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"ABSTRAKTingginya angka insidens TB MDR di Indonesia, dibarengi dengan tingginya tingkatLost to Follow-up LTFU pada pengobatan pasien TB MDR. Pasien TB resisten obatmemiliki kemungkinan LTFU lebih besar dibandingkan pasien TB sensitif obatdikarenakan durasi pengobatan yang lebih lama. Selain itu, pasien TB MDR yang tidakmelanjutkan pengobatannya sampai tuntas memiliki peningkatan risiko kematian akibatTB. Studi ini bertujuan untuk mengetahui pengaruh rujuk balik dan tipe pasien terhadapkejadian LTFU pada pasien Multidrug-Resistant Tuberculosis TB MDR di Indonesia.Studi dilakukan pada Mei-Juni 2018 di Subdit TB ndash; Direktorat P2PML, Ditjen P2PKementerian Kesehatan RI. Desain studi yang digunakan adalah desain studi kohortretrospektif. Jumlah sampel pada studi ini adalah 961 pasien. Sampel diambil secaratotal sampling. Berdasarkan status rujuk baliknya, 86,3 pasien dilakukan rujuk balikdan 13,97 pasien tidak dirujuk balik. Berdasarkan kategori tipe pasien, 35,17 kasuskambuh, 5,52 pasien baru, 13,94 pasien pernah LTFU, 23,10 kasus gagalpengobatan kategori 1, 20,29 kasus gagal pengobatan kategori 2, 1,9 lain-lain pasien tidak diketahui riwayat pengobatan TB sebelumnya . Dari studi ini, diketahuibahwa proporsi kejadian LTFU sebesar 28,40 dengan kumulatif hazard LTFU sebesarsebesar 1,12 selama 39 bulan pengamatan, sehingga didapatkan hazard rate sebesar2,88/100 orang-bulan. Hasil analisis multivariabel dengan regresi cox time-dependentmenunjukkan bahwa rujuk balik menurunkan peluang terjadinya LTFU sebesar 46 HR 0,54; 95 CI 0,35-0,84 pada kondisi variabel tipe pasien dan umur sama adjusted . Untuk tipe pasien, tipe pernah LTFU, gagal pengobatan kategori 2 dan tidakdiketahui riwayat pengobatan TB sebelumnya meningkatkan peluang terjadinya LTFUmasing-masing sebesar 50 HR 2,02; 95 CI 1,18-3,45 , 53 HR 2,13; 95 CI1,240-3,66 , dan 74 HR 3,80; 95 CI 1,54-9,36 dibandingkan dengan tipe pasienkambuh baseline pada kondisi variabel rujuk balik, jenis kelamin, dan umur sama adjusted . Pada laki-laki, efek tipe gagal pengobatan kategori 2 lebih rendah 0,26 kalidibandingkan dengan pasien wanita dengan tipe gagal pengobatan kategori 2. Petugaskesehatan perlu meluangkan waktu yang lebih banyak untuk memberikan komunikasi,informasi, dan edukasi mengenai pengobatan TB serta mengenai manfaat rujuk balikkepada pasien TB MDR. Risiko LTFU meningkat pada pasien yang bertipe pernahLTFU, gagal pengobatan kategori 2, dan tidak diketahui riwayat pengobatan TBsebelumnya dibandingkan pasien dengan tipe kambuh, karena tipe kambuh sudah terujikepatuhannya terhadap pengobatan sebelumnya. Perlunya skrinning tipe pasien denganbaik untuk mengidentifikasi risiko LTFU berdasarkan tipe pasien sejak awal pasienmemulai pengobatan.Kata kunci: LTFU, rujuk balik, tipe pasien, TB MDR

