Microscopic features of HeLa cells implanted into mice

in HeLa cells, Oncogene ,1999. 18, 4538-4545. Griffiths, G.D., Leek, M.D. and Gee, D.J. The toxic plant proteins Ehrenberg, O.P and Graue. Wiechers, F. In vivo study of Biological Effects of Photodynamic Therapy on ricinand abrin induce apoptotic Cervical Cancer, Physica changes in mammalian lymphoid tissues and intestine, J. Pathol ., 1987.,151,221-229. Scripta 2005., 71,1-4. Price, S.A. Patofisiologi: Konsep Klinis Proses-Proses Penyakit , edisi Marquez-Lemus, V.A., Noguez- ke-4 buku 1, diterjemahkan oleh Juarez,B.M., Salano-Rodriguez, Peter Anugerah, 119-120, L., Perez Zepata, A.J., Ramon- Penerbit buku Kedokteran Gallegos, E., Schneider- 31 EGC., 1994, Jakarta THE EFFECT OF ELDERLY EXERCISE TO COGNITIVE DIMENSIA ELDERLY FUNCTION IN “MAWAR”AGE CARE FACILITIES PSLU BLITAR TULUNGAGUNG Prima Dewi Kusumawati Institute Of Health Surya Mitra Husada Email:primastikesgmail.com ABSTRACT Elderly would decrease of nerve cells in the brain that would lead to dementia in the elderly. Effective ways that could be used by the elderly to decrease aging process. The aim of this study was to determine the effect of Elderly exercise to cognitive dimensia elderly function in “Mawar” age care facilities PSLU Blitar Tulungagung.This study design was quasi-experimental approach to One Group Pre Test - Post Test design. The population all dimensia elderly in “Mawar” age care facilities PSLU Blitar Tulungagung totaling 15 respondents with a total sampling method obtained a sample of 15 respondents. Results of statistical test Paired Samples T-Test p value 0.027 to 0.027 value 0.05 can be concluded that the H0 is rejected, which means there was influence of elderly exercise cognitive function in dimensia elderly function in “Mawar” age care facilities PSLU Blitar Tulungagung.Exercise elderly provides benefits that emotional stress is reduced, the mind is more clear, the relationship between humans and the atmosphere is more relaxed and happy, language skills and memory increases, people become more passionate, more creative and efficient, people feel more healthy because the stress is reduced. Keywords: Exercise Elderly, Elderly Cognitive Function INTRODUCTION The process of aging and being aging is a natural process that everyone experiences Atum, 2008. Entering old age means setbacks, such as physical deterioration characterized by sagging skin, graying hair, beginning toothless, lessening clear hearing, getting eyesight worse, being slow motion, and not having figure proportional Nugroho, 2008. The elderly population in Indonesia in 2006 amounted to approximately 19 million 8.9 with a life expectancy of 66.2 years, in 2010 amounted to 23.9 million 9.77 with a life expectancy of 67.4 years and in 2020 is estimated at 28.8 million 11.43 with a life expectancy of 71.1 years the Central Bureau of Statistics, 2010. The amount includes the fourth largest after China, India and Japan the Central Bureau of 31 Statistics, 2010. In the Asia Pacific region, the number of elderly people will increase rapidly from 410 million in 2007 to 733 million in 2025, and estimated to be 1.3 billion by 2050 Murwani, 2011. The number of elderly people who are in dormitory of PSLU Blitar Tulungagung around 77 inhabitants, whereas in Mawar dormitory of PSLU Blitar Tulungagung, there were 14 people still in good health. Elder is an old person because of his old age changes the biological, physical, psychological, and social. This change will affect all aspects of life, including health. Therefore, the health for the elders needs special attention while providing motivation for the elderly people can live productively based on their abilities Health Act No. 36 of 2009 Article 138. The increasing number of the elderly population will be able to provide a problem - the problem of disease in the elderly. According to the Ministry of Health in 1998, there was 7.2 of the population aged 60 years and older up to cases of dementia. A total of 5 of old age 65-70 years suffers from dementia and will double every 5 year reaching 45 at the age above 85 years Nugroho, 2008. Dementia is a disorder of memory function that occurs slowly, and can disrupt the performance and daily activities Atum, 2010. Dementia is marked with disturbances of memorizing and learning something new in short term, eloquence interference difficult to name objects and search for words to speak, wrong about the place, time, person or object, difficult to count, unable to plan, organize, make decisions and other things Sumijatun, 2005. The results of a preliminary study conducted by researchers at Dormitory of PLSU Blitar Tulungaggung are the number of elderly people 80 and the number of elders in Mawar Dormitory is 15 people. The results of interviews of 15 elderly people in Mawar Dormitory of PSLU Blitar Tulungagung showed that they often perceived in the dormitory and often forgetful when they put something, it is easy to forget the names of fellow elders and often confused when someone asks. The way to improve cognitive function for the elders is a group therapy with Reminiscene therapy is beneficial to maintain individual identity and also can improve the cognitive function, because the elders will use his past to defend his opinions and criticism Johnson, 2005. The other way to improve cognitive function is Brain Gym or sports. It can also use exercise for the elders to inhibit the aging process. Exercise for elders will not only facilitate the flow of blood and oxygen to the brain, but also stimulate both sides of the brain to work Tammase, 2009. 32 The purpose of this study is to determine the influence of exercise for cognitive function from elderly people with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung. MATERIAL AND METHOD Research design Based on the research objectives, the design of the study is quasi- experimental. The model used is the pre and post-test without control. Population and Sample Research The design of the study is quasi- experimental design with pre and post test without control. Sampling technique in this research is total sampling where all population can be sampled, and the samples are elderly suffering from dementia amounts to 15 people. Independent variables of this study are elderly exercise while the dependent variable is the cognitive function in elderly dementia. And data analysis uses Paired sample t-test. RESULTS 1. Characteristics of respondents a. By age Figure 1 shows almost all respondents are 60 -74 years 73 b. Based on Gender Figure 2 shows most of the respondents are male 53 c. based education Figure 3 shows that the majority of the respondents are no schooling 53 2. Characteristics of variables a. MMSE before being given elderly exercise Dormitory of PSLU Blitar Tulungagung based on the research results of cognitive value before being granted elderly exercise the respondents with the highest cognitive value was as much as seven respondents 47. According Pudjiastuti 2003, that decrease of the cognitive function ability due to morphological and biochemical, decreased brain weight for the elders due to a reduced content of protein and fat in the brain so that the brain becomes lighter. Axons, dendrites and nerve cell bodies experience many changes; dendrites which serve as a means for communication between nerve cells change to become thinner and lose cell contact between nerve cells, nerve conductivity decreased so that the movement becomes slow. 2. Cognitive Function after being given elderly exercise for Elders with Dementia in the Mawar Dormitory of PSLU Blitar Tulungagung The results of the study are after being given elderly exercise for Elders with Dementia found that mild cognitive score as many as 8 respondents 53. Figure 4 shows that most of the respondents have moderate cognitive function 47 b. MMSE after being given elderly gymnastics Figure 5 shows that most respondents have mild cognitive functions 53 Discussion1. Cognitive Function for Elderly people with Dementia before given elderly exercise the Mawar 33 There are several ways to cope with the occurrence of dementia in the elderly, both pharmacological and non pharmacological. In this study, we use non-pharmacological means by giving for 15 minutes exerciser for the elders every day for 3 days. In addition, researchers are consistent with the theory stated by an expert who discovered the exercise movements for elders stating that therapeutic exercise for elders conducted over 1 time a day within 15 minutes for 3 days, on a regular basis can reduce the decline in cognitive function Denisson, 2009. 3. The effect of elderly exercise for the elders with Dementia on Cognitive Function In the Mawar Dormitory of PSLU Blitar Tulungagung based on the statistical test result with Paired sample t-test p value 0.027 thus obtained 0.027 0.05 it can be concluded that the H0 is rejected, which means that there is influence of elderly exercise with cognitive function for the elders with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung. The results showed that elderly exercise for the elders is significantly beneficial in improving the cognitive function of elderly people with dementia proved by the meaningful score results in cognitive function after being given elderly exercise. Conclusion 1. It was found that before doing elderly exercise 15 mostly elderly respondents have moderate cognitive functions are seven respondents 47. 2. It was found that after doing elderly exercise 15 respondents mostly elderly people have mild cognitive functions i.e. 8 respondents 53. 3. Based on the research showed the value of .8667 and a pre-test to post-test value of 1.4000 so that it could be seen The result of this study is expected to provide objective information and feedback related to the handling of the elderly people who have dementia to optimize cognitive function by elderly exercise. For elderly people with dementia is expected to do elderly exercise regularly. 3. For Researcher The result of this study is expected to add the knowledge and experience for the researchers themselves in conducting research on elders with dementia, especially in optimizing cognitive function by elderly exercise. 4. For further research The result of this study is expected to be used as a source of information in future research as well as other measures such as cognitive therapy to optimize cognitive function for elderly people with dementia. Bibliography Dahlan, Sopiyudin. 2008. Statistika an increase in cognitive function before Untuk Kedokteran dan and after treatment 5,333. Whereas the results of statistical test Paired Samples Test using SPSS with  = 0.05. P value 0.027 to 0.027 value 0.05 it can be concluded that the H0 is rejected, which means that there is an influence of elderly exercise with cognitive function for elderly people with dementia in the Mawar Dormitory of PSLU Blitar Tulungagung. Suggestion 1. For Respondents The result of research on elderly exercise therapy is expected to be used for pre-seniors with dementia and to prevent the occurrence of a more severe degree of dementia. 2. For Elder Dormitory of PSLU Blitar Tulungagung 34 Kesehatan . Jakarta : Salemba Medika Dennison, Paul E,. Gail E. Dennison. 2008. Buku Panduan Lengkap Brain Gym . Jakarta : Grasindo Depkes RI. 2008. Pedoman Pembinaan Kesehatan Usia Lanjut Bagi Petugas kesehatan . Jakarta : Direktorat Pembinaan Kesehatan Masyarakat. Hartati. 2010. Clock Drawing : Asesmen Untuk Demensia . Semarang : Fakultas Psikologi Universitas Diponegoro. Jonhson, M.H,. 2005. Developmental Cognitive Neuroscience , Edisi 2. Oxford : Blacwell Publishing 35 36 SOCIAL INTERACTION EFFECT THE RECURRENCE OF CORONARY HEART DISEASE PATIENT IN POLI JANTUNG RSUD Dr. MOHAMAD SALEH PROBOLINGGO Nia Sari STIKes Surya Mitra Husada ABSTRACT The recurrence is a condition of the patient when arissing the same symptom which is like before dan makes the patient must nurse back. The condition arround or the society that is full of stress with dietary habit that is not healthy can cause someone infected a heart attack. The purpose of this research is for analyze the effect of social interaction on the recurrence of coronary heart disease patients. The kind of this research used quantitative approach with cross sectional design. The data is got by using a questioner paper for social interaction and medical record for recurrence. The totality of the samples that are taken in this research are 57 respondents By “Simple Random Sampling”. This research on February until Juni, 2015. From 57 respondent which is researched, 71,93 of the respondents gets relapse and 28,07 of the respondents gets relapse over the last month. From 71,935 of the respondents who is relapse, 21,1 has a bad social interaction.The test results of Logistic Regresion with α = 0,05 got the variable result which is influenced significant on recurrence is social interraction p=0,026. To prevent the recurrence of coronary heart can be done by healthy social interaction in communities. Key words : Coronary Heart, Social Interraction, Recurrence 35 INTRODUCTION Indonesia today has a double burden in the face of disease problems. On one side of communicable diseases are still high even tends to increase, on the other hand non-communicable diseases are generally classified as degenerative disease began to increase. One of the degenerative disease is the leading cause of death is coronary heart disease CHD. The disease is generally caused by the behavior or unhealthy lifestyle Notoatmodjo, 2011. Cardiovascular disease CVD is the leading cause of death in many develop countries and looks for a rising trend as a cause of death in many developing countries. Coronary heart disease CHD is the cause of that need more in-depth attention to the developing countries. Impact of economic progress, the rapid eradication of infectious diseases. As a consequence, on the other hand CHD shifted into