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"This randomized double-blind placebo-controlled trial aimed to compare the efficacy of daily iron supplementation and multi-micronutrient supplementation both daily and weekly basis on increasing iron status among 284 apparently healthy Indonesian infants aged 6-12 mo. Infants were randomly assigned to receive either daily 1 RDA multi micronutrient supplement (n = 72), weekly 2 RDA multi micronutrient supplement (n = 70), daily ferrous sulphate 10 mg (n = 72), or placebo (n = 70) for wk. Blood hemoglobin, plasma ferritin, plasma zinc, and plasma C-reactive protein concentrations were measured prior to intervention and after 23 wk of supplementation. At baseline, 58.1% of subjects were anemic, 28.2% were iron deficient, and 11.2% were zinc deficient. After 23 wk of supplementation, both daily 1 RDA multi micronutrient and iron supplemented groups had significantly increased blood hemoglobin and plasma ferritin concentration, furthermore reducing the percentage of anemia and iron deficiency. However, the changes of hemoglobin were not significantly different among the treatment groups. Changes of hemoglobin were significantly higher in daily 1 RDA multi micronutrient group than in placebo group when initial blood hemoglobin was low. The change of plasma ferritin concentration in both daily 1 RDA multi micronutrient and iron groups was significantly higher than in other groups. Hemoglobin and ferritin concentrations of weekly 2 RDA multi micronutrient group were not significantly increase, but there were significantly increased in the subjects with low concentration of blood hemoglobin or plasma ferritin. Proportion of infants with zinc deficiency was increased significantly in iron group Daily I RDA multi micronutrient and daily iron supplementation are efficacious in improving the concentration of blood hemoglobin and plasma ferritin and reducing the percentage of infants with anemia and iron deficiency of Indonesian infants aged 6-12 months in a rural community. However, there was an increasing proportion of infants with zinc deficiency in daily iron supplementation. The efficacy of daily 1 RDA multi micronutrient supplementation was higher among the children with blood hemoglobin < 110 g/L Efficacy of weekly 2 RDA multi micronutrient supplementation on the concentration of blood hemoglobin and plasma ferritin of all subjects was not found, but it affected in children with low concentration of blood hemoglobin or plasma ferritin."

"Merokok dapat meningkatkan angka morbiditas dan mortalitas.World Health Organization (WHO) memprediksi pada tahun 2020 penyakit yang disebabkan oleh rokok akan menyebabkan kematian sebanyak 8.4 juta orang di dunia dan setengahnya berasal dari Asia. Varenicline, sebagai agonis parsial reseptor α4β2 nikotin asetilkolin, memiliki potensi yang cukup baik pada program berhenti merokok dengan cara melepaskan withdrawal effect dari nikotin dan menurunkan kebutuhan akan nikotin. METODE. Uji acak tersamar ganda antara bulan Juli 2012 sampai dengan Desember 2012 dengan 12 minggu waktu terapi dan 12 minggu waktu pengamatan status merokok. 80 laki-laki perokok yang bersedia mengikuti penelitian dibagi kedalam kelompok varenciline dan kelompok plasebo.Varenicline dititrasi hingga 2x1 mg (n=40) dan plasebo (n=40) ditambah konseling mingguan. HASIL. Pada pengamatan 4 minggu (minggu 1-4) setelah 12 minggu terapi menunjukkan 55% peserta kelompok varenicline berhenti merokok dibandingkan kelompok plasebo sebesar 27,5%. (Prevalence Ratio [PR] 2,0). Pada pengamatan minggu ke 5-8, 52.5% peserta pada kelompok varenicline masih berhenti merokok dibandingkan dengan 20% pada kelompok plasebo (PR, 2,6). Pada pengamatan minggu 9-12, 47,5% peserta pada kelompok varenicline masih berhenti merokok dibandingkan 17,5% pada kelompok plasebo (PR, 2,7). Rerata hari pertama bebas rokok pada kelompok varenicline adalah 40,63 hari, sedangkan pada kelompok plasebo 56,43 hari. Efek samping yang paling banyak pada penggunaan varenicline adalah mual yang terdapat pada 9 peseerta (22,5%). Rerata kadar CO awal adalah 18,46 ppm, rerata Fagerstrom test untuk ketergantungan nikotin adalah 6,4 dan rerata indeks Binkman adalah 317,9. KESIMPULAN. Varenicline memiliki efikasi yang baik, aman dan dapat ditoleransi baik sebagai farmakoterapi program berhenti merokok.

