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"The skin, the body’s largest organ, is strategically located at the interface with the external environment where it detects, integrates and responds to a diverse range of stressors, including solar radiation. It has already been established that the skin is an important peripheral neuroendocrine-immune organ that is closely networked with central regulatory systems. These capabilities contribute to the maintenance of peripheral homeostasis. Specifically, epidermal and dermal cells produce and respond to classical stress neurotransmitters, neuropeptides and hormones, production which is stimulated by ultraviolet radiation (UVR), biological factors (infectious and non-infectious) and other physical and chemical agents. Examples of local biologically active products are cytokines, biogenic amines (catecholamines, histamine, serotonin and N-acetyl-serotonin), melatonin, acetylocholine, neuropeptides including pituitary (proopiomelanocortin-derived ACTH, b-endorphin or MSH peptides, thyroid stimulating hormone) and hypothalamic (corticotropin-releasing factor and related urocortins, thyroid-releasing hormone) hormones, as well as enkephalins and dynorphins, thyroid hormones, steroids (glucocorticoids, mineralocorticoids, sex hormones, 7-δ steroids), secosteroids, opioids and endocannabinoids. The production of these molecules is hierarchical, organized along the algorithms of classical neuroendocrine axes such as the hypothalamic pituitary adrenal axis (HPA), hypothalamic-thyroid axis (HPT), serotoninergic, melatoninergic, catecholaminergic, cholinergic, steroid/secosteroidogenic, opioid and endocannabinoid systems. Disruptions of these axes or of communication between them may lead to skin and/or systemic diseases. These local neuroendocrine networks also serve to limit the effect of noxious environmental agents to preserve local and consequently global homeostasis. Moreover, the skin-derived factors/systems can also activate cutaneous nerve endings to alert the brain to changes in the epidermal or dermal environments, or alternatively to activate other coordinating centers by direct (spinal cord) neurotransmission without brain involvement. Furthermore, rapid and reciprocal communications between epidermal and dermal and adnexal compartments are also mediated by neurotransmission including antidromic modes of conduction. Lastly, skin cells and the skin as an organ coordinate and/or regulate not only peripheral but also global homeostasis."

"Burnout Syndrome (BOS) adalah kumpulan gejala akibat stres fisik maupun psikis akibat beban dan stresor pekerjaan yang tinggi. BOS memengaruhi tubuh dalam aspek psikis, neuroautonom, imunologi, maupun endokrin (PNIE). Terapi musik terbukti dapat membantu mengatasi stres psikis dan fisik. Musik tradisional dapat digunakan untuk terapi musik karena sesuai dengan latar budaya masyarakat Indonesia.Studi I merupakan penelitian kuantitatif untuk menentukan nilai baseline pada kelompok tidak burnout. Studi II merupakan studi kualitatif dengan teknik clinical expert judgement untuk menentukan model terapi musik. Studi III desain RCT dengan intervensi terapi musik pada tenaga kesehatan dengan BOS selama 4 minggu. Skor Maslach Burnout Inventory (MBI-HSS), Heart Rate Variability (HRV), endorfin, kortisol dan IgA saliva, dan kadar T-Regulator (FOXP3) serum dilakukan pada awal penelitian, minggu ke-2, ke-4, dan ke-6. Analisis data menggunakan SPSS 20, dengan nilai kemaknaan < 0,05.Pada studi I, didapatkan nilai baseline HRV sebesar 51,153 ms2 , endorfin sebesar 503 pg/mL, kortisol saliva sebesar 5,55 ng/mL, IgA saliva sebesar 0,44 mg/mL, dan FOXP3 sebesar 4%. Pada Studi II, didapatkan aransemen 20 jenis musik bergenre tradisional untuk terapi, uji coba musik terapi di laboratorium musik dan model terapi sebanyak 3 kali per minggu, durasi 10–15 menit setiap sesi, diberikan selama 4 minggu. Pada studi III didapatkan peningkatan bermakna skor MBI-HSS (p 0,022), HRV (p < 0,0001), dan kadar FOX-P3 (p 0,035) setelah intervensi terapi musik dibanding dengan kontrol. Didapatkan persistensi terapi musik terhadap skor MBI-HSS.Terapi musik terbukti memperbaiki BOS melalui jalur PNIE, sehingga dapat diaplikasikan dalam praktik sebagai terapi supportif. Perlu dilakukan penelitian lebih lanjut untuk menilai manfaat terapi musik dengan frekuensi dan durasi yang lebih panjang, serta kombinasi dengan modalitas terapi lain.