the main cause of death in which previous infectious disease is the leading cause of death. High levels of plasma total cholesterol, arterial heart disease CHD, 23.73 of primary hypertension, 18.9 of heart failure, myocardial infarction 7.5 and there are still some other heart disease. From the above results it can be concluded that patients with coronary heart disease continues to grow each year, and CHD is also the largest type of heart disease during 2014 in the Hospital Dr. Mohamad Saleh Probolinggo. MATERIALS AND METHODS RESEARCH This study uses a quantitative approach, using cross sectional design. Social interaction data obtained using a questionnaire. While the variable dependentnya is recurrence outpatient coronary heart disease CHD. The population in this study were all outpatients coronary heart disease CHD in the heart poly Hospital Dr. Mohamad Saleh Probolinggo. On average there are 66 patients a week which will be used as the study population. Samples are taken as many hypertension and smoking are three as 57 respondents, with Simple major risk factor for CHD. Random Sampling technik. Data Hipercholesterolemia occupies a very important position because hipercholesterolemia is the only risk factor that can lead to the onset of analysis using logistic regression. RESULTS Characteristics of the subjects in this artherosclerosis. Diet is related to study include sex, age, education level hipercholesterolemia. Diet is one of the main environmental factors causing coronary heart disease through blood cholesterol. The scientific evidence in recent years shows the importance of the role of social factors as determinants of the health status of non-communicable and occupation. The description of the characteristics of variables as in table 1. Table 1. Characteristics of Research Based on gender, age, education level and occupation. diseases, especially in this case cardiovascular disease Bulletin of No 1 Karakteristik Sex N Health Indonesia, 2012. Male 33 57,89 Based on data obtained from cardiac poly Hospital Dr. Mohamad Saleh Probolinggo, it was found that each year the number of patients with heart disease is increasing. The increase in the number of patients with heart disease from 2013 to 2014 increased from 8191 to 10.311 patients or 25.88. The percentages of 30.73 of heart disease is coronary 2. 3 Female Age 50 th ≥50 th Education level SD SMP SMA PT 24 9 48 9 8 27 13 42,11 15,79 84,21 15,79 14,04 47,37 22,81 36 4 Occupation Hospital Dr. Mohamad Saleh 5 6 7 Swasta PNS Tdk bekerja Social Interaction Good Bad Smoking Smoker No Recurrence yes never Total 14 12 31 44 13 3 54 41 16 57 24,56 21,05 54,39 77,19 22,81 5,26 94,74 71,93 28,07 100 Probolinggo showed that of the 57 respondents surveyed, 13 respondents 22.81 had a poor social interaction, and 44 respondents 77.19 have a good social interaction. Of the 13 respondents who have poor social interaction, the average of them is a man who does not work and aged over 50 years. Social interaction is said to be bad because most of them are rarely interact or cooperate with groups in the community such as for example, Posyandu elderly, spiritual groups, group gathering and so forth. So that Based on Table 1 it can be seen that the majority of respondents are male as many as 33 people 57.89, aged more than 50 years as many as 48 people 84.21 and have a high school education level as many as 27 people 47 , 37, most respondents do not work as many as 31 people 54.39, the majority of respondents have a good interaction as many as 44 people 77.1, there are three 5.26 of respondents who have smoking as many as three people, as many as 41 respondents 71.93 experienced a recurrence. they are the elderly tend to be aloof and less interaction with groups in the community, so the majority, or 10 of 13 respondents poor social interaction, they tend to experience stress. According Soekanto 2006, social interaction is the key to all social life. In the absence of communication or interaction between each other then there may be a life together. If only the physical line of sight between each other, can not produce a form of social groups can interact. And the age factor also affects the elderly lazy to interact and cooperate with social groups because they feel he is old, their ability Table 2. Results of the logistic to interact with and adapt to already not regression analysis optimal due to the aging process. Variabel Social Interaction Sig. 0,026 OR 3,576 Recurrence Outpatient Coronary Heart Disease in Space Poly Heart Hospital Dr. Mohamad Saleh Probolinggo P value of social interaction = 0.026 α = 0.05, which means that H0 is rejected. Recurrence is a condition in which the patients symptoms are the same as Results of logistic regression test before and the resulting patient should showed no significant influence of social interaction with the patient relapse. And the value of OR = 3.576, which means, the worse the social interaction of a patient then the person is more likely to relapse 3 times greater compared with patients who have good social interaction. DISCUSSION Social interaction outpatient coronary heart disease CHD in the heart poly 37 be nursed back Andrew, 2008. Family with full of stress can trigger a heart attack. In people who are susceptible to heart disease in need of attention and recognition of risk factors that exist in people and that immediate action can be taken against these patients in a short time in order to avoid complications that can bring unintended consequences. According to Niven, in 2005 the factors that influence relapse is noncompliance, depression, behavioral patterns, and the individuals themselves. Based on the results of a study of outpatient coronary heart disease CHD in the heart poly Hospital Dr. Mohamad Saleh Probolinggo found that of 57 respondents surveyed, as many as 41 people 71.93 experienced a relapse and 16 did not have a relapse or 28.07. From the results of cross tabulation between respondent characteristics with recurrence as many as 23 respondents 40.4 who experienced a relapse-sex male, 33 respondents 57.9 who experienced recurrence over 50 years, 14 respondents 24, 6 who experienced a relapse are college graduates and 24.6 of high school graduates, and as many as 22 respondents 38.6 who did not work also experienced a relapse. Conclusion 1. Social interactions in outpatients coronary heart disease CHD in the Hospital Dr. Mohamad Saleh Probolinggo showed that 13 respondents 22.81 had a poor social interaction, and 44 respondents 77.19 have a good social interaction. 2. Results of statistical test by using logistic regression showed no significant influence of social interaction with the patient relapse. Suggestion 1. Patient and Family Outpatient CHD a. Outpatient coronary heart disease should have to further enhance friendly relations with their peers. b. For families of patients should continue to provide support and keep control of the activities conducted in order to maintain the health of the patient. 2. For Hospital Dr. Mohamad Saleh Probolinggo Can be added to the program of relaxation for people with coronary heart disease, such as the holding of yoga to reduce stress levels and maintain the health of CHD patients. 3. For Educational Institutions Once this study is expected to further research to follow up on other factors that influence relapse patients with coronary heart disease. 38 4. For researchers Coming Once this study is expected to further research in order to pay more attention to the frequency of recurrence of CHD patients. REFERENCES Albery I.P dan Munafo, M. 2011. Psikologi Kesehatan Panduan Lengkap dan Komprehensif Bagi Studi Psikologi Kesehatan .Yogyakarta : Palmall Arikunto, Suharsimi. 2010. Prosedur Penelitian suatu Pendekatan Praktik . Jakarta : Rineka Cipta Feldman, Robert S. 2012. Pengantar Psikologi Understanding Psychology. Jakarta : Salemba Humanika. Hidayat, Alimul. 2011. Riset Keperawatan dan Penulisan Ilmiah .Jakarta : EGC Kabo, Peter. 2008. Mengungkap Pengobatan Penyakit Jantung Koroner . Jakarta : Gramedia Pustaka Utama Niven, Neil. 2005. Psikologi Kesehatan Pengantar untuk Perawat Profesional Kesehatan Lain . Jakarta : EGC Notoatmodjo, Soekidjo.2011. Kesehatan Masyarakat Ilmu Seni . Jakarta : Rineka Cipta. Ridwan, Muhamad. 2009. Mengenal, Mencegah, Mengatasi Silent Killer Jantung Koroner . Semarang : Pustaka Widyamara. Sugiyono. 2013. Metode Penelitian Kuantitatif Kualitatif dan R D . Bandung : Alfabeta Supriyono, Mamat.2008. Faktor-Faktor Resiko yang Berpengaruh terhadap Kejadian Penyakit Jantung Koroner pada Kelompok Usia 45 Tahun . Tesis.Semarang : Universitas Diponegoro, 13-34 Soekanto, Soerjono. 2006. Sosiologi Suatu Pengantar . Jakarta : Raja Grafindo Persada. Wilkinson, Greg. 2005. Stres .Jakarta : Dian Rakyat 39 THE EFFECT OF PHASE I CARDIAC REHABILITATION ON ACTIVITY TOLERANCE OF PATIENTS WITH CORONARY HEART DISEASE Sutrisno STIKES Surya Mitra Husada Kediri Email :sutrisno250214gmail.com ABSTRACT Phase I cardiac rehabilitation program is one of the efforts to achieve a functional level that allows patients to perform their own activity early in preparation to carry out daily activities at home and yet, to prevent unfavorable effects of prolonged bed rest. This program needs to be implemented as soon as possible in patients who have stable hemodynamics since in ICUICCU until the time to discharge from the hospital. The purpose of this study was to identify the effect of phase I cardiac rehabilitation toward activity tolerance in patients with Coronary Heart Disease. The design of the research was a quasi experiment design with post test only non-equivalent control group. The sample was 24 respondents. The measurement tools used the Barthel index, six-minute walking test, digital sphygmomanometer and digital oxymeter. The results showed that there is a significant difference in the ability to perform ADL p value=0.004, but there is no significant difference in systolic blood pressure p value=0.875, diastolic blood pressure p value=0.179, SpO 2 p value=0.920, pulse p value=0.428, and the maximal VO 2 p value=0.220 between the intervention and control groups after being given the phase I cardiac rehabilitation. Further, the ability to perform activities ADL of respondents in the intervention group is significantly higher than the control group and the maximal VO 2 values of the intervention group shows a better value than respondents in the control group. It can be concluded that phase I cardiac rehabilitation exercise have an effect on the tolerance activity in patients with CHD. Therefore, nurses as part of a cardiac rehabilitation program team are expected to assist patients in improving their adaptability on tolerance activity. Keywords: phase I cardiac rehabilitation, tolerance activity, coronary heart diseases CHD recognized to have the largest proportion causes of death INTRODUCTION Coronary heart disease is a disorder of the coronary arteries due to a block or plaque of atherosclerosis. The term atherosclerosis comes from the Greek meaning intima thickening of the arteries sclerosis, thickening, and cardiovascular diseases 48, followed by cancer 21, and chronic respiratory diseases 12. Coronary heart disease is causing the reduced amount of oxygen needed by accumulation of lipids athere, pasta the myocardium. If the oxygen which characterizes the typical lesions Lewis, Dirksen, Heitkemper, Bucher, and Camera, 2011. WHO statistics 2012 describes the global mortality estimate of 57 million in 2008, 36 million 63 are caused by non- communicable diseases. Risk factors for non-communicable diseases that are 39 requirement is not met according to the needs, it will cause myocardial ischemia. Conditions such as this will reduce cardiac contraction and movement disorder if persistent occur which eventually causes hemodynamic changes of the body. Furthermore, the left ventricular function will decrease and may reduce cardiac output with reduced stroke volume the amount of Improve Physical Functioning in Refractory Angina: A Pilot Study. The blood ejected each time the heart beats. results showed that after cardiac One result of the decreased cardiac output or low perfusion and decreased peripheral blood flow causes weakness fatigue in patients Anderson McCarty, 2005. rehabilitation, patients showed an increase in physical abilities compared with patients in the control group the level of achievement Progressive Shuttle Walk p value = 0.005 and the total distance p value = 0.015. Weak conditions in patients with coronary heart disease requires the patient should reduce physical activity with complete bed rest to reduce the hearts work and the need for oxygen in the body. Bed rest is given to patients with coronary heart disease because of weakness or fatigue caused by the prognosis of the disease. However, total bed rest can increase the activity intolerance in patients. The impact that occurs when the patient does not do early mobilization or physical activity gradually cause bad effects to the physical condition of the body. This is in line with research conducted by Dolansky et al 2010 which says that a physical disability due to heart disease occur because of decreased aerobic capacity and threshold tolerance to perform physical functions. Management to overcome the negative effect caused by coronary heart disease and to prevent the re-admission of patients to the hospital with the same Research on cardiac rehabilitation phase 1 has also been carried out in Indonesia by I Made Mertha 2010 with the title PengaruhLatihanAktifitasRehabilitasiJa ntungFase I TerhadapEfikasiDiri Dan KecemasanPasienPenyakitJantungKoro ner Di RsupSanglah Denpasar with the results of data analysis showed that there is a significant influence of exercise activities to increase self-efficacy p value = 0.001, and to decrease anxiety respondents p value = 0.001 after the exercise intervention activities. Phenomenon above shows the immense possibilities for patients with coronary heart disease activity intolerance, but because the disease process is also due to the effects of totall bed rest or not carried out his early mobilization after patients got hemodynamically stable condition. Research on the effect of cardiac rehabilitation phase I to increase activity tolerance in patients with CHD has not been widely described in the nursing research in Indonesia. Therefore complaint, the cardiac rehabilitation this research was conducted to program can be administered to patients ranging from hospitalization to long- term maintenance program outpatient. According to The National Hearth Foundation of Australia 2004, cardiac rehabilitation are all measures that are determine “The Effect of Phase I Cardiac Rehabilitation on Activity Tolerance of patients with Coronary Heart Disease”. METHOD used to help people who suffer from The research design was quasi- heart disease reactive, achieving life satisfaction and prevent a recurrence of heart disease. experimental research design with post- test-only non-equivalent control group. The number of samples in thisresearch as many as 24 respondents, the Other studies of cardiac rehabilitation program in patients with coronary heart disease are also carried by Asbury, Elizabeth Webb, Probert, Wright, Barbir, Fox, Collins, 2012 with the title of Cardiac Rehabilitation to 40 respondents were divided into two intervention and control. The inclusion criteria respondents, namely 1 Patients with a diagnosis of CHD were treated in the ICCU was continued in a regular patient room. 2 Willing to be a responder. 