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Smoking has increased risk of morbidity and mortality. World Health Organization predicts that by 2020, disease caused by smoking will result in the deaths of around 8.4 million people in the world and half of these deaths from Asia. Varenicline, a partial agonist at the α4β2 nicotinic acetylcholine receptor, has the potential to aid smoking cessation by relieving nicotine withdrawal symptoms and reducing the rewarding properties of nicotine.

METHOD. A randomized, single-blind, placebo controlled trial conducted between July 2012 and December 2012 with a 12 week treatment period and 12 week follow-up of smoking status. 80 male adult smokers who volunteered for the study divide into varenicline and placebo group. Varenicline titrated to 1 mg twice daily (n=40) or placebo (n=40) for 12 weeks, plus weekly smoking cessation counseling.

RESULT. During 4 weeks (weeks 1-4) after 12 weeks of treatment, 55% of participants in the varenicline group were continuously abstinent from smoking compared with 27.5% in the placebo group (Prevalence Ratio [PR] 2,0). For weeks 5 through 8, 52.5% of participants in the varenicline group were continuously abstinent compared with 20% in the placebo group (PR, 2,6). For weeks 9-12, 47.5% of participants in the varenicline group were continuously abstinent compared with 17.5% in the placebo group (PR, 2,7). Mean of first day free of smoking used Varenicline for smoking cessation was 40,63 days and mean of first day free of smoking used placebo was 56.43 days. The most adverse event with varenicline was nausea, which occurred in 9 Participants (22,5%). Mean of CO level was 18,46 ppm, mean of Fagerstrom score for nicotine dependence was 6,4, and mean of Brinkman index was 317,9.

CONCLUSION. Varenicline is an efficacious, safe, and well-tolerated smoking cessation pharmacotherapy."

"Background: low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents.Methods: this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test.Results: a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another.Conclusion: in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels."

"Anak di bawah dua tahun berisiko tinggi untuk defisiensi zat gizi mikro khususnya defisiensi zat besi, sebagian dikarenakan praktek pemberian makanan tambahan yang salah. Untuk meningkatkan kualitas pemberian makanan tambahan, rekomendasi makanan tambahan (Complementary Feeding Recommendation - CFR) berbasis pangan lokal dibutuhkan. Suplementasi zat besi digunakan secara luas untuk menanggulangi defisiensi zat besi di negara berkembang; namun, efek dari suplementasi tersebut pada mikronutrien lain dan pertumbuhan menjadi perhatian tersendiri. Fortifikasi zat besi telah menunjukkan dampak negatif pada mikrobiota usus melalui peningkatan pertumbuhan bakteri patogen pada usus dikarenakan peningkatan besi yang diserap dan suplementasi zat besi mungkin memiliki dampak yang serupa pada mikrobiota usus tetapi masih belum pernah diteliti. Sebaliknya, jika suplementasi zat besi diberikan dengan optimalisasi diet menggunakan CFR, status gizi anak-anak akan meningkat dengan efek samping yang lebih kecil pada mikronutrien lain dan pertumbuhan. Studi ini meneliti efek dari suplementasi zat besi; dengan atau tanpa diet optimal; pada status mikronutrien, mikrobiota usus dan pertumbuhan anak-anak Myanmar yang berusia di bawah 2 tahun. Sebuah percobaan acak terkontrol (NCT01758159) dilaksanakan selama 24 minggu pada anak usia 12-23 bulan di Ayeyarwady, Myanmar. Optimalisasi CFR berbasis pangan lokal dikembangkan dengan pendekatan Linear Programming. Pengacakan berdasarkan Desa untuk CFR dan non-CFR dan berdasarkan anak (n=433) untuk suplemen besi atau placebo, menghasilkan: 1. kelompok CFR+Fe (n=112); 2. kelompok CFR (n=112); 3. kelompok Fe (n=105); or 4. kelompok pembanding (plasebo) (n=104). Ibu dari kelompok CFR menerima pendidikan CFR dan anak-anak dari kelompok Fe menerima 15 mg Ferric NaEDTA setiap hari. Serum Feritin, Transferin receptor (sTfR), Zinc, retinol-binding-protein (RBP), C-reactive protein dan α-1 acid glycoprotein; feces untuk melihat mikrobiota usus (Bifidobacteria, Lactobacilli, Enterobacteriaceae, E.coli, EPEC, EAEC dan ETEC) diukur pada awal dan akhir penelitian. Di awal penelitian, 88.4% anak mengalami anemia (Hb<110g/L); setelah dikontrol dengan infeksi, 74.4% mengalami defisiensi zat besi (SF<12μg/L dan/ atau sTfR>8.3mg/L) dan 68.9% mengalami anemia gizi besi (AGB) (Hb<110g/L and ID), 41.3% mempunyai kadar serum Send rendah (serum send <10.7µmol/L). Suplementasi besi menurunkan anemia, defisiensi zat besi dan AGB dengan atau tanpa pemberian diet optimal. Namun, suplementasi besi meningkatkan risiko serum Send rendah dan pendek (stunting) bila diberikan tanpa penambahan diet optimal. Efek samping ini tidak terlihat saat suplementasi tablet besi diberikan bersama dengan diet yang optimal. Tidak ada perbedaan yang nyata pada komposisi mikrobiota usus diantara semua kelompok. Suplementasi zat besi harus diberikan bersama dengan diet optimal untuk mengurangi efek samping baik pada kadar zat gizi mikro lainnya di dalam tubuh maupun pertumbuhan anak.

