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ABSTRAK
Siklofosfamid adalah salah satu jenis obat kemoterapi yang oleh International Agency for Research on Cancer (IARC) dinyatakan mempunyai sifat karsinogenik, mutagenik, dan teratogenik bagi manusia. Penelitian ini bertujuan untuk mengetahui proporsi pekerja kesehatan yang terdeteksi kadar siklofosfamid dalam plasma dan faktor yang berhubungan. Penelitian ini dilakukan secara potong lintang. Data dikumpulkan dengan kuesioner, wawancara, observasi dan pemeriksaan sampel darah untuk menilai kadar siklofosfamid dalam plasma. Responden penelitian ini terdiri dari semua pekerja farmasi yang terpajan siklofosfamid berjumlah 10 orang dan perawat yang terpajan siklofosfamid diambil secara purposive 100 orang dari 187 orang. Pemeriksaan kadar siklofosfamid dalam plasma menggunakan LCMSMS dengan LOD sebesar 0.025ng/mL. Proporsi pekerja kesehatan yang terdeteksi kadar siklofosfamid dalam plasma sebesar 38.2%. Pada analisis bivariat tidak didapatkan hubungan bermakna antara faktor risiko yang diteliti dengan terdeteksi kadar siklofosfamid dalam plasma (p>0,05). Dari pengamatan ditemukan bahwa sistem pembuangan udara tidak baik dan alat pelindung diri yang tidak sesuai dengan kebutuhan yaitu menggunakan masker bedah yang tidak memberi proteksi pada pekerja. Pada penelitian ini tidak didapatkan adanya hubungan bermakna antara faktor risiko dengan terdeteksi kadar siklofosfamid dalam plasma. Tingginya proporsi pekerja kesehatan yang terdeteksi kadar siklofosfamid dalam plasma kemungkinan disebabkan karena pengaruh sistem pembuangan udara dan penggunaan alat pelindung diri yang tidak sesuai.

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ABSTRACT
Cyclophosphamide is one of chemotherapy drug which has declared have carcinogenic, mutagenic, and teratogenic to humans by the International Agency for Research on Cancer (IARC). This study aimed to determine the proportion and related factors of health workers who were detected with levels of cyclophosphamide in plasma. This study was conducted with cross-sectional method. Data were collected by questionnaires, interviews, observation and examination of blood samples to assess levels of cyclophosphamide in plasma. Respondents of this study consisted of all workers which exposed to cyclophosphamide, pharmacists about 10 people and nurses purposively drawn 100 people from 187 people. The level of cyclophosphamide in plasma was examined using LCMSMS with LOD of 0.025ng/mL. The proportion of health workers who were detected with cyclophosphamide in their plasma are 38.2%. Bivariate analysis found no significant association between the risk factors studied with detectable levels of cyclophosphamide in plasma (p> 0.05). On the observation found the improper use of exhaust system and the personal protective equipment that does not comply with the requirement using the surgical masks that is not provide any protection to workers. This study found no significant relationship between the risk factors with detectable levels of cyclophosphamide in plasma. The high proportion of health workers cyclophosphamide levels detected in plasma is probably due to the influence of improper air exhaust system and the inappropriate use of personal protective equipment.

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Tujuan: Penelitian ini dilakukan untuk mengetahui korelasi perubahan nilai ADC pada DWMRI dengan perubahan ukuran tumor pasca kemoterapi neoajuvan kanker payudara dalam menilai respons kemoterapi neoajuvan. Metode: Penelitian studi deskriptif analitik dari data sekunder MRI pasien kanker payudara yang mendapat kemoterapi neoajuvan serta menjalankan pemeriksaan MRI. Pemeriksaan MRI dilakukan sebelum pasien mendapat kemoterapi neoajuvan, setelah pasien mendapat kemoterapi neoajuvan siklus pertama dan siklus ketiga. Pengukuran ukuran tumor dilakukan sesuai standar RECIST, sedangkan nilai ADC diperoleh pada nilai b800s/mm2. Hasil dan diskusi: Dilakukan analisis bivariat dengan menggunakan korelasi Pearson untuk melihat korelasi perubahan nilai ADC kedua terhadap nilai ADC pertama dengan perubahan ukuran tumor pada pemeriksaan MRI ketiga terhadap pemeriksaan MRI pertama. Sebanyak 17 pasien penelitian dengan usia antara 40 tahun sampai 65 tahun dan ukuran tumor antara 5,41 cm sampai 13,41 cm. Terdapat 16 pasien yang mengalami peningkatan nilai ADC dan 1 pasien yang mengalami penurunan nilai ADC setelah pemberian kemoterapi neoajuvan siklus pertama. Sebanyak 17 pasien mengalami pengurangan ukuran tumor setelah kemoterapi neoajuvan siklus ketiga. Berdasarkan standar RECIST diperoleh sebanyak 7 pasien dengan pengurangan ukuran tumor lebih dari 30% (antara 31,55% sampai 56,25%) dan sebanyak 10 pasien dengan pengurangan ukuran tumor kurang dari 30% (antara 7,47% sampai 29,22%). Nilai korelasi yang diperoleh sebesar -0,499. Kesimpulan: Terdapat korelasi yang bermakna antara perubahan nilai ADC pada DWMRI dengan perubahan ukuran tumor sebagai respons kemoterapi neoajuvan kanker payudara dengan kekuatan korelasi yang sedang dan arah negatif. ...... Objectives: To determine the correlation of changes in ADC values in DWMRI with changes in tumor size after neoadjuvant chemotherapy in breast cancer to assess neoadjuvant chemotherapy response. Methods: Analytical descriptive study using secondary data from MRI of breast cancer patients receiving neoadjuvant chemotherapy as well as running an MRI. MRI examination performed before neoadjuvant chemotherapy, after received first cycle neoadjuvant chemotherapy and third cycle. Tumor size measurements carried out according to standard RECIST, whereas the ADC values obtained in the b800s/mm2. Bivariate analysis using Pearson correlation was conducted to determine the correlation of changes in the value of the second ADC to first ADC and changes of the tumor size on the third MRI to the first MRI examination. Result and discussion: A total of 17 study patients, 40 years to 65 years old, tumor size between 5.41 cm to 13.41 cm. 16 patients experienced an increase in ADC values while 1 patient had decreased ADC values after the first cycle of neoadjuvant chemotherapy. Tumor size in all patients decreased after three cycles of neoadjuvant chemotherapy. Based on RECIST standards, 7 patients showed tumor size reduction of more than 30% (between 31.55% to 56.25%) and tumor size in 10 patients was reduced less than 30% (between 7.47% to 29.22% ). Correlation value of -0.499 obtained. Conclusions: There is a significant moderate and negative correlation between in ADC value changes in DWMRI with tumor size changes in response to neoadjuvant chemotherapy.