3 Patients are invited smooth communication. While exclusion criteria: 1 Angina that continuesuncontrolled, 2 heart block degree two or three, 3 Patients CHD haemodynamic not stable systolic 200 mmHg, diastolic 110 mmHg, tachycardiaHR 130xmnt, hypotension, 4 the ventricular or atrial Sistolik Diastolik Frekuensinadi SpO 2 Intervensi Kontrol Intervensi Kontrol Intervensi Kontrol Intervensi Kontrol 116.82 117,53 76.86 81,94 84.79 81,66 97,5 97,5 10.88 11,14 9.09 8,84 10.69 8,18 0,89 0,44 arrhythmias are severe, 5 Patients with coronary heart disease with complications such as arrhythmias, congestive heart failure CHF Tabel 1.2 Distribution of respondents by VO2 max and ADL on the sixth day n1 = n2 = 12 functional class III-IV, 6 Patients with CHD muskulosketal system problems. Analysis of the data used is the analysis of univariate and bivariate. The statistical test used for bivariate analysis Variabel VO 2 ADL Kelompok Intervensi Kontrol Intervensi Kontrol Mean 19.14 16.86 97.08 87.50 SD 5.20 3.43 5.42 7.54 is independent t test test for normal numerical variables and test Mann Whitney test for numerical variables are not normal Hastono, 2001. Result Characteristics of respondents or confounding variables in this study obtained. On this research, the mean age of the respondents is at 55.29 years, with the majority of the male sex 18 75. History of smoking among respondents obtained more than half of the respondents do not smoke are 14 58.33 of respondents, and in this study the majority of respondents have a body mass index of obesity as many as 17 70.8 of respondents. In the bivariate analysis showed that the values obtained are not significant p value 0.05 from the average variable pulse rate, systolic blood pressure, diastolic blood pressure and SpO2 after intervention for five days in both the respondents both intervention and control, it is showed no significant difference between the two groups. On the sixth day ADL measurement values obtained are significant p value = 0.004, which says there is a significant difference between the intervention group and the group. While the variable VO2 max no significant difference p value = 0.22 between the intervention and control respondents. Characteristic variable pulse systolic blood pressure, diastolic pressure, SpO2, VO2 max, and data can be seen in Table 1.1 and 1.2 rate, blood ADL Table Discussion Effect of cardiac rehabilitation phase I of the systolic blood pressure, diastolic blood pressure, pulse rate and SpO2 responder after intervention. Tabel 1.1 Distribution characteristics of respondents based on the average of the mean pulse frequency of blood pressure systolic and diastolic and mean SpO2 post intervention and control interventions respondents n1 = n2 = 12 Variabel Kelompok Mean SD 41 Results of this research showed a mean systolic blood pressure intervention respondents less than control respondent, it is possible to intervention respondents have started a process of adaptation to the condition of the body because it has given physical activity exercises for five days. So that hemodynamic conditions began to In this research, the mean diastolic change when the body perform physical blood pressure values in control activity. Physical exercise regularly and respondents is higher than intervention continuously will cause the bodys respondents. It is possible the adaptive changes. This is consistent with research that studies conducted Stem Cleary 1982 that regular exercise will lower systolic blood pressure. This research is in line with the literature that suggests that exercise regularly and continuously can provide chronic effects on the body as a decrease in systolic blood pressure through the process of spending Nitrite oksit a potent bronchodilator after four weeks of exercise Gormley Hussey, 2005. intervention of respondents have started a process of adaptation to the condition of the body because it has given physical activity exercises for five days. As in systolic blood pressure response. Based on the theory of physical activity exercises if done continuously, the heart muscle and skeletal muscle will experience an increase in employment adaptation to chronic namely hypertrophy. Enlargement of muscle mass from the normal state can be between 300 g and 500 g Huonker et al, result analysis found there is no 1996. This can lead to end-diastolic significant difference in mean systolic post intervention in the intervention and control. It showed no difference in the average value of systolic blood pressure was statistically the second respondent. The maximum value of systolic blood pressure in the intervention respondents in the amount of 137.02 mmHg, indicating increase in systolic pressure value is not shown in conditions that endanger the health of the respondent or still within the tolerance limits of the body. It can be said that the cardiac rehabilitation phase I does not cause harmful effects if done in accordance with procedures and strict supervision. Based on the theory advanced by Gormley Hussey 2005 acute effect of physical activity was immediate activation of the sympathetic nerves in the heart and blood vessels can release adrenaline in the blood circulation of the adrenal medulla. One of these effects that cause vasoconstriction of blood vessels. Body compensated to accelerate the flow of blood in the body as a result of physical activity also increases the heart rate so it needs a large preload as compensation of increased heart rate. Vasoconstriction necessary for blood flow to be fast to meet the needs of large preload so after load also must be increased. 42 volume will increase, and it will also stoke volume increase heart. So the diastolic blood pressure will decrease. Research conducted Spartaro 1991 also reported a decrease in systolic 8and diastolic 5 respondents who frequently perform regular physical activity. It is possible to occur in the intervention group who had suffered during the given intervention adaptation exercise physical activity. The analysis results obtained p value not significant that the average diastolic post intervention in the intervention and control. It showed no statistically significant difference in mean diastolic blood pressure in both groups. Respondents were given a five-day intervention during physical activity and exercise interventions show the value of the increase in diastolic blood pressure after the intervention. The maximum value of diastolic blood pressure in the intervention respondents were given a physical exercise-based interventions obtained by 76.86 mmHg. This value indicates no increase is so large and endanger the health condition of respondents coronary heart disease. Increasing the value of diastolic blood pressure in intervention respondents during the given intervention is in line with the theory advanced by Gormley Hussey 2005 that during the movement of the body or physical activity then it will be activated the sympathetic nerves in the body that lead the left atrium, predicted as the cause of the appearance of atrial fibrillation during cardiac rehabilitation. to increase contraktility heart and accelerate the work of fibers Purkinje that serves to accelerate emptying the contents of the heart volume. This causes an increase in diastolic blood pressure in the body. The analysis results obtained p value not significant mean pulse rate post intervention in the intervention and control. It showed no statistical difference in the average value of the pulse frequency of respondents intervention and control after the Exercise physical activity on a regular basis will provide a great benefit to the body of the adaptation process occurs both at the heart organ and the blood vessels in the body. This is consistent with the theory put forward by Kusuma 2003 which says that physical activity exercise increases the blood flow is pulsatile increase the production of nitric oxide NO which parallel increase production of EDRF endothelial relaxing factor derive. Coronary blood flow at rest about 200 intervention. In this reseach, the ml min 4 of total cardiac output frequency of the pulse values obtained after exercise increased physical activity among respondents intervention. The increase in the pulse frequency of the respondents intervention is the result of several mechanisms in the body due to the movement of the body or as a result of physical exercise. When the physical exercise increased sympathetic stimulation of the heart organ that affects the hearts electrical system, increased to 350 ml min increase of 150 ml min while moderate weight training. If the heart rate increases to 10 times only, the coronary blood flow increased to 224 ml min, which means an increase of 24 ml min and already exceeds 4 ml min, as a condition of increased production of nitric oxide. Moderate physical activity exercise or walking will increase the heart rate to 110 beats per minute, an increase of 40 especially the SA node therefore times seadainya resting heart rate of 70 increasing heart ratepulse Gormley Hussey, 2005. This effect can be seen when the body physical activity are irregular or can be said is the acute effects of physical activity on the body. The increase in the pulse rate that exceeds the maximum limit should feared the presence of an electrical disorders on the heart and can threaten death to the respondent. This will lead to atrial fibrillation according to research conducted by Giaccardi et al, 2011 which said that the incidence of atrial beats per minute. Research in the laboratory showed that the increased flow of 4 ml min was able to produce nitric oxide, which means it is sufficient to stimulate the improvement of vascular endothelial function Takahashi, 1997. Nitric oxide NO is a potent vasodilator that is located in the intima layer endothelium of the arteries where the compound is very important for blood vessels to reduce the risk of atherosclerosis. Results of the analysis we found no fibrillation was significantly high significant values mean oxygen number of patients who follow a cardiac saturation post intervention in the rehabilitation program that is sorely lacking in exercise intensity physical activity compared with that follows program of physical exercise with moderate intensity. This is due to the large volume of the left atrium and the intervention and control. It showed no significant difference in the average value of the oxygen saturation in both groups post intervention. In this study found an increase in oxygen saturation after cardiac rehabilitation interventions low effort emptyvalumepemompoaan to 43 conducted in the respondents intervention. It is very useful to respondents to assist in accelerating the healing process of the disease. Based on the literature says the Based on the literature it is said that there is one example of respiration also plays a role in increasing the working capacity of the body is the breathing exercise prescription for patients with existence of some mechanism of post-operative cardiac surgery. changes in the respiratory system during a physical activity on the body: 1 The dilution air in the dead-space lungs during inspiration as a result of the increased pressure of pulmonary alveolar PO2, causing vasodilation of the pulmonary arteries that are activated by the receptor Blood vessels are hypoxic. 2 increase in thoracic volume during the development of lung parenchyma during inspiration. 