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"Sets out guidelines for the design and implementation of rehabilitation programmes aimed at improving the outcome of cardiovascular diseases and enhancing the patient's quality of life. Citing evidence from over 100 studies, the book underscores the many benefits that can be expected when all patients in all age groups are given appropriate care and counselling. Emphasis is placed on the importance of exercise as both a powerful non-invasive assessment tool and a key component of rehabilitative care. In formulating guidelines and recommendations, the book gives particular attention to the needs of patients in developing countries, where rheumatic heart disease, hypertension, and cardiomyopathy are prevalent, and coronary heart disease is assuming growing significance. With these needs in mind, the book concentrates on the design of state-of-the-art rehabilitation programmes, tailored to diagnostic categories, that can be implemented even when resources are scarce and trained staff limited. Throughout the book, recommendations concerning methods of functional assessment, schedules of exercise, and staff and equipment requirements are given for three different levels of care, moving from a basic facility within the community, through hospital facilities, to an advanced cardiovascular rehabilitation centre linked to a major medical centre. Information is presented in five sections. The first reviews recent developments in rehabilitative care, concentrating on advances that have made virtually all cardiovascular patients candidates for rehabilitation. The concept of risk stratification as an organizational strategy is also presented and discussed. The second section provides highly detailed advice on the design and implementation of cardiac rehabilitation in developing countries. Citing non-equipment-based rehabilitation as the most practicable option for developing countries, the book explains the components of rehabilitative care and exercise training according to diagnostic group, level of risk, and type of facility available. In view of the goals of rehabilitation, readers are also given extensive advice on the assessment of patients for return to work, concentrating on the physical demands of activities commonly performed in developing countries. The third section considers the special needs of children and young adults with cardiovascular disease, giving particular attention to the use of dynamic exercise testing to identify children or young adults who will benefit from exercise training. Readers are given advice on the clinical evaluation, recommended levels of physical activity, exercise testing, and exercise training for fourteen specific conditions. The remaining sections provide guidelines for the rehabilitation of the severely disabled, medically complex cardiac patient, and discuss current and future approaches to education as a vital part of rehabilitative care."

"Hypertension is the commonest cardiovascular disorder, affecting about 20% of the adult population in many countries. It is linked with coronary heart disease, stroke, congestive heart failure and renal dysfunction and is one of the major risk factors for cardiovascular mortality, which accounts for 20-50% of all deaths. Raised awareness of the public health and economic implications of hypertension is now directing attention to the need for long-term control programmes that focus on primary prevention, early detection and adequate treatment. This report of a WHO Expert Committee reviews the epidemiology and pathophysiology of hypertension, enumerates its risk factors and predictors, and makes specific proposals for its prevention and control in populations. Current approaches to the assessment and management of patients with hypertension are discussed, with emphasis on the general usefulness of systolic blood pressure measurements and on the special features of hypertension in children and adolescents, women, elderly people and those with diabetes. The potential impact of lifestyle changes is evaluated, together with the various pharmacological treatment options. While recognizing the need to take account of resource constraints and diversity in health care systems, the Committee recommends that hypertension control programmes are set up worldwide as part of a comprehensive strategy to reduce total cardiovascular risk. Its practical recommendations for policy, hypertension management and research are intended to guide decision-makers in public health, managers of control programmes and physicians and to facilitate the selection of cost-effective means of controlling hypertension in different socioeconomic settings."

"Considers what can be done to improve the quality of urban health services and make them more accessible to residents in low-income areas and slums. Noting that a shortage of resources for urban health is a problem everywhere, the report concentrates on organizational and administrative changes that can upgrade the quality of health centres, extend coverage to underserved populations, and reduce the inefficiencies that occur when hospitals are overburdened by patients suffering from minor complaints. The objective is to help health administrators and municipal authorities analyse the weaknesses in urban health systems, appraise options for strengthening primary health care, and introduce interventions that help obtain the maximum health gains from restricted budgets. Throughout the report, experiences in different cities around the world are used to illustrate both the shortcomings of many urban health systems and the specific changes that have brought improvements. The opening sections identify key issues in the organization of urban health systems and review the extent to which health systems in the worlds cities are providing primary health care, particularly for low-income communities. Details range from a list of mistakes frequently made by municipal and public health authorities, through an explanation of methods for collecting basic data, to a series of 10 questions to be asked when moving from an analysis of problems to a programme of action. Noting that almost half of the residents of cities in developing countries live in conditions of extreme poverty and squalor, the report cites evidence of an impending health crisis as urban populations continue to grow and the incidence of chronic diseases rises alongside traditional health problems and the added burdens of HIV infection and AIDS, alcohol and drug abuse, and injuries caused by violence and road accidents. The report also identifies weaknesses in urban health centres and health posts, which frequently suffer from a low standard of services and lack of credibility, and are often bypassed, resulting in an overloading of hospital services. Against this background, the report introduces the concept of reference health centres that would provide an extended range of high-quality, round-the-clock health services in defined catchment areas and link with hospitals for referral support. According to this concept, an urban reference health centre aims to support and strengthen local health centres in their role as providers of primary health care and to bring comprehensive medical care to local communities, making health services accessible to all city-dwellers on a more equitable basis. A review of experiences to date in developing such centres in various urban settings underscores the potential contribution that reference health centres can make to urban public health."

