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Abstrak :
ABSTRACT
The study aimed to investigate the impact of 12 weeks supplementation with multi-micronutrient and iron-folate supplements on hematological status, morbidity and work productivity. Female factory workers were selected as the subjects because: high prevalence of anemia found in this group which might have health and economic consequences since anemia was related to decrease work productivity and decrease resistance to infection, and the increasing number of female workers in developing country.

A preliminary study was conducted to investigate the bioavailability of iron from a multi~micronutrient supplement compared to watery ferrous(II)-sulfate solution. In a randomized cross over design, 14 volunteers received 108 mg elemental iron as four tablets of multi-micronutrient supplements (each tablet contained 27 mg elemental iron) or as a solution of 537.60 mg Ferrous(Il)-sulfate. Serum iron concentrations were measured at 0, 2, 4, 6 and 8 hours after dosing. The maximum serum iron level was significantly lower with multi-micronutrient supplement compared to ferrous sulfate solution but the time to reach the peak" serum iron level was not significantly different between those two treatments. The median relative bioavailability of iron in multi-micronutrient supplement was 32.22%

The main study was conducted in a shoe factory, West Java. A total of 308 subjects were selected and divided randomly into three groups that respectively received multi-micronutrient (each tablet contained 27 mg elemental iron), iron-folate supplements (each tablet contained 200 mg ferrous sulfate equal to 60 mg elemental iron) and placebo. Multimicronutrient supplements and placebo were given time times per week and iron-folate supplements were given once a week. All of the supplementations were supervised and last for 12 weeks. Hematological assessed in sub sample of each group based on Willingness; making a total of 140 subjects.

Significant increments in the levels of hemoglobin, serum ferritin, and serum retinol were observed in multi-micronutrient group (0.6 g/dl, 13.44 ug/l, and 0_6 pmol/l respectively) and iron-folate group (0.3 g/dl, 11.26 ug/l, and 0.4 umolfl respectively); the increments were higher in multi-micronutrient group but not statistically different from iron-folate group. In the placebo group, hemoglobin level was decreased by 0_3 g/dl, serum ferritin was increased by 4.28 ug/1, and serum retinol was relatively constant. The prevalence of anemia and low iron status were decreased after treatment with multi-micronutrient (7% and 20.5%, respectively) or iron-folate supplements (91% and 12.8%, respectively). The anemia prevalence in placebo group was increased by 6.6% while the prevalence of low iron status was decreased by 2.5%. The morbidity was increased in all groups with the lowest increment was observed in multi-micronutrient group (65% in multi-micronutrient group compared to 14.1% in iron group and 22.4% in placebo group). The work productivity was increased by 6.3% in iron group and 3.6% in multi-micronutrient group while it was relatively constant in placebo group. In conclusion, multi-micronutrient supplement had better impact on hematological status and reducing morbidity level compared to iron-folate supplement that had better impact on work productivity.

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Latar Belakang: Obstruksi usus strangulata merupakan masalah kegawatdaruratan yang sering ditemui, mencakup 20% dari total pasien di unit gawat darurat. Obstruksi usus strangulata memiliki morbiditas dan mortalitas yang tinggi. Terdapat banyak faktor yang memengaruhi luaran pascaoperasi obstruksi usus strangulata, dan sebgaian besar berhubungan dengan komplikasi respirasi, infeksi daerah operasi, dan acute kidney injury (AKI). Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang memengaruhi morbiditas dan mortalitas pascaoperasi pada pasien dengan obstruksi usus strangulata. Metode: Studi kohort retrospektif dengan menggunakan total sampling dari registrasi Divisi Bedah Digestif dari tahun 2015-2019. Analasis bivariat digunakan dengan menggunakan studi Chi Square, Fisher, Mann Whitney, dan Spearman. Total 133 pasien tercakup di dalam analisis studi. Hasil: Angka mortalitas obstruksi usus strangulata di RS Cipto Mangunkusumo sebesar 7,5%. Angka kejadian acute kidney injury (AKI) pascaoperasi sebesar 30,1%. Terdapat beberapa faktor yang berhubungan dengan luaran morbiditas dan mortalitas, seperti usia pasien, onset strangulata, kondisi sepsis, dan kadar asam laktat serum. Kesimpulan: Faktor-faktor seperti usia pasien, onset strangulata, kondisi sepsis, dan kadar asam laktat serum berpengaruh terhadap morbiditas dan mortalitas pascaoperasi pada pasien dengan obstruksi usus strangulata. Beberapa faktor lain juga berhubungan dengan luaran mortalitas