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ABSTRACTThe high incidence rate of MDR TB in Indonesia is accompanied by high rate of lost tofollow up LTFU in the treatment of MDR TB patients. Drug resistant TB patients havea greater risk of LTFU than drug sensitive TB patients due to longer treatmentduration. In addition, MDR TB patients who did not continue treatment completely hadan increased risk of dying from TB. The aims of this study were to determine thedecentralization influence and patient type on the incidence of LTFU in Multidrug Resistant Tuberculosis MDR TB patients in Indonesia. This study was conducted inMay June 2018 at Subdirectorate of TB Directorate of Prevention and CommunicableDisease Control, Directorate General of Prevention and Disease Control Ministry ofHealth of the Republic of Indonesia. The study design was retrospective cohort. Thenumber of samples in this study was 961 patients. Samples were taken in total sampling.Based on the decentralization status, 86.3 of patients were decentralized. Based onthe type of patient category, 35.17 of relapse, 5.52 of new, 13.94 of after LTFU,23.10 of failure category 1, 20.29 of failure category 2, 1.9 of other patients unknown history of previous TB treatment . The proportion of incidence of LTFU is28.40 with cumulative hazard of LTFU equal to 1.12 during 39 months ofobservation, so hazard rate is 2.88 100 person month. In multivariable analysis withcox regression time dependent revealed that decentralization reduced the probability ofLTFU up to 46 HR 0.54, 95 CI 0.35 0.84 after controlled by type of patient andage. For patient type, treatment after LTFU, failure category 2 and unknown history ofprevious TB treatment increased the probability of LTFU by 50 HR 2,02 95 CI1,18 3,45 , 53 HR 2,13 95 CI 1,240 3,66 , and 74 HR 3,80 95 CI 1,54 9,36 consecutively compared with the type of relapse patients baseline after controlled bythe decentralization, gender, and age. In male patients with failure treatment category2, the effect was 0.26 times lower compared with failure category 2 in female patients.Health workers need to spend more time in communicating, informing and educatingabout TB treatment and the benefits of decentralization to MDR TB patients. The risk ofLTFU increased in type of patient after LTFU, treatment failure category 2, andunknown history of previous TB treatment compared with patients with relapse types.The need for good patient type screening to identify the risk of LTFU by type of patientfrom the initial of treatment.Keywords LTFU, decentralization, type of patient, MDR TB"

"Pengobatan TB MDR yang berlangsung lama menimbulkan isolasi sosial, kehilangan pekerjaan, efek sosioekonomi dan psikologis jangka panjang pada pasien. Faktor individu, sosial budaya dan lingkungan serta kemungkinan efek samping psikiatri menjadikan pasien TB MDR cenderung mengalami gejala depresi. Depresi dapat mempengaruhi kualitas hidup. Penelitian ini menilai perubahan status depresi dan hubungannya dengan kualitas hidup pasien TB MDR. MetodePenelitian ini menggunakan metode kohort observasional di Poliklinik TB MDR RSUP Persahabatan. Dua puluh sembilan subjek TB MDR dinilai status depresi dan kualitas hidupnya dengan kuesioner Beck Depression Inventory BDI dan WHOQOL BREF sebelum dan setelah 6 bulan pengobatan TB MDR. HasilProporsi pasien depresi sebelum pengobatan sebesar 75,9 22 subjek . Setelah 6 bulan pengobatan TB MDR, 13 orang skor BDInya menurun, 9 orang meningkat dan terdapat 4 orang yang sebelumnya tidak depresi mengalami depresi. Skor WHOQOL BREF mengalami peningkatan pada ranah fisis, psikologis dan peningkatan bermakna pada ranah lingkungan. Pada ranah sosial, skor kualitas hidup mengalami penurunan. Tidak didapatkan hubungan bermakna antara perubahan status depresi dan kualitas hidup. Keterkaitan antara faktor usia, jenis kelamin, tingkat pendidikan, status ekonomi, lama sakit TB dan atau TB MDR serta beratnya merokok dengan depresi tidak dapat dibuktikan pada penelitian ini. KesimpulanSebanyak 22 subjek 75,9 mengalami gejala depresi sebelum memulai pengobatan TB MDR. Setelah 6 bulan, 13 orang gejala depresinya membaik, 9 orang memburuk dan terdapat 4 orang mengalami onset baru depresi. Kualitas hidup ranah fisis, psikologis dan lingkungan mengalami kenaikan.Kata-kata kunci: tuberkulosis multidrug resistant, depresi, kualitas hidup