"Latar Belakang : Infeksi COVID-19 telah diketahui masih dapat menyebabkan gejala sampai 90 hari dan bahkan lebih, meski infeksi akutnya telah berlalu. Hal ini disebabkan karena adanya fenomena sindroma pasca COVID-19. Mekanisme kejadian tersebut sampai saat ini masih belum diketahui pasti. Hal tersebut diduga kuat akibat adanya fibrosis di beberapa organ, terutama jantung dan paru. Sementara itu, beberapa studi telah menyebutkan bahwa sST2 merupakan penanda fibrosis jantung. Meskipun demikian, sampai saat ini belum ada penelitian yang mencoba mengetahui faktor-faktor apa saja yang memiliki hubungan dengan kejadian fibrosis pasca infeksi COVID-19. Kadar sST2 pada pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, khususnya di Indonesia juga belum diketahui.Tujuan : Mengetahui perbandingan kadar sST2 pada pasien komorbid kardiovaskular 12 minggu pasca infeksi COVID-19 dengan pasien komorbid kardiovaskular tanpa COVID-19 dan populasi orang sehat, serta hubungannya dengan faktor-faktor admisi.Metode : Penelitian ini merupakan studi observasional potong lintang. Kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dibandingkan dengan komorbid kardiovaskular akan dibandingkan dengan kelompok kontrol, yaitu kontrol 1 yang merupakan pasien komorbid kardiovaskular tanpa COVID-19 dan kontrol 2 yang merupakan populasi orang sehat. Kelompok kontrol dipilih menggunakan metode matching. Hubungan faktor klinis dan laboratoris saat dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19 dianalisis menggunakan analisis multivariat.Hasil : Terdapat 162 subjek yang menyelesaikan rangkaian penelitian yang terdiri atas 100 subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular (kelompok kasus), 31 subjek dengan komorbiditas kardiovaskular tanpa COVID-19 (kelompok kontrol 1), dan 31 subjek sehat tanpa riwayat COVID-19 dan komorbiditas kardiovaskular (kelompok kontrol 2). Ketiga kelompok memiliki karakteristik yang sama. Terdapat perbedaan signifikan rerata nilai sST2 antara kelompok kasus dibandingkan kontrol 1 dan kontrol 2 (2786 ± 73 vs 2666 ± 162 pg/l, p <0.001 dan 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001), serta kontrol 1 dibandingkan kontrol 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Analisis multivariat menunjukkan PaO2 (p < 0.001) dan nilai CT (p = 0.04) memiliki hubungan dengan kadar sST2 pada pasien 12 minggu pasca infeksi COVID-19.Kesimpulan : Terdapat perbedaan signifikan antara kadar sST2 sebagai penanda fibrosis jantung pada ketiga kelompok subjek penelitian, dengan kadar sST2 lebih tinggi pada subjek dengan penyintas COVID-19 disertai komorbiditas kardiovaskular. Terdapat hubungan PaO2 dan nilai CT saat admisi dengan kadar sST2.

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Background : Recent findings showed that symptoms associated with COVID-19 infection may persist up to 90 days even after the acute disease period has passed. This condition is now termed as post COVID-19 syndrome. Several pathophysiologic mechanisms of this event had been proposed, all of which still needed further elaboration. One of the proposed mechanisms involves fibrotic processes in several organs, especially heart and the lungs. SST2 has been suggested as a novel biomarker for cardiac fibrosis. However data are still needed to further elucidate the factors which are associated with the incidence of fibrosis post COVID-19 infection. Furthermore, data regarding sST2 levels in patients with cardiovascular comorbidities and in healthy subjects are still limited.

