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"Penyakit TB masih merupakan masalah kesehatan di Indonesia, walaupun upaya pengendalian sudah dilakukan sejak jaman penjajahan. Evaluasi yang dilakukan selama ini masih merupakan evaluasi proses, maka kali ini peneliti menawarkan suatu evaluasi yang menyeluruh yaitu adanya cara pengukuran baru berupa variabel laten ( lingkungan, sarana prasarana, proses, target dan output) dengan tujuan hasil evaluasi ini untuk memberi masukan pada penentu kebijakan pengendalian TB di masa yang akan datang.Penelitian di lakukan dengan memakai gabungan data Rifaskes 2011 dan P2PL 2011.Metode yang dipakai adalah analisa data sekunder, serta penambahan data kualitatif dengan memakai penelitian sistem, serta metode pemodelan variabel dengan menggunakan analisa Struktural Equation Modeling. Hasil yang didapat adalah di perolehnya 4 model hasil evaluasi program pengendalian TB: Model nasional, model wilayah Sumatra, model Jawa Bali, model wilayah lainnya. Secara garis besar ada beberapa perbedaan kontribusi setiap hubungan variabel laten; pada model nasional kontribusi terbesar (1.sarana prasarana ke proses, 2. Target 1 dan CDR 3. proses ke target 2) pada hasil evaluasi Sumatra (1. sarana prasarana ke proses; 2. target 1 dan CDR 2. target 1 dengan CNR 3.lingkungan dan sarana prasarana) hasil evaluasi Jawa Bali (1.target 1 dan CNR 2.target 1 dengan CDR 3. Target 2 dan CR ) dan hasil evaluasi wilayah lainnya (1. target 1 dengan CNR 2. lingkung dan sarana prasarana 3. sarana prasarana ke proses).

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TB disease remains a health problem in Indonesia, despite the control measures already carried out since the colonial era. Evaluations were conducted for this is still an evaluation process, so this time offers researchers a comprehensive evaluation that is the way of new measures in the form of latent variables (environment, infrastructure, processes, targets and output) with the purpose of this evaluation to provide input on policy makers TB control in the future.

The experiment was conducted using a combination of data P2PL Rifaskes 2011 and 2011. The method used is the analysis of secondary data, as well as additional qualitative data using systems research, as well as variable modeling methods using Structural Equation Modeling analysis. The result is a model of evaluation results oBTAin it 4 TB control program: The national model, a model region of Sumatra, Java and Bali models, models of other regions. Broadly speaking, there are some differences in the contribution of each relationship latent variables; the largest contribution to the national model (1. infrastructure to process, targets 1 and CDR 3.target 1 to process) on evaluation of Sumatra (1. infrastructure to process; 2. target 1 and CDR 2. target of 1 to CNR. 3.the environment and infrastructure) on the evaluation of Java Bali (1.target 1 and CNR 2.target 1 with CDR 3. Target 2 and CR) and the results of evaluation of other areas (1.targets 1 with CNR 2. infrastructure with the environment and 3.infrastructure to process)."

