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"ABSTRACT

INTRODUCTION : Based on Indonesian Constitution, article 2712 mention that every Indonesian citizen has the right of having a job and wages in accordance to humanity. Bajaj as an model in this study is public transportation vehicle which is noisy and vibrating and potential to induce hearing and balance disturbances which could be dangerous to himself or to others. General Objectives of this study : To investigate the risks of noise and vibration in bajaj's drivers and to find the solutions to prevent them from hearing loss and balance disturbances.

Specific objectives : To determine : 1, hearing and balance functions induced by noise and vibration by audiometric and posturography tests 2. To find other physiologic factors such as age, blood pressure, blood glucose level, smoking habit and body mass index which could influence those functions ; 3, To determine the threshold of noise frequencies, intensity and also acceleration of vibration which contributed to noise.

Setting : Subdivision of Neurotology of ENT Department of Cipto Mangunkusumo Hospital, Jakarta, Study subjects : Bajaj drivers.

METHODS: The study was carried out from March 2000 until October 2001.Noise and vibration were measured using octave band analyzer and vibration meter. Clinical ENT examination, height and body weight for body mass index, blood pressure and blood glucose level tests were performed. The subjects were divided into four groups : the normal one, only hearing or balance problem group, group of both disturbances. The risk factors were calculated by bivariate and multivariate or logistic regression analyses.

RESULTS : Mean of bajaj's intensity level was 91 dBA, with minimum intensity 64 dBA, maximum intensity 96 dBA, mean acceleration of vibration was 4,2 misec2. Those results showed that noise and vibration of bajajs were over safety threshold, which has been established by OSHA. The rate of normal subjects was 27.72 %, whereas that of those who suffered from hearing and balance problems was 27,43%, and only 17.14% had hearing problems and 27,71 % had balance problems. The total was 72,28 % of disturbance. From the multivariate analysis, hearing and balance problems were influenced by age more than 40 years old, working periods more than 9 years, daily working hours more than 8 hours, history of heavy smoking habit and obesity. Balance problems were influenced by the same factors. But the working period was 5.9 years and hearing problems were only influenced by age more than 40 years old. It was concluded that balance function was more sensitive than hearing one. For prevention, this study also introduced risk scores for hearing and balance functions based on those physiological factors for workers who worked in noisy and vibrating areas, low risk for scores 0-5, moderate risk for scares 6-10 and high risk for scores more than 11. The sensitivity level was 70,83% and specificity was 73,20 %.

CONCLUSIONS : Mean of bajaj's intensity level was 91 dBA, with minimum intensity 64 dBA, maximum intensity 96 dBA. mean acceleration of vibration was 4,2 misec2, which are over the safety threshold. Noise and vibration could induce hearing and balance problems in 72,28% of drivers. Those problems are influenced by several factors such as age, working periods, daily working hours, smoking habit and obesity."

"Sleep disturbances and fatigue are frequently complained by adolescents with cancer. These problems will lead to avariety of changes that may affect adolescents? development. However, there is very limited data concerningadolescents with cancer in Indonesia. The research aimed to explore sleep disturbances and fatigue in adolescents withcancer who are receiving chemotherapy. The research applied a qualitative design with phenomenology approach. Datawere collected using in-depth interviews with seven adolescents with cancer in Jakarta, Bogor, and Bekasi. Theinterviews involved open questions on seven aspects, consisting of level of fatigue, responses to psychological drives,sleep disturbances, sleep disruption due to illness and chemotherapy, disruptions in some aspects of daily life, responsesto problematic situations, and general perspective on life. Participants stated that chemotherapy induced sleepdisturbances and fatigue, and this situation greatly influenced their overall quality of life. These problems areinterrelated to each other and may affect the success of chemotherapy program. In terms of nursing, this research alsoshows the importance of developing a more effective system for managing sleep disturbances and fatigue duringchemotherapy program.Gangguan Tidur dan Kelelahan pada Remaja Pengidap Kanker yang Menjalani Kemoterapi. Gangguan tidur dankelelahan seringkali dikeluhkan oleh para remaja yang mengidap kanker. Keluhan ini mengakibatkan timbulnyaberbagai perubahan yang dapat memengaruhi pertumbuhan remaja. Namun, data tentang remaja penderita kanker diIndonesia masih sangat terbatas. Penelitian ini bertujuan untuk menyelidiki keluhan-keluhan berupa gangguan tidur dankelelahan yang diderita oleh remaja pengidap kanker yang sedang menjalani kemoterapi. Penelitian ini menerapkanrancangan kualitatif dengan pendekatan fenomenologis. Pengumpulan data dilakukan dengan mengadakan wawancaramendalam mengenai tujuh aspek yang terdiri dari tingkat kelelahan, reaksi terhadap dorongan-dorongan psikologis,gangguan tidur, tidur tidak nyenyak karena penyakit dan kemoterapi, gangguan pada sejumlah aspek dalam kehidupansehari-hari, reaksi terhadap keadaan yang menyulitkan, dan pandangan hidup secara umum. Para responden menyatakanbahwa kemoterapi menimbulkan gangguan tidur dan kelelahan. Selain itu, mereka juga menyatakan bahwa situasi inisangat memengaruhi kualitas hidup mereka secara umum. Masalah-masalah ini berkait satu sama lain dan dapatmemengaruhi kesuksesan program kemoterapi yang mereka jalankan. Dari segi keperawatan, penelitian ini jugamenunjukkan pentingnya merancang sebuah sistem yang lebih efektif untuk menghadapi gangguan tidur dan kelelahanselama program kemoterapi."