Objective : Knowing the differences on sST2 levels between subjects with cardiovascular comorbidities 12 weeks post COVID-19 infection, those without history of COVID-19 but with cardiovascular comorbidities, and healthy population, as well as knowing its relationship with admission factors.

Methods : This study is a cross-sectional observational study on patients 3 months after COVID-19 infection presented with cardiovascular comorbidities. Age and sex-matched control groups were used as comparison. The results were compared with a group without history of COVID-19 and healthy populations. Relationship between admission factors was assessed using multivariate analysis

Results : 162 subjects completed the study series, consisting of 100 subjects with COVID-19 survivors with cardiovascular comorbidities (case group), 31 subjects with cardiovascular comorbidities without COVID-19 (control group 1), and 31 healthy subjects without a history of COVID-19 and cardiovascular comorbidities (control group 2). All three groups had similar characteristics. There was a significant difference in the mean sST2 value between the case groups compared to control 1 and control 2 (2786 ± 73 vs 2666 ± 162 pg/l, p < 0.001 and 2786 ± 73 vs 2517.15 ± 321 pg/l, p < 0.001 respectively), and control 1 compared to control 2 (2666 ± 162 pg/l vs 2517.15 ± 321 pg/l, p < 0.001). Multivariate analysis revealed PaO2 (p < 0.001 and CT values (p = 0.04) as admission factor associated with increased sST2 3 months after initial COVID-19 infection.

Conclusion : SST2 levels were found to be significantly different between the three groups, with the highest level on the case group (subjects with history of COVID-19 and cardiovascular comorbidities). Factors upon admissions which include Arterial oxygen partial pressure (PaO2) (p < 0.001) and CT value (p = 0.04) were found to be associated with increased sST2 levels."

"Secara global, kesehatan adalah industri senilai USD 3.5 triliun atau setara dengan 8% dari PDB dunia. Menurut data, masih ada kekurangan dari sistem kesehatan saat ini, antara lain: (i) angka harapan hidup yang masih bervariasi; (ii) 100 juta orang dimiskinkan oleh pengeluaran kesehatan; (iii) kesenjangan kesehatan yang terus terjadi, bahkan di negara-negara kaya (US dan Australia); (iv) sebagian besar peralatan yang tidak digunakan dengan semestinya. Memperkuat sistem kesehatan berarti mengatasi kendala utama di setiap bidang, dengan demikian derajat kesehatan akan meningkat. Penelitian ini menggunakan pendekatan kualitatif yang bersifat deskriptif analitik. Metode yang digunakan adalah tinjauan kepustakaan. Jenis data yang digunakan adalah data sekunder yang didapatkan melalui pencarian studi/penelitian yang sudah ada sebelumnya dan teori-teori yang berkaitan dengan topik. Kriteria inklusi pada penelitian ini adalah penelitian dengan semua jenis metode yang dapat menjawab topik dan menggunakan framework WHO: Six Building Blocks. Kriteria eksklusi penelitian adalah penelitian lebih dari 10 tahun, serta penelitian yang tidak dapat menjawab pertanyaan penelitian. Informasi yang didapatkan dari studi literatur ini akan diuraikan dalam bentuk table hasil dan narasi, dengan hasil temuannya yaitu kinerja sistem kesehatan di negara berkembang belum lebih baik dari negara maju, dilihat dari status kesehatan masyarakat dan permasalahan kesehatan yang sedang dialami.

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Globally, healthcare is an industry of USD 3.5 trillion worth or equal to 8% of the world GDP. According to the data, there are still shortcomings of the current health system, as follows: (i) life expectancy that still varies; (ii) 100 million people are impoverished by health spending; (iii) health gaps that continue to occur, even in wealthy countries (the US and Australia); (iv) most of the equipment is not used properly. Strengthening the health system means overcoming the main obstacles in each field, thus the value of health will increase. This research uses a qualitative approach that is descriptive-analytic. The methods used are a literature review. The type of data used is secondary data obtained through pre-existing study/research searches and topic-related theories. The inclusion criteria for this study are research with all types of methods that can answer topics and use the WHO framework: Six Building Blocks. The research exclusion criteria are the research of more than 10 years, as well as research that cannot answer research questions. The information obtained from this literature study will be described in the form of results table and narration, with the result of the health systems performance in the developing countries has not been better than in developed countries, judging by the public health status and the health problems that are being experienced."

