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"ABSTRACTMultidiscipline care is defined as a care consisting of at least a physician, a nurse, and other healthcare worker (eg. dietician). Multidiscipline care has generated benefits, both in medical aspects (eg. increasing patients compliance) and nonmedical aspects (eg. more cost-effective than conventional treatment). There are several models of multidiscpline care; however, which model is more suitable for type 2 diabetes care is not clear yet. In this review, we aimed to identify and compare multidiscipline care method for reducing glycated hemoglobin ( HbA1C) levels in type 2 diabetes patients, particularly Asian patients because they have greater tendency to develop type 2 diabetes at lower degrees of obesity and at younger ages than Caucasian ethnic group. There were limited number of studies examining multidiscipline care for type 2 diabetes patients, moreover for Asian patients. They showed mixed results on the efficacy of multidiscipline care in achieving HbA1C target. Healthcare personnel visit, either personal or group session, appeared effective both for general and Asian T2DM patients. It needs further studies to clarify which models are most effective for practices of varying cultures, socio-economic condition, and healthcare settings."

"Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK.

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Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG."

"Diabetes Mellitus (DM ) merupakan salah satu masalah kesehatan yang terjadi pada masyarakat perkotaan akibat gaya hidup dan stressor. Berbagai komplikasi dapat muncul apabila kadar glukosa tidak dikontrol dengan baik akibat resistensi insulin. Komplikasi yang muncul, perubahan gaya hidup, dan terapi yang harus dijalani sepanjang hidup mengakibatkan terjadinya masalah psikososial keputusasaan. Tujuan penulisan ini adalah untuk melakukan analisis mengenai asuhan keperawatan psikososial keputusasaan pada kilen dengan DM tipe 2. Hasil menunjukkan bahwa kondisi psikososial keputusasaan mungkin menyebabkan ketidakstabilan glukosa darah dan masalah fisik akibat komplikasi DM tipe 2 juga mempengaruhi keadaan psikososial keputusasaan.

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Diabetes mellitus (DM) is the one of health problems in urban communities because their lifestyles and stressors. Various complications develop when glucose levels can not be controlled properly due to insulin resistance. Complications, lifestyle changes, and treatment can stimulate psychosocial problems including hopelessness. The purpose of this paper is to analyze the psychosocial nursing care about clients with hopelessness associated with DM type 2. The results show that hopelessness may induce unstable blood glucose level and physical problems as a result of complications of DM type 2."

"ABSTRAKBackground: periodontitis is a major cause of chronic infection in diabetic patients. Diabetic patients have four-fold risk of having cardiovascular disease. Chronic inflammation caused by periodontitis, a non-traditional cardiovascular risk factor is widely known to play a major role in atherogenesis. Among non-diabetics, an association has been found between periodontitis and arterial stiffness, but in diabetic patients the result is inconsistent. No study has investigated either the proportion of periodontitis or its correlation with arterial stiffness in type 2 diabetes population in Indonesia. Methods: this study was a cross-sectional study involving 97 patients with type 2 diabetics, who were recruited on Endocrinology Clinic from April to August 2017. Periodontitis was measured for pocket depth, clinical attachment loss and bleeding on probing by a periodontist. Carotid-femoral PWV (Pulse Wave Velocity) was measured using SphygmoCor Xcel with cuff-based tonometry technique. Results: periodontitis was found in 99% type 2 diabetic subjects and 78% of them had severe periodontitis. There was no significant correlation found between pocket depth, clinical attachment loss and cfPWV (r=0.024, p=0.407 and r=0.011, p=0.456); whereas there was a weak positive correlation between pocket depth and PWV (r=0.294, p=0.041) in well-controlled type 2 diabetics. Conclusion: most of type-2 diabetics had severe periodontitis; however, the correlation between periodontitis and arterial stiffness could not be concluded in this study."