"Salah satu sasaran pembangunan millenium adalah meningkatkan kesehatan ibu dengan target pada th 2015 menurunkan kematian maternal sebesar 75% antara th 1990-2015. Kematian maternal mencakup kematian wanita selama kehamilan, melahirkan dan selama 42 hari setelah melahirkan, masih merupakan masalah dan tantangan bagi kesehatan. Selain faktor obstetrik, kematian maternal juga disebabkan 3 faktor keterlambatan dan 4 terlalu yaitu muda, terlalu tua, terlalu sering dan terlalu rapat jarak melahirkan.Penelitian ini bertujuan mengidentifikasi secara diskriptif karakteristik kematian maternal dan mengidentifikasi faktor resiko kematian maternal, berdasarkan variabel utama penolong persalinan.Desain penelitian adalah kasus kontrol, analisis data dengan univariat, bivariat dengan uji Chi Square dan dan multivariat dengan uji regresi logistik ganda. Lokasi penelitian di Kabupaten Karawang dengan subyek penelitian sebanyak 324 responden terdiri dari 108 kasus kematian maternal dan 216 kontrol.Diperoleh hasil kematian maternal sebagian besar termasuk kelompok ibu umur resiko tinggi <20 th dan ≥ 35 th, dengan paritas 1kali, dan berpendidikan rendah.Faktor resiko yang berperan terhadap kematian maternal adalah ibu yang terlambat mengenal tanda bahaya dan mencari pertolongan mempunyai resiko kematian maternal 7,51 (CI 2,551-22,124), komplikasi kehamilan/persalinan resiko 5,59 (CI 2,634-11,148), Ibu yang terlambat mencapai fasilitas kesehatan mempunyai resiko kematian maternal 5,59 (CI 2,634-11,856), rujukan mempunyai resiko 3,12 (CI 1,330-7,344), umur ibu mempunyai resiko 2,33 (CI 1,185-4,603).Kematian maternal pada ibu yang penolong persalinan awal oleh non nakes tidak menunjukkan hubungan yang signifikan dengan kematian maternal.Berdasarkan hasil penelitian, disarankan kepada pengelola program untuk optimalisasi implementasi kebijakan yang telah ditetapkan pemerintah dalam menekan kematian maternal seperti program KB, preventif dengan Program P4K, serta intervensi pada faktor keterlambatan mengenal tanda bahaya/mencari pertolongan dan terlambat mencapai faskes, dengan mendekatkan akses ke faskes termasuk menjamin transportasinya, serta meningkatkan kualitas tenaga kesehatan.

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One of the millennium development goals is to improve maternal health by reducing the target three fourth of the maternal mortality between 1990-2015. Maternal mortality which includes deaths of women during pregnancy, childbirth and for 42 days after chilbirth, is still a problem and a challenge for health. In addition to obstetric factors, maternal mortality are also caused by 3 delays factors and 4 too much, too early or too late for giving birth,d and too frequent give birth and to many children. The objective of the study was to identify the descriptive characteristics of maternal mortality and identify risk factors of maternal mortality, and measure the probabilityof maternal mortalitybased on the main variables of the birth attendant.

The study design was a case-control study. We used Chi Square test for bivariate analysis and multiple logistic regression for multivariate analysis. The study was performed toward 324 respondents, consisted of 108 cases of maternal deaths and 216 controls in Karawang distric.

The result showed that maternal mortality mostly were in high risk groups of women aged <20 years and ≥ 35 years old, parity with 1 child or ≥ 4 and lower education. Other factors that had significant corelation with maternal mortality were mother who late in recognizing the danger , signs and late in seeking help with an OR = 7,51 (CI 2.551 - 22,124), women aged had an OR 2,33 (CI 1,185-4,603), complications of pregnancy/ childbirth had an OR 5,62 (CI 2,838-11,148), mothers who late in reaching health facilities had an OR= 5.58 (CI 2.624 - 11.856), refferal had an OR 3,12 (CI 1,330-7,344). Birthattendants by non health workers had no significant association with maternal mortality.

Based on our finding, it is suggested to optimize the implementation of policies that have been regulated by the government in suppressing the maternal mortality, such as family planning, preventif program P4K, as well as interventions in the delay factors which are recognizing danger signs/ seek help and not late reaching health facility with nearer access to facility including transportation, as well as improving the quality of health personnel."