"Nilai titik potong lingkar lengan atas (LiLA) untuk diagnosis gizi buruk berdasarkan WHO adalah 11,5 cm. Nilai titik potong ini dinilai kurang sensitif dalam menjaring kasus gizi buruk pada balita. Berbagai nilai titik potong LiLA baru diusulkan dengan nilai diagnostik yang lebih baik namun memiliki interval yang lebar, 12 cm-14,1 cm. Saat penelitian ini dilakukan belum ada data mengenai evaluasi nilai titik potong LiLA 11,5 cm dalam diagnosis gizi buruk pada balita di Indonesia. Diperlukan penelitian untuk mengevaluasi nilai diagnostik LiLA dalam diagnosis gizi buruk dan mencari titik potong yang paling optimal pada balita Indonesia. Penelitian ini bertujuan untuk mengetahui nilai diagnostik LiLA dibandingkan dengan indeks BB/TB dalam diagnosis gizi buruk pada balita, mengetahui sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif nilai titik potong LiLA < 11,5 cm dalam diagnosis gizi buruk dan mencari rekomendasi nilai titik potong LiLA yang memiliki nilai diagnostik yang lebih baik untuk skrining balita dengan gizi buruk. Pengambilan subyek penelitian pada studi diagnostik ini dilakukan secara konsekutif pada bulan Januari-Februari 2020 di RSCM dan Puskesmas Cengkareng Jakarta Barat. Penelitian ini melibatkan 421 subyek. Data dasar, jenis kelamin, usia didapatkan melalui wawancara singkat. Pengukuran antropometri berupa berat badan, tinggi badan/panjang badan dan lingkar lengan atas dilakukan oleh peneliti/asisten peneliti yang memiliki realibilitas pengukuran yang baik. LiLA memiliki nilai diagnostik yang tinggi ditandai dengan AUC 0,939 (CI95% 0,903-0,974). Nilai diagnostik LiLA dengan titik potong 11,5 cm memiliki sensitivitas yang rendah. Nilai diagnostik LiLA dengan nilai titik potong 11,5 cm: Se 21% Sp 99,7% NDP 80%, NDN 96%, IY 0,2. Nilai titik potong LiLA 13,3 cm memberikan hasil terbaik dalam identifikasi gizi buruk dengan Se 89%, Sp 87%, NDP 25%, NDN 99% dan IY 0,76. Nilai titik potong LiLA 11,5 cm untuk kasus gizi buruk memiliki sensitivitas yang rendah dan sebaiknya tidak digunakan dalam upaya skrining kasus gizi buruk di masyarakat. Nilai titik potong LiLA 13,3 cm memberikan nilai diagnostik yang lebih baik dalam upaya skrining gizi buruk pada balita usia 6-59 bulan.

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World Health Organization recommends 11,5 cm as cut off value of mid-upper arm circumference (MUAC) to diagnose severe acute malnutrition (SAM) in under-five. Many studies indicate that the recommended cut off value is not sensitive to screen severe acute malnutrition cases. Various new cut off values have been proposed with very wide interval, 12-14.1 cm. When this study started there was no available data regarding diagnostic value of MUAC in diagnosing severe acute malnutrition in under-five in Indonesia. Aims of this study are to evaluate diagnostic value of MUAC in diagnosing SAM compare to WHZ index, to evaluate sensitivity, specificity, positive prediction value, negative prediction value of MUAC with 11,5 cm as standard cut off in diagnosing SAM and to find alternative cut off value that may offer better diagnostic performance. This diagnostic study recruits subjects consecutively in January-February 2020 in Cipto Mangunkusumo hospital and Puskesmas Cengkareng. We collected 421 subjects. Demographic data was obtained by using brief conversation. Physical examination and anthropometric measurement were performed by researcher and research assistant that had been trained, evaluated and proven to have excellence reliability. In general, MUAC has excellent diagnostic value to assess SAM in under-five with AUC 0,939 (CI95% 0,903-0,974). The recommended cut off value has low sensitivity. Proportion SAM using WHZ index and MUAC < 11,5 cm are 4,5% and 1,2%. Diagnostic values MUAC using cut off 11,5 cm are Se 21%, Sp 99,7%, PPV 80%, NPV 96% and YI 0,2. By using 13.3 cm as new cut off value, MUAC will have Se 89%, Sp 87%, PPV 25%, NPV 99% and YI 0,76. We conclude that MUAC using 11,5 cm has low sensitivity to detect SAM cases in population, therefore should not be implemented in the community for screening SAM cases. The new cut of value 13,3 cm has better diagnostic value to screen SAM cases in under-fives."