Introduction: Soursop leaves have various contents of alkaloid, flavonoid, and acetogenin compounds. Soursop ethanol extract leaves (Annona muricata) showed many beneficialsas antivirus, anti-hyperglycemic, anticancer, etc. As anticancer showed with cytotoxicity insome cancer cell line.But there was no research about wound assay in Widr colon cancercell line as a model of colon cancer diseases. This research carried out to explore theoverviewofwoundassaymethodofsoursopethanolextractleavesininhibitingmigrationofWiDrcoloncancercells.

Methods: The series of studies included extra ethanol cytotoxic tests of soursop leaves (Annona muricata L.) on WiDr colon cancer cells usingMTT to assess cell viability and antimigration testing using the scratch wound healingassay method to assess the presentation of closure of WiDr colon cancer cell migration.

Results: Cytotoxic test of soursop ethanol extract leaves (Annona muricata L.) on WiDr colon cancer cells obtained IC50 values of 905.77 µg/ml and the cell antimigration test at 24 hours obtained the greatest migration inhibition, namely soursop ethanol extract leaves (Annona muricata L.) at a dose of ½ IC50 or equal to 452.85 µg/ml.

Conclusions: Soursop ethanol extract leaves (Annona muricata L.) has an effect on inhibiting migration of WiDr colon cancer cells so that it can be used instead of chemotherapy which can prevent and inhibit the growth of cancer cells.

Background: The COVID-19 pandemic has disrupted human activities, one of which is education, which requires a modification of learning. Online-based audio-visual learning methods are needed to deliver material until offline learning is active again so that learning activities can still be carried out. This study aims at a simulation and audio-visual learning method on cardiac, pulmonary resuscitation skills in nursing undergraduate students.

Methods: The research uses a descriptive-analytic cross sectional approach. The variables in this study are simulation learning, audio-visual and knowledge of resuscitation. The sample was 83 respondents, and the sampling technique was probability sampling utilizing proportionate stratified random sampling.

Results: The results showed that most of the respondents considered both simulation and audio-visual methods learning, 56 respondents (67.5%) and 62 respondents (74.7%), considered 27 respondents (32.5%) and 21 respondents (25.3%) bad. Knowledge of good category skills were 62 respondents (74.7%), and bad were 21 respondents (25.3%). Chi-Square test results obtained p-value 0.025 <a = 0.05.

Conclusions: There is a significant relationship between learning method simulation and audio-visual methods on the knowledge of cardiac, pulmonary resuscitation laboratory skills in undergraduate nursing students in the COVID-19 pandemic. 

Introduction: Black Cumin Seed Oil (BCSO) is a traditional medicine widely used as an antioxidant and immunomodulator. Objective: The purpose of this study is to investigate the effect of dose variation of BCSO (1.5 ml/day versus 3 ml/day) on IL-10 activity and MDA levels in patients at risk of MS at Jetis 1 Public Health Center (J1PHC), Bantul Regency, Yogyakarta, Indonesia.

Methods: We conducted an analytical cross-sectional study. 66 patients at risk of metabolic syndrome (MS) were divided into two groups. In stage 1, group 1 received a 1.5 ml/day dose, and group 2 received 3 ml/day for 20 days. The clinical parameters of MS, IL-10 activity, and MDA levels were measured at the end of the study stages.

Results: The mean activity of IL-10 in the 1.5 ml/day dose group was 4.83 and in the 3 ml/day dose group was 5.49, which showed an increase of around 13.66% (p = 0.300). The mean MDA level in the 1.5 ml/day group was 3.92 ?mol/L, which increased to 4.31 ?mol/L in the 3 ml/day group or approximately 9.95% (p = 0.802). Statistically, IL-10 activity and MDA levels in the two-dose groups did not differ significantly.

Conclusion: The results of this study indicate that the administration of BCSO at doses of 1.5 ml/day and 3 ml/day for 20 days has the same effect on IL-10 activity and MDA levels in patients at risk of MS. 

Introduction: The anxiety of pregnant women during the Covid-19 pandemic increased compared to pregnancy in ordinary conditions because pregnant women are one of the populations vulnerable to Covid-19 infection. The Covid-19 Pandemic can affect the health of pregnant women and fetuses, even feared increased morbidity and mortality. This study aimed to determine the anxiety of pregnant women, especially related to maternal and infant health in the Covid-19 pandemic.

Method: This research is using a quantitative descriptive method with a cross-sectional design. The sample in this study were all pregnant women who were willing to take part in this study. Respondents came from three islands in Indonesia, namely   Java, Sulawesi and Sumatra. The sampling technique used accidental sampling; as many as 20 respondents carried out checks at health  facilities during the pandemic Covid-19. Researchers adopted the Pregnancy Stress Rating Scale (PSRS) instrument for 36 items statement and converted it in a google form for online surveys. The data analysis in this study used a frequency distribution.

Results: The results showed that most of the pregnant women who experienced a severe level of anxiety in “finding safe health facilities for mothers and babies during pregnancy, and childbirth” (32.3) with a tertiary level of education (71.4), live outside the island of Java (83.3), and anxiety increased in the second trimester (61.5) and the third trimester (66.7).

Conclusion: The emotional well-being of pregnant women must be maintained to produce a good quality  pregnancy outcome, so that health workers need to identify pregnant women's anxiety early to minimize its effects. In addition, pregnant women must have the self-awareness to assess  the health conditions, including anxiety during the pregnancy process.