"Kekurangan gizi pada awal kehidupan (1000 hari pertama) terutama masa prenatal akan memberikan multiple effect yang bersifat irreversible yaitu hambatan pertumbuhan linier yang direpresentasikan oleh pendek, pertumbuhan dan perkembangan organ termasuk pancreas yang direpresentasikan oleh diabetes mellitus dan tumbuh kembang otak yang direpresentasikan oleh kemampuan kognitif. Tingginya pendek pada populasi dewasa dan tingginya penyakit diabates mellitus di perkotaan berdasarkan survei Riskesdas 2007 mengindikasikan bahwa gangguan pertumbuhan linier dan perkembangan organ terjadi secara parallel.Tujuan penelitian ini adalah untuk menilai apakah pendek usia dewasa mewakili stunting awal kehidupan dalam menjelaskan risiko penyakit diabetes mellitus usia dewasa.Penelitian ini memanfaatkan data Riset Kesehatan Dasar 2007 dengan disain cross sectional yang mewakili daerah perkotaan di 33 propinsi di Indonesia. Subyek penelitian adalah 12.639 laki-laki dan perempuan berumur 20 - 49 tahun. Penyakit diabetes mellitus ditegakkan berdasarkan kadar gula darah puasa 2 jam post prandial sedangkan hambatan pertumbuhan linier awal kehidupan diukur dengan pencapaian tinggi badan (pendek) di usia dewasa.Analisis dilakukan 2 level yaitu : (1) melakukan uji bivariat, stratifikasi, multivariat pada kondisi saat ini (subyek dewasa). (2) Melakukan analisis risiko kekurangan gizi awal kehidupan terhadap penyakit diabetes mellitus menggunakan teori dan bukti ilmiah hasil penelitian sebelumnya. Data yang digunakan dalam analisis penelitian ini cukup memadai yang ditunjukkan dengan konsistensi antar variabel dan konsisten dengan hasil penelitian lain.Hasil penelitian menunjukkan bahwa proporsi diabetes mellitus sebesar 3,8% dan proporsi pendek sebesar 37,7%. Pendek usia dewasa pada IMT<23 merupakan faktor risiko penyakit diabetes mellitus OR adjusted 1,52 (CI 95% : 1.08-2.12). Bertambahnya umur meningkatkan risiko terkena penyakit diabetes mellitus dengan OR 3,05 (CI 95% : 1,82-5,09) pada umur 30-39 tahun dan OR 7,58 (CI 95% : 4,69-12,27) pada umur 40-49 tahun. Keluarga kaya mempunyai risiko lebih tinggi untuk menderita diabetes mellitus dengan OR 1.90 (CI 95% : 1.36-2.66). Minum minuman berkafein ≥1 x/hr dapat mencegah penyakit diabetes mellitus dengan OR 0,48 (CI 95% : 0,33-0,71).Kesimpulan penelitian ini adalah pendek usia dewasa pada kelompok IMT < 23 merupakan faktor risiko penyakit diabetes mellitus.

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Malnutrition in early life (1000 first day), especially during pregnancy would cause multiple effect which were irreversible, such as obstruction in linear growth were represented by short stature, growth and development of organs, including the pancreas represented by diabetes mellitus, and brain growth is represented by deficiency in cognitive abilities. The high prevalence of short stature in adult and the high prevalence of diabetes mellitus disease in urban population based on Riskesdas 2007 survey data indicated that disruption of linear growth and organ development occured in parallel.The purpose of this study was to assess whether short stature in adulthood represent stunting in their early life, in order to explain the risk of diabetes mellitus in adult. This study was utilized data from Indonesian Basic Health Research 2007 with a cross-sectional design representing urban areas in 33 provinces in Indonesia. Subjects were 12,639 men and women aged 20-49 years. Diabetes mellitus was diagnosed based on fasting blood glucose levels, 2 hours post prandial, while linear growth retardation in early life is measured by the attainment of height (short stature) in adulthood. Analysis was done in 2 levels:(1) Worked on bivariate, stratified, multivariate testing on current conditions (adult subjects). (2) Performed a risk analysis of malnutrition in early life towards diabetes mellitus disease using theories and scientific evidence based on previous researches. The data used in this analysis were sufficient, indicated by consistency between variables and consistency with the results of other related studies.Results of this study showed that the proportion of diabetes mellitus was 3.8% and the proportion of short stature was 37.7%. Short stature in adults with BMI <23 was a risk factor for diabetes mellitus with adjusted OR of 1.52 (CI 95%: 1:08-2:12). Increasing age increased the risk of diabetes mellitus with 3.05 OR (95% CI: 1.82 to 5.09) at the age 30-39 years and 7.58 OR (95% CI: 4.69 to 12.27) at the age of 40-49 years. Wealthier families have a higher risk of developing diabetes mellitus with OR 1.90 (95% CI: 1.36-.66). Drinking caffeinated beverages ≥1 x / day could prevent diabetes mellitus with OR 0.48 (95% CI: 0.33 to 0.71).Conclusion of this study was short stature in adult with BMI <23 was a risk factor for diabetes mellitus."