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Background: Strangulated bowel obstruction is common emergency problem, included 20% of total patients registered to emergency department. Strangulated bowel obstruction is serious medical conditioin with high morbidity and mortality. There are many factors influencing postoperative outcome of strangulated bowel obstruction, and most related to respiratory complications, surgical site infection, and acute kidney injury. The objective of this study is to find out which factors contributing to postoperative morbidity and mortality in patients with strangulated bowel obstruction. Method: A cohort retrospective with total sampling is used from Digestive Surgery Division registry by the year 2015-2019. Bivariate analysis has been done using Chi Square, Fisher, Mann Whitney, and Spearman study. Total of 133 patients were included in the analysis Result: Mortality rate of strangulated bowel obstruction was 7,5% in Cipto Mangunkusumo Hospital. The acute kidney injury morbidity rate was 30,1%. There are some factors related to the postoperative morbidity and mortality outcome, such as age, strangulation onset, sepsis condition, and lactate acid serum level. Conclusion: Factors such as age, strangulation onset, sepsis condition, and lactate acid serum level are contributing to postoperative morbidity and mortality outcome in patients with strangulated bowel obstruction. Some of these factors also related to mortality outcome.

Abstrak :
Background: Community acquired pneumonia (CAP) in the elderly is still a major problem due to its high morbidity and mortality. There is considerable variability in ?the result of various studies on prognostic factors. The prognostic factors in Indonesia have not been identified. Methods: We performed a prospective cohort study on 147 elderly patients hospitalized with CAP in the internal medicine ward of Cipto Mangunkusumo National Central General Hospital, Jakarta from September 2002 to March 2003. We calculated the survival rate during hospitalize-tion. We used Cox proportional-hazard regression analysis to examine factors associated with mortality in the first 48 hours of hospitalization. . Results: There were 34 deaths (23.1) associated with CAP in 1471 person-days. The survival rate at day 5, 10 and 15 were 88.9%, 77.2 and 67.2% respectively. Severe. pneumonia, an serum albumin of d"3.5 g/dL, reduced consciousness, temperature > 37.0"C, and a hemoglobin level of d" 9.0 g/dL demonstrated a tendency towards increased mortality rate. Other factors such as age, sex, immobilization, swollen disorders, co-morbidities, leukocyte count, and serum creatinine level demonstrated no significant relationship with mortality. Conclusion: Severe pneumonia, low serum albumin, decreased consciousness, high temperature and low hemoglobin level in the first 48 hours hospitalization were found to be worse prognostic factors. Early identification and modification of these factors are recommended.