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Burnout Syndrome (BOS) is a collection of symptoms due to physical and psychological stress due to high workload and stressors. BOS affects the body in psychological, neuroautonomic, immunological, and endocrine (PNIE) aspects. Music therapy has been proven to help overcome psychological and physical stress. Traditional music can be used for music therapy because it is in accordance with the cultural background of Indonesian society.

Study I is a quantitative study to determine the baseline value in the non-burnout group. Study II is a qualitative study using clinical expert judgment techniques to determine the music therapy model. Study III RCT design with music therapy intervention in health workers with BOS for 4 weeks. Maslach Burnout Inventory (MBI-HSS) scores, Heart Rate Variability (HRV), endorphins, cortisol and salivary IgA, and serum T-Regulator (FOXP3) levels were carried out at the beginning of the study, weeks 2, 4, and 6. Data analysis using SPSS 20, with a significance value of < 0.05.

In study I, baseline HRV values were obtained at 51.153 ms2, endorphin at 503 pg/mL, salivary cortisol at 5.55 ng/mL, salivary IgA at 0.44 mg/mL, and FOXP3 at 4%. In study II, arrangements of 20 types of traditional music genres for therapy were obtained, music therapy trials in a music laboratory and therapy models were carried out 3 times per week, with a duration of 10–15 minutes per session, given for 4 weeks. In study III, there was a significant increase in MBI-HSS scores (p 0.022), HRV (p < 0.0001), and FOX-P3 levels (p 0.035) after music therapy intervention compared to control. A retention effect of music therapy on MBI-HSS scores was obtained.

Music therapy has been shown to improve BOS through the PNIE pathway, so it can be applied in practice as a supportive therapy. Further research is needed to assess the benefits of music therapy with longer frequencies and durations, as well as in combination with other therapeutic modalities."

"Menikah dan memiliki keturunan merupakan sebuah fase penting dalam siklus kehidupan. Apabila kehamilan tak kunjung terjadi setelah dua belas bulan berhubungan teratur tanpa pengaman, maka disebut sebagai infertilitas. Fertilisasi in vitro (FIV) dilakukan saat metode lain telah mengalami kegagalan, namun tahapan yang dilalui memberikan stres bagi yang menjalaninya. Melihat kompleksitas permasalahan, perlu untuk dikembangkan model pendampingan, berupa Terapi Kognitif Perilaku (TKP). Penelitian ini bertujuan untuk mengetahui efektivitas TKP dalam memperbaiki faktor psiko-neuro-endokrin.Penelitian terdiri dari dua tahap yaitu uji face validity dan studi eksperimental berupa uji klinis tersamar ganda. Penelitian dilakukan di Klinik Infertilitas Yasmin RSCM dan Klinik Dr Sander B Daya Medika. Waktu penelitian adalah bulan Mei 2016 – Maret 2023. Pengumpulan data menggunakan kuesioner dan penilaian selama prosedur FIV, meliputi kecemasan, depresi, serta kadar hormonal berupa kortisol, norepinefrin, triiodotironin bebas (fT3), estradiol, dan progesteron. Interaksi antara kelompok intervensi dan waktu pengukuran terhadap variabel dianalisis dengan menggunakan mixed-model repeated measure ANOVA dan analisis post-hoc menggunakan uji t tidak berpasangan pada setiap pengukuran.Analisis akhir melibatkan 75 subjek, terdiri dari 38 subjek kelompok kontrol dan 37 subjek kelompok TKP. Distorsi kognitif yang paling sering dialami subjek penelitian adalah fortune telling (34,2%), personalization (22,8%), dan should statement (14,3%). Terdapat penurunan skor kecemasan di sesi 8 TKP (p < 0,001) dan penurunan skor depresi di sesi 6 dan 8 TKP (p = 0,027 dan p = 0,007). Penurunan skor kecemasan sejalan dengan penurunan kadar norepinefrin (p = 0,002), sementara penurunan skor depresi bersesuaian dengan penurunan kadar kortisol (p < 0,001) dan perbaikan kadar estradiol (p = 0,024). Kadar fT3 dan progesteron tidak mengalami perbaikan hingga akhir sesi TKP. Mixed-model repeated measure ANOVA menguatkan hasil dengan adanya tren penurunan kecemasan, depresi, norepinefrin, dan kortisol pada kelompok TKP, dengan ukuran efek kecil hingga sedang.Dari hasil penelitian disimpulkan bahwa TKP terbukti efektif dalam memperbaiki faktor psiko-neuro-endokrin pada perempuan yang mengikuti FIV. Penting untuk dilakukan advokasi hasil penelitian kepada rumah sakit dengan layanan FIV dan mengintegrasikan panduan TKP pada FIV ke dalam prosedur standar dan panduan pelayanan klinis rumah sakit. Penting untuk melakukan penelitian lanjutan pada populasi dengan karakteristik lebih beragam dan mengembangkan bentuk pendampingan bagi pasangan agar dapat memberikan dukungan yang adekuat dan mengoptimalkan luaran FIV.