"Masa 1000 hari pertama kehidupan terutama pada masa prenatal merupakan masa terjadinya perkembangan sel-sel otak, pertumbuhan linier, dan pembentukan organ yang terjadi secara paralel dan berlanjut sampai umur 2 tahun. Akibat jangka panjang dapat menurunkan fungsi kognitif, risiko stunting, dan risiko menderita penyakit kronis, seperti hipertensi. Bukti beberapa penelitian menunjukkan gangguan pertumbuhan pada masa prenatal memberikan retained effect pada periode umur selanjutnya yaitu sejak bayi sampai dewasa, sehingga pada penelitian ini menggunakan tinggi badan usia dewasa sebagai indikator proxy untuk memprediksi adanya gangguan pertumbuhan pada masa dini kehidupan. Di Indonesia, ada indikasi tingginya prevalensi stunting pada anak balita, anak usia sekolah dan usia dewasa berkaitan dengan tingginya prevalensi hipertensi, termasuk pada kelompok miskin.Tujuan penelitian ini ingin membuktikan apakah tinggi badan dewasa dapat digunakan sebagai indikator proxy adanya gangguan pertumbuhan pada masa dini kehidupan dan paralel dengan kejadian hipertensi di Indonesia. Penelitian ini menggunakan data Riskesdas, 2007 dengan desain kros-seksional melibatkan 481.489 subyek, umur 20-60 tahun, menggunakan alat pengukur tekanan darah digital omron A2 dan alat ukur tinggi badan microtoise dengan ketelitian 0,1 cm yang dilakukan oleh tenaga kesehatan terlatih. Hasil penelitian tidak terbukti ada hubungan antara tinggi badan dengan hipertensi dengan OR= 0,981 (95% CI: 0,955-1,008) setelah dikontrol oleh faktor konfounding potensial seperti umur, kegemukan, obesitas sentral, dan lama merokok. Oleh karena itu, tinggi badan dewasa di Indonesia tidak dapat digunakan untuk memprediksi risiko hipertensi. Perlu penelitian lebih lanjut dengan desain kohor untuk membuktikan apakah tingginya masalah gangguan pertumbuhan di Indonesia yang ditunjukkan dengan tingginya prevalensi stunting terjadi secara paralel dengan peningkatan risiko hipertensi.

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The first period of 1000 days, especially during prenatal life is a period of the development of brain cells, linear growth, and organ formation occurs in parallel and continued until the age of 2 years. Long-term consequences can decrease cognitive function, risk of stunting, and the risk of chronic diseases, such as hypertension. Evidence showed some growth retardation during prenatal give effect retained in subsequent age period, since the period of infancy to adult so in this study using a high body adult age as a proxy indicator for predicting growth retardation in the early life. In Indonesia, there is an indication of the high prevalence of stunting in children under five, children of school age and adulthood is associated with high prevalence of hypertension, including in the poor.The purpose of this study to prove whether adult height can be used as a proxy indicator of growth retardation during the early and parallel to the incidence of hypertension in Indonesia. This study uses data Riskesdas, 2007 with crosssectional design, involving 481.489 subjects, aged between 20-60 years, using a digital blood pressure meter omron A2 and using microtoise the nearest 0.1 cm to measure adult height by trained health personnel. The results showed that short stature was not associated with hypertension with OR= 0,981 (95% CI: 0,955-1,008) after potential konfounding controlled by factors such as obesity, central obesity, and age. Therefore, adult height in Indonesia can not be used as a proxy indicator of the risk of hypertension. Need further research to design kohor to prove whether high growth retardation in Indonesia as shown by the high prevalence of stunting occurs in parallel with an increased risk of hypertension."