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[ABSTRAK
LATAR BELAKANG: Katiadaan instrumen penilaian kompetensi yang valid menyulitkan penilaian praktik konseling terhadap tenaga gizi desa (Barangay Nutrition Scholars, BNS) yang mendapat pelatihan konseling pemberian makanan pada bayi dan anak (infant and young child feeding, IYCF). Studi ini dirancang untuk mengembangkan dan memvalidasi instrumen penilaian kompetensi BNS dalam memberikan konseling IYCF. METODE: Desain penelitian metodologi digunakan untuk mengembangkan dan validasi instrumen pengukur kompetensi konseling IYCF meliputi pengetahuan, sikap, dan keterampilan, berdasarkan frekuensi, intensitas, dan aktivitas. Instrumen ini ditujukan penggunaanya oleh BNS, supervisor, maupun klien. Uji coba dan revisi berdasarkan hasil analisis item dilakukan pada 320 BNS dan dilanjutkan dengan uji lapangan terhadap 280 BNS. Validitas isi (content validity) dikaji oleh beberapa pakar, sedangkan konsistensi internal (internal consistency) dan validitas konstruk (construct validity) diuji dengan Cronbach?s alpha dan, exploratory dan confirmatory factor analysis. Distribusi bobot pengetahuan, sikap dan keterampilan dan nilai titik potong kompetensi untuk tiap construct dan instrumen ditetapkan berdasarkan sensitivitas dan spesifisitas menggunakan ROC Curve. HASIL: Instrumen yang valid terdiri dari: 1) 28 item terkait pengetahuan BNS dengan tipe memilih benar atau salah suatu pertanyaan, pertanyaan dengan jawaban singkat, dan pilihan ganda; 2) 10 item terkait sikap BNS dengan Likert scale untuk menilai pandangan pribadi, sikap terhadap implementasi, dan hambatan yang dirasakan saat konseling IYCF; 3) 18 item menggunakan 5 skala frekuensi penilaian BNS dalam mendengarkan, memberikan support, dan praktik penilaian dan keterampilan; 4) 18 item dengan 4 skala nilai untuk atasan BNS menilai intensitas proses konseling, penilaian dan penggunaan materi IYCF; dan 5) 17 item berupa daftar tilik kegiatan untuk klien menilai pemberian support, penilaian, dan praktik keterampilan. Gabungan item masing-masing menjadi instrumen penilaian kompetensi KAS-WOR, KAS-SUP, KAS-MOM dan KAS-COM dengan nilai titik potong masing-masing yaitu 75%, 50%, 80% dan 65%. Berdasarkan pembobotan 20% untuk pengetahuan, 10% sikap, dan 70% keterampilan diperoleh 30% BNS yang kompeten dalam konseling IYCF. KESIMPULAN: Hasil pengembangan instrumen penilaian kompetensi BNS melakukan konseling IYCF memiliki konsistensi internal dan tingkat validitas yang sedang sampai tinggi.