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Marriage and parenthood are significant life stages. When a couple has regular, unprotected intercourse for 12 months without pregnancy, they are considered infertile. In vitro fertilization (IVF) is pursued when other methods fail, though it can cause significant stress for women. This study aims to assess the effectiveness of Cognitive Behavioral Therapy (CBT) in improving psycho-neuro-endocrine factors in women undergoing IVF.

The research comprises two phases: the assessment of face validity and an experimental study designed as a double-blind clinical trial, conducted at the Yasmin Infertility Clinic RSCM and Dr. Sander B Daya Medika Clinic. The research spanned from May 2016 – March 2023. Data were collected through questionnaires and evaluations during the IVF process, focusing on anxiety, depression, and hormonal levels, including cortisol, norepinephrine, free triiodothyronine (fT3), estradiol, and progesterone. The interaction between the intervention group and the timing of measurements for each variable was analyzed using a mixed-model repeated measures ANOVA and post hoc analysis with an unpaired t-test at each measurement interval.

The final analysis comprised 75 participants, 38 assigned to the control and 37 to the cognitive behavioral therapy (CBT) group. The predominant cognitive distortions identified included fortune telling (34.2%), personalization (22.8%), and should statements (14.3%). Notably, there was a significant reduction in anxiety scores observed during session 8 of CBT (p < 0.001), alongside a marked decrease in depression scores during sessions 6 and 8 (p = 0.027 and p = 0.007, respectively). The decline in anxiety scores was significantly correlated with a reduction in norepinephrine levels (p = 0.002), while the decrease in depression scores was linked to a significant drop in cortisol levels (p < 0.001) and an enhancement in estradiol levels (p = 0.024). However, no improvements were noted in the levels of fT3 and progesterone. The mixed-model repeated measures ANOVA corroborated these findings, indicating a significant trend in the reduction of anxiety, depression, norepinephrine, and cortisol within the CBT group, with effect sizes ranging from small to medium.

It can be inferred that CBT is effective in enhancing psycho-neuro-endocrine factors among women undergoing IVF. Consequently, it is crucial to promote these research outcomes within IVF service hospitals and incorporate CBT protocols into standard practices and clinical guidelines. Additional research should be pursued involving more diverse populations and the formulation of support models for couples, aimed at delivering adequate assistance to women undergoing IVF and optimizing the outcomes of the procedure."

