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Abstrak :
Latar belakang: Anak dengan penyakit ginjal kronik (PGK) memiliki tantangan risiko gangguan cemas dan depresi yang besar karena stres fisis dan psikologis yang dialami. Kadar kortisol meningkat pada kondisi stres. Metode: Penelitian potong lintang ini melibatkan 91 anak dan remaja usia 8- 18 tahun dengan PGK di Rumah Sakit Cipto Mangunkusumo (RSCM). Gangguan psikososial melalui pengisian kuesioner screen for anxiety and related disorders dan children depression inventory. Kadar kortisol saliva diperiksa melalui pemeriksaan ELISA. Hasil: Prevalens gejala kecemasan pada stadium 1-3 sebesar 38,6% dan stadium 4-5 sebesar 40,4%. Prevalens gejala depresi pada stadium 1-3 sebesar 29,5% dan stadium 4-5 sebesar 38,3%. Median kadar kortisol pada anak dengan PGK yang mengalami gejala depresi 4,48 µg/dL tidak bermakna secara statistik dibandingkan yang tidak 3,85 µg/dL. Median kadar kortisol pada anak dengan PGK yang mengalami gejala kecemasan 4,57 µg/dL tidak bermakna secara statistik dibandingkan yang tidak 3,87 µg/dL. Median kortisol pada stadium 1-3 dan stadium 4-5 terhadap CDI tidak bermakna secara statistik. Median kortisol pada stadium 1-3 terhadap SCARED tidak bermakna secara stastistik, tetapi bermakna pada stadium 4-5 dengan p=0,034. Kesimpulan: Kortisol saliva pada PGK stadium 4-5 terdapat perbedaan bermakna antara yang mengalami gejala kecemasan dan tidak. ......Objective: Children with chronic kidney disease (CKD) have a higher risk of anxiety and depression due to the physical and psychological stress. Cortisol levels increase under stressful conditions. Methods: This cross-sectional study involved 91 children and adolescents aged 8-18 years with CKD at Cipto Mangunkusumo Hospital. Psychosocial disorders through filling out screen for the anxiety and related disorders and children depression inventory questionnaires. Salivary cortisol levels were checked via ELISA. Results: The prevalence of anxiety symptoms in stages 1-3 was 38.6% and stages 4-5 was 40.4%. Prevalence of depressive symptoms in stages 1-3 was 29.4% and stages 4-5 was 38.3%. Median cortisol level in children with CKD who experienced depression symptoms was 4.48 µg/dL which was not statistically significant compared to 3.85 µg/dL for those who did not and who experienced anxiety symptoms was 4.57 µg/dL which was not statistically significant compared to 3.87 µg/dL for those who did not. Median cortisol at stages 1-3 and stages 4-5 for CDI was not statistically significant. Median cortisol at stages 1-3 of SCARED was not statistically significant, but was significant at stages 4-5 with p=0.034. Conclusion: There is a significant difference in stage 4-5 CKD who experienced anxiety symptoms and those who did not.

Abstrak :
Kenyamanan merupakan salah satu aspek penting dalam perawatan luka diabetes mellitus (DM). Penelitian ini bertujuan menganalisis ekspresi transforming growth factor beta 1 (TGF â1) dan kadar kortisol pada perawatan luka teknik modern dan konvensional pada luka DM dikaitkan dengan aspek kenyamanan. Penelitian menggunakan true experimental design dengan metode pengumpulan sampel secara stratified random sampling. Pengukuran ekspresi TGF â1 dan kadar kortisol dilakukan pada hari ke 0 (pretest) dan 4 (posttest). Sampel yang diambil berasal dari pasien luka kaki DM di Rumah Sakit Saiful Anwar Malang. Ekspresi TGF â1 diukur dengan metode imunohistokimia, sedangkan pengukuran kadar kortisol dilakukan dengan metode ELISA di laboratorium Fisiologi dan Histologi FK Universitas Brawijaya Malang. Hasil penelitian menunjukkan bahwa pada kelompok modern terjadi peningkatan ekspresi TGF â1, sedangkan pada kelompok konvensional terjadi penurunan ekspresi TGF â1. Kadar kortisol pada kelompok modern menunjukkan penurunan lebih besar dibandingkan kelompok konvensional. Hasil uji t menunjukkan ada perbedaan yang signifikan antara perawatan luka teknik modern dan konvensional terhadap ekspresi TGF â1 dan kadar kortisol pada luka DM (p value < 0,05). Hasil uji korelasi Pearson menunjukkan hubungan yang signifikan antara perubahan ekspresi TGF â 1 dengan perubahan kadar kortisol (p = 0,028). Dapat disimpulkan bahwa teknik perawatan luka secara modern mampu meningkatkan ekspresi TGF â1 dan menurunkan kadar kortisol dibandingkan teknik konvensional.