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ABSTRACT
BACKGROUND: The Barangay (Village) Nutrition Scholars (BNS) has been trained to do infant and young child feeding (IYCF) counseling but the absence of a validated competency instruments constrained the assessment of their competency to do IYCF counseling to their client. This study was designed to develop and validate the instruments to assess the competency of BNS on IYCF counseling and answer the question: how valid and reliable were the developed instrument to measure the competency of trained BNS on IYCF counseling? METHODS: Methodological research design were used to develop and validate the instruments to measure IYCF counseling competency based on knowledge, attitude and skills in terms of frequency, intensity and activity designed for the BNS, supervisor and client, respectively. The instruments were pilot-tested to assess 320 BNS. Item analyses results were used for revisions prior to field test to 280 BNS. Experts checked the content validity; internal consistency and construct validity were assessed using Cronbach?s alpha and exploratory and confirmatory factor analysis, respectively. The weighting distribution for knowledge, attitude and skills and cut-off score for each construct and instrument were established based on sensitivity and specificity using ROC Curve to calculate the score and to identify competent BNS. RESULTS: The validated instruments included: 1) 28 items for BNS knowledge test with true or false, fill-in-the-blanks and multiple-choice formats; 2) 10 items for BNS attitude test with four scale Likert scale to assess personal view, attitude towards implementation, and perceived barriers on IYCF counseling; 3) 18 items of five-scale frequency instrument for BNS to assess listening, giving support, assessment and action skills; 4) 18-item four-scale instrument for BNS supervisor to assess the intensity in doing the counseling process, assessment and use of IYCF materials; and 5) 17-item activity checklist designed for client to assess giving support, assessment and actions skills. These constructs were combined into competency assessment instruments KAS-WOR, KAS-SUP, KAS-MOM and KAS-COM with 75%, 50%, 80% and 65% as cut-off score. Based on the 20-10-70 weighting distributions for knowledge-attitude-skills competent BNS on IYCF counseling was about 30%. CONCLUSIONS: The assessment instruments developed to measure the IYCF counseling competency of BNS had relatively moderate to high internal consistency and validity. This assures that the results of the tests can be relied upon for making dependable judgments and interpretations.;BACKGROUND: The Barangay (Village) Nutrition Scholars (BNS) has been trained to do infant and young child feeding (IYCF) counseling but the absence of a validated competency instruments constrained the assessment of their competency to do IYCF counseling to their client. This study was designed to develop and validate the instruments to assess the competency of BNS on IYCF counseling and answer the question: how valid and reliable were the developed instrument to measure the competency of trained BNS on IYCF counseling? METHODS: Methodological research design were used to develop and validate the instruments to measure IYCF counseling competency based on knowledge, attitude and skills in terms of frequency, intensity and activity designed for the BNS, supervisor and client, respectively. The instruments were pilot-tested to assess 320 BNS. Item analyses results were used for revisions prior to field test to 280 BNS. Experts checked the content validity; internal consistency and construct validity were assessed using Cronbach?s alpha and exploratory and confirmatory factor analysis, respectively. The weighting distribution for knowledge, attitude and skills and cut-off score for each construct and instrument were established based on sensitivity and specificity using ROC Curve to calculate the score and to identify competent BNS. RESULTS: The validated instruments included: 1) 28 items for BNS knowledge test with true or false, fill-in-the-blanks and multiple-choice formats; 2) 10 items for BNS attitude test with four scale Likert scale to assess personal view, attitude towards implementation, and perceived barriers on IYCF counseling; 3) 18 items of five-scale frequency instrument for BNS to assess listening, giving support, assessment and action skills; 4) 18-item four-scale instrument for BNS supervisor to assess the intensity in doing the counseling process, assessment and use of IYCF materials; and 5) 17-item activity checklist designed for client to assess giving support, assessment and actions skills. These constructs were combined into competency assessment instruments KAS-WOR, KAS-SUP, KAS-MOM and KAS-COM with 75%, 50%, 80% and 65% as cut-off score. Based on the 20-10-70 weighting distributions for knowledge-attitude-skills competent BNS on IYCF counseling was about 30%. CONCLUSIONS: The assessment instruments developed to measure the IYCF counseling competency of BNS had relatively moderate to high internal consistency and validity. This assures that the results of the tests can be relied upon for making dependable judgments and interpretations.;BACKGROUND: The Barangay (Village) Nutrition Scholars (BNS) has been trained to do infant and young child feeding (IYCF) counseling but the absence of a validated competency instruments constrained the assessment of their competency to do IYCF counseling to their client. This study was designed to develop and validate the instruments to assess the competency of BNS on IYCF counseling and answer the question: how valid and reliable were the developed instrument to measure the competency of trained BNS on IYCF counseling? METHODS: Methodological research design were used to develop and validate the instruments to measure IYCF counseling competency based on knowledge, attitude and skills in terms of frequency, intensity and activity designed for the BNS, supervisor and client, respectively. The instruments were pilot-tested to assess 320 BNS. Item analyses results were used for revisions prior to field test to 280 BNS. Experts checked the content validity; internal consistency and construct validity were assessed using Cronbach?s alpha and exploratory and confirmatory factor analysis, respectively. The weighting distribution for knowledge, attitude and skills and cut-off score for each construct and instrument were established based on sensitivity and specificity using ROC Curve to calculate the score and to identify competent BNS. RESULTS: The validated instruments included: 1) 28 items for BNS knowledge test with true or false, fill-in-the-blanks and multiple-choice formats; 2) 10 items for BNS attitude test with four scale Likert scale to assess personal view, attitude towards implementation, and perceived barriers on IYCF counseling; 3) 18 items of five-scale frequency instrument for BNS to assess listening, giving support, assessment and action skills; 4) 18-item four-scale instrument for BNS supervisor to assess the intensity in doing the counseling process, assessment and use of IYCF materials; and 5) 17-item activity checklist designed for client to assess giving support, assessment and actions skills. These constructs were combined into competency assessment instruments KAS-WOR, KAS-SUP, KAS-MOM and KAS-COM with 75%, 50%, 80% and 65% as cut-off score. Based on the 20-10-70 weighting distributions for knowledge-attitude-skills competent BNS on IYCF counseling was about 30%. CONCLUSIONS: The assessment instruments developed to measure the IYCF counseling competency of BNS had relatively moderate to high internal consistency and validity. This assures that the results of the tests can be relied upon for making dependable judgments and interpretations., BACKGROUND: The Barangay (Village) Nutrition Scholars (BNS) has been trained to do infant and young child feeding (IYCF) counseling but the absence of a validated competency instruments constrained the assessment of their competency to do IYCF counseling to their client. This study was designed to develop and validate the instruments to assess the competency of BNS on IYCF counseling and answer the question: how valid and reliable were the developed instrument to measure the competency of trained BNS on IYCF counseling? METHODS: Methodological research design were used to develop and validate the instruments to measure IYCF counseling competency based on knowledge, attitude and skills in terms of frequency, intensity and activity designed for the BNS, supervisor and client, respectively. The instruments were pilot-tested to assess 320 BNS. Item analyses results were used for revisions prior to field test to 280 BNS. Experts checked the content validity; internal consistency and construct validity were assessed using Cronbach’s alpha and exploratory and confirmatory factor analysis, respectively. The weighting distribution for knowledge, attitude and skills and cut-off score for each construct and instrument were established based on sensitivity and specificity using ROC Curve to calculate the score and to identify competent BNS. RESULTS: The validated instruments included: 1) 28 items for BNS knowledge test with true or false, fill-in-the-blanks and multiple-choice formats; 2) 10 items for BNS attitude test with four scale Likert scale to assess personal view, attitude towards implementation, and perceived barriers on IYCF counseling; 3) 18 items of five-scale frequency instrument for BNS to assess listening, giving support, assessment and action skills; 4) 18-item four-scale instrument for BNS supervisor to assess the intensity in doing the counseling process, assessment and use of IYCF materials; and 5) 17-item activity checklist designed for client to assess giving support, assessment and actions skills. These constructs were combined into competency assessment instruments KAS-WOR, KAS-SUP, KAS-MOM and KAS-COM with 75%, 50%, 80% and 65% as cut-off score. Based on the 20-10-70 weighting distributions for knowledge-attitude-skills competent BNS on IYCF counseling was about 30%. CONCLUSIONS: The assessment instruments developed to measure the IYCF counseling competency of BNS had relatively moderate to high internal consistency and validity. This assures that the results of the tests can be relied upon for making dependable judgments and interpretations.]