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Children under 2-years of age are at high risk of micronutrient deficiencies especially iron deficiency (ID), partly due to poor complementary feeding practices. To improve feeding practices, local food-based complementary feeding recommendations (CFR) are needed. Iron supplementation is widely used to treat ID in developing countries; however, its potential effects on other micronutrients and growth are of concern. Iron fortification had shown negative impact on gut microbiota with increased growth of gut pathogens due to increased unabsorbed iron. It was assumed that iron supplementation may have similar impact on gut microbiota but has not yet been explored. On the other hand, if iron supplementation is given with optimized diet using CFRs, nutritional status of children would be improved with less adverse effects on other micronutrients status and growth.

The study investigated the effect of iron supplementation; given with or without optimized diet; on micronutrient status, gut microbiota and growth of under 2-year Myanmar children. A randomizedcontrolled trial (NCT01758159) was conducted for 24 weeks among 12-23 month old children from Ayeyarwady, Myanmar. Optimized CFRs based on locally available foods were developed by Linear Programming approach. Randomization by village for CFRs or non-CFRs and by child (n=433) for iron supplements or placebo, created: 1.CFR+Fe (n=112); 2.CFR-alone (n=112); 3.Fe-alone (n=105); or 4.Placebo (n=104) groups. Mothers from CFR-groups received education on CFRs and children from Fe groups received 15mg Ferric NaEDTA daily.

Serum for ferritin (SF), transferrinreceptor (sTfR), zinc, retinol-binding-protein (RBP), C-reactive protein and α-1 acid glycoprotein; stool for gut microbiota (Bifidobacteria, Lactobacilli, Enterobacteriaceae, E.coli, EPEC, EAEC and ETEC) were measured at baseline and endline. At baseline, 88.4% of children were anemic (Hb<110g/L); after adjusting for infection, 74.4% had ID (SF<12μg/L and/or sTfR>8.3mg/L) 68.9% had irondeficiency- anemia (IDA) (Hb<110g/L and ID), and 41.3% had low serum zinc status (serum zinc <10.7μmol/L).

Iron supplementation reduced anemia, ID and IDA whether or not it was given with optimized diet. However, iron supplementation increased the risk of low serum zinc and stunting when it is given without optimized diet. These adverse effects were not seen when iron supplementation was given with optimized diet. No significant difference was found in gut microbiota composition among groups. In conclusion, iron supplementation should be given together with optimized diet to reduce its adverse effect on other micronutrients status and growth to best improve nutritional status of these children."