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IntroductionTreating drug resistant TB MDR TB which requires longer courses resulting in social isolation, loss of employment, and long-term socioeconomic and also psychological impacts for patients. Individual factors, sociocultural and environment condition also psychiatric adverse events lead the patients tend to have depression symptoms. Depression can majorly affects patients rsquo; quality of life. This study assesses the alteration of depression and its rsquo; relation with the quality of life among MDR TB patients. MethodsThis study used observational cohort methods in MDR Outpatients Clinic of Persahabatan Hospital. Twenty nine patients were diagnosed with MDR, measured depression status and the quality of life with Beck Depression Inventory BDI and WHOQOL BREF questionnaire from baseline and after 6 months therapy. ResultsPropotion of depression at baseline is 75,9 22 subjects . After 6 months treatment, the BDI score of 13 subjects were decreased, 9 subjects were increased and there were 4 subjects experienced new onset depression. The WHOQOL BREF improved in physical, psychological and significantly increased in environmental domain. In social domain, it was decreasing. This study didn rsquo;t find relation between depression status changes and the quality of life. The association between age, gender, level of education, economic status, duration of illness and smoking with depression could not be proven by this study. ConclusionsThere are 22 subjects 75,9 have already been depressed at baseline. After 6 months treatment, 13 subjects improving the symptoms, 9 subjects worsening and 4 subjects have experienced new onset depression. The quality of life in physical, psychological and environmental domain have improved. "

"Pulmonary tuberculosis is a chronic lung disease which has a physical as well as psychosocial impact on the patients.Until recently, existing government programs still focus on the treatment and contamination prevention of the disease.The current existing program is not directed towards solving the patients’ psychosocial problems, although the impactthereof is very influential towards the discipline in undergoing treatment and the prognosis of Tuberculosis (TB) as adisease in patients. This research aims to analyze factors that are most influential in fulfilling the psychosocial needs ofTB patients in the city of Cirebon. This research uses a corelational descriptive method. 171 pulmonary TB patientsinvolved in this research were chosen through consecutive sampling from 10 public health centers in the City andRegion of Cirebon. The psychosocial needs of pulmonary TB patients are measured by instruments developed by theresearchers. Prior to using the instrument, a validity and reliability test has been conducted. The result indicates thatthere are three dominant factors that are closely related to the patients’ satisfaction in meeting their psychosocial needs.These factors are the psychological condition during the last week, duration of treatment and supporting services,whereas demographic factors are not related to their satisfaction in meeting their psychosocial needs. The result of thisresearch can be considered by the government to provide supporting services at Public Health Centers in order to fulfillthe psychosocial needs of pulmonary TBC patients and avoid drop out cases.Analisis Kebutuhan Psikososial Penderita Tuberkulosis Paru. Tuberkulosis paru adalah penyakit paru-paru kronisyang berdampak secara fisik dan psikososial bagi penderitanya. Hingga saat ini program-program pemerintah yang adamasih berfokus pada pengobatan dan pencegahan penularan penyakit. Program yang ada belum mengarah padapemecahan masalah psikososial penderita, padahal dampak masalah psikososial sangat besar pengaruhnya terhadapkepatuhan berobat dan prognosis penyakit penderita Tuberculosis (TB). Penelitian ini bertujuan menganalisis faktoryang paling mempengaruhi pemenuhan kebutuhan psikososial penderita TB di kota Cirebon. Penelitian inimenggunakan metode deskriptif korelasional. Sejumlah 171 orang penderita TB paru yang terlibat dalam penelitian inidipilih dengan cara consecutive sampling dari sepuluh puskesmas di Kota dan Kabupaten Cirebon. Kebutuhanpsikososial penderita TB paru diukur dengan alat ukur yang dikembangkan sendiri oleh peneliti. Sebelum digunakan,instrumen tersebut sudah diuji validitas dan reliabilitasnya. Hasil penelitian menunjukkan bahwa ada tiga faktordominan yang paling berhubungan dengan tingkat kepuasan pasien terhadap pemenuhan kebutuhan psikososial mereka.Faktor tersebut adalah kondisi psikologis dalam seminggu terakhir, lama pengobatan, dan layanan pendukung.Sementara itu, faktor demografi tidak berhubungan dengan kepuasan mereka terhadap pemenuhan kebutuhanpsikososial. Hasil penelitian ini dapat dijadikan pertimbangan bagi pemerintah untuk mengadakan layanan pendukungdi puskesmas sehingga kebutuhan psikososial penderita TB paru bisa terpenuhi dan kasus drop out bisa dicegah."