"[ABSTRAKLatar Belakang: Penghitungan Estimated Blood Loss (EBL) berdasarkan rumus Allowable Blood Loss (ABL) dengan target hemoglobin tertentu, kerap dijadikan panduan untuk memutuskan secara cepat transfusi intraoperatif. Penghitungan EBL mengandalkan penilaian visual sulit untuk distandardisasi. Seiring perkembangan teknologi, Point of Care Testing (POCT) makin memudahkan pemeriksaan hemoglobin. Penelitian ini bertujuan membandingkan akurasi penghitungan hemoglobin intraoperatif antara EBL dan POCT, dibandingkan dengan Hematology Analyzer yang merupakan pengukuran baku di laboratorium. Metode: Penelitian ini menggunakan Uji Bland-Altman pada pengukuran hemoglobin intraoperatif terhadap pasien yang menjalani operasi elektif yang diperkirakan mengalami banyak perdarahan dan memerlukan transfusi, di Instalasi Bedah Pusat (IBP) RSUPN Cipto Mangunkusumo, antara Desember 2014 hingga Maret 2015. Subjek penelitian dipilih dengan metode consecutive sampling. Saat penghitungan EBL mencapai ABL dengan target Hb 7 g/dL sebelum transfusi diberikan, sampel darah diambil untuk pengukuran hemoglobin dengan Sysmex XE-2100® sebagai Hematology Analyzer dan HemoCue® Hb 201+ sebagai POCT. Hasil: Sebanyak 43 subjek diikutsertakan dalam penelitian. Uji Bland-Altman Hb ABL (7 g/dL) terhadap Hb Sysmex. Interval yang dianggap akurat terhadap kadar Hb 7 g/dL adalah -1 hingga 1, diperoleh limits of agreement yang besar yaitu -2,267 hingga 2,467. Uji Bland-Altman Hb HemoCue terhadap Hb Sysmex, diperoleh limits of agreement yang kecil yaitu -0.418 hingga 0.372. Simpulan: Terdapat perbedaan bermakna dalam akurasi penghitungan hemoglobin intraoperatif antara EBL dengan Hematology Analyzer, sedangkan pengukuran dengan HemoCue® Hb 201+ sebagai perangkat POCT, mempunyai keakuratan yang baik. EBL berdasarkan rumus ABL dengan target Hb 7 g/dL tidak bisa digunakan untuk pengambilan keputusan transfusi intraoperatif karena tidak mempunyai keakuratan yang baik.

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ABSTRACTBackground: Measurement of Estimated Blood Loss (EBL) based on the Allowable Blood Loss (ABL) formula with certain hemoglobin target is often used as a guidance to make a fast decision for intraoperative transfusion. Measurement of EBL relies on visual assessment is difficult to standardized and a new technique called Point of Care Testing (POCT) offered easier way to measure haemoglobin. This study aimed to compare the accuracy of the intraoperative hemoglobin measurement by EBL and POCT with Hematology Analyzer in the laboratory as a golden standard. Methods: This study used a Bland-Altman test on intraoperative hemoglobin measurement in patients undergoing elective surgery which was expected to experience a lot of bleeding and require blood transfusions in Center Operating Theater of Cipto Mangunkusumo Hospital from December 2014 until March 2015. Subjects were selected by consecutive sampling method. When EBL had reached ABL with a Hb level target 7 g / dL before transfusion was given, blood samples were taken for measurement of hemoglobin with Sysmex XE-2100® as Hematology Analyzer and HemoCue® Hb 201+ as POCT. Results: A total of 43 subjects were included in the study. Bland-Altman analysis of Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered as accurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to 2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealed narrow limits of agreement (-0418 to 0372). Conclusion: There was a significant difference in the accuracy of intraoperative hemoglobin measurement by EBL compared to Hematology Analyzer, while the measurement by POCT device had good accuracy. EBL based on the formula ABL with a Hb level target 7 g / dL could not be used for intraoperative transfusion decision making because it did not has good accuracy., Background: Measurement of Estimated Blood Loss (EBL) based on the formulaAllowable Blood Loss (ABL) with certain hemoglobin target, is often used as aguidance to make a quick decision for intraoperative transfusion. Measurement ofEBL relies on visual assessment cannot be standardized. As developingtechnology, Point of Care Testing (POCT) makes hemoglobin measurementeasier. This study aimed to compare the accuracy of the intraoperativehemoglobin measurement by EBL and POCT with Hematology Analyzer in thelaboratory as a golden standard.Methods: This study used a Bland-Altman test on intraoperative hemoglobinmeasurement in patients undergoing elective surgery that was expected toexperience a lot of bleeding and need transfusion in Center Operating Theater ofCipto Mangunkusumo Hospital from December 2014 until March 2015. Subjectswere selected by consecutive sampling method. When EBL had reached ABLwith a Hb level target 7 g / dL before transfusion was given, blood samples weretaken for measurement of hemoglobin with Sysmex XE-2100® as HematologyAnalyzer and HemoCue® Hb 201+ as POCT.Results: A total of 43 subjects were included in the study. Bland-Altman analysisof Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered asaccurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealednarrow limits of agreement (-0418 to 0372).Conclusion: There was a significant difference in the accuracy of intraoperativehemoglobin measurement by EBL compared to Hematology Analyzer, while themeasurement by POCT device had good accuracy. EBL based on the formulaABL with a Hb level target 7 g/dL could not be used for intraoperative transfusion decision making because it did not has good accuracy.]"