Introduction: The Indonesian government's efforts to deal with the COVID-19 pandemic are implementing a Large-Scale Social Restriction (LSSR) policy. This LSSR policy becomes a problem for the quality of life of the people who carry out the policy, including college students and students. This research aims to determine the quality of life of college students and students in Indonesia who undergo LSSR during the COVID-19 pandemic.

Methods: This research is a descriptive study with a cross-sectional approach. This research used accidental sampling methods by 30 days of distributing e-questionnaires. The samples used in this study were college students and students who were undergoing the LSSR in Indonesia. The instrument used for this research was WHOQOL-BREF. The quality of life was analyzed descriptively by calculating each domain's average transformed score.

Results: Through this research, obtained 280 respondents consisting of 67 men and 213 women. Respondents aged 12-17 years were nine respondents, and 18-25 years were 271 respondents. The majority of respondents underwent LSSR for 9-12 weeks. Analysis of quality of life showed that the physical health domain had an average of 62.65 ± 0.87; psychological health of 62.58 ± 1.04; social relations of 53.76 ± 1.16; and the environment 61.53 ± 0.98.

Conclusion: The conclusion in this study is that college students and students who undergo PSBB have good physical health, good psychological health, moderate social relationship quality, and good environmental quality.

Introduction: The inability of patients with chronic renal failure to follow a diet is influenced by low self-efficacy. (Inter Dialytic Weight Gain) IDWG is used as a common measure of patient compliance, as it shows fluid retention that occurs between two hemodialysis sessions. This study aims to analyze the effect of providing education using a booklet on self-efficacy, and level of knowledge, and IDWG in hemodialysis patients.

Methods: The research design was a pre-experimental design, with a group comparison design approach. The use of samples using accidental sampling. A sample of 48 respondents was divided into two groups: 25 and 23 respondents in the intervention and control groups respectively. The intervention group was given education using lecture and booklet methods for 45 minutes. The Control group was given education using the lecture method only.  IDWG was measured by observing weight between hemodialysis sessions. The measurements of self-efficacy and level of knowledge were undertaken by employing a questionnaire. Wilcoxon test was used to determine the difference between the pre and post mean of the intervention group and the control group. Mann Whitney statistical test was used to determine the mean difference in the intervention and control groups on the variables of self-efficacy, level of knowledge, and IDWG.

Results: Intervention group increased self-efficacy (p <0.05), increased knowledge (p <0.05) and decreased IDWG (p <0.05). Control group increase self-efficacy (p <0.05), increase knowledge (p <0.05), but not the value IDWG (p> 0.05).

Conclusion: Education using booklets helps patients in increasing self-confidence, knowledge of CKD patient care including controlling fluid overload.

Introduction: Street children still become a big concern in the world, and United Nations has concerns about a homeless child or live-in poverty. Dysfunction of the family process has the worst implication for the child as a vulnerable population. It does not only increase anxiety and depression but also leads to self-neglect especially among street children. The nurse especially the mental health nurse and community nurse needs to identify the risk factor of dysfunctional family process and self-neglect to make possible prevention and intervention for street children. This study aims to determine the correlation between the dysfunction of the family process and the self-neglect of street children in Yogyakarta.

Methods: The sample was 90 street children who are from the district in Yogyakarta. The sample was taken by accidental sampling technique, with the sampling criteria: 1) the street children who live in Yogyakarta, 2) willing to fill inform consent, 3) both boys or girls, 4) age 10-21 years old, 5) not marriage yet. The instrument was using a dysfunction of family process questionnaire and self-neglect questionnaire which are both are developed from NANDA-I Nursing Diagnoses. The data analysis was used Pearson Correlation Test.

Results: The mean score of dysfunctions of the family process is 109 and self-neglect has a mean score of 28.33. There was a significant relationship between dysfunction of family process and self-neglect among street children in Yogyakarta (p= 0.000) with a correlation coefficient were 0.659.

Conclusions: There was a significant relationship between dysfunction of family process and self-neglect among street children in Yogyakarta

Introduction: Patients with a diagnosis of Diabetes Mellitus (DM) in Sleman Regency in 2020 were 20,097 patients. The treatment of diabetes requires good motivation from patients. Self-confidence or self-efficacy will help shape behaviors that support healing. Spiritual Emotional Freedom Technique (SEFT) was a therapy that can create positive emotional conditions and a calm mind so that the right thoughts emerge to decide attitudes in helping the healing process. This study aims to determine the effect of SEFT for self-efficacy of patients with DM-Type 2 at the working area of public health center Seyegan, Sleman, Yogyakarta, Indonesia.

Methods: This study used a quasi-experiment with pre-test post-test using control group design. Patients were assessed pre-test and post-test with the DM-Self Efficacy Scale. The intervention group was subjected to SEFT therapy. The sample of this study was 40 respondents from the intervention group and 40 respondents from the control group. The sampling technique used the purposive sampling technique. Data collection was carried out between July and August 2020.

Results: The results of the data collected were processed using the Wilcoxon test and the Mann Whitney test. Wilcoxon test results in the intervention group obtained p = 0.000 (p <0.05) and in the control group obtained p = 0.000 (p <0.05). Mann Whitney test results obtained p = 0.003 (p <0.05).

Conclusion:  SEFT technique affects the increasing self-efficacy in type II DM patients.

Introduction: The COVID-19 pandemic has a major effect on nursing education in Indonesia, it needs for adaptation of the curriculum to achieve competent nursing graduates meet national and international standards. The aim of this study is to explore the barriers and strategies of nursing education of private institutions, in curriculum planning in the new normal era during the COVID-19 pandemic.