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Pengelolaan hipertensi dan diabetes melitus yang memerlukan pengelolaan terkoordinasi, menjadi perhatian karena prevalensinya semakin meningkat. Kemampuan dokter sebagai care coordinator tidak terlepas dari kemampuan kepemimpinan, dan belum ada penilaiannya di Indonesia. Penelitian ini bertujuan mengembangkan intrumen penilaian kinerja dokter di layanan primer sebagai care coordinator dan kaitannya dengan kepemimpinan. Pendapat pakar dan metode Delphi digunakan untuk mengembangkan dimensi dan butir penilaian. Validasi instrumen dilakukan dengan analisis faktor eksplorasi. Kurva ROC digunakan untuk mencari titik potong skor care coordinator pada pasien hipertensi atau DM terkontrol dibandingkan tidak terkontrol. Korelasi Pearson dilakukan untuk melihat korelasi antara skor care coordinator dengan skor kepemimpinan klinis, kepemimpinan transformasional, komitmen, kepuasan kerja, dan budaya organisasi, serta faktor-faktor sosiodemografis dokter dan praktik keprofesian. Pengumpulan data dilakukan selama periode April−November 2015. Melalui penggalian pendapat 19 orang pakar (akademisi, praktisi, pengandil), 2 kali putaran Metode Delphi (110 sampel dan 81 sampel), dan 249 sampel analisis faktor, didapatkan instrumen penilaian kinerja dokter pengelola kasus PTM di puskesmas sebagai care coordinator yang terdiri dari 11 dimensi dan 33 butir penilaian dengan koefisien alpha sebesar 0,94 dan korelasi butir penilaian dengan dimensinya lebih dari 0,4. Terdapat perbedaan skor care coordinator antara pasien hipertensi atau diabetes terkontrol dan tidak terkontrol (p = 0,02) dengan titik potong sebesar 7,7. (skor maksimal 9). Terdapat korelasi positif antara skor kepemimpinan klinis, skor kepemimpinan transformasional, skor kepuasan kerja, usia dokter, lama lulus dokter, lama bekerja di puskesmas, pelatihan dokter keluarga, dan status kepegawaian terhadap skor care coordinator. Faktor yang paling berperan terhadap peningkatan skor care coordinator adalah skor kepemimpinan klinis dan skor kepemimpinan transformasional (R square 0,47). Telah dikembangkan instrumen penilaian kinerja dokter sebagai care coordinator di layanan primer yang valid dan handal. Walaupun dokter pengelola kasus dalam kesehariannya berinteraksi dengan pasien dan tidak menduduki jabatan struktural sebagai pimpinan, namun mereka harus tetap memiliki kemampuan kepemimpinan klinis serta kepemimpinan transformasional untuk menunjang kinerja sebagai care coordinator dalam pengelolaan masalah kesehatan pasien.

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Hypertension and Diabetes Mellitus management that need coordination of care is vital because of their increasing prevalence. To become care coordinator, primary care physician should have leadership capabilities. However, there is no instrument available to measure care coordination and leadership for primary care physician in Indonesia. This research aims to develop instruments for primary care physician's performance as care coordinator in primary care facilities and its correlation with leadership. Data collection was conducted from April to November 2015. Expert opinion and Delphi method were conducted to develop dimensions and item indicators. Exploratory Factor Analysis was performed for instrument validation. ROC curves were used to gain cut-off point of care coordinator's score from controlled and uncontrolled hypertension or diabetes mellitus patient. Pearson correlation was conducted to determine correlation between care coordinator score and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as doctor's sociodemographic factors and professional practice. Nineteen experts panel (academics, practitioners, health policy makers), 110 participants of 1st round Delphi Method, 81 participant of 2nd round of Delphi Method, and 249 samples for factor analysis were gathered to create 11 dimensions and 33 items with loading factors at least 0.4 and alpha cronbach as high as 0,94. There was care coordinator score difference between controlled and uncontrolled hypertension or diabetes mellitus patients (p = 0.02) with cut-off point 7,7 (maximum score 9). There was positive correlation between care coordinator score and clinical leadership score, transformasional leadership score, satisfaction score, age, graduation period, working period, family medicine training, and employment status. Dominant factors correlate to care coordinator score were clinical leadership score and transformational leadership score (R square 0.47). A valid and reliable instrument of care coordinator performance for Indonesian primary care physician has been developed. Although the main activity of practitioner is very much relate to patient interaction, they should also have leadership capacities to support their role as care coordinator for patient?s health management.