"Bandara sebagai pusat pelayanan transportasi udara pada dasarnya merupakan lingkungan yang selalu berkembang seiring dengan kesibukan yang ada didalamnya. Operasi pesawat udara mengemisikan tingkat bising yang tinggi sehingga menurunkan kualitas lingkungan di sekitar bandar udara. Penurunan kualitas lingkungan ini diduga mempunyai dampak negatif terhadap kesehatan masyarakat, sehingga menimbulkan biaya kesehatan dan biaya fisik yang harus ditanggung oleh masyarakat.Penelitian ini bertujuan untuk : (1). Mengetahui besarnya tingkat kebisingan di sekitar bandar udara Sepinggan Balikpapan yang telah melampaui baku mutu yang ditetapkan, (2). Mengetahui pengaruh tingkat kebisingan yang telah melampaui baku mutu yang ditetapkan terhadap gangguan kesehatan masyarakat dan kerusakan lingkungan fisik di sekitar bandar udara Sepinggan Balikpapan, (3). Mengetahui pengaruh kebisingan terhadap gangguan kesehatan masyarakat dan kerusakan lingkungan fisik dengan tingkat kesediaan masyarakat untuk membayar (Willingness to pay = WTP) jika tingkat bising di sekitar bandar udara dapat diturunkan sesuai baku mutu.Hipotesis dalam penelitian ini adalah : (1). Tingkat bising di sekitar bandar udara Sepinggan Balikpapan telah melewati baku mutu yang telah ditetapkan, (2). Terdapat pengaruh tingkat bising terhadap gangguan kesehatan masyarkat dan kerusakan lingkungan fisik di sekitar bandar udara Sepinggang Balikpapan, (3). Terdapat pengaruh gangguan kesehatan masyarakat dan kerusakan lingkungan fisik dengan tingkat kesediaan membayar oleh masyarakat (WTP).Penelitian dilakukan di sekitar bandar udara Sepinggan Balikpapan pada bulan Agustus 2001 sampai dengan Juni 2002. Dilaksanakan dalam dua tahap kegiatan. Tahap pertama berupa pengumpulan data primer yang meliputi pengukuran tingkat bising. Tahap kedua, berupa survai sosial melalui wawancara dan pengumpulan data melalui kuesioner yang ditunjang dengan pengumpulan data sekunder di lokasi I, II yang terletak di RT. 14 dan RT. 15 Kelurahan Sepinggan dan lokasi III yang terletak di RT.52 Kelurahan Gunung Bahagia Kota Balikpapan, dengan jumlah responden sebanyak 50 responden untuk tiap-tiap lokasi sehingga total responden sebanyak 150 responden. Di dalam tahap ini juga diukur kondisi sosial ekonomi serta kesanggupan membayar (WTP) masyarakat untuk mengurangi tingkat bising. Data hasil pengukuran dianalisis dengan menggunakan metode statistik dan metode valuasi kontingensi (Contingent Valuation Method).Berdasarkan hasil pengukuran tingkat bising di lokasi I didapatkan nilai siang (Ls) sebesar 78,5 dB (A), malam (Lm) 45,3 dB (A) dan siang-malam (Lsm) 76,70 dB(A). Pengukuran di lokasi II pada siang (Ls) 66,70 dB(A), malam (Lm) 66,80 dB(A) dan siang-malam (Lsm) 69,10 dB(A). Pengukuran di lokasi III, pada siang (Ls) 69,40 dB(A), malam (Lm) 57,10 dB(A) dan siang-malam (Lsm) 68,00 dB(A). Berdasarkan hasil perhitungan WECPNL pada lokasi I, rekomendasi ICAO untuk lokasi I sangat berbahaya untuk mendirikan bangunan, kecuali permukiman kedap suara. Ketiga lokasi yang telah diukur telah melampaui baku tingkat kebisingan yang ditetapkan.Dampak bising terhadap gangguan kesehatan dan kenyamanan masyarakat di daerah penelitian dengan tingkat kedatangan pesawat yang tinggi adalah sulit tidur dan berkomunikasi (9,3%), sulit tidur, berkomunikasi dan pendengaran (32,7%), sulit berkomunikasi dan ketulian (8,7%), dan sulit berkomunikasi (16%), dan sulit berkomunikasi dan gangguan pendengaran (24,7%). Ketidaknyamanan responden terhadap tingkat kebisingan adalah sangat terganggu 30,66%, terganggu 62,66% dan cukup terganggu 6,66%.Kesimpulan bahwa 1) tingkat pengukuran tingkat bising di sekitar lokasi bandar udara Sepinggan Balikpapan telah melampaui baku mutu tingkat kebisingan yang ditetapkan, 2) Tingkat bising berpengaruh terhadap gangguan kesehatan dan lingkungan fisik di sekitar bandara udara Sepinggan Balikpapan dan 3) Dampak tingkat bising berpengaruh terhadap tingkat kesediaan membayar masyarakat di sekitar bandar udara Sepinggan Balikpapan.Dengan menggunakan metode langsung, rata-rata tingkat kesediaan membayar masyarakat yang bermukim di sekitar bandar udara Sepinggan Balikpapan dalam daerah paparan bising adalah Rp. 357.800,00 per tahun. Dengan menggunakan metode tidak langsung, rata-rata pengeluaran biaya pengganti kesehatan masyarakat dan kerusakan lingkungan fisik adalah Rp. 461.000,00 per tahun. Berdasarkan hasil survei bahwa biaya-biaya yang dikeluarkan oleh masyarakat cenderung akan meningkat pada waktu-waktu yang akan datang khususnya pada saat pelaksanaan kegiatan embarkasi jamaah haji di bandar udara Sepinggan Balikpapan.Penulis menyarankan beberapa penyelesaian alternatif terhadap pengelolaan bising di bandar udara Sepinggan Balikpapan antara lain: 1) Penetapan jadwal penerbangan dengan jumlah frekuensi penerbangan pada siang hari lebih besar dari pada malam dan dengan tingkat bising di bawah baku mutu lingkungan, 2) Pihak pengelola bandar udara Sepinggan Balikpapan, Pemerintah Kota Balikpapan, Lembaga Swadaya Masyarakat (LSM), masyarakat, perguruan tinggi dan pemerhati lingkungan secara bersama-sama membahas masalah bising dan getar dengan memperhatikan tingkat kesediaan membayar (WTP) guna mengurangi dampak bising dan getar, 3) Penggunaan jalur hijau dan pertamanan untuk dapat mereduksi tingkat bising yang tinggi terhadap masyarakat sekitar bandara, 4) Memperhatikan jarak ideal antara sumber bising dengan permukiman penduduk di sekitar bandara, 5) Menerbitkan dan meimplementasikan peraturan penetapan wilayah paparan bising lewat hukum serta membatasi tingkat bising maksimum yang diperbolehkan di daerah permukiman, 6) Hasil penelitian ini dapat dianggap sebagai tanggapan dari masyarakat yang ingin mendapatkan lingkungan yang sehat (bebas dari tingkat kebisingan di atas baku mutu lingkungan).