"Background: Each kidney injury may develop into chronic kidney disease (CKD) and end stage renal disease (ESRD) that associates with high mortality and socio-economic burden. There is limited data about clinical characteristics of children having CKD in developing countries, espesially in Indonesia.Objective: To describe clinical profiles and characteristics of kidney diseases in adolescents aged 15-18 years.Methods: This study was a cross-sectional study which used data from National Basic Health Survey (Riskesdas) 2013. There were 2 data groups. The first data group included questionnaires about history of kidney stone disease, hypertension, chronic renal failure, antihypertension administration, and blood pressure measurement. The second data group included subsamples of the first group which had laboratory test results, i.e. hemoglobin and serum creatinine levels. All of the data were classified by nutritional status, estimated glomerulofiltration rate (eGFR), blood pressure classification, and hemoglobin level.Results: Among 52,454 adolescents in the first data group, 20,537 (39%) had kidney diseases with female predominance and good nutritional status. Other findings found were history of kidney stone disease (0.2%), chronic renal failure (0.1%), history of hypertension (0.6%), antihypertensive agents consumption (0.1%). Prehypertension and hypertension were found in 51% and 48.3% of adolescents, respectively. Adolescents with decreased eGFR were accounted for 1.4%.Conclusion: The proportion of prehypertension and hypertension in adolescents aged 15-18 years in Indonesia is high. Hence, routine blood pressure measurement is important for early detection and prevention of kidney disease progression."

"Continuity of breastfeeding process when mothers return to work is a serious issue that immediately must be followed up, so that exclusive breastfeedingprogram within the first six months can be achieved. Beside providing many benefits for babies, breastfeeding is also beneficial for mothers and entrepreneurs.This study aimed to determine relation of working mothers to exclusive breastfeeding. This study used was cross-sectional design with secondary dataof Indonesia Demographic and Health Survey 2012 with samples as many as 1,193 mothers aged 15 – 49 years who had 0 – 5-month-old babies. Basedon multivariate analysis, working mothers could decrease opportunity of exclusive breastfeeding in which mother who worked all the time were 1.54 timesmore likely not to give exclusive breastfeeding than mothers who did not work after controlled by maternal age at childbirth, household wealth index, and antenatalcare frequency (p = 0.038; 95% CI = 1.0 to 2.3). Fulltime working mothers are twofold more likely to not be able to give exclusive breasfedding thanunemployed mothers after being controlled by counfounder variable.Keberlangsungan proses menyusui pada saat ibu kembali bekerja merupakan isu serius yang harus segera ditindaklanjuti agar program pemberian Air SusuIbu (ASI) eksklusif selama enam bulan pertama kehidupan dapat tercapai. Selain memberikan banyak manfaat bagi bayi, ASI juga bermanfaat bagi ibu danpengusaha. Penelitian ini bertujuan untuk mengetahui hubungan ibu bekerja terhadap pemberian ASI eksklusif. Desain penelitian yang digunakan adalah potonglintang dengan data sekunder Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2012 dengan sampel berjumlah 1.193 ibu berusia 15 – 49 tahunyang memiliki bayi berusia 0-5 bulan. Berdasarkan analisis multivariat, ibu bekerja dapat menurunkan peluang pemberian ASI eksklusif dimana ibu yang bekerjasepanjang waktu lebih berisiko 1,54 kali untuk tidak memberikan ASI eksklusif dibandingkan ibu yang tidak bekerja setelah dikontrol oleh usia melahirkanibu, indeks kesejahteraan rumah tangga dan frekuensi pemeriksaan kehamilan (p = 0,038; CI 95% = 1,0 - 2,3). Ibu bekerja dua kali memiliki peluang untuktidak dapat memberikan ASI eksklusif daripada ibu yang tidak bekerja setelah dikontrol oleh variabel perancu."

"Due to particular conditions, sometimes actual height can not be measured. Thus, this study was conducted to develop height prediction model of adolescent from knee height and ulna length. This cross sectional study involved 205 students of SMPN 7 Depok and SMAN 6 Depok. Subjects’s identity was recorded using questionairre, while stature height, knee height, and ulna length was measured directly. Prediction models was developed using multiple regression. Height prediction model from knee height has the highest R2 and the lowest MAE with equation Height (cm) = 38,422 - 1,878 Sex + 1,453 Age (year) + 2,071 knee height (cm).