"Menikah dan memiliki keturunan merupakan sebuah fase penting dalam siklus kehidupan. Apabila kehamilan tak kunjung terjadi setelah dua belas bulan berhubungan teratur tanpa pengaman, maka disebut sebagai infertilitas. Fertilisasi in vitro (FIV) dilakukan saat metode lain telah mengalami kegagalan, namun tahapan yang dilalui memberikan stres bagi yang menjalaninya. Melihat kompleksitas permasalahan, perlu untuk dikembangkan model pendampingan, berupa Terapi Kognitif Perilaku (TKP). Penelitian ini bertujuan untuk mengetahui efektivitas TKP dalam memperbaiki faktor psiko-neuro-endokrin.Penelitian terdiri dari dua tahap yaitu uji face validity dan studi eksperimental berupa uji klinis tersamar ganda. Penelitian dilakukan di Klinik Infertilitas Yasmin RSCM dan Klinik Dr Sander B Daya Medika. Waktu penelitian adalah bulan Mei 2016 – Maret 2023. Pengumpulan data menggunakan kuesioner dan penilaian selama prosedur FIV, meliputi kecemasan, depresi, serta kadar hormonal berupa kortisol, norepinefrin, triiodotironin bebas (fT3), estradiol, dan progesteron. Interaksi antara kelompok intervensi dan waktu pengukuran terhadap variabel dianalisis dengan menggunakan mixed-model repeated measure ANOVA dan analisis post-hoc menggunakan uji t tidak berpasangan pada setiap pengukuran.Analisis akhir melibatkan 75 subjek, terdiri dari 38 subjek kelompok kontrol dan 37 subjek kelompok TKP. Distorsi kognitif yang paling sering dialami subjek penelitian adalah fortune telling (34,2%), personalization (22,8%), dan should statement (14,3%). Terdapat penurunan skor kecemasan di sesi 8 TKP (p < 0,001) dan penurunan skor depresi di sesi 6 dan 8 TKP (p = 0,027 dan p = 0,007). Penurunan skor kecemasan sejalan dengan penurunan kadar norepinefrin (p = 0,002), sementara penurunan skor depresi bersesuaian dengan penurunan kadar kortisol (p < 0,001) dan perbaikan kadar estradiol (p = 0,024). Kadar fT3 dan progesteron tidak mengalami perbaikan hingga akhir sesi TKP. Mixed-model repeated measure ANOVA menguatkan hasil dengan adanya tren penurunan kecemasan, depresi, norepinefrin, dan kortisol pada kelompok TKP, dengan ukuran efek kecil hingga sedang.Dari hasil penelitian disimpulkan bahwa TKP terbukti efektif dalam memperbaiki faktor psiko-neuro-endokrin pada perempuan yang mengikuti FIV. Penting untuk dilakukan advokasi hasil penelitian kepada rumah sakit dengan layanan FIV dan mengintegrasikan panduan TKP pada FIV ke dalam prosedur standar dan panduan pelayanan klinis rumah sakit. Penting untuk melakukan penelitian lanjutan pada populasi dengan karakteristik lebih beragam dan mengembangkan bentuk pendampingan bagi pasangan agar dapat memberikan dukungan yang adekuat dan mengoptimalkan luaran FIV.

---

Marriage and parenthood are significant life stages. When a couple has regular, unprotected intercourse for 12 months without pregnancy, they are considered infertile. In vitro fertilization (IVF) is pursued when other methods fail, though it can cause significant stress for women. This study aims to assess the effectiveness of Cognitive Behavioral Therapy (CBT) in improving psycho-neuro-endocrine factors in women undergoing IVF.

The research comprises two phases: the assessment of face validity and an experimental study designed as a double-blind clinical trial, conducted at the Yasmin Infertility Clinic RSCM and Dr. Sander B Daya Medika Clinic. The research spanned from May 2016 – March 2023. Data were collected through questionnaires and evaluations during the IVF process, focusing on anxiety, depression, and hormonal levels, including cortisol, norepinephrine, free triiodothyronine (fT3), estradiol, and progesterone. The interaction between the intervention group and the timing of measurements for each variable was analyzed using a mixed-model repeated measures ANOVA and post hoc analysis with an unpaired t-test at each measurement interval.

The final analysis comprised 75 participants, 38 assigned to the control and 37 to the cognitive behavioral therapy (CBT) group. The predominant cognitive distortions identified included fortune telling (34.2%), personalization (22.8%), and should statements (14.3%). Notably, there was a significant reduction in anxiety scores observed during session 8 of CBT (p < 0.001), alongside a marked decrease in depression scores during sessions 6 and 8 (p = 0.027 and p = 0.007, respectively). The decline in anxiety scores was significantly correlated with a reduction in norepinephrine levels (p = 0.002), while the decrease in depression scores was linked to a significant drop in cortisol levels (p < 0.001) and an enhancement in estradiol levels (p = 0.024). However, no improvements were noted in the levels of fT3 and progesterone. The mixed-model repeated measures ANOVA corroborated these findings, indicating a significant trend in the reduction of anxiety, depression, norepinephrine, and cortisol within the CBT group, with effect sizes ranging from small to medium.

It can be inferred that CBT is effective in enhancing psycho-neuro-endocrine factors among women undergoing IVF. Consequently, it is crucial to promote these research outcomes within IVF service hospitals and incorporate CBT protocols into standard practices and clinical guidelines. Additional research should be pursued involving more diverse populations and the formulation of support models for couples, aimed at delivering adequate assistance to women undergoing IVF and optimizing the outcomes of the procedure."