"DM tipe 2 memiliki pengaruh cukup besar terhadap seluruh aspek kehidupan klien serta memiliki risiko terjadinya berbagai komplikasi yang dapat mengancam jiwa. Self-care diyakini mampu mempertahankan dan meningkatkan status kesehatan klien DM serta mencegah terjadinya komplikasi. Selain perhatian dan kasih sayang klien DM juga membutuhkan informasi terkait penyakit DM dari lingkungan sekitarnya termasuk keluarga. Penelitian ini bertujuan untuk mengetahui hubungan dukungan informasi keluarga dengan self-care klien DM tipe 2 di Kelurahan Ambarketawang Yogyakarta. Desain penelitian menggunakan analitic correlation dengan pendekatan cross sectional. Pengumpulan data dilakukan dengan menggunakan kuesioner dukungan informasi keluarga dan self-care kepada 119 responden. Hasil menunjukkan bahwa dukungan informasi keluarga memiliki hubungan kuat dan positif dengan self-care klien DM tipe 2 p value: 0,000 . Peningkatan dukungan informasi keluarga dianjurkan guna meningkatkan status kesehatan klien DM.

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DM type 2 has a considerable influence on all aspects of a client 39 s life as well as having the risk of complications that can be life threatening. Self care is believed to be able to maintain and improve the health status of the DM client and prevent complications. DM client also requires information related to DM disease of the surrounding environment, including the family. This study aims to determine the relationship of the family with information support self care clients type 2 diabetes in Ambarketawang Yogyakarta. The study design using analytic correlation with cross sectional approach. The data collection was conducted using questionnaires family support and self care to 120 respondents. The results show that the support of family information has a strong and positive relationship with self care clients with type 2 diabetes p Value 0,000 . Improved the support of family information is recommended in order to improve the health status of the DM client."