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Economic Valuation of Noise Impact on Disturbances of Society Health and Physical Environment (A case: study of Noises Impact of Aircraft Operation on Disturbance of Society Health and Physical Environment around the Sepinggan Airport Balikpapan)Airport as a center of air-borne basically is an environment which grows along with their activities. The aircraft operation emits high noises decreasing the quality of environment around the airport. This decreasing environmental quality has negative impact on the disturbances of society's health and physical environment so that results cost of health and physical of which society have to carry on.The objectives of this research are : (1) to know the noise level which is over-limit of determination around the airport of Sepinggan Balikpapan, (2) to find out the influences of over-limit noise level on disturbances of society health and physical environment around the airport, (3) to know the willingness to pay of society for taking less of the noise.The hypotheses of this research are: (1) the over-limit noise level in Sepinggan airport Balikpapan, (2) influences of noise level on disturbances of society health and physical environment, (3) influences of the disturbances of society health and physical environment on their willingness to pay for the noise they carry on.This research had occurred around the airport of Sepinggan Balikpapan in August 2001 until June 2002. It was performed in two steps of activities. First, it was collecting primary data including measuring the noise level. The second one is a social survey including interview and collecting data through in questioners supported by collecting secondary data. In this step it was not only measured economic society but also their willingness to pay for taking less noise they carry on. The result data were analyzed by using statistical and contingent valuation methods.Based on the measurements of noise level was gained at midday (Ls) 78.5 dB (A) and night (Lm) 45.3 dB (A). On site I was resulted at midday (Ls) 78.5 dB (A), night (Lm) 45.3 and day-night (Lsm) 76.70 dB (A). On site II it is gained at midday (Ls) 66.70 dB (A), night (Lm) 66.80 and day-night (Lsm) 69.10 dB (A). On site III it is gained at midday 69.40 dB (A), night (Lm) 57.10 dB (A) and day-night (Lsm) 68.00 dB (A). Based on the WECPNL calculation followed by recommending ICAO that on site I was very dangerous for building structure without any support by noise reduction structure.The influences of noise level upon disturbances of society health living in the research area of which has highly aircraft arrivals include communication and sleeping-problem (9.3%), sleep disturbances, communication and hearing diseases (32.7%), difficult to communicate and deaf (8.7%), difficulty communication (16%), and difficulty communication and hearing disturbances (24.7%). The respondent's uncomfortable on this noise level is highly annoying (30.66%), annoying (62.66%), and annoying enough (6.66%).This research concludes that: 1). based on measurement results shows the noise level is over-limit of determination around the airport of Sepinggan Balikpapan, 2). noise level around the airport has influences on the disturbances of society health and physical environment, 3). all around the airport of Sepinggan Balikpapan noise level has close relations with the society's willingness to pay who live in around the airport.The average of society's willingness to pay for taking less the noise on site I is Rp. 455,000.00, site II is Rp. 325,000.00, and site III is 251, 000.00. It takes overall average of Rp. 347, 000.00. Meanwhile, in using indirect method (replacement cost) on site I is Rp. 548,000.00, site II is Rp. 434,050.00 and site III is Rp. 372,000.00 The overall average is Rp. 451,350.00.Based on this research , writer suggests : 1). high decrease of noise on aircraft must be taken by choosing aircraft's machines and equipment which produce low noise providing a comfortable life for society live in around the airport of Sepinggan Balikpapan, 2). Exploring green-line and gardening to be able to reduce the high noise around the airport, 3). Considering an ideal distance between the noise sources and people's residence around the airport, 4). Establishing a regulation of area determination and an safety area of noise through in law followed by making a noise maximum standard which is permitted in residence area, 5). it's time to consider this research as a response of society who want get healthy environment (free of high noise which disturbs the environmental quality)."