3 an increase in cardiac filling the right side along with an increase in the exploitation of moments of inspiration, this means an increase in venous return and that will increase the ejection volume of the right ventricle and pulmonary systolic pressure. With this change, the efficiency of ventilation and perfusion of the body tissue will be balanced Gormley Hussey, 2005. This led to the intervention of Peripheral to tolerate the practice of physical activity, many patients require special breathing while working, which could increase lung volume and gas exchange capacity and, consequently improve the distribution and capture systemic oxygen and increase exercise tolerance McKirnanFroelicher, 1993. Effect of Cardiac Rehabilitation Phase I Against Capability ADL and VO2 max Respondents. Results of bivariate analysis of the ability to perform activities of daily living ADL in the intervention group and the control group showed a significant difference. In this study, the intervention group get exercise physical activity gradually in accordance with the capacity and condition of the respondents, while the control group respondents experiencing respiratory without exercise just given bed rest system of compensation which improves the functional capacity of the lungs can eventually increase the maximum working Traffic from the body. In this research, interventionrespondents always increase even improvement of the respiratory system, while at the controls of the respondents there were some respondents who sometimes experience down the value of saturation. On the intervention of the respondents only one of the respondents who experienced a decrease in oxygen saturation, whereas the control of the respondents there were eight respondents who experienced deterioration in oxygen saturation. It is possible the intervention of respondents functional capacity of the lungs had increased as a result of the intervention given the exercise of physical activity compared to control respondent. 44 alone. So it can be said that the exercise- based cardiac rehabilitation that physical activity can stimulate the adaptation and improvement of exercise tolerance capability in the intervention group compared with the control group. Based on the first congress of cardiac rehabilitation in Hamburg in 1977, insists that the need for early mobilization in patients with heart disease Balady, Fletcher, Froelicher et al, 1994. Phase I is the effort to be done while the patient is still being treated, the main purpose of this phase is to reduce or eliminate the adverse effects of the condition due to total bed rest, to educate early and that the patient is able to perform daily activities independently and safely Basuni et al, 2009. Another theory says that one of the objectives of rehabilitation of cardiac rehabilitation phase I that patients can perform self- care and activities of daily life ADL and domestic work except for up and down stairs Garrison, 2001. This study ADL ability intervention group obtained only three respondents who have a value below 100, it indicates that the Barthel index on respondent intervention is better than the control respondents were only two respondents who had ADL value of 100. The results are also consistent with research conducted by Weberg et al 2013 which says that a significantly increased function and physical role, increased ability and endurance to pain on the effects of cardiac rehabilitation phase I, and the disclosure directly from the respondents experienced an increase in physical and mental after following cardiac rehabilitation Phase I. Improved physical function and role, increased ability and endurance to pain due to a cardiac rehabilitation phase I also found in a study conducted by Hsu et al 2011 the research done on post-CABG patients and organ transplants. Another study said the effect of exercise physical activity on improving exercise tolerance was also carried out by Marzolini et al 2008 who showed that a combination of aerobic exercise and resistance cause changes more evident in physiological adaptations such as muscle strength and endurance, and body composition compared to aerobic exercise alone in patients with coronary artery disease. Physical exercise-based cardiac rehabilitation also reduces overall mortality cardiovascular disease mortality [RR 0.87 95 CI 0.75, 0.99 and 0.74 95 CI 0.63, Physical activity everyday is useful not just to get a healthy body condition but also beneficial to mental health, entertainment in preventing stress. Results of bivariate analysis were not significant values between maximal oxygen uptake VO2 max in the intervention group and the control. It showed no significant difference VO2 maximum value of both respondents statistically. At respondents intervention lowest value of VO2 max respondents, 11.15 ml kg min, which means all respondents have been able to meet the target of cardiac rehabilitation phase I 3 MET = 10.5 ml kg min, but the respondent control limits bottom of VO2 max is nothing less than the expected target of Phase I of 10:34 ml kg min. Physical activity the body will consume the oxygen that will be used as fuel in energy production. Ones ability to consume oxygen during physical activity to the formation of energy, until it reaches the maximum value without being able to go up again though with the addition of the intensity of the exercise known as VO2 Max Astorin, 2000. The gold standard to measure cardiovascular fitness is maximal oxygen consumption VO2 max. it is defined maximal oxygen consumption as a measure of exercise are achieved by an individual, who at that point of fatigue or symptoms that arise prevent such individuals to exercise more Garrison, 2001. This is in line with research Belardinelli 1999 who said 0.87, respectively -masing], and that clearly defined, measured by hospitalizations [RR 0.69 95 CI 0.51, exercise tolerance and oxygen 0.93] in the short term 12 months of follow-up. Cardiac rehabilitation does not reduce the total risk of MI, CABG or PTCA Strange, 2011. Numerous studies have also shown that aerobic training increases muscle strength and exercise tolerance in patients after open- consumption as well as a good predictor of prognosis in patients with cardiovascular disease. Based on the theory advanced by Guyton 2007 not only the respiratory system are instrumental in determining a heart surgery and patients with persons VO2 maximum, but there are MiocardInfark Ueshima et al, 2005. 45 four systems that determine the maximum VO2 is the respiratory The results also show the benefits of system, cardiovascular, biochemical exercise-based cardiac rehabilitation oxygen transport and network systems. The fourth system is interrelated to one another, so that when the respiratory system is in good condition but there are one or more of the three other systems in the state is not good then it can affect the value of a persons VO2 maximum. While the value of a persons VO2 maximum is also determined by a persons posture, between the one and the other will certainly be different if say both equally healthy but have a different body portur. This is in line with research conducted by Nury 2011 which says that the main determinant of the cycle runs in addition to height is leg length measurements when the maximum VO2. This study shows the difference between the value of the maximum VO2 intervention and control groups was not so great can be seen from the average of the two groups is 19.14 ml kg min and 16.87 ml kg min. From this it was found that the mean maximal VO2 values greater intervention group than the control group. Value of maximal VO2 could be improved on a person, with increasing VO2 maximum, it can be said the maximum working ability of the body to be achieved. This is according to research conducted by Ueshima et al 2004 peak VO2 increased by less than 25 after exercising, especially in patients who have undergone heart valve surgery. This research can provide input that cardiac rehabilitation program that is most important is when Phase I, which in this phase requires the mobilization of patients as early as possible to reduce the undesirable effects of bedrest old thrombophlebitis, hypotension orthosatik, muscle atrophy, etc. etc. and knowledge about the disease in order to return later after there is a change of behavior in the control of risk factors that may lead to heart disease occur so do not get heart disease later in life. 46 phase I of physical activity that can be done by a nurse if a physiotherapist human resource is not in the hospital. Phase I cardiac rehabilitation nursing in the world can be said to help the patient in the process of adapting to be able to perform daily activities independently, improve the tolerance of the patients activity. CONCLUSION On this study, the mean age of the respondents is at 55.29 years, with the majority of the male sex 18 75. History of smoking among respondents obtained more than half of the respondents do not smoke are 14 58.33 of respondents, and in this study the majority of respondents have a body mass index of obesity as many as 17 70.8 of respondents. The mean systolic blood pressure of both groups showed similar values and within normal limits. Mean diastolic blood pressure in the control group was slightly higher than in the intervention group and both were within normal limits. The mean frequency of the pulse after the intervention in the intervention group was slightly higher than in the control group and both were within normal limits. The mean SpO2 after the intervention in both groups of equal value.The mean maximal VO2 greater intervention group than in the control group.The mean ADL higher intervention group than in the control group. It was found no significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, and oxygen saturation after the intervention in the intervention and control. There are significant differences ability to perform ADLs between intervention and control groups on the sixth day. But there was no significant difference between the value of the maximum VO2 intervention and control groups on the sixth day. This research requires a socialization statement for health care programs the Phase I cardiac professionals from aha. rehabilitation program based physical activity practice, to accelerate the healing process in patients that could reduce the lenght of stay LOS patients. And the need for nurses to give an Circulation; 90;1602-1610. Basuni, Radi; Andang, H. Joesoef; Dede, Kusmana.2009. RehabilitasiKardiovaskular Di Indonesia.J KardiolIndones. evaluation of the action exercise 30:43-5. ISSN 01263773. physical activity is given to know the development of tolerance to the patients physical activity. The need to develop therapeutic modalities nursing to overcome the problems associated with the physical activity of the patients therapy, which can be applied in providing training physical activity in patients requiring early mobilization during hospitalization. And disseminate information about the importance of mobilization as early as possible after Belardinelli, R; Georgiou, D; Cianci, G; Purcaro, A. 1999. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation; 99:1173-82. Dolansky, M.A., Xu, F., Zullo, M., Shishehbor, M., Moore, S.M., Rimm, A.A. 2010. Post-Acute Care Services Received by Older Adults Following aCardiac Event: the patients hemodynamic condition a Population-Based Analysis. stabilized, to reduce the unfavorable effects of total bedrest. Journal of Cardiovascular Nursing, 25,342-249 Garrison, Susan. 2001. Dasar- This research can be a reference to conduct further research that can improve understanding and knowledge of the cardiac rehabilitation program, especially the phase I. Maybe it could be done further research to determine the relationship of drugs and laboratory values hemoglobin, hematocrit, and dasarterapirehabilitasifisik. Jaka rta :Hipokrates. Garrison, Susan, J. 2003. Lippincott Williams and Wilkins Handbook : Handbook of Physical Medicine and Rehabilitation Basics 2nd Edition. LWW, p.172-180. Gormley, John and Hussy, Juliette. others are influential toward physical 2005. xerciseTheraphy : activity in a cardiac rehabilitation program phase I. REFERANSI Anderson, S And McCarty, L. 2005. Prevention And Treatment Of Diseases . Oxford : Blackwell. Giaccardi M, Macchi C, Colella A, Polcaro P, Zipoli R, et al. 2011. Patofisiologi Proses-proses :KonsepKlinik Penyakit. Edisi Postacute rehabilitation after coronary 6.Volume 1 .Jakarta : EGC Asbury, Elizabeth, Webb, C, Probert, H, Wright, C, Barbir, M, Fox, K, Collins, P. 2012. Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study. Cardiology 2012; 122;170-177 Balady, J.G; Fletcher, B.J; Froelicher, V.F,et al. 1994. AHA medicalscientific statement: position statement: cardiac rehabilitation programs: a 47 surgery: the effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation. Am J Phys Med Rehabil ; 90:308 –15. Hastono, P.S. 2001. ModulAnalisis Data .Depok : FKM-UI Heran, B.S; Chen, J.M.H; Ebrahim, S; Moxham, T; Oldridge, N; Rees, K; Thompson, D.R; Taylor, R.S. 2011. Exercise-based cardiac rehabilitation for coronary heart disease Review. The Cochrane Library , Issue 7. Hsu, C.J; Chen, S.Y; Su, S; Yang, M.C; Lan, C; Chou N.K et al, 2011. The effect of early cardiac rehabilitation on health-related quality of life among heart transplant recipients and patients with coronary artery bypass graft surgery. Transplant Proc; 43:2714-7. Huoker, M; Halle, M; and Keul, J. 1996.Structure and fungtional adaptation of the cardiovascular system by training. International journal of sports medicine 17, S164-172. I Made Merta 2010. PengaruhLatihanAktifitasRehabili tasiJantungFase I TerhadapEfikasiDiri Dan KecemasanPasienPenyakitJantun gKoroner Di RsupSanglah Denpasar.TesisUniversitas Indonesia. Lewis, Dirksen, Heitkemper, Bucher, Camera. 2011. Medical Surgical Nursin : Assessment and Management of Clinical Problem Eighth edition,Vol. 1. USA : ELSEVIER Stangl, V, et al , 2002. Coronary atherogenic risk factors in women, Eur Heart J; 23:1738- 1752. Weberg, M, Hjermstad, M.J, Hilmarsen, C.W, Oldervoll, L. 2013. Inpatient cardiac rehabilitation and changes in self-reported health related quality of life – a pilot study . Annals of Physical and Rehabilitation Medicine 56; 342 –355. World Health Organization.2012. World Health Statistics 2012. WHO Library Cataloguing- in-Publication Data . 