Abstrak :
Latar belakang: Modified Blalock-Taussig shunt (MBTS) merupakan prosedur bedah jantung sederhana namun memiliki angka mortalitas cukup tinggi. Karakteristik terutama usia pasien yang menjalani prosedur MBTS di Indonesia berbeda dengan negara lain. Tujuan: Membandingkan angka mortalitas operatif MBTS berdasarkan kriteria usia dan  mengidentifikasi faktor prediktor mortalitas operatif dan morbiditas pascaoperasi MBTS. Metode: Penelitian ini merupakan studi kohort retrospektif mortalitas pada 400 pasien yang menjalani operasi MBTS di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Hasil: Mortalitas berdasarkan kriteria usia yaitu 32,1% pada usia ≤ 28 hari, 19,9% pada usia 29-365 hari, 3,6% pada usia 366-1825 hari dan 8% pada usia > 1825 hari. Berat badan kurang dari 3 kg, kadar hematokrit lebih dari 45% sebelum operasi dan kadar activated partial thromboplastine time (aPTT) < 60 detik sebagai prediktor mortalitas. Transfusi packed red cell  (PRC) > 6 ml/kg, penggunaan ventilasi mekanik dan penggunaan prostaglandin preoperasi dan kadar aPTT < 60 detik 4 jam pasca operasi terbukti sebagai prediktor morbiditas. Kesimpulan: Terdapat perbedaan bermakna angka mortalitas pascaoperasi berdasarkan usia. Kriteria usia tidak terbukti sebagai prediktor mortalitas. Berat badan < 3 kg meningkatkan mortalitas. Prediktor morbiditas pascaoperasi adalah transfusi PRC > 6ml/kg, penggunaan ventilator, penggunaan prostaglandin dan kadar aPTT < 60 detik. ...... Background: Modified Blalock-Taussig shunt (MBTS) is a simple procedure but has a considerable operative mortality rate. Patient’s characteristics who underwent MBTS in Indonesia is different than other country. There was no predictor of operative mortality has been identified in Indonesian. Objectives: To compare mortality rate based on age criteria and to identify mortality and morbidity predictors after MBTS procedure. Methods: A retrospectively cohort study was conducted on 400 patients who underwent MBTS at National cardiovascular center Harapan Kita (NCCHK). Results: There were 32,1% death at age ≤ 28 days, 19,9% at age 29-365 days, 3,6% at age 366-1825 days and 8% at age > 1825 days. Body weight < 3 kg, haematocrite level > 45% before procedure and activated partial thromboplastine time level (aPTT) < 60 seconds were operative mortality  predictors. Packed red cell  transfusion (PRC) > 6 ml/kg, mechanical ventilator and prostaglandin E1 use before procedure, aPTT level < 60 seconds after procedure were identified as postoperative morbidity predictors. Conclusion: age was not proven as an operative mortality predictors. Body weight < 3 kg increase mortality rate. Postoperative morbidity predictors were PRC transfusion > 6ml/kg, aPTT level < 60 seconds, mechanical ventilator and prostaglandine E1 use.

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Pendahuluan: Atresia bilier adalah kelainan pada saluran empedu yang merupakan penyebab kolestasis ekstrahepatik neonatal terbanyak dan menjadi indikasi transplantasi hati tersering (+ 50%) pada bayi dan anak. Keterlambatan diagnosis pada pasien atresia bilier di Indonesia menyebabkan angka THDH (transplantasi hati donor hidup) primer pada atresia bilier lebih tinggi dibandingkan dengan pusat transplantasi lain di dunia. Penelitian ini bertujuan untuk menilai luaran THDH primer pada pasien atresia bilier di RSCMdan faktor-faktor yang memengaruhinya. Metode: Penelitian ini merupakan penelitian kohort retrospektif dengan menggunakan data pasien anak dengan atresia bilier yang dilakukan THDH primer sejak Desember 2010 hingga Desember 2019. Luaran pasien dalam satu tahun pascaoperasi berupa morbiditas (komplikasi, lama rawat, relaparotomi) dan mortalitas dianalisis terhadap faktor prognostik praoperasi dan intraoperasi. Hasil: Telah dilakukan 58 operasi transplantasi hati di RSCM dengan 85% (34 subjek) merupakan THDH primer pada anak dengan atresia bilier. Mayoritas adalah laki-laki dengan median usia 14 bulan. Sebagian besar subjek mengalami gizi kurang (64,5%). Rerata skor PELD adalah 17,09, rerata GRWR sebesar 3,11. Rerata perdarahan intraoperasi sebesar 670,4 mL dengan median lama operasi 690 menit, median CIT adalah 57 menit dan rerata WIT adalah 54,9 menit. Komplikasi terjadi pada 96,7% subjek, dengan infeksi (77,4%) sebagai komplikasi tertinggi. Relaparotomi dilakukan pada 54,8% subjek. Median lama rawat 41 hari dengan rentang 18-117 hari. Mortalitas dalam satu tahun pascatransplantasi sebesar 9,3%. Hubungan bermakna didapatkan antara gizi kurang terhadap komplikasi infeksi (p = 0,033), GRWR terhadap lama perawatan pascaprosedur THDH primer (p = 0,00) dan WIT terhadap kejadian relaparotomi (p = 0,007). Simpulan: Dengan karakteristik pasien atresia bilier yang ada di Indonesia (mayoritas gizi kurang dan rerata skor PELD tinggi) didapatkan angka mortalitas satu tahun cukup kecil dan sebanding dengan pusat transplantasi di dunia. Kejadian relaparotomi dan komplikasi infeksi masih menjadi masalah utama dan perlu dilakukan penelitian lebih lanjut untuk mengevaluasi intervensi baik pembedahan maupun medikamentosa dalam memeperkecil kejadian morbiditas dan mortalitas. Kata Kunci : Atresia bilier, THDH primer, luaran, morbiditas, mortalitas