Methods: This qualitative study was conducted in five nursing study programs in East Java. Data collection was carried out by in-depth interviews, observations, documentation studies of 25 participants, with the criteria of lecturers being actively involved in curriculum planning based on Indonesian national standards. The data used purposive sampling and snowball sampling. The data validity is carried out with four criteria: credibility, dependability, confirmability, and transferability. Data analysis was carried out using the model approach of Miles, Huberman & Saldana. Data records from interviews, observations and documentation then carried out data selection, reducing, focusing on data findings (data condensation).

Results: The study found five themes: (1) barriers from human resources, (2) barriers during the curriculum planning process, (3) barriers for Nursing Study Program lecturers in obtaining information sources related to Indonesian Qualification framework-based curriculum planning, (4) strengthen the pro-active leadership of study programs; (5) foster dynamic communication between curriculum teams.

Conclusion: The results showed, in pandemic crisis COVID-19, the need for a curriculum planning workshop with clear technical guidelines in producing an effective, efficient, adaptable nursing curriculum, the effective one of planning has high potential in producing high quality nursing graduates.

Introduction: Helminthiasis is an endemic and chronic disease caused by parasitic worms with a high prevalence rate and is non-fatal, but it affects the health of the human body by reducing the absorption of nutrients and proteins in infected individuals and reducing blood levels in the human body so that if it occurs in pregnant women, it can affect pregnancy and childbirth. This study aimed to examine the influence of findings on attitudes of pregnant women towards the prevention of helminthiasis in the work area of the Gatak Health Center, Sukoharjo. 

Methods: This study used a descriptive observational research method with a cross-sectional approach with 144 samples taken with an all-sampling technique. 

Results: Statistical test shows that the value of p 0.000 is less than alpha 0.05, which means there is a relationship between the knowledge the Pregnant women and the attitude of pregnant women insist the mother in preventing the occurrence of worms. 

Conclusion: The pregnant woman's posture is classified as functional because it influences the mother in the prevention and treatment of helminthiasis and affects her state of health.

Background: Mental health is a good emotional and psychological state. Globally 10-20% of children and adolescents experience mental health disorders. Risk factors for mental health problems in children are the mental and physical health of poor/poor parents, problems in childcare and lack of support from neighbors/ neighborhoods. Children who have autism are prone to mental problems.

Objective: know the influence of parenting and maternal mental health on the mental health of children who have autism

Methods : The study used a mixed, cross-sectional method to find out the relationship of free variables and bound variables and qualitative secondary data analysis. The analyses used are chi square and multiple linear regressions. The respondents in this study numbered 35 people.

Results: Maternal parenting does not affect a child's mental health, while the mother's mental health significantly affects the child's mental health. Maternal acceptance is influenced by family support, professional, and family autism networks. Coping mechanisms that mothers apply are positive thinking, understanding children, and activities with children.

Conclussion: The child's mental health condition is affected by the mother's mental health, but simultaneously the mother's parenting also affects the child's mental health. Early treatment in mothers who have mental health problems can reduce the risk of children experiencing mental health problems, so the negative impact on the child can be reduced.

Introduction: Childcare centers are a type of daycare that is increasingly used by families all over the world. Indonesia is experiencing a similar trend. Childcare centers have essential roles in supporting child's growth and development in the center. This study aims to explore how childcare centers support the healthy growth and development of young children.

Methods: A qualitative research approach using a case study design was used for exploring the perspectives of two childcare managers and eight teachers in two public and two private childcare centers in Yogyakarta, Indonesia. Semi-structured interviews of one hour each, audiotaped recorded with the participants' consent, were used to collect the data. Content analysis was used to generate findings from the data. Findings from the public and private centers were compared and contrasted to generate the study's overall findings.

Results: The findings identified that childcare centers in Yogyakarta, Indonesia, actively promote child growth and development by providing high-quality environments and services. The environment is safe, homelike, has high standards of cleanliness and sanitation, and provides appropriate toys and equipment. Services include nutrition, supervision, and health checks. Linking centers to the community was an essential strategy for improving the funds and resources needed to promote child growth and development.

Conclusion: This study suggests that providing training for childcare workers, refining the curriculum, and developing stimulating activities for children in the center are needed. 

Introduction: Immunization is an essential component of global efforts worthwhile to reduce illness and child mortality. The results of initial interviews with residents found that residents were traumatized by fake immunization, were afraid of the incidence of infants dying from immunization, felt distrust of the benefits of immunization. This study aims to determine the description of parents’ knowledge, attitudes, and perceptions towards the toddler’s immunization in one village in Tangerang.

Method: The design of this study is quantitative descriptive with a positivism approach. The population includes all parents who have children under five in one village in Tangerang. This study involved 148 respondents obtained through a purposive sampling technique. Data retrieval uses a valid and reliable measurement tool. Univariate data analysis uses descriptive test techniques, which are presented in the frequency distribution table.

Result: The results in this study found that most respondents had good knowledge of immunization as many as 121 respondents (81.8%), more than half of respondents had positive attitudes as many as 82 respondents (55.4%), and more than half of respondents had positive perceptions against immunization, as many as 78 respondents (52.7%).

Conclusion: We need accountable information through the provision of education under local wisdom to change the perceptions and attitudes of parents towards immunization. Further research is necessary to identify parents’ behavior and how it relates to the completeness of toddler immunization.