"Menurut WHO, prevalensi anemia pada ibu hamil adalah 41,8%. Penanggulangan masalah anemia pada ibu hamil yaitu dengan pemberian tablet tambah darah sebanyak 90 tablet selama kehamilan. Kurangnya tenaga apoteker di puskesmas, menyebabkan konseling tidak dapat dilakukan. Penelitian ini bertujuan menilai pengaruh pemberian konseling dan leaflet terhadap peningkatan kepatuhan dan kadar hemoglobin ibu hamil dengan anemia di Puskesmas Cibungbulang dan Puskesmas Cileungsi Kabupaten Bogor tahun 2013. Desain penelitian yang digunakan adalah quasi eksperiment. Jumlah sampel 158 ibu hamil dengan anemia. Pengukuran kepatuhan dilakukan menggunakan kuesioner MMAS-8 (Morisky Medication Adherence Scale) dan kadar Hb dengan alat STAT-Site MHgb. Pengukuran pada kelompok konseling di Puskesmas Cibungbulang dan kelompok leaflet di Puskesmas Cileungsi Kabupaten Bogor. Analisis data dilakukan dengan uji Chi-square, uji Wilcoxon dan analisis regresi logistic bivariat. Hasil penelitian menunjukkan pengaruh pemberian konseling pada ibu hamil dengan anemia meningkatkan kepatuhan minum tablet tambah darah (p<0,05) dan kadar Hb (p<0,05). Pemberian leaflet pada ibu hamil dengan anemia meningkatkan kepatuhan minum tablet tambah darah (p<0,05) dan kadar Hb (p<0,05). Ibu hamil dengan anemia yang patuh minum tablet tambah darah kadar Hbnya meningkat sebesar 3,24 kali dibandingkan ibu yang tidak patuh minum tablet tambah darah. Ibu hamil dengan anemia yang makan makanan sumber heme setiap hari meningkatkan kadar Hb sebesar 2,31 kali dibandingkan yang tidak setiap hari makan makanan sumber heme.

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According to WHO, the prevalence of anemia in pregnant mothers is 41,8%. The treatment of anemia in pregnant mothers namely by giving iron tablet of 90 tablet during the pregnancy. The lack of pharmacists in primary care, resulting in the counseling can not be carried out. This research has a purpose to assess the effect of counseling and leaflet giving have influence to improve adherence and hemoglobin rate of pregnant mothers in primary care Cibungbulang and Cileungsi Bogor Regency in 2013. Research design applied is quasi experiment. Number of samples 158 pregnant mothers with anemia. The measurement of adherence was conducted by using MMAS-8 (Morisky Medication Adherence Scale) questionnaires and Hb rate with STAT-Site MHgb equipment. The measurements in group counseling at primary care Cibungbulang and group leaflet at primary care Cileungsi Bogor Regency. Data analysis was carried out with Chi-square test, Wilcoxon test and bivariate logistic regression analysis.

Results of this research suggest that influence of counseling giving to pregnant mothers with anemia increases adherence to take iron tablets (p<0,05) and Hb rate (p<0,05). Influence of leaflet giving to pregnant mothers with anemia increases adherence to take iron tablets (p<0,05) and Hb rate (p<0,05). Pregnant mothers with anemia who adhere to take iron tablet have their Hb rate improved 3,24 times compared to those who do not adhere to take iron tablet. Pregnant mothers with anemia who eat food source of heme every day have their Hb rate improved 2,31 times compared to those who do not eat food source of heme every day."

"Kepatuhan perawatan diri diabetes berdampak positif terhadap peningkatan outcome klinis. Hasil penelitian terdahulu pada penyandang diabetes melitus tipe 2 menunjukkan kepatuhan perawatan diri yang buruk. Inovasi teknologi dapat menjadi alternatif solusi dalam mengatasi masalah ini. Penelitian bertujuan mengetahui pengaruh aplikasi berbasis web terhadap perilaku kepatuhan perawatan diri pada pasien diabetes melitus tipe 2. Penelitian ini berdesain quasi eksperimental pre-posttest dengan kelompok kontrol. Partisipan direkrut di program prolanis di klinik dan persadia. Analisis data menggunakan komputerisasi pada 56 responden. Pada analisis bivariat, terdapat peningkatan skor kepatuhan pada kelompok intervensi di akhir penelitian yang tidak bermakna (p=0,649) dan terjadi penurunan skor kepatuhan yang tidak bermakna pada kelompok kontrol (p=0,490). Tidak ada pengaruh penggunaan aplikasi terhadap perilaku diabetes (p=0,433). Pada analisis multivariat, didapatkan hubungan yang signifikan antara tingkat pendidikan (p=0,007) terhadap skor kepatuhan posttest. Aplikasi peduli diabetes berpotensi meningkatkan skor kepatuhan perawatan diri. Perbaikan desain aplikasi diharapkan dapat meningkatkan efektivitas penggunaan aplikasi.