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Comfort is one among several aspects that should be considered in the treatment of diabetic wounds. This study aimed to analyze the expression of TGF β1 and the level of cortisol in modern and conventional wound care techniques of diabetic wounds. TGF β1 expression and cortisol levels were measured on day 0 (pretest) and 4 (posttest). Samples were taken from patients with diabetic ulcer in the Saiful Anwar District Hospital at Malang. The expression of TGF β1 was measured by immunohistochemical methods in the Department of Physiology, Brawijaya University Faculty of Medicine. Cortisol level was measured with ELISA method. The results obtained from the modern group were increased TGF β1 expression and decreased cortisol level. The conventional group yielded decreased TGF β1 expression and decreased cortisol level. The cortisol level decrease was greater in the modern group. T test results showed no significant differences of modern wound care techniques and conventional on the expression of TGF β1 and cortisol levels in diabetic wounds (p value < 0,05). Pearson correlation test results showed a significant relationship between changes in cortisol levels with changes in expression of TGF β1 (p = 0,028). It can be concluded that the techniques of modern wound care is more able to increase the expression of TGF β1 and to decrease the cortisol levels compared with conventional techniques.

Abstrak :
Penelitian bertujuan untuk mengetahui perbedaan tingkat stres anak Autisme dengan intervensi Modul Pedagogi Visual dan Video Modeling ‘Berkunjung ke Dokter Gigi’ yang diukur dari kadar kortisol saliva. Desain penelitian berupa eksperimental klinis dan laboratoris dengan mengukur kadar kortisol saliva sebelum dan sesudah intervensi. Subjek terdiri dari 20 anak usia 6-10 tahun yang telah didiagnosis Autisme oleh dokter spesialis anak atau psikiater, tidak terdapat riwayat penyakit sistemik, tidak terdapat gangguan pada penglihatan dan pendengaran, dapat mengikuti instruksi sederhana, serta belum pernah ke dokter gigi. Subjek dibagi dalam dua kelompok yaitu kelompok Modul Pedagogi Visual ‘Berkunjung ke Dokter Gigi’ dan Video Modeling ‘Berkunjung ke Dokter Gigi’. Saliva diambil pada saat sebelum dan sesudah intervensi kemudian dianalisis di laboratorium untuk mengukur perbedaan kadar kortisol saliva. Hasil analisis tingkat stres anak autisme yang diukur dari kadar kortisol saliva menggunakan Uji Mann Whitney-U menunjukkan nilai median kadar kortisol saliva anak autisme pada kelompok intervensi Modul Pedagogi Visual ‘Berkunjung ke Dokter Gigi’ sebesar 0,0005 μg/mL dan nilai median kadar kortisol saliva kelompok intervensi Video Modeling ‘Berkunjung ke Dokter Gigi’ sebesar 0,0010 μg/mL. Hal ini menunjukkan terdapat perbedaan yang tidak bermakna secara statistik (p > 0,050) dalam tingkat stres anak autisme yang diukur dari kadar kortisol saliva pada kelompok intervensi Modul Pedagogi Visual dan Video Modeling 'Berkunjung ke Dokter Gigi'. Hal ini menandakan efektivitas Video Modeling ‘Berkunjung ke Dokter Gigi’ untuk menurunkan tingkat stres anak autisme pada saat perawatan gigi sama dengan Modul Pedagogi Visual ‘Berkunjung ke Dokter Gigi’ yang diukur dari kadar kortisol saliva . ......The aim of this study was to determine the differences of the Visual Pedagogy Module and Video Modeling ‘Berkunjung ke Dokter Gigi’ intervention method in reducing stress levels in autism children measured by salivary cortisol levels during dental treatment. The study design was clinical and laboratory experimental by measuring salivary cortisol levels before and after the intervention. Subjects consisted of 20 children aged 6-10 years who had been diagnosed with Autism by a pediatrician or psychiatrist, had no history of systemic disease, had no impairment of vision and hearing, could follow simple instructions, and had never been to a dentist. They were divided into two groups based on the type of intervention: Visual Pedagogy Module ‘Berkunjung ke Dokter Gigi’ and Video Modeling ‘Berkunjung ke Dokter Gigi’. Saliva was collected from the children before and after the interventions and analyzed in the laboratory to measure the differences of salivary cortisol concentration. The Mann-Whitney test was used to analyze salivary concentration differences in two intervention groups. The median values in the two intervention groups were 0,0005 and 0,0010 μg/mL. The stress levels measured by salivary cortisol levels showed that both Visual Pedagogy Module and Video Modeling ‘Berkunjung ke Dokter Gigi’ proven to be effective in decreasing the level of stress among the children with autism. No significant statistical difference in the delta values was observed between the two groups (p >.050). Both Visual Pedagogy Module and Video Modeling ‘Berkunjung ke Dokter Gigi’ are equally effective in reducing stress levels in children with autism measured by salivary cortisol levels.