Background: Coronavirus (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) virus. This disease is transmitted from human to human, where most of (COVID-19) infected people experience mild to moderate respiratory disease and recover without requiring special care. Health education is a top priority and is one of the effective nursing interventions to improve knowledge level and public awareness about the importance of correct understanding regarding COVID-19. The researcher was aimed to analyze knowledge level differences of Posbindu (Integrated guided care) participants in Puskesmas (Community Health Center) Gesi regarding COVID-19 disease before and after the implementation of health education.

Methods: It was a queasy experimental quantitative research with a one-group pretest-post-test control design. There were 40 participants with ages ranging from 15 to 50 years old.

Result: The Posbindu participants' knowledge level about Covid-19 before receiving health education was categorized as poor. Meanwhile, Posbindu participants' knowledge level about Covid-19 before receiving health education was average. The Independent Sample T-Test showed that the sig. (2-tailed) value was 0.009 <0.05, then Ho was rejected, and Ha was accepted. Therefore, it could be concluded that there are differences in Posbindu participants' knowledge level before and after being given the health education about Covid-19 in Puskesmas Gesi.

Conclusion: The health education given in Puskesmas Gesi affects Posbindu participants' knowledge level about Covid-19. It is hoped that the public health center regularly puts more consent to increase the community's knowledge about COVID-19.

Background: Someone who plays online games continuously will experience feelings of extreme pleasure and want to play the games repeatedly, resulting in online game addiction. The high prevalence of online game addiction causes poor relationships between children and parents since children are too busy playing online games. A considerable amount of time spent playing online games also causes university students to lack opportunities for social interactions. This study aims to explore family communication experiences among university students addicted to online games.

Methods: This study adopted a qualitative method with a phenomenological approach, involving eight respondents. The data were collected using in-depth interviews, observations, and documentation. The Indonesian Online Game Addiction Questionnaire was distributed to the participants to determine who fitted into the addiction criteria.

Result: This study resulted in five themes as follows: students’ awareness of the importance of family communication; the intensity of communication between students and their parents; the changes in students’ contact with family due to online game addiction; the impact of parenting style on students’ online game addiction; and online game addiction as the cause of conflicts between students and their parents.

Conclusion:  Parenting style contributes to online game addiction. Online game addiction among students causes changes, especially in the intensity and need for communication with parents despite students’ good awareness of the importance of maintaining contact with their parents.

Introduction: Self-monitoring of blood glucose is one of the ways to treat type 2 diabetes mellitus, which is a chronic disease that affects many people. Blood glucose is measured by taking a sample from a capillary blood vessel, such as a finger. To decrease the pain, it is vital to learn more about the exact position of the puncture on the finger. The aims of this study is compare the location of the capillary blood collection at the median and lateral fingertips to the level of pain experienced by patients

Methods: With a sample of 50 participants, the lateral area of the finger and the median finger were separated into two groups. The Visual Analog Scale is the tool used to assess pain (VAS).

Results: The lateral group's mean pain level was low. The median group had the greatest pain scale among 50 responders whose pain level was assessed using the VAS instrument. Based on the Mann-Whitney test results, there were differences in the level of pain in blood glucose in the lateral and median fingers (p = 0.036).

Conclusion: The lateral and median fingertips in the capillary blood sample have different levels of pain. Although the location lateral to the fingertip is a less painful site for capillary blood collection than the median fingertip location, it still needs to be validated in bigger clinical trials.

Introduction: The process of degenerative aging was natural and experienced by every human being. One of the psychological problems experienced by the elderly was anxiety. Anxiety is defined as an emotional response that is influenced by the subconsciousness in a person associated with feelings of restlessness, worry, uncertainty, and other specific causes. One of the therapies to reduce the level of anxiety was by giving Cananga aromatherapy and practicing Dhikr. This study aims to determine the effectiveness of giving Cananga aromatherapy and Dhikr to reduce anxiety in older people with hypertension at Posyandu Tawarsari Wonosari Gunungkidul.

Metodh: This study used a quantitative method with a pre-experimental with the pre-post test without a control group. The participants were 30 older people using a total sampling technique that was divided into two intervention groups. This study used paired sample t-test and an independent sample t-test to analyze the data. The anxiety response in the elderly was measured by using the HARS scale (Hamilton Anxiety Rating Scale). This study obtained a p-value = 0.000 (p <0.05), indicating a significant difference in anxiety after the intervention of giving Cananga aromatherapy and Dhikr.

Result: The comparison test results between the two intervention groups obtained a significant value, namely p = 0.876. It means that “HA” was accepted, namely the provision of Cananga aromatherapy and Dhikr, which effectively changed the anxiety levels.

Conclusions: However, there was no significant difference between giving Cananga aromatherapy and Dhikr.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) had spread worldwide. Nurses as health care workers (HCWs) are at great risk of contracting the virus, so they are prioritized for accepting the Covid-19 vaccination. This study aimed to determine the intention of nurses to accept the covid-19 vaccination.

Method: This online survey was given to all nurses in East Java who are scheduled to get the Covid-19 vaccine and had not been confirmed of Covid-19. This survey was conducted during 20^th-27^th February 2021 and distributed through social media. Data analysis used using an ordinal logistic regression.