"Ruang lingkup dan Cara penelitian : Bahan dasar uang kertas adalah serat kapas. Di Bank X uang kertas tak layak edar dihancurkan menjadi debu dan serpihan-serpihannya. Banyak laporan mengatakan debu dan serat kapas berpengaruh negatif pada fungsi paru tenaga kerja dengan menyebabkan terjadinya obstruksi. Selama ini belum diketahui dengan pasti pengaruh debu uang kertas terhadap fungsi paru. Suatu studi cross sectional dengan pembanding telah dilaksanakan di Bank X Jakarta untuk mengetahui prevalensi gangguan faal ventilasi paru yang berupa obstruksi kronik dan akut serta restriksi dan dianalisis hubungannya dengan kadar debu total, umur, lama kerja, kebiasaan merokok, gejala klinis serta riwayat alergi. Sampel adalah tenaga kerja di Bagian Kas sebagai kelompok terpajan dan tenaga kerja pada Bagian Sumber Daya Manusia (SDM) sebagai kelompok tidak terpajan. Data keduanya dianalisis dan dibandingkan.Hasil dan Kesimpulan : Kadar rata-rata debu total pada Bagian Kas 243,0 hg/m3 dan Bagian SDM 42,8 pg/m3. Kadar debu tersebut berbeda bermakna ( p = 0,00 ). Kadar ini tidak dapat dibandingkan. Gejala klinis yang menonjol adalah batuk-batuk (pada Bagian Kas 51,3% dan Bagian SDM 11,3% ) yang secara statistik berbeda bermakna (p = 0,00 ). Prevalensi obstrukai kronik pada Bagian Kas 19,4% dan di Bagian SDM 32,3% ; obstruksi akut di Bagian Kas 7,7%, di Bagian SDM 8,1 %; dan restriksi di Bagian Kas 14,1 %, di Bagian SDM 11,3 % . Uji statistik tidak menunjukkan perbedaan bermakna antara obstruksi kronik dan akut serta restriksi dengan kadar debu, umur, lama kerja, merokok,- gejala klinis yang berupa batuk-batuk serta riwayat alergi. Efek debu uang kertas pada kelainan faal ventilasi paru belum terlihat.

