Asam urat yang berlebihan tidak akan tertampung dan termetabolisme seluruhnya oleh tubuh, sehingga akan terjadi peningkatan kadar asam urat dalam darah yang disebut sebagai perurisemia. Gangguan asam urat ditandai dengan suatu serangan tiba-tiba di daerah persendian. Nyeri yang timbul pada umumnya muncul secara tiba-tiba. Kemunculan secaratiba-tiba ini sering menyebabkan penderita asam urat sulit bergerak. Tujuan penelitian ini adalah untuk menguji efektivitas pemberian rebusan daun sirsak terhadap penurunan kadar asam urat pada lansia wanita penderita Gout Artritis. Desain penelitian ini menggunakan rancangan penelitian dengan metode analitik (Pra ex. Design one group pre-post test design). Sampel penelitian ini adalah lansia wanita penderita gout artrhitis di Kecamatan Lawangan Daya sebanyak 14 responden. Pengambilan data menggunakan lembar observasi, hasil pengujian kadar asam urat dianalisis dengan uji statistik Paired T Test menggunakan SPSS. Hasil penelitian menunjukkan P<0.05 artinya terjadi penurunan yang signifikan dari pemberian rebusan daun sirsat terhadap kadar asam urat Lansia Wanita penderita Gout Artritis di Kelurahan Lawangan Daya Kabupaten Pamekasan. Melihat hasil penelitian ini diperlukan pemberian rebusan daun sirsak secara rutin. Kesimpulan dari penelitian ini adalah pemberian rebusan daun sirsak terbukti efektif dapat menurunkan kadar asam urat pada penderita Gout Artrhitis. Rebusan daun sirsak dapat dijadikan obat herbal yang tidak memiliki efek samping bagi penderita atau responden.    Kata Kunci : Lansia wanita, daun sirsak, Gout Artritis.

There are several treatments for hemiparesis stroke patients, namely medical treatment (conventional) and complementary alternative medicine. So far, in rural areas treating hemiparase stroke patients prefer complementary alternative treatments in the form of reflexology, namely massaging the hands, feet and other body parts by focusing on the nerves of the body. The purpose of this study was to determine the effectiveness of reflexology on hemiparesis muscle strength in stroke patients in the working area of the Puskesmas Guluk-guluk, Sumenep Regency. In this study using analytical methods. The variables in this study consisted of pre-test variables, namely muscle strength before being given reflexology and post-test variables, namely hemiparesis muscle strength after reflexology. The technique of collecting data is purposive sampling in getting 5 respondents. With research data using muscle strength observation sheets with data processing editing, scoring, coding, tabulating, and statistical tests using SPSS. The results of the output test statistics in the Mann-Whitney test found that the asymmp.sig (2-tailed) value in the upper and lower extremities of 0.007 is smaller than the probability value of 005.  Based on the results of the p-value, there are differences in the results of muscle strength before reflexology and after reflexology. Because there is a significant difference, reflexology is effective in increasing the hemiparesis muscle strength of stroke patients. Therefore, good family support is needed for stroke patients in the rehabilitation phase who experience hemiparesis so that reflexology is carried out regularly.Keywords: Reflexology, Muscle strength, Hemiparesis

Each workplace always feeds on the potential hazards that may affect the health of the workforce or may cause work-related illness. Psychic disorder is a potential hazard that is often overlooked when the potential of this psychic hazard is also an important factor that needs to be considered in relation to the mental health of workers. Factors that are suspected to be stressors of work stress are the personality, workload, organizational structure and climate, career development and work environment. The purpose of this study is to analyze the factors that affect the work stress of employees Akper Pemkab Pamekasan. The type of this research is quantitative research with analytic observational research design with cross sectional approach. The study was conducted on 12 to 23 February 2018 at Akper Pemkab Pamekasan with a population of 42 employees. The sample size is 38 respondents. The independent variables are personality, workload, organizational structure and climate, career development and work environment. Variable dependent is work stress of Akper employees Pamekasan regency. data were collected using questionnaires. Data were analyzed using logistic regression test with α = 0,05. The results showed that variable X1 (personality) with p = 0,639; OR = 13,749, Variable X4 (career development) with p = 0,028; OR = 15.270, variable X5 (working environment) with p = 0.999; OR = 1,460. So it can be concluded that the dominant factor and influence work stress employees Akper Pemkab Pamekasan is career development factor with the influence of 15.270. Employee career development that does not satisfy the cause of work stress so it is necessary to provide information and communication in a transparent and accountable about the mechanism of career development level in accordance with the performance.

Introductions: The decrease in depression in leprosy patients using Spiritual-based Cognitive Behavior Therapy shows progressive results. Objectives: This study aimed to determine the effectiveness of spiritual-based Cognitive Behavior Therapy on the level of depression of leprosy patients at the Waru Health Centre, Pamekasan Regency. Methods: This research design was Quasi-Experiment Design with a pre-test – post-test group. Respondents consisted of 12 people who received spiritual-based CBT therapy. Spiritual-based CBT therapy was given in 3 sessions in 3 meetings. Data collection by filling out the DASS questionnaire pre- and post-spiritual-based CBT therapy interventions. Data was collected using the triangulation method, namely in-depth interviews (depth interviews) face to face with observations and scales. Results: The results showed that from the interpretation of the analysis results using the Paired T-Test statistical test, it was known that in the test before and after treatment, the value of p = 0.000 at the significance level of p = 0.05 (α = 0.05). When compared with the level of significance, which is 0.000 < 0.05, it can be concluded that there is an influence on the application of spiritual-based cognitive behavior therapy to people with leprosy who experience depression. Conclusions: Through cognitive restructuring techniques, participants' distorted cognitions become more rational. Participants can accept their condition and reduce negative thoughts that cause depression.