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Dalam pelayanan kesehatan, peranan Fasilitas Kesehatan Primer yang berhadapan langsung dengan masyarakat sangat penting. Kompetensi personal fasilitas pelayanan kesehatan dalam tatakelola pelayanan khususnya di fasilitas pelayanan primer masih terbatas. Hal itu disebabkan pembekalan melalui pendidikan dan pelatihan belum memenuhi kebutuhan kompetensi manajemen akibat kurikulum pendidikan dan pelatihan yang belum dirancang dan dilaksanakan sesuai dengan kebutuhan dan harapan masyarakat. Penelitian ini merupakan penelitian terapan bertujuan mengembangkan model manajemen peningkatan mutu terpadu pelayanan di Fasilitas Kesehatan Primer. Penelitian menggunakan metode  Kombinasi Kuantitatif-Kualitatif (Mixed Methods) dan rancangan  sequential explanatory. Penelitian ini terdiri dari dua tahap yaitu, tahap penelitian kuantitatif bertujuan menilai mutu layanan dari sisi pelanggan dengan rancangan potong lintang. Tahap penelitian kualitatif bertujuan menilai mutu dari sisi penyedia. Responden penelitian kuantitatif adalah akseptor penerima pelayanan KB AKDR Pasca Persalinan di Fasilitas Kesehatan Primer di Jakarta. Responden penelitian kualitatif adalah tim petugas di Fasilitas Pelayanan Primer dan Pakar di bidang Keluarga Berencana. Pengumpulan data penelitian kuanititatif menggunakan kuesioner yang telah divalidasi. Pengumpulan data penelitian kualitatif menggunakan metode wawancara mendalam menggunakan instrumen maturitas organisasi dan penilaian oleh pakar menggunakan metode Delphi.  Model akhir manajemen peningkatan mutu terpadu dikembangkan dari model awal yang disusun berdasarkan tinjauan pustaka. Berdasarkan kepuasan pelanggan sebanyak 141 (81,1%) responden merasa puas, 35 (19,9%) responden merasa tidak puas. Berdasarkan keselamatan pasien 166 (94,3%) responden menyatakan keselamatan baik, 10 (5,7%) responden menyatakan keselamatan kurang. Pada penilaian mutu dari sisi pelanggan variabel yang memengaruhi mutu adalah regulasi dan standarisasi, sarana prasarana, komunikasi efektif dan kepemimpinan klinik. Pada penilaian mutu dari sisi penyedia dengan penilaian maturitas proses dan maturitas organisasi masing-masing pada tingkat pertama dan kedua dari empat tingkat maturitas. Dari model awal berdasarkan tinjauan pustaka dan hasil penelitian disintesis model akhir Manajemen Peningkatan Mutu Terpadu di Fasilitas Kesehatan Primer. Simpulan: Telah berhasil dikembangkan model Manajemen Peningkatan Mutu Terpadu (M-PMT) di fasilitas Kesehatan Primer yang merupakan perangkat manajemen fasilitas Kesehatan Primer dalam proses manajemen mutu pelayanan untuk mencapai kinerja mutu unggul. Model dikembangkan dengan pendekatan terpadu, komprehensif, holistik dan berkelanjutan. Pendekatan terpadu dalam struktur rancangan sistem sebagai komponen input. Komponen proses dengan pendekatan komprehensif dalam siklus perencanaan, pelaksanaan dan pemantauan evaluasi melalui proses pembelajaran mencapai tingkat kematangan proses dan organisasi berkelanjutan.

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In health services, Primary Health Facilities plays an important role in dealing directly with the community. The personal competence of health service facilities in service governance, especially in primary care facilities, is still limited. This is due to the fact that debriefing through education and training has not met the needs of management competencies due to education and training curricula that have not been designed and implemented according to the needs and expectations of the community. This is an applied research aimed at developing an integrated quality improvement management model of service in Primary Health Facilities. The study combined quantitative methods and sequential explanatory design. This study consists of two stages. The quantitative research stage aims to assess the quality of service from the customer side with a cross-sectional design. The qualitative research phase aims to assess the quality of the provider. Quantitative research respondents are acceptors of contraceptive services of postnatal IUD at Primary Health Facilities in Jakarta. respondents from qualitative research team were officers at Primary Service Facilities and experts in the field of Family Planning. Quantitative research data is collected using validated questionnaires. Collecting qualitative research data using in-depth interview methods using organizational maturity instruments and expert assessment using the Delphi method. The final model of integrated quality improvement management was developed from the initial model which was compiled based on literature review. Regarding customer satisfaction, 141 (81.1%) respondents were satisfied and 35 (19.9%) respondents felt dissatisfied. Regarding patient safety, 166 (94.3%) respondents stated safety was good and 10 (5.7%) respondents said that safety was lacking. In the quality assessment from the customer side, the variables that affect quality are regulation and standardization, infrastructure, effective communication and clinical leadership. In the assessment of quality from the provider side by assessing the process maturity and organizational maturity of each at the first and second levels of the four maturity levels. The final model of Integrated Quality Improvement Management in Primary Health Facilities is synthesized from the initial model based on literature review and the results of the study. Conclusion: The Integrated Quality Improvement Management (M-PMT) Management model in Primary Health facilities has been successfully developed. The result is a primary health facility management tool in the service quality management process to achieve superior quality performance. The model is developed with an integrated, comprehensive, holistic and sustainable approach. Integrated approach in the structure of the system design served as as an input component. The process component with a comprehensive approach in the cycle of planning, implementing and monitoring evaluations through the learning process reaches a sustainable level of process and organization maturity.