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Introduction: Biliary atresia is a disorder of the bile duct that the most common cause neonatal extrahepatic cholestasis and the most common indication for liver transplantation (+ 50%) in infants and children. Delayed in diagnosis patients with biliary atresia in Indonesia causes the primary LDLT (living donor liver transplantation) rate to be higher than other transplant centers in the world. This study aimed to assess the primary LDLT outcome patients with biliary atresia in RSCM and influencing factors. Methods: This study was a retrospective cohort study using data on pediatric patients with biliary atresia who were undergoing primary LDLT from December 2010 to December 2019 in RSCM. Patient outcomes within one year postoperatively in the form of morbidity (complications, length of stay, relaparotomy) and mortality were analyzed for preoperative and intraoperative prognostic factors. Results: There have been 58 liver transplantions in RSCM with 85% (34 subjects) being primary LDLT in children with biliary atresia. The majority were men with median age 14 months. Most of the subjects experienced malnutrition (64.5%). The average PELD score was 17.09, the average GRWR was 3.11. The mean intraoperative bleeding was 670.4 mL with median operating time 690 minutes, median CIT was 57 minutes and the mean WIT was 54.9 minutes. Complications occurred in 96.7% subjects with infection (77.4%) as the highest complication. Relaparotomy was performed in 54.8% subjects. The median length of stay was 41 days with a range of 18-117 days. One year post transplantation mortality was 9.3%. There were statistically significant found between malnutrition and infection complications (p = 0.033), GRWR with length of stay after primary LDLT (p = 0.00) and WIT with incidence of relaparotomy (p = 0.007). Conclusion: With the characteristics of biliary atresia patients in Indonesia (majority was malnutrition and the average PELD score is high) the one-year mortality rate is quite small and comparable to transplantation centers in the world. The incidence of relaparotomy and infectious complications are still major problems and further research is needed to evaluate both surgical and medical interventions in minimizing the incidence of morbidity and mortality. Key words: Biliary atresia, primary LDLT, outcome, morbidity, mortality

Abstrak :
Salah satu upaya menunmkan angka kesakitan dan kematian ibu adalah melalui pemberian pelayanan yang berkualilas. Pelayanan yang berkualitm dapai di wujudkan dengan adanya tenaga kesehatan yang kompeten, termasuk bidan di desa. Desain Penelitian dengan cross sectional untuk mengelahui kompetensi dan kinexja bidan di desa dalam melaksanakan pelayanan asuhan parsalinan nommal di Kabupaten Bengkayang lahun 2008. Populasi adalah bidan di desa yang bertugas di polindes. Sampel pmelitian ini adalah semua bidan di desa yang bexjumlah 53 orang yang sudah meudapatkan pelatihan asuhan persalinan normal (APN). Hasil penelitian menunjukkan sebagian besar (83,2%) bidan di desa kurang kompeten mc-laksanakan suhan persalinan normal (APN). Kompetensi merupakan faktor yang bermalcna terhadap kinexja bidan di desa dalam melaksanakan asuhan persalinan nomml berdmarkan indikator cakupan persalinan dengan Oddss Ratio 31 (95% CI: 3,4 - 28l,9) dan berdasarkan persentase kasus yang di mjuk pada alpha 5% terdapat perbedaan yang signiiikan antara rata-rata persentase kasus komplikasi persalinan yang di rujuk oleh bidan di desa dengan kompetensi. Bidan yang kurang kompelen merujuk rata-rata 13 % kasus komplikwi persalinan, sedangkan bidan yang kompeten merujuk rata-rata 4 % kmus komplikasi persalinam Vayiabel lain yang bennakna dengan lcineaja adalah pengalaman kelja bidan di desa dengan Oddss Ratio 6,7 (95% CI: 1,3 - 3317). Variabel pendidikan, umur, peralatan dan bahan menunjukkan hubungan yang tidak bemiakna. Oleh karena itu kompelensi bidan di dwa perlu ditingkatlcan bukan hanya dengan pelatihan saja tetapi perlu ditindak lanjuti dengan supervisi yang teerprogram dan uji sertifikasi kompefersi oleh suatu badan yang terakreditasi. ......One of effort for decrease of morbidity and maternal mortality be giving a quality health care.That is necessary human resources of health which having competency, included midwife in the village This research to be done with cross- sectional design for knowing competency of midwife in the village on going nomially birth attendant care at Bengkayang District 2008. Population research are midwives in tlievillage which on duty at the village centre attendant Samples research are all of the midwives intthe village, there are 53 persons which got training normally birth attendant care. The result showed most of midwifes (83,2%) have not enough competent on going normally birth attendant care. Competency is afsigniticant factor to midwife performent on going normally birth attendant indicated birth attendant target with Odds Ratio '31 (95% CI:3,4 - 28I,9) and presentation of cases refered on alpha 5 %, there is a differentiation signilicantly between mean procentace cased refered with competency. The village's midwives which not enough competent refered mean 13% cases birth attendant complication, the midwives in the village which competent refered 4 % cases birth attendant complication. Significant variable with perrofmmtee is experienee job, odds nano 6,1 (95% cr; 1,3 _ sag). Another variables are educatiorg age and equipment showed not significant. That is why competency of the midwivx in the village necessary to be increased not only with training but also a programmly supervising and competency sertilication test from accreditation organization.