"Tujuan mengevaluasi efek suplementasi susu yang diperkaya dengan zat besi dan zink terhadap indikator pertumbuhan, kapasitas fisik dan kecepatan berpikir anak sekolah yang kurang berat (underweight). Metode Eksperimen pada dua kelompok paralel tersamar ganda dilaksanakan di beberapa sekolah dasar di Jakarta dan Surakarta, Indonesia. Sejumlah 245 anak sekolah usia 7-9 tahun yang underweight di daerah miskin perkotaan Jakarta and Solo dialokasikan secara acak menerima dua gelas susu yang diperkaya zat besi dan zink (n = 121) atau susu biasa (n= 124) setiap hari selama enam bulan. Indikator biokimia, antropometri, kapasitas fisik dan fungsi kognisi diukur saat awal, bulan ke-3 dan ke-6. Hasil Antara kelompok susu diperkaya dibandingkan dengan kelompok susu biasa, peningkatan kadar hemoglobin (berturut-turut 0,01 + 0,96 mg/dL dan 0.17 + 0.81 mg/dL) dan serum feritin (berturut-turut 12,77 + 25,50 mcg/dL dan 14,99 + 29,56 mcg/dL) tidak berbeda bermakna antara kedua kelompok. Selanjutnya, terjadi penurunan kadar serum zink (berturut-turut 3,01 + 3,24 mMol/dL dan 3,12 + 3,71mMol/dL) yang tidak bermakna antara kedua kelompok. Penambahan berat badan pada kelompok susu diperkaya (1,31 + 0,69 kg) berbeda secara bermakna (P=0.045) dibandingkan dengan kelompok susu biasa (1,13 + 0,69 kg), sejalan dengan peningkatan indikator underweight (WAZ) pada kelompok susu diperkaya (1.47 + 0.50) yang lebih besar secara bermakna (P=0.025) dibandingkan dengan peningkatannya pada kelompok susu biasa (1,33 + 0,47). Terdapat perbaikan skor kecepatan berpikir yang bermakna (P=0.001) pada kelompok susu diperkaya (12,74 + 11,76) dibandingkan dengan kelompok susu biasa (8.31 + 9,60), namun tidak ada perbedaan yang bermakna untuk perbaikan skor kapasitas fisik antara kedua kelompok (berturut-turut 10323,77 + 9253,83 dan 8435,94 + 8824,55). Kesimpulan pada anak sekolah usia 7-9 tahun yang underweight, suplementasi susu yang diperkaya dengan zat besi dan zink akan lebih mendukung pertumbuhan dan kecepatan berpikir.

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AbstractAim to evaluated the effect of milk supplementation enriched with iron and zinc on indicators of growth, physical capacity and cognitive performance in underweight school-children. Method Two-armed, randomized controlled double-blind trial was performed in several primary schools in Jakarta and Surakarta, Indonesia. A total of 245 underweight schoolchildren aged 7-9 years living in urban poor areas of Jakarta and Solo were randomly allocated to receive two cups of iron-zinc fortified-milk (n = 121) or non-iron-zinc fortified milk (n= 124) supplementation daily for six months. Biochemical indicators, anthropometric indices, physical capacity and cognitive performance were measured at before and after the supplementation. Results The study shows that between the fortified and non-fortified milk group, there was no significant different in haemoglobin increase (0.01 + 0.96 mg/dL versus 0.17 + 0.81 mg/dL) nor serum ferritin increase (12.77 + 25.50 mcg/dL versus 14.99 + 29.56 mcg/dL). Unexpectedly, decreased in serum zinc was found in both groups (3.01 + 3.24 mMol/dL and 3.12 + 3.71 mMol/dL). There was significant higher increment (P=0.045) in body weight among the fortified milk group (1.31 + 0.69 kg) as compared to the non-fortified group (1.13 + 0.69 kg). Consistently, there was significant increase (P=0.025) in the indicator of underweight (WAZ) among the fortified milk group (1.47 + 0.50) as compared to the non-fortified group (1.33 + 0.47). There was significant improvement (P=0.001) of cognitive performance, i.e. coding test-score among the fortified group (12.74 + 11.76) as compared to the non-fortified group (8.31 + 9.60), but there was no significant difference found in the improvement of physical capacity score in both groups (10323.77 + 9253.83 versus 8435.94 + 8824.55). Conclusion Among underweight schoolchildren aged 7-9 y, supplementation of milk fortified with iron and zinc can provide better growth, and better speed processing of learning ability. "

