Nursing is a profession that entails a high risk of burnout, so effective organizational management is needed to reduce its occurrence. This study aims to investigate the moderating effects of Nurse Manager caring behaviors and work environment in burnout syndrome among nurses. This study design uses exploratory descriptions with a cross-sectional approach and considers a sample of 485 nurses in the medical surgical wards at three general hospitals in East Java Province, Indonesia. Data collection was performed using three separate questionnaires: The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) to identify burnout syndrome among nurses, Caring Assessment Tool: Administration (CAT: Admn) to identify caring behaviors in nurse managers, and My Relationship with Work test (MRW) to identify work environments. The data was analyzed using Partial Least Square analysis. Nurse manager caring behaviors have a direct effect on personal accomplishment among nurses. The caring behaviors of nurse managers influence control, workload, community, fairness, reward and value. Caring behaviors from nurse managers also affect emotional exhaustion and depersonalization through the mediation of rewards, controls and workload.

Background: Many breastfeeding mothers find that their milk production decreases or even stops when they return to work due to reduced breastfeeding hormones. Massage can stimulate the oxytocin hormone, and to replace the manual massage, a digital massager of oxytocin (DMO) is developed.Purpose: This study aimed to identify the effects of the DMO on the milk production of the breastfeeding working mothers. Methods: This study employed a quasi-experiment with pretest-posttest control group design. The samples were 93 breastfeeding working mothers in the community with a baby below 6 months. The samples were assigned into the intervention group (n=46) and the control group (n=47). An intervention of using the DMO was given to the mothers in the intervention group by applying the electrodes on the first intercostae of BL-17 and Bl-18 acupoints for 20 minutes in 3 consecutive days. Meanwhile, a standard treatment was given to the control group. Breast milk expression was carried out before and after the use of DMO. The data were analyzed using the Mann-Whitney and the Wilcoxon tests. Results: The results showed that there were differences in the volume of the expressed breast milk before and after the use of the DMO (p=0.00). The mothers in the intervention group increased their milk production on an average of 23 ml when other variables affecting the breastfeeding were controlled.Conclusion: The DMO stimulated and increased the milk production of working mothers. It can also be an alternative to the complementary therapy, especially for the nursing care management of breastfeeding mothers.

Objective: To evaluate the cephalic indices among Bataknese school students. Material and Methods: An observational study was performed by measuring 95 Bataknese children aged 3-5 years using a purposive sampling technique. The vertical cephalic index was measured directly in children, while the dental arch and palatal depth were measured on maxillary impressions. Vertical cephalic index data were obtained by measuring the height and length of the child's head directly. Measurement was performed three times by three different people. Cephalic height was measured by a digital calipers by placing each edge of the calipers on the nasion and gnathion. Descriptive statistics were used to calculate the mean and standard deviation. Results: The analysis of height and cephalic length showed that the highest values were 9.28 cm and 18.13 cm, while the lowest were 7.43 cm and 13.43 cm, respectively. The means for Maxillary canine arch width and Maxillary molar arch width were 30.66 mm and 46.69 mm, respectively. For the Maxillary canine arch depth, the mean was 12.0 mm, while for the Maxillary molar arch depth was 28.65 mm. The palatal depth was 14.33. Conclusion: The majority of Bataknese children have a dolichocephalic head shape with a tapered maxillary dental arch and a narrow one.

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Objective: To evaluate the oral hygiene status of children with Down syndrome using the busy book Ayo Sikat Gigi as an educational toy. Material and Methods: We ran an experimental study involving 25 educable and trainable children with Down syndrome, comprising 17 males and 8 females aged 7-12 years, who were free from other disabilities and did not use orthodontic or prosthodontic appliances. Parents were instructed to educate their children using the busy book Ayo Sikat Gigi and also to guide their children in brushing their teeth effectively at home. We evaluated the OHI-S score over two visits, one before and the other after education using the busy book Ayo Sikat Gigi over a 7 day period. The Wilcoxon test with the p-value set at 0.05 was used. Results: It was noted a statistically significant decrease in the OHI-S scores of children with Down syndrome (p<0.05), reflecting an improvement in their dental health, after education using the busy book Ayo Sikat Gigi (median scores before and after education: 2.30 and 1.84, respectively). Conclusion: The busy book Ayo Sikat Gigi is a highly effective educational toy for children with Down syndrome, and in our study, it was demonstrated to decrease their OHI-S scores after education for 7 days.

Objective: To analyze the ability of saliva in controlling the growth and the biofilm formation of Streptococcus mutans (S. mutans) as well as the effect of histatin-5 anti-biofilm relate to pH and saliva viscosity. Material and Methods: The S. mutans biofilm assayed by crystal violet 1% and its growth measured by spectrophotometer. The saliva viscosity was analyzed by viscometer, and pH of saliva was measured by pH meter. Results: Based on the optical density values, growth of S. mutans in saliva ranged <300 CFU/mL (0.1 nm) at concentrations of 25%, 12.5% and 6.25% for 24 hours. Whereas at the 48 h and 72 h period of incubation shown an increase in growth of S. mutans ranged 300-600 CFU/mL (0.2-0.36 nm). The inhibitory biofilm formation of S. mutans in saliva was significantly higher at concentrations of 12.5% and 6.25% at 24 h incubation times on a moderate scale, whereas the histatin-5 was effective to inhibit S. mutans biofilm on the 50 and 25 ppm. The saliva possessed a higher inhibitory of biofilm S. mutans than histatin-5 and good level viscosity (0.91-0.92 cP). Conclusion: The saliva was able to control the growth of S. mutans, and histatin-5 can inhibit the biofilm formation S. mutans. Furthermore, the saliva was also able to respond to the pH change with good viscosity of saliva.

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