"ABSTRAKLatar belakang: Sindrom nefrotik idiopatik (SNI) relaps anak terjadi karena ketidakseimbangan sel T-helper dan sel T-regulator. Perubahan komposisi bakteri usus besar dapat menyebabkan gangguan integritas usus, responsi imun, mungkin berperan terhadap relaps pada SNI.Tujuan: Untuk mengetahui jenis dan komposisi bakteri usus besar pada SNI remisi dan relaps, hubungan jenis dan komposisi bakteri usus besar dengan IL-8 serum SNI relaps, gangguan integritas usus besar pada SNI relaps.Metode: Penelitian prospektif di Departemen Ilmu Kesehatan Anak, FKUI- RSCM. Penelitian dua tahap yaitu SNI remisi yang diikuti sampai relaps. Diperiksa komposisi bakteri Enterococcus, Bacteroides, Escherichia, Clostridium, Lactobacillus, dan Bifidobacterium usus besar, alpha-1 antitrypsin dan calprotectin feses, IL-8 serum.Hasil: Terdapat 49 subjek yang relaps berumur 2?12 tahun. Proporsi Enterococcus, Bacteroides, Escherichia, Clostridium lebih tinggi pada SNI relaps daripada SNI remisi. Proporsi Bifidobacterium lebih tinggi pada SNI remisi daripada SNI relaps. Terdapat peningkatan alpha-1 antitrypsin pada 51% SNI remisi dan 48% SNI relaps, serta peningkatan calprotectin pada 91.8% SNI remisi dan 95.9% SNI relaps. Median IL-8 serum lebih tinggi pada SNI relaps (13.2 pg/mL) dibandingkan SNI remisi (11.8 pg/mL).Simpulan: Proporsi bakteri menguntungkan Bifidobacterium lebih tinggi pada SNI remisi dibandingkan SNI relaps. Proporsi bakteri patogen lebih tinggi pada SNI relaps dibandingkan dengan SNI remisi. Tidak terdapat hubungan antara jenis dan komposisi bakteri usus besar dengan peningkatan kadar IL-8 serum pada SNI relaps. Pada SNI relaps terdapat gangguan integritas usus besar.

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ABSTRACT

Backgound: Relapses in idiopathic nephrotic syndrome (INS) may occur due to imbalance of T-helper and regulator T-cells. Alteration of colonic bacteria composition may cause a defect in colonic mucosal integrity and activate the immune system, leading to INS relapse. The aim of this study are to determine the composition of gut bacteria in INS remission and relapse, serum IL-8 in INS relapse, and defective bowel integrity INS relapse.

Methods: This prospective study on children with INS was conducted in two phases, starting in remission and followed up to relapse. Both during remission and during relapse, we collected stool samples from all subjects to examine intestinal bacteria composition comprising Enterococci, Bacteroides, Escherichiae, Clostridia, Lactobacilli, and Bifidobacteria, fecal alpha-1 antitrypsin, and fecal calprotectin. We also collected peripheral blood to measure serum IL-8 levels during remission and relapse.

Results: The proportions of pathogenic bacteria Enteroccocus, Bacteroides, Escherichia, and Clostridium were higher in INS relapse compared to remission. The proportion of the beneficial Bifidobacteria was statistically higher in INS remission compared to relapse. There was an increase of alpha-1 antitrypsin in 51% of INS in remission and 48% in relapse. Fecal calprotectin was increased in 91.8% of INS in remission and 95.9% in relapse. Median serum IL-8 in INS relapse (13.2 pg/mL) was higher than in remission (11.8 pg/mL).

Conclusions: The proportion of Bifidobacteria is higher in INS remission than in relapse, while the proportion of pathogenic bacteria is higher in relapse than in remission. There is no association between the composition of gut bacteria with serum IL-8 increase in relapsing INS. There is a defect in mucosal integrity in relapsing INS as demonstrated by elevated fecal alpha-1-antitrypsin and calprotectin."