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"Pendapat ahli yang disampaikan dalam proses hukum harus dapat dipertanggungjawabkan secara ilmiah, yang dikenal dengan evidence-based practice (EBP). Dalam kedokteran forensik, EBP belum diterapkan secara eksplisit, termasuk di Indonesia. Salah satu pendekatan potensial untuk merumuskan pendapat ahli berbasis bukti disebut dengan INFERENCE (INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements). Selain itu, belum ada pedoman universal untuk membuat laporan patologi forensik. Salah satu pedoman yang potensial bernama PERFORM-P (Principles of evidence-based Reporting in FORensic Medicine-Pathology version). Penelitian ini menggunakan metode campuran (mixed-methods) melalui lima tahapan yang saling terkait yaitu (1) survei potong lintang untuk mengetahui karakteristik dokter forensik Indonesia dan praktiknya saat ini, (2) proses adaptasi dan validasi kedua alat tersebut melalui review oleh Kolegium Ilmu Kedokteran Forensik Indonesia, (3) studi pre-post intervention satu kelompok untuk menilai validitas dan reliabilitas pendapat ahli kedokteran forensik yang diformulasikan menggunakan i-INFERENCE (Indonesian-INFERENCE) dan dilaporkan menggunakan i-PERFORM-P (Indonesian-PERFORM-P), (4) studi kasus analitik menggunakan i-INFERENCE, dan (5) diskusi kelompok terfokus untuk mengeksplorasi kepuasan pelanggan terhadap i-INFERENCE dan i-PERFORM-P. Seluruh penelitian ini dilaksanakan di Jakarta (secara luring dan daring) sejak bulan Desember 2017 sampai Juli 2022. i-INFERENCE dan i-PERFORM-P dapat meningkatkan validitas pendapat ahli kedokteran forensik. Kedua alat tersebut berpotensi untuk digunakan dalam setting Indonesia dengan beberapa tambahan/klarifikasi dalam pedoman pengguna. Keduanya juga mendapat sambutan yang umumnya positif, baik dari pengguna potensial (dokter forensik Indonesia) maupun oleh konsumen (jaksa dan hakim) meskipun diperlukan upaya lebih dalam menggunakannya. Peserta membayangkan bahwa kedua alat tersebut akan sangat berguna dalam kasus yang rumit. Dengan adanya i-INFERENCE dan i-PERFORM-P dokter forensik Indonesia diharapkan lebih siap dalam menganalisis dan melaporkan kasus yang kompleks, serta implementasi EBP dapat ditingkatkan.

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Expert opinions presented in legal proceedings should be scientifically accountable, which is known as evidence-based practice (EBP). In forensic medicine, EBP has not been explicitly applied, including in Indonesia. One potential approach to formulate evidence-based expert opinions is called INFERENCE (INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements). Additionally, there is also no universal guideline for making forensic pathological reports. One prospective guideline is the PERFORM-P (Principles of Evidencebased Reporting in FORensic Medicine-Pathology version). This study uses a mixed-method through five interrelated phases, i.e., (1) a cross-sectional survey to determine the characteristics of Indonesian forensic doctors and their current practice, (2) the adaptation and validation process of the two tools through a review by the Indonesian College of Forensic Medicine, (3) a one-group pre-post intervention study to assess the validity and reliability of forensic medical expert opinions formulated using i-INFERENCE (Indonesian-INFERENCE) and reported using i-PERFORM-P (Indonesian-PERFORM-P), (4) an analytic case study using i-INFERENCE, and (5) a focused group discussion to explore customer satisfaction towards i-INFERENCE and i-PERFORM-P. This study was conducted in Jakarta (online and offline) from December 2017 until July 2022. i-INFERENCE and iPERFORM-P can increase the validity of forensic medical expert opinions. Both tools can potentially be used in the Indonesian setting with some additions/clarifications in the user manuals. They also received a generally positive reception, both by potensial user (Indonesian forensic medical doctors) and by consumers (public prosecutors and judges) albeit the extra effort that is needed in using them. Participants envision that both tools will be most useful in complex cases. By obtaining the i-INFERENCE and the i-PERFORM-P, Indonesian forensic medical doctors are better equipped in analyzing and reporting complex cases, and the implementation of EBP can be improved."

"The process of economic development and industrialization has historically involved fundamental changes in the social and economic organization of populations. These changes are taking place today in Indonesia, and tire effects are dramatic-infectiuts disease rates are declining, population size is increasing. and the population is growing older. Additionally, the many lifestyle changes we associate with development will also mean the rates of chronic disease will likely increase. Changing consumption patterns are the primary culprits for this transition. increased tobacco see will cause significant increases in heart disease rates, lung cancer and many Other cancers. The dietary transition towards a high fat, low fiber, high animal-food based diet that typically accompanies development will also matte a significant contribution to the increased of chronic disease. The costs of tire epidemologic transition ore many. The epidemologic transition will mean a great loss of life and many of the deaths will be premature (i.e during the otherwise productive years of life). Tire direct cost of treatment for the sick will be very large. Additionally. it is not clear that tire agriculture sector 's response to increased demand for livestock based foods will be an environmentally or economically sustainable proposition for indonesia."