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Diabetes self-care adherence has a positive impact on improving clinical outcomes. Observations in people with type 2 diabetes mellitus show poor self-care adherence. Technological innovation can be an alternative solution to overcome this problem. The research aims to determine the effect of web-based applications on self-care adherence behavior in type 2 diabetes mellitus patients. This research has a quasi-experimental pre-posttest design with a control group. Participants were recruited in the prolanis program at the clinic and persadia. Data analysis used computerization on 56 respondents. In bivariate analysis, there was an increase in adherence scores in the intervention group at the end of the study which was not significant (p=0.649) and a decrease in adherence scores which was not significant in the control group (p=0.490). There was no effect of application use on diabetes behavior (p=0.433). In multivariate analysis, a significant relationship was found between education level (p=0.007) and posttest adherence scores. The Peduli Diabetes application has the potential to improve self-care adherence scores. Improvements in application design are expected to increase the effectiveness of application use."

"ABSTRAKDiabetes mellitus merupakan salah satu penyakit kronis yang saat ini sedangberkembang pesat di kota-kota besar, seperti Jakarta, akibat pengaruh pola hidupyang kurang sehat dan gerak yang kurang. Penyakit ini sangat membahayakankarena dapat mengakibatkan berbagai komplikasi kesehatan pada berbagai organtubuh. Untungnya, penderita diabetes dapat menghindari komplikasi-komplikasitersebut dengan mengikuti perawatan yang disarankan oleh dokter, termasukmengkonsumsi obat, melakukan diet yang ketat, olah raga yang rutin, danmemonitor kadar gula darah sendiri. Namun, banyak di antara penderita diabetesyang tidak mentaati saran-saran tersebut, dimana mereka secara sengajamengabaikan, lupa, atau salah mengerti saran yang diberikan dokter (DiMatteo,1991). Ketaatan dipengaruhi oleh berbagai faktor, yang dikelompokkan menjadifaktor penderita, faktor dokter, dan faktor penyakit.Berbagai penelitian telah dilakukan untuk lebih mengerti fenomena ini. Salah satucara mengerti ketaatan adalah dengan melihat penilaian penderita. Model yangtelah lama digunakan untuk menjelaskan tingkah laku kesehatan, dengan berfokuspada penilaian penderita adalah health belief model (HB M). Model ini terdiri dariempat persepsi yang mempengaruhi tingkah laku kesehatan penderita, yaituperceived susceptibilty (persepsi tentang kemungkinan dirinya mengembangkanmasalah kesehatan), perceived severity (persepsi akan keseriusan masalahkesehatan, termasuk konsekuensi dari masalah tersebut), perceived benefits(persepsi tentang keuntungan dari tingkah laku kesehatan yang dapat dilakukanuntuk mengatasi masalah kesehatan), dan perceived barriers (persepsi akankerugian dari tingkah laku kesehatan). Selain itu, terdapat sumber informasi (cuesto action) yang memberi isyarat bagi penderita untuk melakukan tindakantersebut, seperti dokter dan keluarga (Smet, 1994).Penelitian ini bertujuan untuk melihat ketaatan yang ada pada penderita diabetestipe dua, dari sudut health belief model. Penelitian ini melihat persepsi dan sumberinformasi apa yang mendorong penderita diabetes untuk mentaati saran-sarandokter. Penelitian dilakukan terhadap penderita yang berada pada kelompok usiapertengahan, karena pada usia inilah seseorang mempunyai resiko paling besaruntuk mengidap penyakit diabetes tipe dua (Sarafino, 1998).Penelitian ini melibatkan 78 penderita diabetes yang dapat dihubungi di beberapaRumah Sakit di Jakarta. Kepada masing-masing subyek diberikan dua buah alat ukur berupa kuesioner, yaitu alat ukur health belief model, dan alat ukur ketaatan.Alat ukur health belief model yang dipakai dalam penelitian ini, dibuatberdasarkan beberapa penelitian health belief model yang telah dilakukansebelumnya. Sedangkan, alat ukur ketaatan dimodifikasi berdasarkan alat yangdigunakan Kneck (2000) dalam penelitiannya. Untuk menjawab permasalahanpenelitian, dilakukan analisis terhadap data penelitian dengan menggunakan t testfor uncorrelated means.Hasil penelitian ini menunjukkan bahwa lebih banyak penderita diabetes yang taatdaripada yang tidak taat. Penderita diabetes terdorong untuk mentaati saran-sarandokter karena ia yakin bahwa komplikasi diabetes dapat menimbulkan berbagaikonsekuensi serius (perceived severity), dan karena yakin bahwa ia akanmendapatkan berbagai keuntungan dengan mentaati saran-saran dokter (perceivedbenefits). Selain itu, penelitian ini menunjukkan bahwa dokter, rumah sakit, danperkumpulan diabetes, merupakan sumber informasi yang memberi isyarat bagipenderita diabetes untuk mengikuti saran-saran tersebut guna menghindarikomplikasi kesehatan yang mungkin terjadi (cues to action).Untuk penelitian selanjutnya pada topik yang sama, disarankan agar melakukanpenyempurnaan terhadap alat ukur yang telah digunakan dalam penelitian ini.Pada alat ukur health belief model pada perceived benefits, dan perceived barriersdisarankan untuk melakukan elisitasi dan menambahkan item untuk meningkatkanvaliditas dan reliabilitas kedua bagian tersebut. Pengukuran ketaatan juga akanlebih baik jika dilakukan menggunakan alat ukur yang lebih detail, sehingga dapatlebih menggali ketaatan penderita diabetes yang sebenarnya. Selain itu, untukmemperkaya pengetahuan tentang ketaatan, penelitian lebih lanjut diharapkandapat meneliti hasil yang ditemukan berkaitan dengan gambaran umum subyek."