Result: A total of 150 nurses in East Java responded to this survey. Most of the participants were female (68.67%), aged 30-39 years (59.33%), married (67,33%), worked less than 10 years (58.33%), graduated from Ners (60%), worked in non-covid rooms (70 %), had good knowledge about vaccines (85,33%), and had no anxiety about receiving the covid-19 vaccine (66%). There were 69.33% of nurses intend to accept vaccination, 14% had no intention to accept vaccination, and 16.67% were still unsure. Intention to accept vaccination was influenced by marital status (p= 0.043) and anxiety level (p=0.041).

Conclusion: The intention to accept the COVID-19 vaccination reached 69,33% among nurses. The intention to refuse and hesitate to accept vaccines was caused by doubts about the effectiveness and safety of the vaccine.

Introduction: Precision Personalized Care (PPC) defines as a new approach to health care service on improving diabetes patients’ self-management. To date, Taipei Veterans General Hospital has started implement the program of PPC. The purpose of this study was to observe the implementation of PPC and its’ beneficial on the improvement of self-management among diabetes patients at the Taipei Veteran General Hospital, Taiwan.

Methods: This study applied a clinical observational-exploration method such as supervision by visiting the wards, examination rooms and laboratories in the hospital and further discussing with the health professionals’ and patients with diabetes by direct interview while observing each PPC implementation from April 18^th to May 2^nd, 2019. The participants of this observational study included three nurses, a nutritionist, a doctor and 3 patients. Descriptive and explorative methods were attempted to analyze the data.

Results: The comprehensive and continuous implementation of diabetes self-management education (DSME) and diabetes self-management support (DSMS) programs were the target and focus point of activities to improve diabetes patients’ self-management. It focused on the patient centered-care, tailored, and more precise to find patients’ personal meet as defined as PPC. Clinical laboratory tests (e.g., blood sugar, hemoglobin A1C counts, low-density cholesterol, kidney functions, proteinuria, fundus and peripheral neuropathy examinations) were carried out regularly to support the program. Both programs and clinical assessment test were integrated with the Diabetes Pay for Performance (diabetes -P4P), a large-fund government program which supported by Taiwan National Health Insurance (NHI).

Conclusion: The continuous and comprehensive PPC can successfully reduce the incidence of diabetes complications in Taiwan. The PPC approach can be used as a magnificent reference for the development of quality health services and research development for diabetes patients in Indonesia.

Background: The aging process makes the sleep quality of the elderly decrease and irregular. Physical activity that can be done by the elderly is gymnastics. Gymnastics in elderly maintain the blood circulation and avoid cardiovascular disease. Elderly gymnastics must begin with the belief and motivation of the elderly in participating the gymnastics. High motivation in the elderly causes a high spirit to participate in gymnastics and improve their sleep quality. Thus, in this study, we identify the motivation of the elderly in participating in elderly gymnastics for their quality of sleep in Padukuhan Lemahdadi.

Methods: This study used a qualitative method with a phenomenological approach. Data retrieval is carried out by interviews, observations, and field records. Participants included 7 older people who were determined by a purposive sampling technique. Data validity used a triangulation technique. Furthermore, data analysis consisted of data collection, data reduction, data presentation, and conclusion.

Results: In this study evaluate seven elderly. The results of this study showed that the motivation of the elderly to participate in elderly gymnastics affects the quality of elderly sleep quality. It was influenced by several things: elderly motivation in participating in elderly gymnastics, pain reduction measures performed by the elderly, the influence of elderly gymnastics on health, and the positive impact of elderly who participated in gymnastics.

Conclusion: The sleep quality in older people who participated in elderly gymnastics can be seen from the motivation given by family and others, quality of sleep after elderly gymnastics, and efforts to maintain the quality of elderly sleep. Furthermore, the researchers are suggested to conduct further research identifying the role of health services in the motivation of the elderly in participating in elderly gymnastics.

Introduction: Acute and chronic complications can occur in diabetes mellitus with high blood glucose levels and tend to fluctuate. The most common chronic complication is diabetic neuropathy. Treatment of diabetic neuropathy that is not carried out can lead to diabetic foot ulcers and even amputation. The prevention of diabetic neuropathy can be done by improving patients' knowledge to ease neuropathy treatment; as a result, the disability can be avoided. This study aims to determine the relationship between knowledge about preventing and treating diabetic neuropathy in people with diabetes mellitus in Sukoharjo.

Methods: This type of research is descriptive with a correlation design using a cross-sectional approach. The population used in this study was all people with diabetes mellitus, who collected 17,403 patients. The sample used was 120 respondents who were selected by purposive sampling. The research instrument used a knowledge questionnaire. To analyze the data, used Spearman Rank correlation test.

Results: The sample in this study was 120 respondents obtained by the purposive sampling technique. The sample used as research respondents are people with diabetes mellitus who have met the research criteria. This study uses an instrument in the form of google form with data analysis using the Spearman rank test. The results showed the respondents' knowledge level was excellent, as many as 76.7% of 120 respondents and the treatment of diabetic neuropathy was good as many as 65% of 120 respondents. Spearman Rank test results showed an r count of 0.439 and a p-value of 0.001 (<0.05).

Conclusion: Based on the research that has been done, it can be concluded that knowledge about the prevention of neuropathy in patients with diabetes mellitus in Sukoharjo Regency is mostly very good, the management of neuropathy in patients with diabetes mellitus in Sukoharjo Regency is mostly good. There is a significant relationship between knowledge about the prevention and treatment of diabetic neuropathy in people with diabetes mellitus in the Sukoharjo Regency.

Background: UVB radiation may cause skin to experience acute symptoms such as erythema and pain. The acute symptoms are categorized as first-degree sunburn. Prevention can be done through kefir gel administration.