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Analysis on the Relationship between Exposure to Paper-Money Dust and Lung Function Disturbances in Workers of Bank X, 1996Scope and methods :

The main ingredient of paper money is cotton fibers. In Bank X used paper money which is not proper for circulation is destroyed into dust and very fine pieces. Many reports state that cotton dust and fibers negatively affect the lung function by causing obstruction. So far until recently the actual effects of paper money dust to the health of the lungs have not been exactly known. A cross-sectional study with the use of control group has been carried out in Bank X, Jakarta to ascertain the prevalence of pulmonary ventilator disturbances in the forms of chronic and acute obstruction as well as restriction, and analysis has been done on their correlations with total dust concentration in the workroom air, age, length of employment, smoking habits, clinical symptoms and history of allergy. The study samples have covered the workers of the Division of Finance as the exposed and entire workers of the Division of Human Resources Development (HRD} as the unexposed group. Data collected from these two groups were analyzed and compared.

Results and Conclusions :

The average concentrations of paper-money dust were 243.0 ug/m3 at the Division of Finance and 42.8 ug/m" at the Division of HRD. These dust concentrations were of statistically significant difference ( p = 0.00 ). The prominent clinical symptom was coughs found in 51.3 % of workers of the Division of Finance and 11.3 % in the Division of HRD. Statistical analysis has shown significant difference (p = 0.00). The prevalence rates of chronic obstruction were 19.4 % in the Division of Finance and 32.3 % in the Division of HRD. The prevalence rates of acute obstruction were found 7.7 % in the Division of Finance and 8.1 % in the Division of HRD_ The prevalence rates of restriction were 14.1 % in the Division of Finance and 11.3% in the Division of HRD. The statistical analysis has not shown significant correlations among chronic and acute obstruction as well as restriction with dust concentration, age, length of employment, smoking habits, and clinical symptom (coughs) and history of allergy. Exposure to paper-money dust has resulted in clinical symptom i.e. coughs, but its effects to the lung function have not been revealed by this study."

"Gangguan tidur mempengaruhi kualitas hidup anak yang mendapatkan kemoterapi. Penelitian bertujuan untuk mengidentifikasi pengaruh relaksasi otot progresif terhadap kualitas tidur dan efek samping kemoterapi pada anak dengan kanker. Desain penelitian randomized clinical trial dengan metode single blind, 30 anak secara random dialokasikan pada kelompok kontrol dan kelompok intervensi. Kelompok intervensi mendapat relaksasi otot progresif 2x sehari, pagi dan malam hari, 15 menit setiap sesi selama 7 hari. Kelompok kontrol mendapat tindakan keperawatan rutin. Hasil penelitian menyimpulkan tidak ada perbedaan yang bermakna pada kedua kelompok terhadap fatigue, nyeri, dan mual muntah, namun bermakna pada kualitas tidur dimana terdapat penurunan skor kualitas tidur. Terapi relaksasi terutama relaksasi otot progresif dapat menjadi salah satu tindakan keperawatan untuk meningkatkan kualitas tidur dan mengurangi efek samping kemoterapi pada anak dengan kanker.