"ABSTRAKBackground: diabetic nephropathy (DN) is the leading cause of blood dialysis worldwide and a major etiology of End-Stage Renal Disease cases in Indonesia. Previous studies showed a relevant link between A1166C polymorphism of Angiotensin II Type-1 Receptor (AT1R) gene and glomerular hyper-filtration as a part of pathogenesis of DN. The aim of this study was to elaborate the association between A1166C AT1R polymorphism and susceptibility of individual with type-2 diabetes to DN in Malay Indonesian population. Methods: a case-control study of 120 consecutive patients with type-2 diabetes mellitus (40 patients in each groups for macro-albuminuria, micro-albuminuria, and normo-albuminuria) was conducted for A1166C AT1R gene polymorphism. The A1166C polymorphism of the AT1R gene was determined based on PCR/RFLP. Results: the mutant C allele was found in 5%, 13.75%, and 12.5% in normo-, micro-, and macro-albuminuria patients respectively. The heterozygote AC genotype was found significantly higher in micro-albuminuria, compared to normo-albuminuria group. Heterozygote AC genotype (OR 3.2 [1.01-10.08], p=0.03) and C allele (OR 2.8[0.95-8.67], p=0.038) were significantly higher in DN, indicating A1166C AT1R gene polymorphism as a risk factor for DN in Malay Indonesian population with type-2 diabetes. Conclusion: there was positive association between A1166C AT1R polymorphism and susceptibility of type-2 diabetics to DN in Malay Indonesian Population. It also indicated that the A1166C AT1R polymorphism could play a role in early pathogenesis of DN."