terhadap cara perawatan pasien gangguan jiwa pasca pasung menyebabkan dukungan keluarga yang diberikan terhadap pasien tidak optimal. Pandangan keluarga dan masyarakat yang keliru terhadap pasien gangguan jiwa mempengaruhi penanganan yang tepat terhadap pasien gangguan jiwa.Kata kunci: Dukungan keluarga, gangguan jiwa, pasung. AbstractIndonesian free of pasung for mental disorders is a priority program to be achieved by the government in 2019. Currently the effort of free of pasung for mental illness has been well implemented. A new problems arise after the treatment period is over and patients must return to family and community. Families do not want patients to return to then, ignored, relapse or become psychotic homeless. This study aims to obtain a description of pasung phenomenon and family support for patients after having pasung. This research used qualitative phenomenology design, the number of participants for 9 people was chosen by purposive sampling, data collection was done by indepth interview, the data were analyzed by thematic analysis. The result of the research showed two big themes that are; pasung phenomenon and family supports after the patient having pasung. The pasung phenomenon includes; reasons, decisions, methods, exemptions and the effects of deprivation. Family support includes; support assessment, instrumental, informational and emotional support. Family support is needed for patients to achieve healing and prevent recurrence. The lack of knowledge about the way patients care for post pasung mental disorders cause the family support provided to patients is not optimal. Misrepresentation of family and community opinions on psychiatric patients affects the proper treatment of psychiatric patients.Keywords: Family support, mental disorder, pasung.

Background:Various efforts have been made by the Indonesian government to improve mental healthservices. In 2014, the government established Law no 18, which is about mental health and the treatmentof people with mental illness covered by the universal health coverage. However, many people stillexperience difficulty in accessing mental health services. In Indonesia, family plays the role of a caregiverto people with mental illness.Objective:This study aims to identify the perceived barriers on mental health services by families whosemembers suffers from mental illness.Methods:This study is a qualitative research study with a phenomenological approach. Sampling wasconducted by purposive sampling with a sample size of 12 participants. Data were collected usingsemistructured in-depth interviews. Thematic analysis was performed using Colaizzi steps.Results:The obtained results presented three themes. Theme 1, mental health service affordability;theme 2, mental health service availability; and theme 3, negative attitudes (stigma).Conclusion:Families whose members suffered from mental illness still experienced barriers in relation tomental health services even with universal health coverage. Improved mental health services are relatedto the health insurance coverage, affordability, availability of mental health services and stigma reductionin the health professionals and wide community.©2017 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access articleunder the CC BY-NC-ND license