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ABSTRAK
Pekerja merupakan kelompok usia produktif yang berisiko terhadap penyakit tidak menular karena gaya hidup yang tidak sehat. Sebagian besar waktu bangun pekerja akan dihabiskan di tempat kerja dengan aktivitas sedenter berupa duduk. Waktu menjadi kendala utama bagi pekerja melakukan latihan fisik demi meningkatkan kebugaran jasmani, yang diketahui berbanding lurus dengan produktivitas. Salah satu fokus intervensi adalah peningkatan latihan fisik pekerja pada jam kerja. Beberapa upaya telah dilakukan sebelumnya, namun belum ada alat latihan kardiorespirasi yang ergonomis dan mampu laksana bagi pekerja. Tujuan penelitian adalah untuk mendapatkan model alat latihan kardiorespirasi yang secara efektif dapat meningkatkan kebugaran jasmani pekerja duduk. Penelitian terdiri dari tiga tahap, yaitu tahap pengembangan, tahap penentuan validitas, dan tahap pembuktian efektivitas model alat latihan. Kedua tahap awal menggunakan rancang penelitian potong lintang, sedangkan tahap akhir menggunakan rancang kuasi eksperimental. Pemilihan sampel dilakukan pada populasi pekerja duduk di Jabodetabek. Peneliti mendapatkan 3 aspek yang memengaruhi pencapaian denyut nadi optimal, dengan model regresi yang menjelaskan 86,2% variasi pencapaian denyut nadi latihan optimal (R2 = 0,862). Selain itu, didapatkan protokol dan formula uji ukur daya tahan kardiorespirasi untuk memprediksi nilai VO2maks dengan model alat latihan yang mempunyai tingkat akurasi dan presisi baik. Pada implementasi, didapatkan peningkatan nilai prediksi VO2maks pada kelompok perlakuan di akhir minggu ke-12 dengan selisih rerata 1,21 (2,4) mL/kg/menit (p < 0,005) dan tingkat pemenuhan sesi latihan sebesar 39,7% dari total sesi yang diharapkan. Sementara itu, terjadi penurunan nilai prediksi VO2maks sebesar 2,8 (2,8) mL/kg/menit (p < 0,005) pada kelompok kontrol. Penggunaan model alat latihan kardiorespirasi berbasis pijak kaki Kinesia pada program latihan fisik berbasis tempat kerja dikatakan valid (r > 0,3) dan reliabel (r-alpha > 0,6) untuk meningkatkan daya tahan kardiorespirasi pekerja duduk.

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ABSTRACT
Workers are a productive age group who are at risk of non-communicable diseases because of an unhealthy lifestyle. Most of the workers waking time will be spent in the workplace with a sedentary activity in the form of sitting. Time is a major obstacle for workers doing physical exercise in order to improve physical fitness, which is known to be directly proportional to productivity. One of the focuses of the intervention is to increase the physical exercise of workers during working hours. Several efforts have been made before, but there is no ergonomic cardiorespiratory training devices yet that able to do by workers. The purpose of study was to obtain a model of cardiorespiratory exercise devices that effectively improve physical fitness of sitting workers. It consists of three stages, namely the development phase, the stage of determining the validity, and the stage of proving the effectiveness of the exercise model. The first two stages use a cross-sectional design, while the final stage uses a quasi-experimental design. The sample selection was carried out in the sitting working population in Jabodetabek. The researcher obtained 3 aspects that influenced the achievement of optimal exercise heart rate, with a regression model that explained 86.2% variation in the achievement of optimal exercise heart rate (R2 = 0.862). In addition, the cardiorespiratory endurance test protocol and formulas was obtained to predict VO2max values with a training tool model that had good accuracy and precision. In implementation, it was found an increase in the predictive value of VO2max in the treatment group at the end of the 12th week with an average difference of 1.21 (2.4) mL/kg/minute (p < 0.005) with a training session fulfillment rate of 39.7% of the total expected session. Meanwhile, in the control group there was a decrease in the predicted value of VO2max of 2.8 (2.8) mL/kg/minute (p < 0.005). It was concluded that the use of Kinesia foot rest-based cardiorespiratory exercise devices model in workplace-based physical training program is said to be valid (r > 0.3) and reliable (r-alpha > 0.6) to increase the cardiorespiratory endurance of sitting workers.

Abstrak :

Studi diagnostik ini bertujuan untuk menghasilkan kuesioner skor risiko resistensi insulin, yang merupakan alat skrining untuk membedakan seseorang dengan dan tanpa risiko resistensi insulin. Alat skrining diperlukan untuk pencegahan dini diabetes mellitus tipe 2. Model prediksi resistensi insulin ini dikembangkan melalui analisis regresi logistik multivariat menggunakan indikator diet dan non-diet untuk memprediksi kejadian resistensi insulin yang didefinisikan sebagai HOMA-IR ≥ 0.97. Asupan rata-rata harian dari nasi, telur, ikan dan udang, ayam, bersama dengan indeks massa tubuh (IMT) dipilih sebagai komponen model prediksi terbaik untuk menghitung risiko resistensi insulin. Skor risiko dari penelitian ini memiliki validitas yang baik untuk membedakan orang dengan resistensi insulin, Area Under Curve (AUC) 0.779 (0.721-0.838), sensitivitas 0.806, dan spesifisitas 0.577.

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This diagnostic study aimed to generate an insulin resistance risk score questionnaire, which was a screening tool to discriminate someone with and without insulin resistance risk. The screening tool was needed for early prevention of type 2 diabetes mellitus. Insulin resistance prediction models were developed from multivariate logistic regression analysis using dietary and non dietary indicators to predict insulin resistance incidence defined as HOMA-IR ≥ 0.97.  Daily average intake of steamed rice, egg, fish and shrimp, chicken, together with body mass index (BMI), were selected as the components of the best prediction model to calculate insulin resistance risk. The risk score from this study had good validity to discriminate people with insulin resistance, with  Area Under Curve (AUC) of  0.779  (0.721-0.838), sensitivity of 0.806 dan specivicity of 0.577.