Abstrak :

Latar Belakang: Asma merupakan penyakit inflamasi kronik pada saluran napas. Menurut Global Initiative for Asthma (GINA) latihan fisis merupakan salah satu penatalaksanaan non farmakologi yang direkomendasikan. Tujuan penelitian ini untuk mengetahui pengaruh senam asma terhadap hormon kortisol yang meregulasi beberapa faktor sistem imun (IL-10, IL-5, IgE, eosinofil) dan parameter perbaikan fungsi paru.

Metode Penelitian: Rancangan penelitian adalah quasi eksperimen dengan pre post grup design. Jumlah sampel 39 kelompok asma atopi daari Rumah Sakit Prof. Dr. dr. Margono Soekarjo Purwokerto Jawa Tengah tahun 2017-2018 dan 26 sampel kelompok non asma non atopi. IL-10 dan IL-5 diambil dari supernatan dengan isolasi PBMC dengan stimulasi alergen Der p, kontrol negatif menggunakan medium Roswell Park Memorial Institute (RPMI) dan kontrol positif menggunakan medium phytohemagglutinin (PHA). Hormon kortisol dan IgE diambil dari plasma darah dan eosinofil dengan pemeriksaan darah rutin. IL-10, IL-5, hormon kortisol dan IgE dianalisis dengan ELISA, sedangkan VEP₁ dan VEP₁/KVP diukur dengan spirometri H-101 dengan penghitungan prediksi dengan Pneumobile 2009. Kualitas hidup diukur dengan kuesioner Asthma Quality of Life Questionnaire (AQLQ) dan kemampuan mengontrol asma diukur dengan kuesioner Asthma Control Questionnaire (ACQ). Analisis statistik dengan uji t-test berpasangan dan Wilcoxon untuk uji pengaruh sebelum dan setelah  senam asma, sedangkan Pearson untuk analisis hubungan antar variabel.

Hasil: Terdapat peningkatan bermakna antara kadar hormon kortisol, IL-10, VEP₁, VEP₁/KVP, kualitas hidup, kemampuan mengontrol asma dan penurunan IL-5, IgE dan eosinofil setelah senam asma pada pasien asma atopi persisten ringan-sedang dibandingkan sebelumnya. Terdapat hubungan bermakna antara peningkatan hormon kortisol dengan perbaikan fungsi paru (VEP₁ dan KVP) dan peningkatan hormon kortisol dengan penurunan IL-5, sedangkan peningkatan hormon kortisol berhubungan tidak bermakna dengan peningkatan IL-10 dan penurunan IgE.

Kesimpulan: Senam asma meningkatkan kadar hormon kortisol, IL-10, perbaikan fungsi paru, kualitas hidup dan kemampuan mengontrol asma serta dapat menurunkan IL-5, IgE, eosinofil pada asma atopi persisten.

 

 

Kata Kunci : Hormon Kortisol, IL-10, IL-5, IgE, Eosinofil, Fungsi paru, Asma Atopi Persisten

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Background: Asthma is a chronic inflammatory disease of the airways. One of the management of non-pharmacological asthma recommended by the Global Initiative for Asthma (GINA) is physical exercise. The purpose of this study was to investigate the role of exercise on cortisol which regulates several immune system factors (IL-10, IL-5, IgE, eosinophil) and lung function improvement parameters.