Purpose: This study aimed to determine differences between effect kefir oral, topical gel, and combination (oral and topical gel) effects and the negative control group on epithelial thickness in first-degree sunburn. 

Method: An experimental study with post-test only control group design was conducted on BALB/c mice, and the negative control group exposed only with UVB without kefir and oral, topical, and combination (oral and gel) group administration with dose of 0.25 mL/KgBB/day. The epithelial thickness was determined by histopathological preparations of back skin tissue through HE painting. Distribution analysis of data normality was through Shapiro-Wilk test. Homogeneity test of both groups was done through Levene test. One-way Anova test was continued with Post Hoc TukeyHSD test for epithelial thickness.

Result: The analysis of Post Hoc TukeyHSD test showed p score <0.05 which meant that there was a significantly higher difference in epithelial thickness of topical group (12.59 ± 2.067) than the negative control (5.30 ± 0.353). Kefir gel dose of 0.25mL/kgBW/day escalates thickness of epithelialization compared to negative control group.

Conclusion: There is a significant difference in epithelial thickness between the negative control group and the topical kefir gel treatment groups and the combination of both (oral and topical).

Background: Pregnancy anxiety occurs due to the transition period of a woman's life due to the physical and emotional changes of pregnancy. About 20% of all pregnancies have a risk of pregnancy that causes a source of stress and anxiety for pregnant women at high risk. Spiritual well-being is a factor that contributes to the quality of life in mothers with high-risk pregnancies.

The aims: This study aims to determine the association between spiritual well-being and anxiety among high-risk pregnant women.

Methods: The type of this research is quantitative non-experimental with a cross-sectional approach involving 96 pregnant women was selected using a purposive sampling technique. The instrument used was a spiritual well-being questionnaire in the form of a modified Spiritual Well-Being Scale (SWBS) and a modified Hamilton Anxiety Rating Scale (HARS) questionnaire for high-risk pregnant women.

Results: The results showed that spiritual well-being in the high category was 73 people (76 %), mild 22 people (22,9), and low 1 people (1%). The anxiety in the category of severe anxiety was 8 people (8,3%), moderate anxiety was 24 people (25%), mild anxiety was 31 people (32%), and no anxiety was 33 people (34,4%). The Spearman's rho analysis results obtained a p-value of 0,000 (p <0, 05) with a correlation coefficient of r of -0.448.

Conclusion: There was a significant association between spiritual well-being and anxiety among high-risk pregnant women. The higher the spiritual well-being, the lower the anxiety of high-risk pregnant women.

Introduction: The COVID-19 pandemic had an impact on everyone, including pregnant women. This pandemic has made pregnant women have limitations for physical activity. The moderate activity recommendation to pregnant women. Physical activity including household, caregiving, occupational, and exercise. Physical activity provides many benefits for pregnant women include physical and mental health. This study aimed to identify the physical activity of pregnant women during a pandemic.

Methods: The descriptive study used in this study with cross-sectional design. This research used 78 pregnant women who live with her husband, doesn't have a complication of pregnancy, doesn't have COVID-19. The data collection used the pregnancy physical activity questionnaire (PPAQ) Indonesian version.

Result: The result showed that 73% of pregnant women had vigorous activity, 21,8% had moderate activity and 5,1% of pregnant women had light activity. The activity of pregnant women to household/caregiving showed that 66,7% of pregnant women had vigorous activity. More than half of pregnant women in this research had sedentary activity 59% in sports activity, and 66,7% of pregnant women had sedentary activity in a type of occupational.

Conclusion: The pregnant mother had vigorous intensity during pregnancy in COVID-19 outbreak. The vigorous activity can affect the immune system.  

Introduction: Self-care is an important component to control blood pressure in people with hypertension. Low self-care ability will have an impact on increasing the risk of complications. The purpose of this study was to explore the experiences of hypertensive patients in self-care.

Methods: The study used a qualitative method with a phenomenological approach. Nine hypertensive patients were taken by purposive sampling technique. The data collection was using semi-structured interviews. Thematically analyzed data based on transcribed interview data.

Results: The results of the study obtained six themes related to self-care, namely perceptions of the causes of recurrence, emotional responses, social support, accessibility of health-care services, self-care behavior and barriers of self-care.

Conclusions: Self-care in hypertensive patients is influenced by the availability of social support from both family and health workers as well as the affordability of health-care services. The implication of this study is the need to improve a good support system, especially from nurses to be able to minimize the barriers felt by patients so as to improve self-care abilities

Introduction: The COVID-19 pandemic has a serious impact on health care workers both physically and psychologically since they become more susceptible to COVID-19 infection due to frequent exposure to individuals infected by COVID-19, work pressure, inadequate conditions of protective equipment, and the accuracy of decision making. This study aims to identify factors affecting the spread of COVID-19 in hospitals.

Methods: The study used the literature review method, with article searches on five databases, namely PubMed, EBSCOhost, MEDLINE, ProQuest, and google scholar. The searching process for articles used keywords, including related word synonyms and MESH. The number of the research articles identified included PubMed, EBSCOhost, MEDLINE, ProQuest and google scholar, with 1302. The next step was to use prism chart analysis and select 15 journals that met the inclusion and predefined exclusion criteria.