48 ANALYSIS OF THE USE OF PERSONAL PROTECTIVE EQUIPMENT PPE TO CLEANING SERVICE WORK ACCIDENT Dr. ISKAK HOSPITAL TULUNGAGUNG Sandu Siyoto Institute Of Health Surya Mitra Husada Kediri Email : siyotosyahoo.com ABSTRACT Accident is an event that is unexpected and undesirable. The use of personal protective equipment is one of the factors that cause accidents. Personal protective equipment is a set of tools used by workers to protect all or part of his body against the possibility of any potential hazards in the workplace or work accident. The purpose of this study was to determine the effect of the use of personal protective equipment PPE to cleaning service work accident. This study uses a quantitative approach to the observation method. Data were obtained using a questionnaire. The population in this study were all cleaning service in Dr.Iskak hospital Tulungagung as many as 71 people. The sample were 62 people. The sampling technique using Simple Random Sampling. The results of data analysis with logistic regression test is obtained p = 0.005 p 0.05. The results of this study concluded there is the influence of the use of personal protective equipment PPE to cleaning service work accident. Keywords: Personal Protective Equipment, Work Accident INTRODUCTION One effort to increase productivity is to provide protection to workers for her work. This protection is given with the intent to obtain assurance worker health and safety so that they avoid accidents. Work accident is an event that is unexpected and undesirable that may disrupt the process that has been set for an activity Kurniawati, 2013. Hospital as a health care institution with core service activities of preventive, curative, rehabilitative and promotive have positive and negative impacts. The positive impact is the increasing level of public health, while the negative impacts among others are garbage and medical waste or non-medical that can cause disease and pollution that needs special attention. The number of hospitals in Indonesia in 2014 amounted to 2,415 with as many as 296 087 beds and solid waste as much as 376 089 tonnes day of wastewater as well as 48 985 tonnes day Departement of Health, 2014. As a result of accidents and occupational diseases can attack all workers in the hospital, one of them being a cleaning service. Cleaning service has the greatest risk of exposure to hazardous biological substances biohazard, contact with the disposable medical instruments disposable equipment such as used syringes, IV tubes former. That requires safety and health efforts to prevent and control accidents occupational diseases in hospitals. Therefore, protection is very important to prevent injuries for all workers 48 who are at risk. The officer in charge of waste management should ensure that all risks have been identified and rapid protection available. Based on data from the ILO International Labour Organization in 2008, each year an estimated 1.2 million workers died from workplace accidents. Meanwhile, citing data in Anggraini Social Security in 2010, there were 98 711 cases. Of that number, 2,191 workers died, and raises a number of 6667 people permanently disabled. The number of claims to be paid for these cases reached more than Rp 401 billion. Press release International Labour Organization ILO in 2013 recorded 160 million cases of work-related accidents with about 2 million deaths annually. On April 28, 2014, in the framework of the occupational safety and health worldwide, stating that cases of occupational illness and accidents has risen 337 million and 2.3 million deaths annually. Based on data from the Indonesian Kemenkertrans death rate from workplace accidents and occupational diseases in Indonesia is still very high, the data up to September 2013 recorded 9 workers die per day. Based on the preliminary results of a study conducted on 15 people, no workers wearing full personal protective equipment. 3 people claimed get stabbed needle, two people never exposed to infectious fluids and the first person ever to slip while working. Based on the above, the researcher was interested to study about “Analysis Use of Personal Protective Equipment PPE to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung”. The purpose of this study was to analyze the effect of use of Personal Protective Equipment PPE to Cleaning Service Work Accident Dr. Iskak Hospital Tulungagung. The benefits of this research are as an input that can be used as measures and efforts to improve occupational health and safety programs to prevent occupational injuries, so as to create a workplace that is safe and mostly male sex a number of 38 respondents 62 while the female number of 24 respondents 38. convenient for all employees as well as the maximum increase in labor productivity. Figure 3 Characteristics of Respondents According to Education On Hygiene Officer at Dr. Iskak RESEARCH METHODS This type of research used in this research is a correlational study with a cross-sectional which emphasizes the time measurement observation of independent and dependent variables only once in a while. The population in this study is all cleaning service at Dr. Iskak Hospital Tulungagung as many as 76 people. The sampling technique used in this study is simple random sampling with a total sample of 62 people. Data were collected through interviews and observations. The study was conducted in March 2015. Data were analyzed using logistic regression statistical tests. RESEARCH RESULT Hospital Tulungagung Based on Figure 3 shows that respondents whose level education most are high school number 28 respondents 45, junior school of 24 respondents 39, primary school number seven respondents 11, whereas that is un educated number of 3 respondents 5. Figure 4 Characteristics of Respondents based on employment status on cleaning service at Dr. Iskak Hospital Tulungagung Based on Figure 4 shows that most respondents are not permanent employee status a number of 52 respondents 84, while the status of permanent employee number 10 respondents 16. Figure 1 Characteristics of Respondents by Age At Hygiene Officer at Dr. Iskak Hospital Tulungagung. Based on Figure 1 shows that most respondents are in the age group 21-30 years by 56, the age group 31-40 years by 26, and the group of less than 20 years at 18 Figure 5 Characteristics of Respondents According to the marital status of cleaning service at Dr. Iskak Hospital tulungagung Based on Figure 5 shows that the marital status of respondents the most is not has not been Figure 2 Characteristics of Respondents by Gender In Cleaning Service in Dr. Iskak Hospital Tulungagung Based on Figure 2 shows that the cleaning service at Dr. Iskak Hospital Tulungagung 49 married a number of 35 56, while respondents were married a total of 27 44 Age use of PPE Total Y T Y T N N N 20 Year 4 17 7 18 11 18 21-30 Year 1 6 66 1 8 47 34 55 31-40 Year 4 17 1 2 32 16 26 40 Years 1 3 1 2 Total 2 4 100 3 8 100 62 100 Worki ng Long Use of PPE Total Y T Y T N N N 1 Year 1 42 15 39 25 40 1-5 Year 1 4 58 21 55 35 56 5 Years 2 5 2 4,0 Total 2 4 100 38 100 62 100 Educat ional Use of PPE Total Y T Y T N N N Un educat ed 1 4 2 5 3 5 Primar y School 2 8 5 13 7 18 High 10 42 14 37 24 39 Gender use of PPE Total Y T Y T N N N Male 16 67 2 2 58 3 8 61 Female 8 33 1 6 42 2 4 39 Total 24 100 3 8 100 6 2 100 Table 2 Distribution Gender Against Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung Figure 6 Diagram Distribution of Respondents According to Use of Personal Protective Equipment Based on the picture 6 shows that respondents who use personal protective equipment a number of 24 respondents 39, whereas that does not use personal protective equipment a number of 38 respondents 61. Figure 7 Pie Diagram Distribution of Respondents Against Accidents Based on the picture 7 diagram shows that the incidence of occupational accidents in the cleaning service in Dr. Iskak Hospital In Table 2 shows that the use of personal protective equipment based on sex in the cleaning service at the Dr. Iskak Hospital Tulungagung. Respondents who use PPE men 67 and women 33. While respondents were not using PPE male some 58 and women 42. Table 3 Distribution Old Working Against the Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung Tulungagung number of 42 respondents 68 said they had experienced a work accident, while 20 respondents 32 claimed to have never had an accident. Table 1 Age distribution Against the Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung. In Table 3 shows that the use of personal protective equipment based on longer work. Respondents who use PPE with long work 1 year 42 1-5 years 58, while those not using PPE long work 1 year 39 1-5 years 55 and 5 years 5. Table 4 Distribution of educational status Against Use of Personal Protective Equipment At the cleaning service at the Dr. Iskak Hospital Tulungagung In Table 1 shows that the use of personal protective equipment based on the age range cleaning service at Dr. Iskak Hospital Tulungagung. Respondents who use PPE age 20 years of a 17, 66 aged 21-30 years and 31-40 years of age 17. While respondents who do not use personal protective equipment PPE age 20 years some 18, 21-30 years 47 31-40 32 and 40 years of 3. 50 Variables in the Equation St ep a 1 B S. E Wa ld d f Si g. Exp B The use of PPE 1.6 55. .5 86 7.9 88 1 .0 05 5.23 4 Consta nt - 1.8 22 .9 20 3.9 23 1 .0 48 .162 a. Variable s entered on step 1: The use of PPE. Emplo yee Status The use of PPE Total Y T Y T N N N Indepe ndent 2 83 32 84 52 84 Depen dent 4 17 6 16 10 16 Total 2 4 100 38 100 62 100 Marital Status The use of PPE Total Y T Y T N N N No Not married 1 2 50 2 3 60 3 5 56 Married 1 2 50 1 5 40 2 7 44 Total 2 4 100 3 8 100 6 2 100 PPE Accident Total Never Ever N N N Yes 13 65, 11 26,0 2 4 39, No 7 35, 31 74,0 3 8 61, Total 20 100 42 100 6 2 100 School Senior High School 11 46 17 45 28 45 Univer sity Total 24 100 38 100 62 100 cleaning service at Dr. Iskak Hospital Tulungagung In Table 4 shows that the use of personal protective equipment by educational status. Respondents who use PPE school status no amount of 4, primary school 8, 42 junior high school, high school 46 . While not using PPE school status does not amount to 5, SD 13, 37 junior and senior 37. At table 7 above shows the use personal protective equipment against work accidents. Respondents who use PPE and Never crashed Table 5 Distribution Employmentof Status some 26, respondents who use PPE and Against the Use of Personal Protective Equipment In the cleaning service at the Dr. Iskak Hospital Tulungagung never had an accident some 65 of respondents who do not use PPE and never had an accident some 74, while those who did not use PPE and work accident number 35 . Tabel 8 Results Effect Analysis Using Personal protective equipment against work accidents At a cleaning service at Dr. Iskak Hospital Tulungagung In Table 5 shows the use of personal protective equipment based on employment status. Respondents who use PPE status of non- permanent employees 83 and the number of permanent employees 17. While respondents were not using PPE status of permanent employees 84 and 16 permanent staff. Table 6.Distribusi Marital Status Against the Use of Personal Protective Equipment in the cleaning service at the Dr. Iskak Hospital Tulungagung In Table 6 shows the use of personal protective equipment based on marital status. Respondents who use PPE status of unmarried 50 and 50 are married. While respondents were not using PPE status is not married some 60 and 40 are married. Table: 7 Distribusi Use of Personal Protective Equipment Against Accidents in 51 The analysis showed the use of personal protective equipment PPE against occupational accidents in the cleaning service at Dr. Iskak Hospital Tulungagung p value = 0.005 p 0.05 means that there is the effect of the use of personal protective equipment PPE against workplace accidents. Respondents who use personal protective equipment are possibly five times to avoid workplace accidents when compared to workers who do not use personal protective equipment and statistically significant as well as related. DISCUSSION Use of Personal Protective Equipment PPE to the cleaning service in Dr.Iskak Hospital Tulungagung that of 24 respondents 39 who use PPE while 38 respondents 61 did not use PPE. Judging from the use of gloves 44 do not use and 56 use, the use of masks 48 do not use and 52 use, the use of apron watertight 95 do not use and 5 use, the use of the shoes 100 use, while the use of hats or headwear 100 do not use. This is due to lack of compliance officers in the use of personal protective equipment as well as the lack of availability of personal protective equipment for the cleaning service. Proved to be only available one spilkit box in one area, while the officer is in one of the area between 6-8 cleaning service. Besides lack of supervision and lack of sanctions for cleaning service make cleaning service negligent in using personal protective equipment. Personal protective equipment PPE according to OSHA or the Occupational Safety and Health Administration is a tool used to protect workers from injury or illness caused by contact with hazards in the workplace, whether it is chemical, biological, physical radiation, electrical, mechanical and other , The use of PPE is used to protect the body from harm job can cause illness or accidents and labor can work with more secure because it can avoid the various occupational hazards. Thus, the use of PPE has an important role because it is useful not only for workers, but also useful to the company. The number of accidents on the cleaning service at the Dr. Iskak Hospital Tulungagung is 42 respondents 68 never had an accident at work, and 20 respondents 32 have never had an accident at work. Judging from the respondents fell 29 has been dropped and 71 never fall, 24 of respondents had experienced punctured and 76 have never experienced punctured, 44 of respondents had experienced exposure to liquid infectious and 56 of respondents were never exposed to liquid infectious, 40 respondents had spilled hazardous liquids and 60 of respondents have never spilled liquids deadly; 35 of respondents had collided and 65 of respondents had never hit, 31 of respondents never inhaling toxic gases and 69 of