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ABSTRAK
Proses adaptasi dan interaksi dari peserta didik dengan lingkungan baru dapat mengakibatkan gangguan keseimbangan fisiologis tubuh sehingga menjadi rentan terhadap penyakit. Penelitian potong lintang ini bertujuan untuk mengidentifikasi determinan epidemiologi penyakit pada mahasiswa Akademi Keperawatan Pemerintah Kabupaten Garut tahun 2015. Sebanyak 235 mahasiswa menjadi sampel. Data yang dikumpulkan meliputi karakteristik responden, karakteristik tempat asal mahasiswa, kesakitan dengan menggunakan kuesioner tentang riwayat kesakitan atau morbiditas. Hasil penelitian menunjukkan bahwa 70,2% mahasiswa mengalami sakit selama tiga bulan terakhir dan 57,9% mahasiswa memiliki riwayat sakit terdahulu. Terdapat hubungan antara determinan epidemiologi karakteristik responden dengan nilai p= 0,023 dengan 95% CI sebesar 6,48 (2,21-22,56) dan karakteristik tempat pada kesakitan mahasiswa nilai p= 0,045 dengan 95% CI sebesar 0,09 (0,02-0,41). Peran pembimbing akademik perlu ditambah dengan memberikan bimbingan dan penyuluhan terhadap masalah kesehatan mahasiswa. Institusi pendidikan sangat penting memiliki dan menyimpan pangkalan data tentang kesakitan mahasiswa. ABSTRACT
Determinants of Epidemiology of Disease in Nursing Academy Students in Garut, West Java in 2015. The process of adaptation and interaction of students with the new environment can result in physiological balance disorders of the body, thus becoming susceptible to disease. This cross-sectional study aimed to identify the epidemiological determinants of disease in 2015 Garut District Nursing Academy students. A total of 235 students were involved. Data collected included respondent characteristics, the characteristics of the place of origin of the students, morbidity using a questionnaire about the history of previous illness or morbidity. The results showed that 70.2% of students experienced pain during the last three months and 57.9% of students had a history of the previous disease. There was a relationship between the epidemiological determinant of the characteristics of respondents with a value of p= 0.023 with 95% CI of 6.48 (2.21-22.56) and place characteristics in the morbidity of students p= 0.045 with 95% CI of 0.09 (0.02-0.41). The role of academic advisers needs to extend by providing guidance and counseling on student health problems. Educational institutions are significant to have and keep a database of the morbidity of students.