"Buku ini dapat digunakan sebagai bahan bacaan bagi penelitidi bidang pangan, gizi dan kesehatan. Buku ini membahas latar belakang, sejarah, pengertian dan perkembangan epidemiologi gizi, pangan dan zat gizi, metode penilaian konsumsi pangan individu, indikator biokimia asupan zat gizi, desain penelitian epidemiologi gizi, penelitian potong-lintang, penelitian kasus-kontrol, penelitian kohort, penelitian eksperimental, kajian ekologis dan survei gangguan gizi."

"Kekurangan Energi Protein (KEP) pada balita masih merupakan masalah kesehatan di Indonesia. Seperti diketahui bahwa masalah gizi kurang akan berdampak pada penurunan intelegensia dan produktifitas dan pada akhirnya akan berdampak pada rendahnya tingkat intelektualitas bangsa dan menurunnya kualitas sumberdaya manusia sehingga dikhawatirkan bangsa Indonesia tidak dapat bersaing dengan bangsa lain di era globalisasi. Dengan memperhatikan masalah gizi kurang yang dihadapi dewasa ini, pemerintah dan masyarakat perlu meningkatkan kewaspadaan dan upaya penanggulangannya.Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap status gizi balita dan memprediksi faktor yang paling berperan terhadap kejadian status gizi kurang pada balita di pedesaan Jawa Tengah tahun 2002. Penelitian ini menggunakan data sekunder yaitu hasil survei Helen Keller lnternasional (HKI) bekerjasama dengan Dinas Kesehatan Propinsi Jawa Tengah. Disain penelitian adalah cross sectional. Populasi adalah seluruh anak balita (umur 0-60 bulan) di wilayah pedesaan Jawa Tengah. Metode pengambilan sampel adalah multistage cluster. Dari sebanyak 8110 balita yang ada pada data sekunder, berdasarkan kriteria inklusi dan eksklusi yang sudah ditetapkan maka didapatkan sebanyak 7582 balita yang memenuhi kriteria untuk dianalisis. Status gizi balita diukur dengan pengukuran antropornetni menggunakan indeks BB/U dan disajikan dalam Z skor. Analisis data meliputi univariat, bivariat (Pearson Chi Square dan regresi logistik sederhana) dan analisis multivariat (pemodelan dengan regresi logistik multivariat).Hasil penelitian menunjukkan terdapat masalah gizi kurang di Jawa Tengah, khususnya pada balita dengan prevalensi gizi kurang (Z skor < -2 SD) sebesar 31,3 % dimana 4,6 % diantaranya adalah gizi buruk. Hasil analisis multivariat ada 6 faktor yang berpengaruh terhadap status gizi balita adalah umur anak, penyakit infeksi, status gizi ibu, pendidikan bapak, pendidikan ibu, nomor urut lahir anak, dimana masing-masing mempunyai peranan yang spesifik dalam mempengaruhi status gizi. Pengaruh penyakit infeksi pada balita terhadap status gizi berkaitan dengan keadaan sanitasi. lingkungan keluarga yang kurang baik. Faktor yang dominan dalam mempengaruhi status gizi balita adalah umur balita kemudian status gizi ibu, kemudian pendidikan ibu, pendidikan bapak, nomor urut lahir anak dan penyakit infeksi. Model regresi logistik yang terbentuk cukup mantap untuk memprediksi karena hampir 70 % variabel yang ada dalam model dapat menerangkan kondisi status gizi. Hasil ini diharapkan dapat dipakai oleh penentu kebijakan dalam penanggulangan masalah gizi kurang pada balita.Dari hasil penelitian ini disarankan kepada pengelola program dan lintas sektor di tingkat kabupaten/kota dan propinsi, perlu menekankan prioritas penanggulangan masalah gizi kurang pada balita umur 6-23 bulan. Perlu dilakukan peningkatan status gizi ibu khususnya pada keluarga balita dengan sosial ekonomi rendah, melalui program pemberdayaan masyarakat, yaitu program pelatihan .khususnya kepada ibu-ibu untuk meningkatkan pengelolaan sumberdaya rumah tangga Perlu dilakukan pemberdayaan ekonomi keluarga melalui program pemberian paket produktif (sistem bergulir) pengembangan usaha ekonomi produktif sesuai dengan potensi masing-masing daerah. Untuk mengatasi adanya penyakit infeksi pada anak maka perlu penyuluhan tentang sanitasi lingkungan keluarga.Daftar Pustaka: 82 (1982-2004)

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Protein-energy malnutrition of children under five year is still health problem in Indonesia. Like we know that malnutrition will impacts - decreased intelegentia and productivity and so will impact to decreased level of nation intellectuality and decreased human resources and is apprehensived Indonesia nation can not competed with others nation in era globalization. With attention to malnutrition who was attended this time, government and community be needed increased vigilance and efforts to tackling.