respondents never inhaling poisonous gas, 26 of respondents never exposed chemicals and 74 of respondents were never exposed to chemicals. World Health Organization WHO defines accident as an event that can not be Data not sufficient or other accidents that have not entered. While classification according to the cause include: machinery, transport equipment, materials, substances and radiation, work environment, other causes that do not include these factions , Results from the analysis of data obtained p- value: 0.005 p 0.05 means the use of personal protective equipment has a significant relationship with workplace accidents in the cleaning service at the Dr. Iskak Hospital Tulungagung. The results showed that respondents use personal protective equipment PPE 5 times to avoid accidents. While workplace accidents influenced by the use of personal protective equipment PPE by 18. Based on the theory of work accidents caused by several factors and one of them is because they do not use personal protective equipment. As for how to prevent accidents by Ramli 2010 is to wear personal protective equipment in earnest without coercion, aware of the importance of workplace safety and comply with the regulations that exist, because 85 of workplace accidents are caused by human factors with unsafe acts , Joseph 2007 study on Factors Related Accidents also mentioned that there is a significant association between the use of personal protective equipment at work accidents with a value of p: 0.013 p 0.05. CONCLUSIONS AND SUGGESTIONS From the research that has been done and it can be concluded from the discussion of matters related research about the effect of the use of Personal Protective Equipment PPE against occupational accidents in the cleaning service at Dr. Iskak Hospital Tulungagung. Use of Personal Protective Equipment PPE to the cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents, only 39 were using PPE, while 61 did not use PPE. The number of accidents caused by work in the cleaning service at the Dr. Iskak Hospital Tulungagung of 62 respondents 68 had had an accident at work and 32 have never had an accident while work. The use of personal protective equipment has a significant influence with workplace accidents in a prepared in advance countermeasures so as to cleaning service at Dr. Iskak Hospital produce a real injury. Classification of accidents due to work according to Labour Organization is based on the type of accident: such as a fall, hit by falling objects, pierced, pinched, movements that exceed the capabilities, contact with hazardous materials or radiation, Other types, including accidents 52 Tulungagung namely with p-value: 0.005 p 0.05. With regard to the outcome of research and discussion and conclusion, then the advice that can be given is a cleaning service should be submissive in the use of personal protective equipment to reduce the risk of workplace accidents. Maintain and take care of personal protective equipment has been provided by either. BIBLIOGRAPHY RSUD Dr. Iskak. 2014. Buku Panduan Penggunaan Alat Pelindung Diri APD : Tulungagung Rukiyah.2013. Undang-Undang Ketenagakerjaandan Aplikasinya . Arikunto, Suharsimi. 2010. Prosedur Jakarta: Dunia Cerdas Penelitian . Jakarta : Rineka Cipta Depnakertrans. 2012 . Data Kecelakaan Kerja dan Penyakit Akibat Kerja Menurut Provinsi . Jakarta : Ditjen PPK STIKes Surya Mitra Husada. 2013. Buku Panduan Penyusunan Proposal dan Skripsi : Kediri Sugiyono. 2013. Statistika Untuk Penelitian . Depnakertrans. 2014. Sambutan dalam Bandung : CV Alfabeta Rangka Hari Keselamatan dan Sugiyono. 2013. Metode Penelitian Kuantitatif Kesehatan Kerja pada tanggal 12 Kualitatif dan RD . Bandung: Januari 2014 . Jakarta : Alfabeta Mensosnakertrans Suma‟mur. 2009. Higiene Perusahaan dan Hidayat, Alimul Aziz A. 2011. Riset Kesehatan Kerja HIPERKES edisi Keperawatan dan Teknik Penulisan Ilmiah . Jakarta : EGC ILO. 2013. Press release International Labour Organization ILO pada tanggal 26 April 2013 Keputusan Menaker Nomor 609 Tahun 2012 2 . Jakarta : Sagung Seto Undang-Undang Nomor 1 Tahun 1970 tentang Keselamatan Kerja Tentang Pedoman Penyelesaian Kasus Kecelakaan Kerja dan Penyakit Akibat Kerja Kurniawati, Dewi. 2013. Keselamatan dan Kesehatan Kerja.Surakarta : Aksarra Sinergi Media Notoadmodjo, S. 2010. Metodologi Penelitian Kesehatan . Jakarta : Rineka Cipta Nuratika, Desi. 2013. Identifikasi Kecelakaan kerja dan Gambaran Penggunaan Alat pelindung Diri pada Petugas Laundry .Skripsi: Jakarta Nursalam. 2011. Pedoman Skripsi, Tesis, dan Instrumen Penelitian Keperawatan . Jakarta : Salemba Medika Ramli, Soehatman. 2010. Sistem Manajemen Keselamatan dan Kesehatan Kerja OHSAS 180001 . Jakarta : Dian Rakyat Ramli, Soehatman. 2013. Sistem Manajemen Keselamatan dan kesehatan Kerja OHSAS 18001 . Jakarta: Dian rakyat RI, Depkes. 2008. Kesehatan dan Keselamatan Kerja Laboratorium Kesehatan . Jakarta: Depkes RI RI, Depkes. 2011. Pedoman Pencegahan dan Pengendalian Infeksi di rumah sakit dan Fasilitass Pelayanan Kesehatan , Kesiapan Menghadapai Emerging Infectious Diseas . Jakarta: Depkes RI Ridwan.2012. Metode dan Teknik Menyusun Proposal Penelitian .Bandung: Alfabeta 53 AEROBIC COMBINATION WITH RELAXATION YOGA TO FATIGUE LEVELS IN PATIENTS WITH BREAST CANCER UNDER CHEMOTHERAPY PROGRAM Muhammad Taukhid STIKES Karya Husada Kediri E-mail: mtaukhid88gmail.com Abstract Background : Fatigue is feeling tired physically, psychologically, cognitively perceived cancer patients while undergoing therapies for the disease, including chemotherapy. The purpose of this study was to determine differences in the level of fatigue in cancer patients between before and after aerobic exercise combined with relaxation techniques of yoga. Methods : This study used Quasi-experimental design with pre-test – post-test control group in patients with breast cancer in the course of chemotherapy. The sampling methods used purposive sampling. The fatigue level was collected by subjective instruments Pipper Fatigue Scale PFS, and then analysed by the Independent and Dependent T test, and multivariate analysis used linear regression with a significance value of α 0.05. Results : There were differences in the level of fatigue post-test between the intervention group and the control group with a difference of 1.25 p = 0.013. History of previous exercise may explain the 17.8 level of fatigue that occurs in patients with breast cancer in the course of chemotherapy, the rest was explained by other variables. Conclusion : There were a decrease in the level fatigue statistically, however clinically the level of fatigue remain the same categories. Keywords : fatigue, aerobic, yoga, breast cancer Introduction Fatigue is an overwhelming exhaustion more than normally, which are not relieved by rest and nutrition intake. Cancer related Fatigue CRF associated with cancer process and the side effect of cancer therapy. The incidence of fatigue in the US reaching 95 of all cancer patients undergoing chemotherapy or radiotherapy Mustian, 2007. Most incidents fatigue that is between 28 -91 suffered by breast cancer patients who undergo therapy Hofman et. Al, 2007. quality of life and ability of daily activities Wagner, Cella, 2004. Signs and symptoms of fatigue characteristics are multi-biopsychosocial, so that if two people who experience fatigue, the appearance symptoms will not exactly match. CRF are generally influenced by a history of less activity and psychological stress experienced as a result of cancer. Based on the priorities effectiveness against fatigue, Mitchell, Beck, Hood, Moore, Tanner 2007 recommend giving exercise to intervene against fatigue. Suggested CRF will affect the ability, physical capacity, and quality of life of cancer patients, so they will rely on others for daily necessities such as household activities, transportation, personal needs such as eating and bathing. CRF perceived multidimensional feeling, the dimensions are behaviour, cognitive, psychological and social. Fatigue felt by the majority of cancer exercises include walking, cycling, swimming, resistance training or exercises combined. Nursing interventions that are judged to be effective fatigue management is performed for activity management and energy conservation, one of the interventions which includes relaxation techniques. Escalante and Manzullo 2010 tried to patients during therapy may reduce the 223 apply the technique combination of pharmacological and non-pharmacological therapies, among others: energy conservation, regulation of sleep, exercise, relaxation, antidepressants, analgesics, stimulants, anxiolytic and nutritional counseling. The results are 59 of the 140 respondents reported less fatigue.Methods of combination therapy to reduce fatigue have also been made in the research Decker, Cline-Elsen, Galaggher, 1992 and Kim, Kim, 2005, using nursing interventions breath relaxation techniques with yoga positions. The cancer patients were given the intervention reported lower- level experience fatigue. Danismaya research results 2008, who did the application of relaxation techniques of yoga in patients with breast cancer, showed a decrease in the level of fatigue on the 5th day of intervention. Research by wahyuni 2012 suggested that the walking exercise program can reduce fatigue levels in breast cancer patients. The above studies indicate that intervention aerobic walking exercise as well as the relaxation of yoga is effective in lowering the level of fatigue. However, so far researchers have not found a combination of aerobics with yoga relaxation of the intervention to be effective in lowering the level of fatigue. This study aimed to determine differences in fatigue levels in breast cancer patients in chemotherapy program between before and after the combination of aerobic exercise and relaxation techniques of yoga. METHODE The research was used Quasi-experimental pre test post test with control design in patients with breast cancer under chemotherapy program at RSUD Kediri and Amelia Hospital Kediri on April until June 2014. Using purposive sampling technique 34 participant were recruited from 110 patients by medical data record and encountered patients at one day care services unit. Aerobic data was collected with observation sheets about exercise time schedule, and fatigue levels data obtained with Pipper Fatigue Scale PFS. Initially the patient is asked to perform continuous walking for 10 minutes as a form of aerobic 224 exercise , then the patient rested for 2 minutes , then the patient is asked to perform Shavasana position yoga as a form of relaxation for 8 minutes. Rest breaks given to minimize the discomfort that can be perceived by the respondents. Data were collected by questionnaires for the pre-test and post-test. Analysis of data using frequency distribution, bivariate analysis Independent and Dependent T test and multivariate analysis using linear regression. Most respondents chose to participate in the study and are willing to take measurements and interventions at each residence. All existing identity documents and data in this study have been agreed only use initials, all the information from respondents in the form of a hard copy stored in a locked filing cabinet and the data in the form of soft copy stored in a specific folder is secured by using a password. During participated in the study respondents are treated fairly and impartially , by providing the same treatment , but in a different time . Intervention control group given a combination of aerobic exercise with relaxation techniques of yoga after data collection is complete . RESULT Obtained 34 respondents by sex married women are divided into two groups , namely 17 respondents in the intervention group and 17 respondents as the control group . The mean age of the respondents 51.5 years old, mean body weight 57.71 kg, and the mean fatigue score of 6.04 95 CI. Table 1 displays the characteristics of respondents P value R R 2 Adjusted R square P value Langkah 1 0,594 0,353 0,311 0,012 Based on the results of statistical tests, it was found that a significant reduction in fatigue scores between before and after doing a combination of aerobic exercise with relaxation techniques of yoga in the intervention group p = 0.001; α = 0.05. Based on test results, a decrease in fatigue scores were significantly also occurred in the control group p = 0.004; α = 0.05. Based on further testing of the level of fatigue post test between the intervention group and the control group there were significant differences in levels of fatigue p = 0.013; α = 0.05. Table 2 shows the differences in levels of fatigue post test between the intervention group and the control group TABLE 2 Differences in levels of fatigue post-test, intervention group and the control group Mean Mean± Different SD CI 95 Fatigue Levels intervention 4,3±1,6 1,25 group 0,29-2,22 Fatigue Levels 5,5±1,8 control group Langkah 2 0,451 0,203 TABLE 1 Characteristics of Respondents Variable Occupation a. Having a Job b. Jobless Education a. Low Education does not school, Elementary, Junior b. Higher Education High School and Universities Cancer Stadium a. Stadium II b. Stadium III Therapy History a. Nothing b. Exist Exercise History a. None b. Exist Types of chemotherapy drugs 0,013 a. Tamoplex b. Cyclospamit c. Doxorubyn 0,178 n 5 29 27 7 25 9 23 11 30 4 16 11 7 0,001 14,7 85,3 79,4 20,6 73,5 26,5 67,6 32,4 88,2 11,8 47,1 32,4 20,6 independent t test p 0,05 Based on the test results of multivariate linear regression, the level of fatigue in breast cancer patients under chemotherapy program is influenced by prior treatment history and a history of previous exercise p 0.05. Also shown in Table 3 the previous exercise history can explain the fatigue that occurs in cancer patients under chemotherapy program, the rest is explained by other variables. Uji regresi Linier p 0,05 Langkah 1 : riwayat terapi, riwayat atihan Langkah 2 : riwayat