Methods: This study was a quasi-experiment with pre-post group design. The number of samples was 39 atopic asthma groups conducted at Prof. Dr. dr. Margono Soekarjo Hospital Purwokerto Central Java 2017-2018 and 26 non-atopy non-asthma groups which the inclusion criteria. Cortisol hormone and IgE were taken from blood plasma and eosinophil by routine blood test. IL-10, IL-5, cortisol and IgE were analyzed by Enzyme-Linked Immunosorbent Assay (ELISA), while Force Expiration Volume in 1 second / FEV₁ and FEV₁ / FVC (Force Vital Capacity) were measured by H-101 spirometry with predictive calculations with Pneumobile 2009. Quality of life was assessed by the Asthma Quality of Life Questionnaire (AQLQ) and asthma control ability by the Asthma Control Questionnaire (ACQ). Statistical analysis was conducted using paired t-test and Wilcoxon before and after asthma exercise, and Pearson method for the analysis of relationships between variables.

 Results: There were a significant increases in blood cortisol level, IL-10, FEV₁, FEV₁ / FVC, quality of life and the ability to control asthmatic attack and significant decreases in IL-5, IgE and eosinophil blood counts after compared to before asthma exercise. There were correlation among increases cortisol hormone with improving pulmonal function (FEV₁ and FVC), IL-5, eosinophil with increased FEV₁ and FEV₁ / FVC volume. The incerases in hormone cortisol was associated with no significant increases in IL-10 and decreased IgE.

Conclusion: Asthma exercise increases levels of cortisol, IL-10, pulmonary functions, quality of life and control ability, and reduces IL-5, IgE, eosinophil in atopic asthma persistent

 

Abstrak :
Pendahuluan: Kebisingan adalah bunyi atau suara yang tidak diinginkan sebagai suara yang tidak diinginkan yang dapat menyebabkan gangguan pendengaran dan gangguan non-pendengaran, seperti kondisi fisiologis, psikologis, dan komunikasi. Gangguan fisiologi dan psikologi dapat meningkatkan denyut jantung dan tekanan darah. Dampak fisik yang mungkin terjadi dari pajanan kebisingan, adalah kram otot, pusing, mual, muntah dan peningkatan sekresi katekolamin dan kortisol, di mana akan mempengaruhi sistem saraf yang kemudian berpengaruh pada detak jantung, dan akan meningkatkan tekanan darah. Menurut WHO, hipertensi diperkirakan menyebabkan 7.5 juta kematian, sekitar 12.8 dari total semua kematian. Hipertensi merupakan masalah kesehatan dengan prevalensi yang tinggi, yaitu sebesar 25.8 , sesuai dengan data Riskesdas 2013. Tujuan dari penelitian ini adalah untuk melihat hubungan kebisingan >85 dB terhadap kejadian hipertensi. Metode: Pendekatan penelitian yang digunakan dalam penelitian ini adalah pendekatan kuantitatif. Metode penelitian yang digunakan adalah kombinasi metode kuantitatif dan kualitatif, dengan desain penelitian potong lintang. Teknik sampling yang digunakan dalam penelitian ini adalah proportionate stratified random sampling dengan kriteria inklusi dan eksklusi. Pengolahan data dilakukan dengan analisis univariat, bivariat, dan multivariat dengan interval kepercayaan 95 . Dalam penelitian ini juga dilakukan tes laboratorium untuk memvalidasi dan mendapatkan data kondisi stres biologis pada pekerja melalui pengujian hormon kortisol dari air liur. Hasil: Seluruh variabel independen memiliki faktor risiko > 1 terhadap variabel dependen. Terdapat hasil yang signifikan dari variabel independen kebisingan, lama kerja, umur, riwayat keturunan hipertensi, aktivitas fisik, penggunaan APT, indeks massa tubuh, dan kadar hormon kortisol terhadap hipertensi, melalui pengujian secara statistik dengan p value < 0.05. Sedangkan, untuk variabel perilaku merokok dan konsumsi alkohol memiliki p value > 0.05. Kebisingan sebagai variabel utama memiliki OR 19.067 melalui uji multivariat, setelah dilakukan kontrol oleh variabel perancu lama kerja, riwayat keturunan hipertensi, aktivitas fisik, penggunaan APT, dan indeks massa tubuh terhadap hipertensi. Kesimpulan: Pekerja yang terpapar kebisingan berisiko untuk mengalami hipertensi. Pekerja yang memiliki lama kerja lebih dari lima tahun, tidak melakukan aktivitas fisik, tidak menggunakan APT, dan memiliki indeks massa tubuh yang tidak normal berisiko lebih besar untuk mengalami hipertensi.