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Infeksi Saluran Pernafasan Akut (ISPA) terutama pneumonia merupakan penyebab utama kesakitan dan kematian pada bayi dan anak balita di negara berkembang ,sekitar 4 juta kematian disebabkan penyakit tersebut Di Indonesia ISPA bawah terutama pneumonia mengakibatkan kematian sekitar 150.000 balita per tahun. Di Pangkal Pinang, Pneumonia masih menjadi masalah kesehatan masyarakat, cakupan Pneumonia sejak tahun 1998 terus meningkat Pada tahun 1999 berdasarkan Pemantauan Status Gizi (PSG) yang dilakukan oleh Dinas Kesehatan Kota Pangkal Pinang didapatkan 15,37 % balita mengalami gizi buruk. Gizi buruk dapat menyebabkan penyakit infeksi termasuk pneumonia. Penelitian ini bertujuan mengetahui hubungan status gizi dengan kejadian pneumonia balita di kota Pangkalpinang tahun 2000. Jenis desain yang digunakan adalah kasus kontrol, dengan 120 sampel, dimana kasus adalah balita yang datang ke puskesmas dan menderita pneumonia sedangkan kontrol adalah balita yang datang ke puskesmas dan tidak menderita pneumonia. Unit analisis adalah balita usia 9 - 59 bulan. Data dikumpulkan dengan wawancara menggunakan kuesioner terhadap ibu balita yang terpilih sebagai sampel kasus maupun kontrol. Dari hasil penelitian didapatkan adanya hubungan yang bermakna secara statistik antara status gizi dengan kejadian pneumonia balita (OR= 3,194. 95 % CI :1,585 - 6,433 ). Berdasarkan hasil penelitian ini disarankan kepada pengambil keputusan agar lebih memberikan perhatian terhadap status gizi balita dengan meningkatkan kegiatan yang sudah ada.

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Masa nifas adalah masa sesudah persalinan. Selama periode ini, terjadi proses yang memungkinkan tubuh memulihkan kembali organ-organ reproduksinya. Pada masa nifas ini kadang-kadang diikuti dengan terjadinya komplikasi, seperti infeksi, pendarahan, dan preeklamsia/eklamsia. Komplikasi ini merupakan penyebab terbesar yang dapat menimbulkan kematian. Demam nifas (morbiditas puerperalis) merupakan gejala terjadinya infeksi nifas. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan terjadinya demam nifas. Disain yang digunakan adalah kasus kontrol. Jenis data yang digunakan merupakan data sekunder yang berasal dari Survey Kesehatan Rumah Tangga (SKRT) Departemen Kesehatan Republik Indonesia Tahun 1995. Data diolah dan dianalisis secara bivariat dan multivariat dengan menggunakan analisa logistik regresi. Hasil penelitian ini menunjukkan adanya hubungan yang bermakna antara faktor jenis penolong persalinan (p=4,049) dengan terjadinya demam nifas setelah dikendalikan faktor frekwensi pemeriksaan kehamilan (p=9,447). Ibu hamil yang persalinannya ditolong oleh dukun memiliki risiko untuk mengalami demam nifas 2 kali dibandingkan ibu hamil yang persalinannya ditolong oleh dokter/perawat/bidan. Oleh karena itu perlu disarankan kepada masyarakat agar melakukan pemeriksaan dengan tenaga kesehatan seperti dokter/bidan/perawat.

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The Factors Related to Morbidity PuerperialPuerperium is a period that comes after a woman gives a birth. During this period, there is a kind of process which leads the body itself tries to recover woman's reproduction organs. This period is sometimes followed by a complication, such as infection, bleeding, and preeclamsia/eclamsia. Such complication is the biggest of factor that cause early maternal death. Morbidity Puerperial is symptom of puerperium infection. The research purpose is finding out the factors that related with Morbidity Puerperial. To overcome the aim, this research based on a control case as its research design. The data is acquired from Survey Kesehatan Rumah Tangga (SKRT), Depkes RI 1995 and would be analyzed by bivariat and multivariat procedures from logistic regression analysis. The research result shows that there is a significant relationship between the factor of giving birth safety (p=0.049) with Morbidity Puerperial which has been controlled by pregnancy examination factor (p=0.047). A pregnant woman who gives her birth with the help from a traditional medical practitioner will have twice risk greater than the one who gets help from doctor or midwife. Therefore, the public should know that really important to be examined by doctor or midwife for their own good.