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Tinggi badan aktual terkadang tidak dapat diukur karena beberapa kondisi tertentu. Oleh karena itu, penelitian ini bertujuan mengembangkan model prediksi tinggi badan pada remaja berdasarkan tinggi lutut dan panjang ulna. Penelitian pontong lintang ini melibatkan 205 murid SMPN 7 Depok dan SMAN 6 Depok. Data identitas subjek diperoleh melalui pengisian kuesioner, sedangkan tinggi badan, tingi lutut, dan panjang ulna diukur langsung. Model prediksi dikembangkan menggunakan regresi ganda. Model prediksi tinggi badan dari tinggi lutut memiliki R2 terbesar dan MAE terkecil dengan persamaan Tinggi Badan (cm) = 38,422 - 1,878 Jenis Kelamin + 1,453 Umur (thn) + 2,071 Tinggi Lutut (cm)."

"Bervariasinya penerapan SIMPUS IHIS dan e-Health di Kabupaten Bantul membuat laporan SP2TP sebagai keluran dari SIMPUS menjadi terhambat. Dalam penerapan SIMPUS IHIS dan e-Health di Kabupaten Bantul terdapat hambatanhambatan yang perlu diperhatikan dan ditangani dengan baik agar tidak semakin kompleks. Evaluasi SIMPUS di Kabupaten Bantul dengan menggunakan metode HOT-fit digunakan untuk mengetahui sejauh mana penerapan dan kendala dalam implementasi. Metode penelitian dengan menggunakan pendekatan penelitian campuran yaitu penelitian kualitatif dan penelitian kuantitatif. Pengumpulan data dilakukan dengan wawancara mendalam, kuesioner, observasi pada Puskesmas dan dokumentasi tertulis kegiatan penerapan SIMPUS IHIS dan e-Health. Hasil penelitian menunjukkan SIMPUS IHIS dan e-Health sudah digunakan seluruh Puskesmas di Kabupaten Bantul. Faktor organisasi memberikan pengaruh terhadap berjalannya sistem, komitmen Kepala Puskesmas tidak dijabarkan dalam bentuk operasional teknis seperti pembentukan tim SIK dan tidak dibuatnya SOP dalam penerapan SIMPUS IHIS dan e-Health.

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The variations in the application of SIMPUS IHIS and e-Health in Bantul detain SP2TP reports as the output of SIMPUS. There are obstacles in the application of SIMPUS IHIS and e-Health in Bantul that need to be considered and dealt with in order not to become more complex. The evaluation of SIMPUS in Bantul using HOT-fit method is used to determine the effectiveness of implementation and the constraints in implementation. The research uses both qualitative research and quantitative research. Data was collected through in-depth interviews, questionnaires, observation and written documentations on the SIMPUS IHIS and e-Health application. The results shows that SIMPUS IHIS and e-Health have been used in all Puskesmas in Bantul. Organizational factors impact the run of the system, head of the health center's commitment is not described in technical operations such as forming SIK team and SIMPUS IHIS and e-Health SOP is not determined."

"Based on our knowledge, the study of gastrointestinal reflux disease (GERD) among certain profession has never been conducted. The aim of this study is to determine the prevalence and risk factors of GERD among Indonesian doctors.

Methods: A consecutive study involving 515 doctors was conducted in October 2015.The GerdQ score was used to the diagnosis of GERD and determined its impact on daily life. All possible risk factors were also analyzed.

Results: A total of 515 subjects completed the questionnaire. The mean age of them was 41.37±11.92 years old. Fifty-five percent of them were male and 60.6% general practitioners. The prevalence of GERD was 27.4% of which 21.0% was had GERD with low impact on daily life, and 6.4% was GERD with high impact on daily life. The statistically significant risk factors of GERD was found in age >50 y.o (p = 0.002; OR 2.054), BMI >30kg/m2 (p = 0.016; OR 2.53), and smokers (p = 0.031; OR 1.982). Sex and education level were not found significant statistically as the risk factors of GERD.

Conclusions: The prevalence of GERD among Indonesian physician was 27.4%. We found that age over 50 y.o, obesity and smoking habit were the risk factors of GERD in Indonesian doctors."