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Introductions: Noise is defined as an unwanted noise that can cause auditory and non auditory disorders, such as physiological, psychological, and communication conditions. Physiology and psychology disorders can increase heart rate and blood pressure. Possible physiological effects of noise exposure are muscle cramps, dizziness, nausea, vomiting and increased secretion of catecholamines and cortisol, which affects the nervous system which then affects the heart rate, and increases blood pressure. According to WHO, hypertension is estimated to cause 7.5 million deaths, about 12.8 of all deaths. Hypertension is a health problem with a high prevalence of 25.8 , in accordance with Basic Health Research Republic of Indonesia rsquo s 2013 data. The objective in this study to analyze relationship between noise 85 dB to hypertension. Methods: The research approach used in this research is quantitative approach. The research method used is a combination of quantitative and qualitative methods, with cross sectional study design. The sampling technique used in this research is proportionate stratified random sampling with inclusion and exclusion criteria. Data processing was done by univariate, bivariate, and multivariate analysis with 95 confidence interval. In the experiment also conducted laboratory tests to validate and get the biological stress condition data on workers through testing the hormone cortisol by its saliva. Results: All independent variables have risk factor 1 to dependent variable. There were significant results by statistical testing with p value 0.05. Noise as the main variable has OR 19.067 through multivariate test, after controlled by long working confounding variables, hereditary factors, physical activity, PPE usage, and body mass index on hypertension. Conclusions: Workers exposed to noise are at risk for hypertension. The risk for having hypertension will be greater in workers who have worked longer than five years, do no physical activity, do not use PPE, and have an abnormal body mass index.

Abstrak :
There are many determinant factors that may paly roles in pathophysiology of functional dyspepsia. One of them is psychological stress that cab increase plasma cortisol levels, alter inflammation process and affect helicobacter pylori activity. No study has been conducted to find out the dominant factor among them. This study aimed to find the dominant factor among plasma cortisol levels, IL-6 and IL-8 expressions and H.pylori activity, as the determinant factors in the pathophysiology of functional dyspepsia. Methos: a cross-sectional study was conducted in 80 patients with dyspepsia syndrome at M.Djamil General Hospital, Padang, West Sumatera, Indonesia. The patients were categorized into two groups, i.e. the stress and non-stress group, which were identified using DASS 42 questionairre criteris. The inflammatory expressions (IL-6 and IL-8 expressions) as well as H. pylori ativity were determined using immunohistochemistry of gastric biopsy specimens; while plasma cortisol levels was measured from peripheral blood samples. Data were analyzed using binary multivariate logistic regression. Resultss: there were 80 patients with functional dyspepsia with mean age of 38.9 years old. The morning cortisol level was found significantly higher in the stress group. Higher IL-6 and IL-8 expressions were found in patients of non stress group compared to those in the other group (IL-6; 73.28 (SD 16.60) vs. 72.95 (SD 19.49 and IL-8 18.45 (SD 17.32) vs. 14.80 (SD 12.71) ) although stastically not significant. There was greater helicobacter pylori activity in the group with psychological stress compared to those in the non-stress group since there was antigen-antibody reaction invading the submucosa. The dominant determinant factor was the afternoon plasma cortisol levels. Conclusion: many factors can become the determinant factors for gastric mucosal damage; however, our study has demonstrated that the dominant factor is afternoon plasma cortisol levels.