Abstrak :
Guru termasuk dalam profesi dengan tingkat aktivitas fisiknya di tempat kerja yang rendah. Perilaku sedenter, konsumsi tinggi lemak dan karbohidrat, timbulnya obesitas, serta stres akibat beban pekerjaan menyebabkan prevalensi hipertensi yang cukup tinggi pada kelompok ini, khususnya guru SD. Salah satu cara yang sudah terbukti efektif dan efisien untuk mengatasinya adalah melalui upaya perubahan perilaku kesehatan berbasis tempat kerja (workplace wellness program/WWP). Namun hingga saat ini program tersebut, terutama untuk pengendalian tekanan darah (TD), belum ada. Penelitian ini bertujuan untuk mengembangkan model WWP, menilai kemamputerapan, serta efeknya terhadap pengendalian TD. Penelitian dilakukan pada Maret 2021-Maret 2022 melalui 3 tahap, yaitu systematic review dan seminar pakar (FGD) untuk pengembangan model serta one group pre and post study untuk ujicoba. Unsur-unsur model disusun menurut supplier-input-process-outcome-customer (SIPOC). Terdapat 44 guru sebagai subjek penelitian di 3 lokasi sekolah, yaitu SDN Kenari 01, Kramat 01, dan Kramat 06 di Kecamatan Senen, Jakarta Pusat. Intervensi dilakukan selama 3 bulan untuk menilai kemamputerapan dan efek model terhadap pengendalian TD dan faktor risikonya. Analisis statistik menggunakan uji t berpasangan dan Wilcoxon. Penelitian berhasil menyusun Model Penggunaan Skrining sebagai Umpan balik bagi Guru untuk Monitoring mengAtasi tekanan darah tinggi (SUGMA) yang menggunakan pendekatan multikomponen untuk mencapai perubahan perilaku kesehatan individu di tempat kerjanya. Hasil ujicoba menunjukkan bahwa seluruh komponen intervensi terlaksana, tingkat partisipasi > 50%, kepuasan > 4 skala Likert, dan DO < 10%. Model memberikan efek terhadap penurunan TD sistolik dan diastolik ± 5 mmHg (p < 0,05), peningkatan perilaku DASH (p < 0,000) dan aktivitas berjalan (p < 0,05), serta penurunan rasio sodium/kreatinin urin sewaktu pada guru yang TD-nya terkendali (p < 0,05). Model belum memberikan efek terhadap penurunan IMT, pengetahuan, niat/motivasi, perilaku aktivitas fisik total, dan rasio sodium/kreatinin urin sewaktu pada seluruh subjek (p > 0,05). Model SUGMA dinilai mampu terap dan memberikan efek dalam pengendalian TD dan faktor risikonya. Masih dibutuhkan penelitian lebih lanjut untuk evaluasi. Selain untuk penelitian, pemanfaatan model bagi para praktisi di layanan primer sudah dapat dilakukan sebagai alternatif dalam pengembangan program promosi kesehatan berbasis tempat kerja dalam mengatasi penyakit kronik seperti hipertensi. Koordinasi dan kerjasama pemangku kebijakan, lintas sektor dan program, dibutuhkan untuk memperluas cakupan dan kesinambungannya. ......Teachers are considered a profession with low level of physical activity at work (low occupational activity). Sedentary behavior, high consumption of fat and carbohydrates, obesity, and stress due to workload cause a relatively high prevalence of hypertension among this group, especially elementary school teachers. One way that has been proven to be effective and efficient to tackle this issue is through workplace-based health intervention (workplace wellness program/WWP). However, the program, especially for controlling blood pressure (BP), has yet to exist. This study aims to develop a WWP model, assess its applicability, and its effect on hypertension control. The research was conducted in March 2021-March 2022 through 3 stages, namely systematic studies and expert seminars (FGD) for model development and pre and post one group studies for trials. The model elements are arranged according to supplier-input-process-outcome-customer (SIPOC). There were 44 teachers as research subjects in 3 school locations, namely SDN Kenari 01, Kramat 01, and Kramat 06 in Senen District, Central Jakarta. The intervention was carried out for 3 months to assess the efficacy and effect of the model on blood control and its risk factors. Statistical analysis used are paired t test and Wilcoxon. The research succeeded to develop Model Penggunaan Skrining sebagai Umpan balik bagi Guru untuk Monitoring mengAtasi tekanan darah tinggi (SUGMA) that uses a multicomponent approach to achieve changes in individual health behavior in the workplace. The test results show that the model is suitable to be used because all components of the intervention has been successfully applied, the participation rate is > 50%, satisfaction is > 4 on a Likert scale, and DO is < 10%. The model is successful in decreasing systolic and diastolic BP (p < 0.05), increasing DASH behavior (p < 0.000) and walking activity (p < 0.05), and decreasing the urinary sodium/creatinine ratio among teachers whose BP was under control (p < 0.05). The model had no effect on decreasing BMI, knowledge, intention/motivation, total PA behavior, and urinary sodium/creatinine ratio over time in all subjects (p > 0.05). Further research is still needed for evaluation. Besides within the research corridor, the utilization of the model for general practitioners in primary care can already be used as an alternative in the development of workplace-based health promotion programs in overcoming chronic diseases such as hypertension. Stakeholder coordination and collaboration, across sectors and programs, are needed to expand coverage and sustainability.

Abstrak :
LATAR BELAKANG: Peningkatan jumlah ibu bekerja secara konsisten dapat berdampak positif meningkatkan status ekonomi rumah tangga, sebaliknya dapat berdampak negatif bagi pola asuh, asupan makanan serta pertumbuhan anak. Studi menganalisis praktik keragaman makanan (dietary diversity) sebagai komponen penting Makanan Pendamping ASI (MP-ASI) pada anak usia 6-23 bulan khususnya pada tiga tingkatan ibu bekerja: tenaga kerja/buruh tidak terampil, tenaga terlatih, tingkat professional dan ibu tidak bekerja sebagai pembanding. Studi juga menilai hubungan kondisi ibu bekerja dan keragaman makanan dalam menjelaskan mekanisme terjadinya stunting. METODE: Kompilasi Survei Demografi Kesehatan Indonesia (SDKI) serta Riset Kesehatan Dasar (Riskesdas) periode tahun 2002 - 2012 digunakan untuk menganalisis ketepatan praktik konsumsi keragaman pangan pada anak serta determinannya. Sebagai studi kombinasi bertahap (sequential mixed method), hasil kuantitatif diperjelas kajiannya dengan studi kualitatif melalui wawancara mendalam kepada ibu dari berbagai tingkatan pekerjaan. HASIL: Anak dengan keragaman makanan tepat yaitu minimum 4 jenis makanan dari usia 6 bulan hanya 18-24%, sedangkan selebihnya terlambat dikenalkan variasi makanan terutama sumber protein hewani. Ibu bekerja pada tingkat terendah (tenaga kerja tidak terampil) justru berhubungan dengan pola asupan yang kurang baik dan memburuknya stunting, padahal jumlahnya mencapai 40% dari ibu bekerja. Kesejahteraan rumah tangga, akses informasi, pelayanan kesehatan, pendidikan dan pekerjaan orang tua adalah faktor yang berasosiasi terhadap prilaku asupan yang baik. Studi kualitatif mendapatkan bahwa pada komunitas ibu bekerja sebagai buruh tidak terampil, tumbuh persepsi yang kompromi terhadap pemberian makanan seadanya karena keterbatasan sumber daya pengasuhan anak, disamping keharusan mereka untuk tetap bekerja memenuhi kebutuhan rumah tangga. Analisis pathway mendapatkan bahwa ibu bekerja sebagai buruh tidak terampil secara langsung berhubungan dengan kurangnya keragaman makanan dan secara tidak langsung dengan stunting. Untuk menindaklanjuti kelompok ibu dan rumah tangga yang memerlukan intervensi edukasi, studi mengembangkan kuesioner skrining untuk mengidentifikasi rumah tangga yang tidak mampu memberikan keragaman makanan yang baik dengan akurasi 70% . KESIMPULAN: Di Indonesia, banyaknya ibu bekerja sebagai tenaga kerja tidak terampil berpotensi memperburuk masalah stunting. Anak-anak usia 6-23 bulan mengalami masalah kurangnya dan terlambatnya diberikan keragaman makanan yang cukup. Penting untuk keluarga, terutama dengan ibu bekerja dengan anak masih dibawah 2 tahun, untuk meningkatkan kesadaran pengasuhan anak dan ketrampilan pemberian MP-ASI dengan keragaman pangan yang cukup sejak anak berusia 6 bulan, selain ASI eksklusif. Edukasi gizi dapat dilakukan tidak hanya kepada ibu, keluarga dan pengasuh anak, namun juga terhadap komunitas ibu bekerja dengan pemberdayaan program perusahaan sayang ibu dan bayi. ......BACKGROUND: Consistent increasing number of working mothers can positively impact on household economy improvement, but otherwise may negatively affect parenting, child feeding and child growth. This study analyzed dietary diversity practice, as one important component of complementary feeding in children aged 6-23 months, and its determinants especially at the three levels of maternal occupation: unskilled labor, skilled labor, professional and also included non-working mother as reference. Study also analyzed direct and indirect association of maternal occupation and dietary diversity practices to explain mechanism of stunting. METHODS: Compilation of Indonesian Demographic and Health Survey (IDHS) and the Basic Health Research (Riskesdas) from 2002 to 2012 were used to analyze the appropriateness of dietary diversity practice in children and its determinants. As sequential mixed method study, result of quantitative study were further explored by a qualitative study in the form of in-depth interviews RESULTS: Children with timely minimum 4 food groups-dietary diversity (DD) since 6 months were only 18-24%, while the others had delayed introduce of animal source food. Mother worked at the lowest level (unskilled labor) lead to poorer dietary diversity and severe stunting, whilst their number was 40% of working mother. Household wealth, media exposure, access to health care, mother and father education and employment were factors associated to minimum DD. Qualitative studies found that unskilled labor mother community tend to compromise child feeding quality especially dietary diversity, due to limited child care resources, despite necessity to keep working to fulfill household needs. Pathway analysis found that mother working as unskilled labor directly caused poorer dietary diversity and indirectly caused stunting. To assess mother and household that required further education intervention related to DD importance, this study developed a scoring model for identifying household with high risk of inadequate dietary diversity with accuracy of 70%. CONCLUSION: In Indonesia, the number of mothers who work as unskilled labor could potentially exacerbate the problem of stunting. Children aged 6-23 month old had inadequate and delayed timing for minimum dietary diversity in their diet. It is important for family, especially when the mother decided to work yet have under-two children, to re-develop parental awareness about the importance of complementary feeding with appropriate dietary diversity practice, beside exclusive breastfeeding. Nutrition education must not only be targeted to mother, family and caregiver, but also to working mother community via empowerment of mother and baby friendly company program.

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.