Results: The research analysis results showed that the health workers who were most affected by the COVID-19 transmission were the nursing profession. Factors that influenced the message of COVID-19 in hospitals included internal factors, such as comorbidities, work experience, education and training, stress, hand hygiene, and external factors: hospital environmental design, reduction of personal protective equipment, culture and ethnicity, government policies.

Conclusion: The COVID-19 pandemic that has not ended requires changes in the design of care facilities, culture, the behavior of health workers, government policies that can break the chain of transmission of COVID-19 to health workers in hospitals.

Nursing students should have some competencies to be professional nurses, like creativity, the ability to think critically, and have good communication and collaboration skills. We change the traditional learning approach to a student-centered approach to improve critical thinking skills. Some studies implement the SCL methods and we need to know the role of SCL learning strategies in improving critical thinking skills. This literature review aims to analyze the role of the student-centered learning application in improving critical thinking skills in health profession students. The design used literature review with the articles reviewed is the result of original research selected based on inclusion and exclusion criteria using a database with electronic searches on Pubmed, Science Direct, Proquest, Sage Journal, and Google Scholar, published in 2016 - 2021 which contains teaching methods that can increase the health profession student’s critical thinking skills. Search strategies with keywords and terms used in English are health profession student, student center learning, and critical thinking. The various learning methods used to improve the critical thinking of health profession students were case-based learning method, simulation learning method, cooperative learning method, problem-based learning method, team-based learning method, self-directed learning method, experiential learning method, and debate and role-play learning methods. All teaching methods are influential in increasing critical thinking in health profession students.

Background: Effective communication is one of patient safety's foundations that health workers must consider. Poor communication will impact both patients and health professionals. Health profession students have to comprehend communication skills to improve patient safety when providing care for the patient. They have learned effective communication from the education stage through various learning strategies. This study aims to identify multiple learning methods to improve effective communication learning in health professional students.

Methods: This study is a literature review by looking for the main article according to the inclusion criteria of effective learning and communication methods for health professional students. The search was conducted on several databases with ScienceDirect 32,322, Ebsco 1,644, ProQuest 48,449, and SpringerNature 4,994 articles. The result was that nine articles were screened with the PRISMA chart guide.

Results: The results showed that several learning methods such as simulation with a standardized patient, role play with standardized family, experiential learning, cooperative learning, simulation with virtual reality, peer review method, video recording and standardized patient feedback, and specific feedback used to improved communication skills in the health professional students.

Conclusion: These methods can improve the communication skills of health professional students, which is the key to supporting patient safety, and there are many challenges and facilities during communication learning proses.

Background: Reflective learning can be defined as an activity or process that aims to recall the actions and methods of learning that have been carried out in the form of observations. Students mostly obtain and improve their knowledge and skills through experiential learning or reflection. This literature review aims to determine whether there is an effect of the reflective learning method in nursing students and health students, especially on critical thinking.

Methods: This research is a type of literature review conducted by searching for articles related to the reflective learning method in health and nursing students. This literature review is conducted by searching articles associated with the reflective learning method in health and nursing students. The database used to prepare the literature review was Google Scholar, ScienceDirect, and Proquest. The search technique was use specific keywords from the research question: reflective learning OR reflective practice OR reflection AND critical thinking AND problem solving AND nursing students OR medical students OR health profession students OR undergraduate nursing students. Inclusion criteria used for data collection were full text, journal publishing from 2015 to 2020, using English and Indonesian.

Result: The literature review results show that reflective learning is very effective in improving some aspects in health and nursing students, where students learn through their experiences in clinics.

Conclusion: Reflective learning can be used to reference learning models for health and nursing students.

Introduction: Indonesia has experienced a crisis due to the COVID-19 pandemic. Both adults and children are affected by the crisis. The incidence of COVID-19 in children is not as many as in adults, but prevention efforts need to be done by families. Likewise for children with special needs. The article aims to explain family effort in preventing COVID-19 on children with special needs.

Method: A systematic literature review was conducted to identify papers on family efforts to prevent COVID-19 in children with special needs using the PubMed databases between 1^st of January and 31^st of December 2020. The search identified 15 relevant scientific papers.

Results: Indonesia has 80 million children (about 30 percent of the population), and although the health risk from COVID-19 infection is lower in children compared to the older age group, children are most likely to be severely affected by COVID-19 in both the short and long term. Family efforts during the pandemic COVID-19 aim to provide necessities and care, provide nutritional needs, maintain children learning process, protect children from violence, exploitation, and abuse.

Conclusion: Family efforts in preventing COVID-19 include providing knowledge, regional authority, mental health services, finance, nutrition and health, education, and child protection. Studies regarding the impact of COVID-19 on children with special needs have been undertaken, although not many. 

Introduction: The increasing number of patients with resistant tuberculosis requires attention and efforts for prevention. Resistance causes more expensive cost of treatment, longer duration of treatment, more severe side effects and decreasing the chance of recovery. The specific purpose of this literature review was to identify modifiable and nonmodifiable factors associated with previous treatment as predisposing factors for MDR-TB.

Method: This study applies scoping review method of JBI (Joanna briggs Institute) by using 5 databases: Scopus, Ebscohost, Proquest, Science direct and google scholar publication 2015-2021. keywords for MDR-TB search, predisposing factors, previously treatment and adult.

Results: Modifiable factors related to previous tuberculosis treatment include treatment failure or discontinuation, non-adherence, lack of supervision, unclear or inadequate instructions. Meanwhile modifiable factors are side effects and relapse.