Abstrak :
Tujuan: Mengetahui pengaruh pemberian nutrisi enteral dini (NED) terhadap stres metabolisme pada penderita luka bakar, dalam rangka mencari alternafif penatalaksanaan nutrisi pada penderita luka bakar. Tempat: Unit Luka Bakar RSUPN Cipto Mangunkusumo. Bahan dan cara: Penelitian ini merupakan uji klinik pada penderita luka bakar berusia 18 - 60 tahun dengan luka bakar derajat dua seluas 20 - 60% luas permukaan tubuh (LPT). Sepuluh subyek perlakuan diberi Nutrisi Enteral Dini/NED mulai ≤8 jam pasca trauma, sedangkan 10 subyek kontrol diberi nutsisi enteral/oral 24 jam pasca trauma. Stres metabolisme dideteksi dengan pemeriksaan kadar hormon kortisol serum, glukosa darah dan nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan kortisol dan glukosa diambil pada hari ke 1, 7 dan 12. Urin untuk pemeriksaan NUU di kumpulkan selama 24 jam pada hari ke 3, 7 dan 12. Uji statistik yang digunakan adalah uji Mann Whitney U untuk kadar kortisol, NUU dan glukosa darah. Batas kemaknaan yang digunakan 0,05. Hasil: Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna pada kadar kotisol dan NUU, namun demikian pada hari ke 12 tampak penurunan kadar NUU lebih tajam pada kelompok perlakuan. Pada kelompok kontrol justru meningkat Kadar glukosa darah pada hari 12 menunjukkan perbedaan bermakna (p = 0, 04). Kesimpulan: Pemberian NED berhasil menekan stres metabolisme yang terjadi pada penderita luka bakar derajat dua berdasarkan parameter glukosa darah. ......Objective: To investigate the effect of early enteral nutrition (EEN) on the metabolic stress in burned patients, in respect to looking for the alternative of nutrition management in burned patients. Place: Burn Unit RSUPN Cipto Mangunkusumo. Materials and methods: This study was randomized clinical trial was conducted on 18 - 60 years subjects with 20 - 60% total body surface area (FBSA) of second degree burned. Ten subjects were given enteral nutrition started g 8 hours post burn, while 10 control subjects were given enteral/oral nutrition 24 hours post burn. Metabolic stress was detected by measuring of serum cortisol, blood glucose level, and urinary urea nitrogen (UUN) level. Blood samples for cortisol and glucose level were taken on day 1, 7 and 12 Twenty four hours collected urine for UUN level were taken on day 3, 7 and 12. Statistical analysis was performed with Mann Whitney U test for cortisol level, NUU and glucose level. The level of significance was 0, 05. Results: There were no significant differences between the two groups based on serum cortisol and UUN levels, however, the level o UUN of the day 12 decreased in the study group, while it increased in the control group. A significant difference was found of blood glucose between these two groups (p = 0, 04) on day 12. Conclusion: The administration of EEN reduced the metabolic stress of second degree burned patients express by blood glucose parameter.