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Sleep disturbances affects quality of life in children receiving chemotherapy. The aim of this study to identify the effect of progressive muscle relaxation for the sleep quality and side effects of chemotherapy in children with cancer. In this study randomized clinical trial with single blind method applied, 30 children were allocated randomly to the control group and intervention group. The intervention group received progressive muscle relaxation twice a day, in the morning and evening, 15 minutes each session for 7 days. Control group received routine nursing care. The study concluded there was no significant difference in the two groups on fatigue, pain, and nausea, vomiting, however progressive muscle relaxation significant on the quality of sleep in which there is a decrease in sleep quality scores. Relaxation therapy particularly progressive muscle relaxation may be one of the nursing care to improve sleep quality and reduce the side effects of chemotherapy in children with cancer."

"Prevalensi obesitas pada anak usia sekolah di DKI Jakarta adalah sebesar 14.0%. Ketidakseimbangan Indeks Massa Tubuh (IMT) dapat memengaruhi pertumbuhan dan perkembangan melalui hormon ghrelin dan leptin sehingga dapat menyebabkan gangguan tidur pada anak. Prevalensi gangguan tidur pada anak usia sekolah di Jakarta Pusat adalah 25,1%. Penelitian ini bertujuan untuk mengetahui pengaruh IMT terhadap gangguan tidur pada anak usia sekolah di Provinsi DKI Jakarta. Desain yang digunakan dalam penelitian ini adalah desain crosssecitonal dengan data sekunder diperoleh dari South-East Asian Nutrition Survey 2.0 (SEANUTS 2.0). Subjek dalam penelitian ini adalah 104 anak usia 6-12 tahun yang terdiri dari 62 anak perempuan dan 42 anak laki-laki. Analisis bivariat menunjukkan bahwa IMT tidak memiliki hubungan yang signifikan dengan gangguan tidur (p=0,135), sedangkan variabel lain yaitu kecemasan (p=0,000), berkeringat pada malam hari (p=0,013), dan persentase lemak (p=0,034) memiliki hubungan yang signifikan. Hasil analisis regresi linier berganda menyimpulkan bahwa variabel yang paling berpengaruh terhadap gangguan tidur adalah kecemasan (p=0,000) dan berkeringat pada malam hari (0,020). Dengan demikian, dapat disimpulkan bahwa IMT tidak berpengaruh terhadap gangguan tidur pada anak Provinsi DKI Jakarta. Diperlukan penelitian lebih lanjut untuk menyimpulkan faktor-faktor lain yang mendasari yang mungkin memengaruhi gangguan tidur pada anak-anak khususnya di Provinsi DKI Jakarta.

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The prevalence of obesity in DKI Jakarta province is 14,0%. These imbalance in Body Mass Index (BMI) could affect growth development through imbalance of ghrelin and leptin, which could affect the quality of sleep and cause sleep disturbances in children. This study aims to determine the effect of BMI on sleep disturbances in school-aged children in DKI Jakarta Province. The design utilized in this study was a cross-sectional with data obtained from the South-East Asian Nutrition Survey 2.0 (SEANUTS 2.0). The subjects in this study were 104 children aged 6--12 years old, consisting of 62 girls and 42 boys. Bivariate analysis showed that BMI does not have a significant relationship with sleep disturbance (p=0.135), while other variables such as anxiety (p=0.000), sweating at night (p=0.013), and fat percentage (p=0.034) do have significant relationship. Results of multiple linear regression analysis conclude that variable with the influence for sleep disturbances are anxiety (p=0.000) and sweating at night (0.020). In conclusion, BMI does not affect sleep disturbances in children of DKI Jakarta Province. More research is needed to conclude other underlying factors that might affect sleep disturbances in children especially in DKI Jakarta."