Introduction: Stroke sufferers with weakness and paralysis of the lower extremities are at risk of experiencing balance disorders. It causes the risk of falling for stroke sufferers. The effects of falls can result in physical injuries such as bruises, abrasions, lacerations, and even fractures, head injuries, and bleeding. The effects of falling cause physical injury and increase the longer treatment time, so that it adds to the burden on the patient and family to pay for patient care. This literature review aims to identify the types of interventions that can increase the strength of the muscle' lower extremity to prevent falls in stroke sufferers.

Method: This study used JBI Scoping Review Method  (Joanna Briggs Institute) from 2 database sources: Pubmed and Ebscohost. Publication 2015-2021. Keywords to search are stroke, fall risk, intervention, body balance, muscle strength.

Results: There were 1,446 articles found, and six articles were worthy of review. The interventions used are training motor imagery (MI) using structured, progressive circuit class therapy (SPCCT), taping techniques from gluteal taping and hip abductor taping using elastic bands, rehabilitation programs wearing regent suits (RS) based on electromyography (EMG), low-intensity mobility training, perturbation-based balance training (PBT) and a combined assessment of the weight-bearing ratio and the four square step test. The combination of MI with structured, SPCCT provides a greater therapeutic effect on gait and leg muscle strength in stroke patients. Gluteal taping and hip abductor taping techniques using elastic bands improve functional performance in individuals with chronic stroke. A rehabilitation program that wears an RS and EMG were more effective than usual treatment in increasing the EMG pattern during movement and activities of daily living. A PBT can help prevent falls in everyday life after stroke, and the weight-bearing ratio and four square step tests can predict falls in stroke patients more precisely than the berg balance scale.

Conclusion: In conclusion, the exercises, techniques and programs performed can increase lower extremity muscle strength, improve walking balance and reduce the risk of falls in stroke patients. These interventions require different times and tools according to the training carried out.

Controlling blood pressure carried out by hypertensive patients is still less than 50%. It is related to the consumption of antihypertensive drugs. Adherence to medication is a critical factor in achieving blood pressure for resistant hypertension, but lifestyle modifications may be necessary to treat milder forms of hypertension. There are several factors that affect the anti-hypertensive medication adherence needs to be known. This study aims to analyze the findings regarding the factors that influence medication adherence in Hypertension sufferers. A literature review is done by looking for literature related to the theme taken. The databases used in the preparation of literature reviews are obtained from databases such as ProQuest, PubMed, EBSCO, and Google scholar. Search focuses on titles, keywords and articles that are appropriate in journals that have been determined from 2011-2021. Keywords used in the search for factor articles, adherence to taking medication and hypertension. The search results found 6 articles that had been selected based on predetermined inclusion and exclusion criteria. According to the review results, drug compliance plays an essential role in the long-term treatment of hypertension and can reduce the risk of complications. The finding of 11 factors influences medication adherence to Hypertension sufferers, including the level of knowledge, the role of health workers, motivation, family-friends support, attendance at the clinic, age, employment status, education level, belief, gender, and duration of suffering from Hypertension. Adherence to taking medication was measured by taking antihypertensive drugs in individuals, dietary behaviour, exercise, participation in posbindu/prolanis, and visits to health services for routine control. Compliance with drug use plays a vital role in the long-term treatment of hypertension to reduce the risk of complications The findings of 11 factors that influence medication adherence in patients with hypertension can be used as benchmarks for nurses to improve health services further to achieve optimal recovery.

Introduction: Disseminated herpes zoster (DHZ) characterized by the vesicles that appear outside the dermatome with more than 20 lesions. The DHZ common in immunocompromised patient. This case reports DHZ in the immunocompetent patients which is a rare case.

Case: The 45- and 60-years old men came with pain. The dermatological examination showed vesicles on the dermatomal and more 20 vesicles that outside of that dermatome. The patients diagnosed as DHZ involving the ocular and thoracic nerves. The patients work as carpenters who require strenuous physical activity with sun exposure. This physical fatigue can be a trigger for disseminated of lesions in herpes zoster. There are no other factors that can lower the body's resistance, such as systemic disease or drugs. The cases were treated with acyclovir systemic and anti-inflammatory with good results.

Conclusion: These cases showed that physical fatigue is one of the triggers for disseminated herpes zoster. 

Background: Untreated progressive inflammatory periodontal disease can affect attachment loss until bifurcation or trifurcation of multirooted teeth. Hemisection in multirooted is removal of compromised root preserve the good one then restorative coronal part with a fixed prosthesis. It is the treatment option for preserving the remaining part of healthy root who having sound periodontium. The study aimed to describe a case of a hemisection is presented for a tooth where only the mesial root of a mandibular molar was affected.

Case presentation: a 22 years old female comes to RSGM Prof. Soedomo with moderate pain and gum swelling. Perforation in mesial root canal wall in the objective examination. In radiograph, there were radiolucent in mesial root, bifurcation and fracture instrument left in mesial apical root canal. The conditions that can't approach in non-surgical treatment such as fracture instrument, severe vertical bone loss, caries, internal or external resorption in furcation or one root, and furcation lesion, can be treated with surgical approach hemisection as alternative before axtraction teeth. Hemisection treatment includes root canal treatment of the remaining roots, intracanal retention with fiber post then restorative the coronal part use restorative material and splinting with the adjacent tooth to decrease the risk of displacement. Fixed prosthodontic prosthesis to maintain the occlusal balance.

Conclusion: hemisection is a feasible treatment option because more practical and conservative for periodontal-endodontic lesions rather than extraction teeth.