Abstrak :
Latar belakang : Perawat memiliki tingkat stres cukup tinggi terpajan risiko psikososial, termasuk bekerja dengan jadwal kerja shift. Selama ini deteksi kasus stres berdasarkan kuesioner yang validitas dan relibialitasnya cukup baik, seperti antara lain kuesioner PSS. Penelitian bertujuan menguji markah biologi sebagai penanda stres pada perawat shift. Metode : Penelitian dilakukan Desember 2019 sampai Juni 2020, pada perawat shift dan non-shift, masing-masing 40 orang, dari RSCM, dengan mengambil data secara consecutive sampling. Pemeriksaan kortisol, melatonin dan CRF masing-masing dua kali, yaitu pada kelompok shift sebelum bekerja (=pre) pada pukul 24.00 pada hari jaga terakhir (malam kedua), kemudian pasca bekerja (=post) pukul 08.00 keesokannya. Pada non-shift pada hari kerja pukul 08.00 (=pre) dan 16.00 (=post). Pengukuran HRV dilakukan dua kali dan Q-EEG satu kali pada saat lepas jaga (untuk shift) dan saat bekerja (untuk non-shift). Hasil : Perawat usia reproduktif yang bekerja shift dan memiliki tingkat stres sedang-berat lebih banyak jumlahnya daripada jumlah perawat yang bekerja non-shift dan memiliki tingkat stres-berat sedang (30% vs 25%). Terdapat perbedaan bermakna rerata kadar kortisol shift=87,9±79,1 ng/ml dan non-shift=128,8±51,4 ng/ml pra kerja (p<0,001), rerata kadar kortisol shift=139,8±77,7 ng/ml dan non-shift=86,4±51,8 ng/ml pasca kerja (p= 0,001); rerata kadar melatonin shift=51,5±41,2 ng/ml dan non-shift=17,1±20,5 ng/ml pra kerja (p<0,001), serta rerata kadar melatonin shift=24,3±21,2 ng/ml dan non-shift=10,8±7,8 ng/ml pasca kerja (p<0,001). Terdapat rerata kadar melatonin=10,8±7,8 pg/ml (2,15-38,30) pukul 16.00 dan rerata kadar melatonin=51,5±41,2 pg/ml (0,8-135) pukul 24.00. Rerata kadar CRF=19,8±4,9 pg/ml (10,20-36,06) pukul 08.00, rerata kadar CRF=17,8±5,3 pg/ml (8,08-32,20) pukul 16.00 dan rerata kadar CRF=18,0±6,8 pg/ml (7,69-30,59) pukul 24.00. Komponen HRV SDNN cenderung shift=38,1±11,6 ms > non-shift=34,2± 10,7 ms; RMSSD cenderung shift=31,4±11,9 ms > non-shift=28,7±12,6 ms, dan rasio LF/HF cenderung shift=1,2±1,6 < non-shift=1,8±1,3. Q-EEG non-shift kecenderungan peningkatan menonjol di sekitar 10Hz area gelombang Alpha (8-13Hz), yang menunjukkan kondisi dewasa normal terjaga dan tenang; non-shift kecenderungan peningkatan pada area gelombang Beta (14-30Hz) dan Gama (> 30Hz). Uji multivariat Mantel-Haenszel peran bermakna markah biologi (kortisol, CRF, melatonin) terhadap skor PSS secara parsial maupun secara simultan; didapat dari kategori perubahan ketiga markah biologi terhadap stres berdasarkan kategori skor PSS. Simpulan: Perawat shift berpeluang mengalami stres sedang-berat dibandingkan perawat non-shift. Rerata kadar kortisol dan melatonin lebih tinggi pasca dibandingkan pre kerja.Gelombang Beta dan Gama cenderung lebih tinggi pada shift dibandingkan non-shift dan berpotensi sebagai predictor stres akibat kerja shift. Kortisol, CRF dan melatonin secara bersama-sama dapat digunakan sebagai markah biologi stres berdasarkan perubahan dari waktu ke waktu ......Background: A nurse has a high enough stress level because it is directly related to psychosocial hazards on shift work schedules. The Indonesian National Nurses Association stated that the prevalence of stress for nurses reached 50.9%. So far, the detection of stress cases is based on a questionnaire whose validity and relativity are quite good, such as the Perceived Stress Score (PSS) questionnaire. This study aimed to examine biological markers of stress among shift nurses. Method: The study was conducted at the FKUI Integrated Laboratory, “Laboratorium Kesehatan Daerah DKI”, RSCM Intermediate Polyclinic, RSCM Neurology Clinic and Medical Technology IMERI, from December 2019 to March 2020. Respondents came from the shift and non-shift nurses from RSCM, chosen by consecutive sampling. The study involved 40 people individuals in each group. Cortisol, melatonin and CRF were measured twice each, in the shift workgroup (=pre) at 12.00 am on the last watch day (second night), then during post-work, (= post,) at 08.00 am the following day. In the non-shift group blood samples were taken on weekdays at 08.00 am (= pre) and 04.00 pm (=post). HRV measurements were taken twice and Q-EEG once during off-duty (for shift workers) and at work (for non-shift workers). Results: The percentage of nurses who showed moderate stress levels in the shift group (30%) is higher compared to the non-shift group (25%). There were significant differences between the mean of shift group cortisol=87,9±79,1 ng/ml and non-shift group cortisol=128,8±51,4 ng/ml in pre-work (p< 0,001), the mean of shift group cortisol=139,8±77,7 ng/ml and non-shift group cortisol=86,4±51,8 ng/ml in post-work (p=0.001), the mean of shift group melatonin=51,5±41,2 ng/ml and non shift group melatonin=17,1±20,5 ng/ml (p<0.001) in the pre-work, and the mean of shift group melatonin=24,3±21,2 ng/ml and non-shift group melatonin=10,8±7,8 ng/ml in post-work (p<0.001). Melatonin levels mean=10.8±7,8 pg / ml (2.15-38.30) at 04.00 pm and 51.5±41,2 pg / ml (0.8-135) at 12.00 pm. CRF levels mean =19,8±4,9 pg / ml (10,2-36,1) at 08.00 am, 17.8±5,3 pg/ml (8,08-32.20) at 04.00 pm and 18.0±6,8 pg /ml (7.69-30.59) at 12.00 pm. In the HRV component, SDNN mean were higher in the shift group=38,1±11,6 ms than non-shift group=34,2±10,7 ms, higher RMSSD mean on shift group=31,4± 11,9 ms than non-shift group=28,7±12,6 ms, and LF/HF ratio mean on shift group=1,2± 1,6 compared to non-shift group=1,8±1,3. The brain wave image found a tendency of quite prominent increase around 10 Hz in the non-shift group, namely the frequency area Alpha waves (8-13 Hz), which indicate a normal adult state of wakefulness and calm. Brain waves in the shift group tended to increase in the Beta (14-30 Hz) and Gamma (> 30 Hz) wave areas. With the Mantel-Haenszel multivariate test, there is a significant role of biological markers (cortisol, CRF, melatonin) on the PSS score partially or simultaneously. This role is obtained from the category of changes in the three biological markers to stress based on the PSS score category. Conclusion: Nurses working shift are more likely to experience moderate-severe stress than non-shift nurses. The mean levels of cortisol are higher and melatonin is also higher after work than before work. Beta and Gama waves tend to be higher in the shift group than in non-shift groups, potentially as predictors of stress due to shift work. Cortisol, CRF and melatonin can be used together as biological markers of stress based on changes over time.