The purpose of this study is to examine influence factors of nutritional status underfive children and predicted factors was most role in case malnutrition of underfive children in rural Central Java, year of 2002. This study was use secondary data from result survey of Helen Keller International joint with Office of Health Central Java Province. Study designed was cross sectional. The population was underfive children (0-60 years) in rural Central Java. Sampling methods was multistage cluster. From 8110 underfive children in secondary data, with inclusion and exclusion criteria was has been definited, so be obtained 7582 underfive children was fulfill criteria for analyzed. Nutritional status was measured with anthropometric, and weight-for-age index and was asserted with Z-score. Data analysis with univariate, bivariate (Pearson Chi Square and Logistic Regression) and multivariate (Multivariate Logistic Regression Model).

The result of study show there was malnutrition problem in Central Java, especially of underfive children with prevalence of malnutrition (Z-score < -2 SD) are 31,3 %, where 4,6 % of them is severe malnutrition. The result of multivariate analysis was there are 6 factors influenced nutritional status underfive children was children age, infection, mother nutritional status, father education, mother education, number of birth child there were each others have specific role in influenced nutritional status. Role of infection to nutritional status associated with family environment sanitation that less good. Dominant factors influenced nutritional status underfive children was children age then mother nutritional status, mother education, father education, number of birth child and infection. Logistic Regression Models that was resulted enough steady to predict because almost 70 % variable in model can explain condition of nutritional status. This result was hope can applied by provider in tackling malnutrition problem in underfive children.

The study recommended to organizer of program and cross sector in district level and province level, necessary emphasize priority tackling malnutrition problem of children age 6-23 month. Be needed to increasing mother nutritional status especially to family with low social economic, by means of community empowerment program, that is trained program especially to mother for increasing organizing family resources. Necessary to empower family economic by means of distribution productive package (turned system) effort extended productive economic appropriate with potential in each district. To tackling infection in children be needed to conducting communication about family environment sanitation.

Bibliography: 82 (1982-2004)"

"Latar Belakang: Kolestasis adalah hambatan atau supresi sekresi empedu. Kolelitiasis dan obstruksi bilier akibat keganasan merupakan kasus kolestasis yang sering ditemui. Kolestasis dapat menyebabkan gangguan nutrisi dan berbagai komplikasi. Selain pembedahan, terapi nutrisi adalah pendekatan tata laksana pada pasien kolestasis untuk mempertahankan status nutrisi dan kapasitas fungsional. Kasus: Pasien dalam serial kasus ini terdiri atas tiga pasien laki-laki dan satu perempuan, berusia 36-55 tahun dengan diagnosis kolestasis akibat keganasan dan postcholecystectomy syndrome (PCS) dengan riwayat kolelitiasis. Satu pasien dengan keganasan dan dua pasien dengan PCS menjalani operasi bypass biliodigestif dan rekonstruksi, sedangkan satu pasien menjalani perbaikan kondisi klinis sebelum pembedahan. Terapi nutrisi yang diberikan meliputi diet tinggi protein dan rendah lemak dengan nutrien spesifik berupa MCT dan BCAA. Pada kasus pertama terapi nutrisi diberikan pascabedah. Selama perawatan ada kecurigaan leakage anastomosis, tetapi keluaran klinis membaik. Pasien kedua mendapat terapi nutrisi prabedah dan mengalami perbaikan kondisi klinis. Kedua pasien tidak mencapai target nutrisi walaupun toleransi makanan cair baik. Kasus ketiga dan keempat mendapat terapi nutrisi pra dan pascabedah dan pada akhir masa pemantauan, dapat mempertahankan status nutrisi. Pada keempat pasien, kapasitas fungsional dapat dipertahankan, bahkan mengalami perbaikan.Kesimpulan: Terapi nutrisi yang optimal dapat memberikan keluaran klinis yang baik pada pasien kolestasis. Pemberian nutrien spesifik berupa MCT dan BCAA diperlukan untuk meningkatkan toleransi asupan, mempertahankan status nutrisi, dan memperbaiki kapasitas fungsional pasien kolestasis.

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Background: Cholestatis is obstruction or suppression of bile secretion. Cholestasis may cause nutritional disturbance and other complication. Besides surgery, nutritional therapy is needed in cholestasis patient for maintaining nutritional status and functional capacity.

Cases: Four cases (three male and one female) of cholestasis with range of age between 36-55 years old are included in this case series. They were diagnosed with cholestasis because of cancer and post-cholecystectomy syndrome (PCS) with cholelithiasis history. One patient with cancer and two patients with PCS had the biliodigestive bypass surgery and reconstruction, while one patient was restoring her clinical condition before surgery. All patients were given high protein and low fat diet, with specific nutrient such as MCT and BCAA. The first patient received nutrition therapy during postoperative phase. During monitoring, he was suspected with leakage anastomosis, but in the end the outcome was good. Second patient got nutritional therapy in preoperative phase and got better clinical condition. Both patients couldnt reach the nutritional target although their tolerance of ONS was good. The third and the fourth patient got nutritional therapy in pre and postoperative phase and had maintained their nutritional status. In all patients, the functional capacity could be maintained and improved.

Conclusion: Optimal nutritional therapy is needed in cholestasis patients to get better clinical outcomes. Specific nutrients such as MCT and BCAA improve the nutritional tolerance, maintain the nutritional status, and improve the functional capacity."