"Hipertensi merupakan penyakit kardiovaskular yang paling umum dan paling banyak diderita, terutama oleh lanjut usia (lansia). Beberapa penelitian menunjukkan vitamin D berperan dalam tekanan darah. Pada lansia kadar 25(OH)D menurun karena kurangnya paparan sinar matahari dan asupan makanan yang mengandung vitamin D. Kekurangan vitamin D dapat dicegah, salah satunya dengan suplementasi. Penelitian ini merupakan penelitian eksperimental dengan desain uji acak terkendali tersamar ganda pada lansia di Panti Sosial Tresna Werdha Budi Mulia 1 bulan April sampai Juni 2023 dengan tujuan menganalisis pengaruh suplementasi vitamin D terhadap kadar 25(OH)D dan tekanan darah. Kadar 25(OH)D serum diperiksa menggunakan metode Chemiluminescent Immunoassay (CLIA), tekanan darah diperiksa menggunakan sphygmomanometer digital. Suplementasi diberikan 1 kali perhari selama 8 minggu, untuk kelompok kontrol diberikan plasebo sedangkan untuk kelompok perlakuan diberikan vitamin D dengan dosis 2000IU (subjek Insufisiensi) dan 4000IU (subjek defisiensi). 62 subjek penelitian berusia 60-89 tahun (median 67 tahun) ikut serta dalam penelitian ini dan terbagi secara random menjadi 30 subjek kelompok kontrol dan 32 subjek kelompok perlakuan. Peningkatan kadar 25(OH)D pada kelompok kontrol 23 ± 4,87 ng/mL menjadi 27,3 ± 7,34 ng/mL (p=0,000), pada kelompok perlakuan 17,9 ± 4,38 ng/mL menjadi 36,07 ± 9,84 ng/mL (p=0,000). Analisis rerata perubahan menunjukkan bahwa suplementasi vitamin D meningkatkan kadar 25(OH)D secara bermakna (D = 4,2 ± 2,47 ng/mL pada kelompok kontrol dan D = 18,17 ± 5,46 ng/mL pada kelompok perlakuan; p = 0.000). Penurunan tekanan darah sistolik pada kelompok kontrol 133,9(121 – 159,5) mmHg menjadi 129,3(96 – 159) mmHg (p=0,027), pada kelompok perlakuan 135,3(121 - 180) mmHg menjadi 126(101 - 153) mmgHg (p=0,000). Penurunan tekanan darah diastolik pada kelompok kontrol 89,6(80 - 105) mmHg menjadi 82,4(64 - 103) mmHg (p=0,000), pada kelompok perlakuan 89,2(81,5 – 98,5) mmHg menjadi 80,8 (67 – 90) mmHg (p=0,000). Akan tetapi, analisis rerata perubahan menunjukkan bahwa suplementasi vitamin D tidak menyebabkan penurunan tekanan darah sistolik (D = -4,6(-25 - -0,5) mmHg pada kelompok kontrol dan D = -9,2 (-20 - -27) mmHg pada kelompok perlakuan; p = 0.109) dan tekanan darah diastolik secara bermakna (D = -7,2 (-16 - -2) mmHg pada kelompok kontrol dan D = -8,4 (-14,5 - -8,5) mmHg pada kelompok perlakuan; p=0,559). Suplementasi vitamin D dapat meningkatkan kadar 25(OH)D secara bermakna, tetapi tidak menurunkan tekanan darah sistolik dan diastolik secara bermakna pada lansia.