Abstrak :
Latar Belakang: Penyakit kardio-serebrovaskular dengan kematian tertinggi sebagian besar diakibatkan Sindroma Koroner Akut (SKA). Dalam perjalanan penyakit tersebut dapat timbul gangguan psikis berupa depresi. Dilaporkan bahwa depresi sering terjadi dan menetap, dengan prevalensi sekitar 20% pada pasien dengan penyakit jantung. Gangguan psikis memiliki hubungan yang erat dengan pengaruh hormonal seperti kortisol dan serotonin. Pada pasien SKA dapat terjadi disfungsi otonom dan disregulasi aksis HPA yang menyebabkan peningkatan kortisol yang dapat memperburuk prognosispasien SKA. Sehingga penting untuk mengetahui pengaruh hormonal yaitu kadar kortisoldan serotonin dalam mengurangi gejala depresi yang akan ditelaah pada penelitian ini. Metode: Penelitian ini merupakan penelitian cross sectional untuk mengetahui peran kortisol dan serotonin terhadap kejadian depresi pada pasien SKA pasca perawatan. Penelitian dilakukan di ICCU RSUPN dr. Cipto Mangunkusumo Jakarta Pusat, Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM dan Divisi Psikosomatik danPaliatif Departemen Ilmu Penyakit Dalam FKUI/RSCM pada 73 orang responden yang memenuhi kriteria inklusi dengan menggunakan wawancara, pengisian kuesioner HADS,pemeriksaan fisik, dan pemeriksaan laboratorium. Hasil: Sebanyak 15,1% pasien SKA mengalami depresi pasca perawatan. Hasil uji statistik antara serotonin plasma terhadapdepresi tidak bermakna secara statistik dengan p value 0,482, demikian pula dengan kortisol saliva dengan p value 0,275. Namun ditemukan bahwa, kadar rerata hormon serotonin pada pasien SKA dalam penelitian ini adalah 189 ng/ml dan kadar rerata kortisol pada pasien SKA pada penelitian ini adalah 2,19 ng/mL. Kesimpulan: Secara statistik, tidak ditemukan perbedaan signifikan antara kadar kortisol terhadap gejala depresi pada pasien paska sindrom koroner akut dengan nilai p-value 0,275. Namun, penelitian ini bermakna secara klinis dilihat dari kadar serotonin plasma yang lebih rendah pada pasien dengan depresi dan lebih tinggi pada pasien yang tidak depresi. Begitu pula dengan kadar kortisol saliva lebih tinggi pada pasien dengan depresi dan lebih rendah pada pasien yang tidak depresi. ......Background: Cardio-cerebrovascular disease with the highest mortality is mostly due toAcute Coronary Syndrome (ACS). During the course of the disease, psychological disorders such as depression may happen. It has been reported that depression is commonand persistent, with a prevalence of approximately 20% in patients with heart disease. Psychological disorders have a close relationship with hormones such as cortisol and serotonin. In ACS patients, autonomic dysfunction and dysregulation ofthe HPA axis canoccur and cause an increase in cortisol which can worsen the prognosis of ACS patients. So it is important to know the how hormones, namely cortisol and serotonin in reducing depressive symptoms which will be examined in this study. Methods: This study is a cross-sectional study to determine the impact of cortisol and serotonin in the incidence ofdepression in post-treatment ACS patients. The research was conducted at the ICCU RSUPN dr. Cipto Mangunkusumo Central Jakarta, Division of Cardiology Department ofInternal Medicine FKUI/RSCM and Division of Psychosomatics and Palliative Department of Internal Medicine FKUI/RSCM in 73 respondents who met the inclusion criteria by using interviews, filling out HADS questionnaires, physical examinations andlaboratory tests. Results: A total of 15.1% of ACS patients experienced post-treatment depression. The statistical test results between plasma serotonin and depression were notstatistically significant with a p value of0.482, as well as salivary cortisol with a p valueof 0.275. However, it was found that the average serotonin level in ACS patients in this study was 189 ng/ml and the average cortisol level in ACS patients in this study was 2.19 ng/mL. Conclusion: Statistically, there was no significant relationship between cortisol levels and depressive symptoms in post-acute coronary syndrome patients with a p-valueof 0.275. However, this study is clinically significant in view of the lower plasma serotonin levels in patients with depression and higher in patients who are not depressed.Likewise, salivary cortisol levels were higher in patients with depression and lower in patients who were not depressed.