latihan Faktor dependen : tingkat fatigue DISCUSSION Cancer related fatigue is a feeling of fatigue that appears persistently, along with the cancer therapy. Fatigue can arise from the patients physical condition declined due to the disease process, and may also be caused 225 by cancer therapy undertaken. The feeling will make the patients physical abilities decline. The high level of perceived fatigue of breast cancer patients, is associated with a decrease in daily activities performed by patient Rotonda, Guillemin, Bonnetain, Velten, Conroy, 2013. Therefore, physical exercise becomes one of the main recommended treatment for patients with fatigue, so that the patients ability to independently returned. Physical exercises ranging from the mild to severe intended to allow someone to have regular activities, so that the body will be able to compensate for the decrease in the patients physical abilities. If a person feels himself psychologically incapable, then his body will respond to the same thing, so it will be the condition of the patients body increasingly weak. Accordingly, in this study interventions that can increase the activity of the respondent to provide physical fatigue management by walking exercise, and psychological basic ingredient of energy, so that when management by providing relaxation techniques of yoga. The results in this study showed a difference between level of fatigue before and after applying a combination of aerobic exercise with relaxation techniques of yoga in patients with breast cancer under chemotherapy programs. Chemotherapy is a protocol that is almost used in all cancer treatment. Be aware that chemotherapy is a treatment method using a type of cytotoxic drugs, which is intended to inhibit the regeneration of cells. Inhibition mechanism occurs in all cells of the body, not least on healthy cells or non-cancerous, so its also a factor that contributed to the decline in patients physical abilities. important for patients who are undergoing chemotherapy and experiencing fatigue to keep improving activities of daily routine, to compensate for attenuation effects caused by chemotherapy drugs on normal cells. Routine activities such as cooking, sweeping, walking around the house is the method forms of simple aerobic activity that can be done by cancer patients in order to maintain their physical abilities. In accordance with the results of several previous studies which revealed that aerobic exercise walking exercise can be beneficial to the fatigue levels of patients who are in treatment programs Velthuis, Agasi-Idenburg, Aufdemkampe, Wittink 2010; Wahyuni, 2012; Mustian, Sprod, Janelsins, Peppone , Mohile, 2012; Mayo, Moriello, Scott, Dawes, Auais, Chasen, 2014. Decrease in fatigue scores that occurred in the intervention group can explain that feeling of fatigue experienced by cancer patients can be improved by doing aerobic exercise. These types of exercises can strike production increases it will be directly proportional to the bodys ability to perform its duties and functions. Conversely, a decrease in activity deconditioning result in the breakdown and loss of enzymes involved in cellular energy production level. The use of oxygen and energy sources become inefficient. Aerobic exercise is conducted into a stimulation for the body to change the reserves of energy sources into the base material of energy. This is consistent with the first and second laws of thermodynamics theory, which states that energy can neither be created nor destroyed; energy can only be redistributed or changed from one form to another Winningham and Barton-Burke 2000. Aerobic exercise program can be used as an exercise to minimize energy loss in cancer patients whose chemotherapy by using oxygen consumption as an objective parameter in measuring performance. Aerobic exercise showed progress in terms of performance that produces energy despite cancer patients undergoing chemotherapy. Individuals who perform activities would not feel too tired compared to individuals who do not indulge, this is because the energy in individuals whose activities continue to be distributed though the energy used continuously, the opposite situation occurs in individuals who do not perform activities, energy continues to be required but there is no activity undertaken to produce energy anymore. The exercise program can also provide benefits for the psychosocial health of cancer patients, by improving the ability of themselves and the quality of life Doyle, C., et al., 2006. Physically, history or the patients ability to a balance between the needs and the perform activities before experiencing production of energy needed by the body to improve physical abilities. Aerobics can increase the cardio-respiratory activities that will increase the supply of oxygen to the muscles. The presence of oxygen in the muscles will increase energy metabolism through oxidation of fats, carbohydrates and fatigue becomes a factor that greatly affect the compensation body when experiencing fatigue. Analysis of the comparison between each of the factors that influence fatigue in this study suggests that a history of activity contributed 17.8 to the occurrence of fatigue in breast cancer protein to form a small part patients Table 3. Adenotriphosphate ATP Hernawati, nd downloaded from file.upi.edu. ATP is the 226 Meanwhile, the research results also illustrate that yoga relaxation techniques also contribute to the score of fatigue respondents. Yoga is useful to provide and increase the sense of calm in respondents feeling after doing a series of exercises. According Shindu 2013 with yoga positions Shavasana position lying like a corpse relaxation in total will take place gentle pressure on the glands that secrete symptoms that may aggravate tension fatigue does not occur. The results also showed that the level of fatigue also decreased in the control group, who did not get a combination of aerobic exercise with relaxation techniques of yoga. Generally, it can be overcome with fatigue restoration techniques, such as; ensure a hormones to a more stable, blood proper diet, ensuring a good sleep patterns, circulation becomes more smoothly, the body will describe the tension of his muscles, the mind becomes quieter and more serene sense of being. Relaxation become appropriate method chosen for the management of fatigue caused by the burden of or stress of feeling in the minds of cancer patients. Stress experienced by patients could be due to progressive disease process, the phase of self-acceptance on the patients health status, or because of saturation in undergoing cancer therapy who repeatedly and for a long time. According to Hans Selye in the Canadian medical hall of fame, 2013 stress syndrome originated from a situation in which the body is not specifically respond to various stimuli. Under conditions of stress hypothalamus secretes corticotropin releasing hormone CRH, further to stimulate the pituitary to secrete cortisol and directly or indirectly adrenal secrete adrenocorticotropic hormone ACTH, GRH, Somatostatin and release factors releasing the hypothalamus and pituitary hormones other. Cortisol and ACTH will issue vasopressin and catecholamines, causing an increase in blood pressure and heart muscle contraction. Clinically, this phase will bring a feeling of tension accompanied by signs such as ulcers, high blood pressure and heart attacks. Further processing of the situation would lead to a decrease in the secretion of insulin, glucagon and the intake of oxygen in the body. The impact, decrease energy production, while the energy needs in cancer patients who are undergoing chemotherapy are very large. This gap that causes the inadequate energy for the body, causing fatigue. Therefore, cancer patients need to be taught relaxation methods as an effort to adapt to stress, in the hope 227 adjusting a good lifestyle, understanding the psychological problems associated with fatigue, as well as coping management for the energy loss Victoria Minister for Health, 2013. Decrease fatigue that occurs in the control group could be acceptable because some respondents have chemotherapy schedules predetermined, so it is difficult to predict the peak of the respondent fatigue. In addition, the distance between the last chemotherapy respondents to the implementation of the research is very varied, there is a direct post- chemotherapy and some that have a few weeks after the last chemotherapy. In the opinion of Otti cited in Danismaya, 2008 that the peak fatigue occurs on day 7 to day 10 after chemotherapy session and will be back at the starting point before the next cycle. So when performed assessments of respondents could not be ascertained were at the height of fatigue or not, because it may just have been a recovery from fatigue experienced conditions. Interventions that have been given during this study is safe and can be done independently by the respondents during the period of chemotherapy. It is based on the absence of a report from the intervention group who runs a combination of aerobic exercise and yoga relaxation techniques that are harmful and harm him. A decrease in fatigue scores in the intervention group was significantly higher when compared with the control group. Fatigue scores are clinically categorized into four categories, namely; a score of 0 for categories not fatigue, the score 1-3 to the category of mild fatigue, fatigue score of 4-6 to the category of moderate and severe fatigue category 7-10 Pipper, et. al, 1998 and NCCN, 2014. Decline in average scores are statistically obtained either from 0.52 to 1.82 in the intervention group and the control group, from the initial score in the range of 6 scores fell in the range of 5 and 4. Fatigue score 4-6 clinically categorized into moderate category, so it can be concluded that the decrease in fatigue that occurs only statistically significant, but clinically decrease in fatigue that occurs still within the same category, or do not decrease. aerobic exercise with relaxation techniques of yoga for three consecutive days. The results showed a significant influence between the combination of aerobic exercise with relaxation techniques of yoga in cancer patients undergoing chemotherapy, after three days of observation. But according to the law of Thermodynamic III discovered by Rudolf Several other studies also reveal the same Clausius in Barton-Burke and thing, that the reduction in fatigue after exercise and relaxation of yoga significantly only shown in the statistical calculation, but not clinically significant difference Schwartz, Mori, Gao, Nail, King, 2001 Danismaya 2008, Mustian et. al Winningham, 2000 stressed that energy can not only be modified in other forms, but also constantly less available for work. Whenever energy is converted, it always takes more energy than the energy expended a system. This theory can be the 2009. However, the research results basis of that intervention provided in this Mustian et. al 2009 added that although not clinically significant changes occur fatigue, cancer patients were given continuous training to observations of three months showed an improvement in quality of life. As well as on the research results Danismaya 2008 further explained that the provision of the relaxation techniques of yoga over three days showed a decrease in fatigue clinically significant, namely from study can not necessarily eliminate fatigue in just three days, because the body needs a continuous supply of energy along with energy use. So that respondents who perform these interventions are also at risk for getting tired because of the energy requirements continuously. However, at least by providing a combination of aerobic exercise with yoga relaxation techniques on an ongoing basis to balance energy needs, fatigue category of being on the first day can stimulate the aerobic energy become the category of mild fatigue on the fifth day. Exercise and physical activity that exceeds the portion of the ability of cancer patients can also potentially lead to fatigue, thus creating the opportunity to exacerbate fatigue, therefore in this study are still using the criteria of minimal intervention, namely with a frequency of three days a week. Such determination is based on the optimal frequency in adults aerobic ie at least 3 days a week Whalet, 2006 and the duration of time of at least 10 minutes in a day Newton cited in CCWA, 2009. While Danismaya 2008 also mentions that a change fatigue of cancer patients given yoga relaxation occurs from the third day of exercise. This study is an initial attempt to determine the effectiveness of the combination therapy which has not found a reference frequency and duration for the implementation of the combination in previous studies, so that some of the above considerations are used to determine the frequency and duration of combined 228 metabolism and relaxation of yoga can save energy by minimizing internal stress. According Winningham in King and Hinds, 2003 about the proposition of rest and activity states that too much little break will result in fatigue, as well as too much little activity will also lead to fatigue, so the dynamic balance between activity and rest will minimize fatigue, and otherwise the imbalance of which will aggravate fatigue. In addition, fatigue become a different problem to individuals who have completed cancer therapy. Individuals who are no longer undergo therapy and be considered free of cancer called cancer survivor. Fatigue is still a problem that can interfere with quality of life for cancer survivors significantly. According Servaes, Verhagen, Bleijenberg 2002, 38 of women with breast cancer who have completed cancer therapy still merasakana exhausted after 29 days post-therapy. Fatigue is also still perceived by 13 of women with breast cancer 10 years after completion of therapy Bower, Ganz, Desmond 2006. Theory and research conducted