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Hypertension is the most common cardiovascular disease, especially in the elderly. Previous studies have reported that vitamin D play a role in blood pressure. In elderly, serum 25(OH)D levels decrease due to lack of sun exposure and intake of food sources of vitamin D. Vitamin D deficiency can be prevented by supplementation. This is an experimental study with double-blind randomized placebo-controlled trial (RCT) on elderly subjects at the Tresna Werdha Budi Mulia 1 Social Institution from April until June 2023 to analyze the effect of vitamin D supplementation on serum 25(OH)D levels and blood pressure. Serum 25(OH)D levels were examined using Chemiluminescent Immunoassay (CLIA) method, blood pressure was checked using digital sphygmomanometer. Supplementation was given once per day for 8 weeks, control group was given a placebo while treatment group was given vitamin D3 supplementation at dose of 2000IU (insufficiency subjects) and 4000IU (deficiency subjects). A total of 62 research subjects aged 60-89 years (median 67 years) participated in this study and randomized into 30 control group subjects and 32 treatment group subjects. The increase in serum 25(OH)D levels in the control group was 23 ± 4,87 ng/mL to 27,3 ± 7,34 ng/mL (p = 0.000), the treatment group was 17,9 ± 4,38 ng/mL to 36,07 ± 9,84 ng/mL (p = 0.000). Data analysis showed that vitamin D supplementation significantly increased 25(OH)D levels in the treatment group compared to the control group (D = 4,2 ± 2,47 ng/mL for control group and D = 18,17 ± 5,46 ng/mL for treatment group; p = 0.000). The decrease in systolic blood pressure in the control group was 133,9(121 – 159,5) mmHg to 129,3(96 – 159) mmHg (p = 0.027), the treatment group was 135,3(121 - 180) mmHg to 126(101 - 153) mmgHg (p = 0.000). The decrease in diastolic blood pressure in the control group was 89,6(80 - 105) mmHg to 82,4(64 - 103) mmHg (p = 0.000), the treatment group was 89,2(81,5 – 98,5) mmHg to 80,8 (67 – 90) mmHg (p = 0.000). However, data analysis showed that vitamin D supplementation did not cause a significant reduction in systolic blood pressure (D = -4,6(-25 - -0,5) mmHg for control group and D = -9,2 (-20 - -27) mmHg for treatment group; p = 0.109) and diastolic blood pressure in the treatment group compared to the control group (D = -7,2 (-16 - -2) mmHg for control group and D = -8,4(-14,5 - -8,5) mmHg for treatment group; p = 0.559). Vitamin D supplementation significantly increase serum 25(OH)D levels, but not significantly reduce systolic and diastolic blood pressure in the elderly."

"Kanker payudara adalah kanker yang paling banyak di seluruh dunia. Kanker payudara menempati angka tertinggi sebesar 42,1 per 100.000 penduduk Indonesia. Masalah yang paling sering dialami oleh pasien kanker payudara adalah masalah fisik seperti nyeri. Permasalahan nyeri berkaitan dengan kualitas hidup pasien. Teknik guided imagery berbasis digital dengan virtual reality dalam manajemen nyeri pasien masih sangat jarang dilakukan. Penelitian ini bertujuan untuk mengidentifikasi efektivitas teknik guided imagery dengan menggunakan digital terapi virtual reality pada pasien kanker payudara. Metode penelitian menggunakan desain RCT dengan rancangan parallel. Jumlah sampel sebanyak 60 responden yang diacak dengan blok randomisasi ke dalam 30 kelompok kontrol dan 30 kelompok intervensi. Penelitian ini dilaksanakan di RS Kanker Dharmais menggunakan virtual reality selama 10-15 menit pada kelompok intervensi dan pemberian leaflet digital pada kelompok kontrol. Pengukuran skala nyeri menggunakan Numeric Rating Scale dilakukan setiap hari selama 7 hari. Hasil penelitian menunjukkan bahwa terapi guided imagery dengan virtual reality mampu menurunkan skala nyeri pada pasien kanker payudara dibandingkan dengan kelompok kontrol dengan nilai P=0,000 (α < 0,05). Penggunaan virtual reality dapat dijadikan acuan perawat onkologi dalam memberikan terapi non-farmakologi untuk menurunkan nyeri serta stress pada pasien terutama pasien kanker payudara.

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Breast cancer is the most common cancer worldwide. Breast cancer has the highest rate around 42.1 per 100,000 in Indonesian. The most common problems experienced are physical problems such as pain. Pain is related to the patient's quality of life. Digital-based guided imagery with virtual reality in pain management are still rarely used. This study aims to determine the effectiveness of guided imagery using digital therapy virtual reality in breast cancer patients. The method uses RCT with a parallel design. 60 respondents who were randomized using block randomization into 30 in both control and intervention groups. Conducted at Dharmais Cancer Hospital using virtual reality for 10-15 minutes in intervention group and digital leaflets to control group. Measurements using the NRS were carried out every day for 7 days. The results showed that guided imagery with virtual reality was able to reduce the pain scale in breast cancer patients compared to the control group with P = 0.000 (α < 0.05). The use of virtual reality can be used as a reference for oncology nurses in providing non pharmacological therapy to reduce pain and stress in patients especially breast cancer patients."

"This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use."

"ABSTRACTThe aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (GA), and the other with a flapless surgical technique (G B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24 h and 7 days but at the 15 days follow-up the differences were only significant for oral hygiene and pain (P < 0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P > 0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G A and 3.6 (SD 1.02) for G B (P = 0.06). One implant placed in G A (2.0%) failed before prosthetic loading due to mobility and pain at 3 months follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected."