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Ekowati Rahajeng
"Sebagian besar pasien dengan gangguan mental emosional pertama-tama belum berobat ke fasilitas pelayanan kesehatan jiwa. Pasien gangguan mental emosional yang berobat ke Puskesmas wilayah Jakarta Timur hanya 1,88 % dari kasus yang ada di masyarakat dengan rata-rata kunjungan 1,31 kali pada tahun 1994. Agar gangguan tersebut tidak menjadi berat atau menjadi penyakit lain, maka diperlukan pengobatan sedini mungkin. Untuk mencapai maksud tersebut, yang menjadi masalah penelitian ini adalah bagaimana pola perilaku pencarian pengobatan dari pasien gangguan mental emosional dan faktor-faktor apa yang berhubungan dengan perilaku tersebut.
Jenis disain penelitian ini adalah crossectional, namun menggunakan analisis yang lazim digunakan pada studi case control pada penduduk dewasa (17 tahun ke atas) yang mengalami gangguan mental emosional. Gangguan mental emosional ditetapkan berdasarkan pengisian instrumen Self Reporting Questionnaire (SRQ) dengan cut-off points 6. Pengambilan sampel dilakukan secara systematic random sampling dengan sampling fraction 9. Unit sampel adalah rumah tangga dengan jumlah 650 KK yang meliputi 1950 penduduk dewasa sehat. Sampel pasien gangguan mental emosional yang diteliti berjumlah 446 kasus. Untuk mengetahui hubungan faktor dengan perilaku pengobatan dilakukan perhitungan Odds ratio melalui analisis regresi logistik multivariat.
Hasil penelitian menunjukan bahwa pola perilaku pengobatan pertama pasien gangguan mental emmosional di Kelurahan Pulogadung adalah melakukan pengobatan sandhi 27,8 %, ke dokter umum 18,4 %, tidak mencari pengobatan 17,4 %, ke Puskesmas 13,2 %, ke pengobat tradisional 8,7 %, ke rumah sakit umum 6,1 %, ke spesialis penyakit dalarn 5,8 % dan ke psikiater 2,5 %. Pasien yang melakukan kegiatan rujukan adalah 23,6 %. Sebagian besar pasien yang melakukan rujukan dan pasien yang melakukan pengobatan selanjutnya tidak berobat ke fasilitas pelayanan kesehatan jiwa.
Pasien gangguan mental emosional lebih mungkin tidak mencari pengobatan apabila pasien tidak merasa terganggu akibat gangguan mental emosional yang dialaminya (OR 0,01 ; 95% Cl 1,5E-03 - 0,02), kurang mendapatkan informasi pelayanan kesehatan jiwa (OR 0,49 ; 95% CI 0,25 - 0,95) dan apabila pasien malu berobat ke psikiater (OR 2,24 ; 95% 1,02 - 4,85).
Pelayanan kesehatan jiwa di masyarakat diharapkan tidak hanya menunggu pasien datang berobat ke fasilitas kesehatan jiwa. Kegiatan pelayanan kesehatan jiwa di Puskesmas perlu dikembangkan dalam kegiatan Puskesmas lainnya (Taruna Husada, Sala Shakti Husada dan sebagainya). Pelayanan prevensi sekunder (mendorong pasien berobat) melalui peningkatan pengetahuan gangguan mental emosional dan fasilitas pengobatannya perlu lebih diprioritaskan. Penyegaran pengetahuan gangguan mental emosional terhadap dokter umum perlu dilakukan secara periodik. Peningkatan mutu pelayanan jiwa di Puskesmas dan pembinaan pengobat tradisional perlu lebih diperhatikan. Disamping itu perlu juga dipertimbangkan tentang perubahan konsep figur psikiater di masyarakat.

Most patients with mental emotional disorder didn't visit health facility with mental health service at the first treatment. There is only 1,8 % of people with mental emotional disorder who visited Puskesmas at East Jakarta with average 1.31 visit in 1994. To prevent the disturbance become more severe or to become another illness, early treatment is needed. To reach the purpose, the problem of this study is to identify health seeking treatment pattern of patient with mental emotional disturbance and to find factors which was associated with the behavior treatment.
The study design is cross sectional study but method of analysis is case control. Sample of the study are adult (17 years or more) who experience mental emotional disorder. The criteria of mental emotional disorder is based on answers of Self Reporting Questionnaire (SRQ) with cut-off 6. Sampling method is systematic random sampling with sampling fraction of 9. Sampling unit is household with totally 650 household which include 1950 adult with good health. Sample of patient with mental emotional disorder are 446 cases. To identify relationship between factors with health seeking treatment, logistic regression with odds ratio is applied.
The result showed that for the first treatment there is 27,8% of the mental emotional disorder patients performing self medication, 18,4% visit medical doctor, 17,4 % didn't seek any treatment, 13,2 % visit Puskesmas, 8,7 % going to traditional healer, 6,1% to general hospital, 5,8% visit internist and 2,5% visit psychiatrist. There where 23,6 patient who were given referral. Most of the patients who were referred or patient who continue the treatment didn't visit health facility with mental health service.
Patients with mental emotional disorder probably not seek any treatment if they didn't feel uncomfortable with the disturbance they experienced (OR 0,01 ; 95% CI 1,5E-03 - 0,02), did not obtained enough information about mental health service (OR 0,49 ; 95% CI 0,25 - 0,95), or if the patient was ashamed to visit psichiatrist (OR 2,24 ; 95% CI 1,02 - 4,85).
Patients with mental emotional disorder probably would performed self medication if their social economic status is low (OR moderat 0,52 ; 95% CI 0,06-0,83; OR high 0,45 ; 95% CI 0,04-0,62), if they were not bothered by the disturbance they experienced (OR 0,47; 95% CI 0,03-0,91), didn't consider the disturbance as severe (OR 0,54 ; 95% CI 0,07-0,91), didn't obtained enough information on the mental health service (OR 0,52 ; 95% CI 0,06-0,79), were not suggested to have treatment (OR 0,45 ; 95 % CI 0,04-0,57), they have no work (OR 0,35 ; 95 %CI 0,17-0,67) and if they are Askes member (OR 2,48 ; 95% CI 2,40-17,54).
Patients with mental emotional disorder will probably visit traditional healer if they have expectation that the treatment not only give drug (OR 8,76 ; 95% CI 1,86 - 42,26), have supernatural believe (OR 7,53; 95% CI 3,15-40,22), and have enough knowledge on the traditional healer service (OR. 6,67; 95% CI 1.86-23,57), did not feel comfortable with the disturbance they experienced (OR 8,84; 95% CI 3,00 - 26,05), their knowledge on the mental emotional disorder was not good (OR 0,12;95% CI 0,03-0,56), and have no information on the mental emotional service (OR. 0,25; 95% CI 0,06-0,98).
Patients with mental emotional disorder will probably visit mental health service if they felt disturbed (OR 4,43 ; 95% CI 1,76 - 11,13), did not have senior high school or more education (OR 0,36 ; 95% CI 0,16 - 0,81), expected to be given more than just drug (OR 5,93 ; 95% CI 1,93 - 18,17), feeling that the high cost of the treatment influence the effort to seek treatment (OR 7,17 ; 95 % CI 2,83 - 17,81), obtained enough information on the mental health service (OR 5,22 ; 95% CI 2,34 - 11,59), and did not feel ashamed to visit psychiatrist (OR 0,43; 95% CI 0,18 - 0,99).
Patients with mental emotional disorder will probably visit Puskesmas if they feel bothered (OR 14,41 ; 95% CI 4,14 - 50,40), feeling the cost of the treatment influence the effort of seeking treatment (OR. 4,28 ; 95% CI 1,39 - 13,06), their social economic status is low (OR high 0,11 ; 95 % CI 0,03 - 0,37), lived near to Puskesmas (OR 0,21 ; 95% CI 0,06 - 0,77), realize that there is mental health service in the Puskesmas (OR 14,31 ; 95 % CI 4,09 - 49,89), did not know about traditional service (OR 0,05 ; 95 % CI 0,01 - 0,25), did not have knowledge about the general health service (OR 0,23; 95% CI 0,07 - 077), and the healer attitude did not influence the choice of treatment (OR 0,35 ; 95 % CI 0,14 - 0,88).
Mental health service in the public is expected not only waited patients to visit the mental health service. Mental health service at the Puskesmas needs to be integrated and to be developed with the other Puskesmas activity (Taruna Husada, Bhakti Husada, Karang Werdha). Secondary prevention thru knowledge development on the mental emotional disorder, treatment facility and early detection should be give more priority. Knowledge refreshment on the mental emotional disorder to medical doctor needed to be in force periodically. Quality improvement of health service in Puskesmas' and education of traditional healer need to be given more attention. The figure of psychiatrist in the society need to changed as well.
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Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 1996
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UI - Tesis Membership  Universitas Indonesia Library
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Ekowati Rahajeng
"ABSTRAK
Penyakit diabetes melitus tipe 2 (DM tipe 2) merupakan penyakit metabolik dengan karakteristik hiperglikemia yang terjadi karena kelainan sekresi insulin, kerja insulin atau kedua-duanya. Faktor yang berkaitan dengan sekresi dan kerja insulin antara lain kebiasaan minum kopi. ToIeransi Glukosa Terganggu (TGT) merupakan suatu prakondisi kejadian DM. Penelitian bertujuan mengetahui pengaruh kebiasaan minum kopi pada kasus TGT terhadap terjadinya DM tipe 2 dan gambaran laju insidensi DM tipe 2 pada kasus TGT serta kesintasannya.
Penelitian merupakan Study Kohort Praspektif selama 2 tahun 4 bulan terhadap 289 kasus TGT. Konsumsi kopi dinilai dari jumlah kandungan kafein sesuai frekuensi minuet, jumlah bubuk, dan merk minuman kopi. Kandungan kafein diperiksa dengan alat Spektrofotometer Serapan Atom (SSA) menggunakan metode Kromatografi Cair Kinerja Tinggi (KCKT). Diagnosis DM tipe 2 ditetapkan berdasarkan hasil pemeriksaan klinis dan hasil pemeriksaan kadar glukosa darah puasa ?120 mg/dL danlatau hash pemeriksaan glukosa darah 2 jam sesudah pembebanan glukosa > 200mg/dL. Analisis statistik menggunakan perangkat lunak Stata versi 8.0. Penilaian laju insidensi dengan analisis survival, peranan faktor risiko DM tipe 2 dan TGT dengan analisis multivariat Cox Proportional Hazard Regression dan Multinomial Logistic Regression.
Temuan panting dari penelitian ini : (1) Laju insidensi DM tipe 2 adalah 9,3 per I00 kasus TGT per tahun; (2) konsumsi kopi dengan kafein 240 - 359,9 mg per hari hari mempunyai rasio hazard (FIR) 2,33 dan kafein ? 360 mg per hari mempunyai FIR 3,24; (3) faktor lain yang berisiko adalah konsumsi lemak ? 40 gram per hari dengan FIR 2,07, obesitas (IMT ? 25) HR 2,25, obesitas abdominal (RPP L : > 0,95; W: > 0,85) HR 2,28, lama minum kopi (? 10 tahun) HR 1,97, hipertrigliserida (? 200 mg/dL) HR 2,41 dan FFA tinggi (? 0,93 mM) HR. 1,9; (4) mencampur minuman kopi dengan susu atau krim, aktivitas fisik (indeks 120 menitlhari), konsumsi serat ? 25 gram per hari dan konsumsi teh ditemukan mencegah DM tipe 2 masing-masing dengan HR 0,28 0,56, 0,42, dan 0,50; (5) kafein 240 - 359,9 mg mempunyai rasio risiko relatif (rasio RR) tetap mengalami TGT 2,95, kafein ? 360 mg mempunyai rasio RR 3,28;(6) faktor lain yang berisiko TGT adalah konsumsi lemak dengan rasio RR 2,51, obesitas abdominal 2,47 dan hipertrigliserida 2,97; (7) aktivitas fisik dan konsumsi serat ditemukan mencegah TGT masing-masing dengan rasio RR 0,29 dan 0,40; (8) Dari temuan penelitian dihasilkan tiga model sistim skor prediksi DM tipe 2, tiga model untuk memprediksi kejadian tetap TGT dan tiga model untuk memprediksi kejadian normal dengan 4 batasan risiko, dengan probabilitas area ROC model prediksi antara 83,59% -94,73%.
Konsumsi kopi pada kasus TGT mempunyai respon dosis dan respon waktu terhadap kejadian DM tipe 2 dan tetap TGT. Sebaliknya terhadap kejadian normal, respon tersebut berbanding terbalik. Jumlah kafein yang terkandung pada minuman kopi meningkatkan FFA mengakibatkan resistensi insulin dan kelelahan sel j3 dalam mengsekresi insulin yang berakhir dengan diabetes. Campuran susu atau krim pada minuman kopi menambah asupan kalsium pada tubuh dan mereduksi kandungan kafein, sehingga mencegah DM tipe 2 pada peminum kopi. Model predisksi dengan sistim skor cukup baik dan praktis untuk memprediksi risiko DM tipe 2, tetap TGT, dan normal. Jika risiko diketahui lebih dini, tindakan pencegahan dapat segera dilakukan dan memberikan hasil penanggulangan lebih baik.

ABSTRACT
Type 2 Diabetes Mellitus (Type 2 DM) is a metabolic disease characterized by hyperglycemia, due to the abnormal insulin secretion, insulin function, or both. One of the factors related to insulin function and secretion is drinking coffee. Impaired Glucose Tolerance (IGT) is a precondition for the occurrence of Diabetes Mellitus. This research is aimed to study the risk of developing Type 2 DM among impaired glucose tolerant cases that regularly drinks coffee, and to determine the incidence rate of Type 2 DM on IGT cases as well as its survival rate.
This is a cohort prospective study with the duration of 2 years and 4 months among 289 IGT cases. Coffee consumption was assessed by caffeine content according to drinking coffee frequency, weight of coffee powder, and coffee brand's name. The caffeine content was measured by spectrophotometer, used High Performance Liquid Chromatography (HPLC) method. Type 2 DM diagnosis was determined according to ADA 1997 criteria (fasting blood glucose of > 126 mg/dL and/or 2 hours after glucose load of > 200 mg.dL Statistical analysis software used in this study was Stala version 8.0. Assessment of the incidence rate was calculated by survival analysis, while the risk factors of developing Type 2 DM, remained IGT, and reversing to Normal Glucose Tolerance (NGT) were analyzed by multivariate Cox Proportional Hazard Regression and Multinominal Logistic Regression.
Result
Important findings in this research are: (I) The incidence rate of Type 2 DM was 9.3 per 100 cases of IGT person-year; (2) Coffee consumption with caffeine content of 240 - 359,9 mg daily had hazard ratio (HR) of 2.31 and HR for coffee contents > 360 mg caffeine daily was 2.92; (3) Other risk factors for the development Type 2 DM include fat consumption of > 40 g daily, with HR value of 1.99, HR obesity (BMI > 25) was 2.24, and HR for abdominal obesity ( waist hip ratio, men: > 0.95; women: > 0.85) was 2.44, while HR for duration of drinking coffee (? 10 years) was 1.97, for hyper triglyceride (? 200 mg/dL) was 2.74, and for high FFA (> 0.93 mM) was 1.88; (4) Drinking coffee with cream or milk, physical activity (index of 120 minutes/day), and food fiber consumption > 25 gram/day, prevent the development of Type 2 DM with HR value of 0,28, 0.56, and 0.38 respectively; (5) Relative risk ratio (RR) to remain 1GT was 2.95 in drinking coffee with caffeine content of 240 - 359.9 mg, and 3.28 in drinking coffee with caffeine content > 360 mg; (6) Other risk factor of remaining IGT were fat consumption, abdominal obesity, and hyper triglyceride, with RR values of 2.51, 2.47, 2.97 respectively; (7) Physical activity and food fiber consumption prevent reversal to IGT with RR value of 0.29 and 0.40; (8) This study resulted in three prediction score system models for the development of type 2 DM, three prediction score system models for remaining to IGT, and three prediction score system models for reversing to NGT, with the probability of prediction model ROC area between 83.5% to 94.73%.
The incidence rate of Type 2 DM increases every year. Caffeine content in the coffee drinks has linear correlation with increased FFA value, insulin resistance, fasting blood glucose, and two hours after glucose load, as well as the occurrence of DM. Drinking coffee among the IGT cases has dosage and time response relationship to the occurrence of type 2 DM and remaining IGT. On the other hand, the relationship is opposite for the reverse to normal glucose tolerance (NGT). Drinking coffee with cream or milk can prevent the occurrence of type 2 DM. Prediction model with scoring system is good and practical to predict risk of type 2 DM and IGT. If the risk is found earlier, the prevention can be immediately performs and will give better result.
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2004
D574
UI - Disertasi Membership  Universitas Indonesia Library