in patients undergoing cancer therapy can not be applied in a population of cancer survivors, solutions that can be given in this population is to improve themselves to be able to adapt and perform independently of the fatigue management are still being experienced. informed choices. CA Cancer J Clin, 566: p. 323-53. Escalante P. C., Manzullo F. E. 2009 Cancer-Related Fatigue: The Approach and Treatment. J Gen Intern Med, 24Suppl 2:412 –6 DOI: 10.1007s11606-009-1056-z Hernawati, n.d. Produksi asam laktat pada CONCLUSION exercise aerobik dan anaerobik. There are differences in fatigue levels in breast cancer patients who received a combination of aerobic exercise with relaxation techniques of yoga. The decline is statistically significant, but clinically no significant changes in levels of fatigue either the intervention group or the control group. Special interventions for fatigue in cancer patients in this study may be one of the nursing interventions, so that nurses can implement it in order of nursing, especially in the area of oncology nursing. Further diunduh dari file.upi.eduDirektoriFPMIPAJUR._P END._BIOLOGI...FILE_2.pdf Hofman M., Ryan L. J., Figueroa-Moeley D. C, Jean-Pierre P., Morrow G. R.. 2007. Jacobsen PB, Hann DM, Azzarello LM, et al. Fatigue in woman receiving adjuvant chemotherapy for breast cancer: characteristics, course and correlates. J Pain Symptom Manage, 22: 277 –88 Kim, S.D., Kim, H.S. 2005. Effects of a research is needed, especially regarding relaxation breathing exercise on intervention to determine the long-term results of the implementation of the intervention. Specific interventions for fatigue in cancer patients so far is not widely held by hospitals that deal with cancer therapy. The results could be used as a basis for interventions against fatigue that occurs in cancer patients in hospitals, both in hospitals and in the center of the regional fatigue in hematopoietic stem cell transplantation patients. Journal of Clinical Nursing, 14, 51 –55. King, C. R., Hinds, P.S. 2003. Quality of life: from nursing and patients perspectives, theory and research. 3 rd ed. Jones Bartlett Publisher. Mayo NE, Moriello C, Scott SC, Dawes D, Auais M, Chasen M. 2014. hospital. Pedometer-facilitated walking intervention shows promising REFERENCES Bower J. E., Ganz P. A., Desmond, K. A., 2006. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation Danismaya I. 2008. Pengaruh teknik relaksasi Yoga terhadap tingkat fatigue pada penderita kanker payudara pasca kemoterapi di rumah sakit Hasan Sadikin Bandung Thesis. Diunduh dari http:lib.ui.ac.idopacui Doyle, C., Kushi L. H., Byers T, Courneya K. S., Demark-Wahnefried W., Grant effectiveness for reducing cancer fatigue: a pilot randomized trial. Clin Rehabil. pii: 0269215514536209. [Epub ahead of print] PubMed PMID: 24917586 Mitchell A. S., Beck L. S., Hood E. L., Moore K., Tanner R. E. 2007. Putting evidence into practice: evidence-based intervenstion cancer and its treatment. Clinical journal of oncology nursing. 11 1:99-113. Mustian M. K., Morrow R. G., Carroll J. K., Moseley D. C., Pierre P. J., Williams C. G. 2007. Integrative B., ... Andrews K. S. 2006. nonpharmacologic behavioral Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for 229 interventions for the management of cancer-related fatigue. The Oncologist, 12:52 –67. Doi:10.1634theoncologist.12-S1-52 Mustian M. K., Peppone L., darling V. T., Palesh O., Heckler E. C., Morrow R. G. 2009. A 4-week home-based aerobic and resistance exercise program during radiation therapy : a pilot project randomized clinical trial. J support Oncol, 9:158-167. Shindu P. 2013. Panduan lengkap yoga: untuk hidup sehat dan seimbang. Bandung : Mizan Media Utama. The Canadian medical hall of fame 2013. Dr. hans Seyle. Diunduh dari http:www.cdnmedhal.orgdr-hans- seyle Mustian KM, Sprod LK, Janelsins M, Velthuis MJ, Agasi-Idenburg SC, Peppone LJ, Mohile S. 2012. Exercise Recommendations for Aufdemkampe G, Wittink HM. 2010. The effect of physical exercise on Cancer-Related Fatigue, Cognitive cancer-related fatigue during cancer Impairment, Sleep problems, treatment: a meta-analysis of Depression, Pain, Anxiety, and randomised controlled trials. Clin Physical Dysfunction: A Review. Oncol Hematol Rev. 82:81-88. PubMed PMID: 23667857; PubMed Central PMCID: PMC3647480 National Comprehensive Cancer Network. 2014. NCCN clinical practice guidelines in oncology NCCN Oncol R Coll Radiol. 22 3 : 208-21. doi: 10.1016j.clon.2009.12.005. PubMed PMID : 20110159. Victoria Minister for Health. 2013. Fatigue fighting tips reproduced from the better health channel www.betterhealth.vic.gov.au. State guidelines cancer-related fatigue of Victoria. Diunduh dari version 1.2014. NCCN.org. diunduh dari http:www.nccn.orgprofessionalsphy sician_glsf_guidelines.aspsupportive Pipper BF., Dibble SL., Dodd MJ., Weiss MC., Slaugther RE., Paul SM. 1998. The revised piper fatigue scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. http:www.betterhealth.vic.gov.auFati gue_fighting_tips.pdf Wahyuni S.I., 2012. Walking exercise programme WEP menurunkan cancer related fatigue pada pasien kanker payudara di rsud Ibnu Sina Gresik. Diunduh dari http:journal.unair.ac.idfilerPDFabstr ak_5631129_tpjua.pdf 254:677-84. PubMed PMID: Wagner, L.I. Cella D. 2004. Fatigue 9599351 Rotonda C., Guillemin F., Bonnetain F., Velten M., Conroy T. 2013. Factors and cancer: causes, prevalence and treatment approaches. Br J Cancer,

915: p. 822-8.

associated with fatigue after surgery in Winningham M.L., Barton-Burke, M. women with early-stage invasive 2000 Fatigue in cancer: a breast cancer. The oncologist, 18:467- multidimensional approach. United 475. Doi 10.1634theoncologist.2012- 0300 Schwartz L A, Mori M., Gao R., Nail M. L., King E. M. 2001 Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med. Sci. Spsorts Exer.; vol. 33, no. 5:000- 000. Servaes P., Verhagen S., Bleijenberg T. Kingdom: Jones and Bartlett Publisher, inc 2002. Determinants of chronic fatigue in disesase-free breast cancer patients: a cross sectional study. Annal of Oncology,13: 589-590 230 COACHING INTERVENTION MODEL TO IMPROVE COMFORT IN ADOLESENCE WITH DISMINORE Dhina Widayati Bachelor of Nursing Study Programe STIKES Karya Husada Kediri Email : Budinawidagmail.com ABSTRACT Disminore is one of the most common problems experienced by Adolesence during menstruation. Disminore management can be performed pharmacological and non-pharmacological. In non- pharmacological one of which can be done by a model of coaching intervention through the abdominal stretching. Coaching is one type of intervention in the theory of comfort Colcaba. This study aims to determine the effect of coaching intervention models to improvr comfort of adolesence with dysmenorrhea. This study design using pre-experimental, with the approach of one group pre-test post-test design. Sample size are 20 respondents gotten by accidental sampling technique. Data were analyzed using the Wilcoxon Sign Rank Test with results ρ value = 0.001 α = 0.05, which means there is the influence of coaching intervention models to improve level comfort of adolesence with dysmenorrhea. After the intervention most of the respondents increased comfort, from mild levels to be high. This is because the movement of the abdominal stretching can stimulate the hypothalamus to excite endogenous opioids that produce endorphins, which can reduce pain intensity disminore and increased comfort with a mechanism can make the muscles around the stomach to relax, reduce pain and make the body feel comfortable. Abdominal stretching can be applied in the Schools, especially in the provision of health education and be learning in physical health education. Keywords: abdominal stretching, coaching, comfort INTRODUCTION Adolescence starting from age 12 to age 23 years were a period of dynamic development characterized by changes in the physical development of social cognitive and emotional so quickly. The earliest changes at this time that the physical or biological development of one teenager menstruate. At puberty women also experience emotional changes that change as the peak emotional instability emotional development this is caused by an increase in sexual hormone is so rapid Guyton, 2006. Menstruation or menstruation is physiological changes that occur periodically women and influenced by reproductive hormones. This period is important in terms of reproduction, usually occurs every month between adolescence and menopause Bieber, 2011. But in menstruation sometimes arise 235 various problems that interfere with and affect the activity of which the symptoms of premenstrual tension tension before menstruation, mastodinia, mittelschmerz pain during ovulation and dysmenorrhea pain during menstruation. Dysmenorrhea is not a disease but a physical disorder arising from abnormalities of the pelvis are debilitating female. The main manifestations of dysmenorrhea is painful cramping in the lower abdominal area and spread back or surface of the thigh. In the more severe symptoms are often accompanied by nausea, vomiting, diarrhea, dizziness and even fainting. These symptoms cause many women who complained of pain and requires resting Bobak, 2010. Based on the cause of dysmenorrhea is divided into two primary dysmenorrhea experienced by women who are menstruating prostaglandins cause arising from the work contained in the cervix and uterus. Prostaglandins work increase uterine contractions and the excessive levels will activate the large intestine. Prostaglandins can reduce or inhibit temporary blood supply to the uterus, which causes the uterus deprived of oxygen causing myometrial contractions and pain. Unlike the secondary dysmenorrhea usually experienced by women with certain diseases disorders include endometriosis, pelvic infection, appendicitis and cervical cancer Anurogo 2011; Prawirohardjo, 2011. In the epidemiological study of approximately 70-90 of cases of menstrual pain occurs when adolescence Anurogo, 2011. According Wales 2006 quoted of Fatima, 2007, premenstrual syndrome experienced by 50 of women with socio- economic medium that come to the clinic gynecology and approximately 14 of women between the ages of 15 to 35 years experience premenstrual syndrome very great influence that require them to take a break from school or office. According santoso 2008 dysmenorrhea is the case in Indonesia is of primary dysmenorrhea, dysmenorrhea percentage in Indonesia amounted to 64.25, which is divided from primary dysmenorrhea as much as 54.89 and in secondary dysmenorrhea as much as 9.36. According to Hendrik, 2006 as many as 60-75 of young women experience primary dysmenorrhea provided three-quarters of women experience dysmenorrhea pain mild to moderate and a quarter again experiencing severe pain. Fatimah Research 2007 conducted in Semarang, showed that 71.9 of the 154 respondents experienced premenstrual syndrome. About 40 of women aged 14-50 years experiencing premenstrual syndrome. In dysmenorrhea that is safe and without side effects include warm compresses, messase, distraction, getting enough sleep, low-salt diet, physical activity exercise and increased use of diuretics naturally like celery Bobak et al., 2005 , As according to Woo and McEnerney 2010 in Charles 2012 there is a strategy that New eventto dysmenorrhea with vitamin B1, B6, and vitamin E, magnesium and omega 3, exercise, acupuncture and Chinese medicine. Many researchers say exercise can cope with dysmenorrhea and exercise more safe and contains no side effects due to use of the physiological processes of the body it is supported by the results of the Daley 2008 which states exercise effective in reducing the intensity of primary dysmenorrhea and study of istiqomah 2009 stating motion gymnastics effective in reducing the scale of dysmenorrhea dysmenorrhea. In the exercise the body will produce endorpien produced by the brain and spinal cord that can serve as a natural tranquilizer, causing a sense of relaxed and comfortable Arifin, 2008. According Thermacare 2010 in the Retna 2011, exercise that effectively lower scale of dysmenorrhea is abdominal stretching exercise to increase muscle strength abdominal flexibility stomach and immune system in certain circumstances, as well as relaxation breathing for relaxation, release tension and improve pulmonary ventilation so that the blood oxygen can lowering the scale of dysmenorrhea Wong, et al. and Smeltzer 2002. Distraction is a technique used to reduce pain by means of diverting attention for example to sing, pray, tell loudly, and listen to music, music therapy is a way to reduce pain by distracting and thoughts to the music is most of the young girls of primary heard so that the clients awareness of the dysmenorrhea an ordeal is quite disturbing and should be experienced by every month so that young women must be able to seek appropriate solutions to overcome them. Management of the intensity of pain during dysmenorrhea can be done in two ways, namely by pharmacological and non- pharmacological treatment early in patients with menstrual pain primer is to provide medicines penghilangrasa pain and 80 of patients experienced a decrease in pain of menstruation after taking drugs inhibiting prostaglandin Arifin, 2008; Anurogo , 2011. Some ways nonpharmacologic to relieve 236 painful menstruation or dysmenorrhea is reduced , listening to music can stimulate the release of endorphins that can reduce pain and make the mind relaxes Potter, 2011. Dysmenorrhea arising during menstruation is very influential on the activities of daily living many symptoms resulting decline in immunity and the effect on the emotional level of women when dysmenorrhea not be handled will have an impact on activity disorder menstrual moving backward, infertility, pregnancy is not detected, the infection and the emotional disorders emerging feelings of tension and anxiety that will affect personal skills and