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"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.

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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."

"ABSTRAKKeberhasilan Pemerintah dalam pembangunan, khususnya pembangunan kesehatan tidak diragukan lagi, hal ini terlihat dari semakin meratanya pelayanan kesehatan, dimana pada setiap kecamatan minimal ada 1 Puskesmas.Namun disamping itu ada hal yang menarik dalam pelayanan kesehatan, yaitu pengobatan tradisional sampai saat ini masih diakui keberadaannya oleh masyarakat. Hasil Survai Kesehatan Rumah Tangga (SKRT) menunjukkan data tentang masih adanya masyarakat yang menggunakan pengobatan tradisional, baik itu dilakukan sendiri dengan ramuan-ramuan ataupun dengan pertolongan pengobat tradisional.Kebijaksanaan Pemerintah tentang pengobatan tradisional telah digariskan dengan jelas dalam GBHN 1993, yaitu pengobatan tradisional yang secara medis dapat dipertanggung jawabkan perlu terus dibina untuk perluasan dan pemerataan pelayanan kesehatan. Disamping itu dalam Sistem Kesehatan Nasional (SKN) juga dinyatakan bahwa terhadap pengobatan tradisional yang terbukti berhasil guna dan berdaya guna terus dilakukan pembinaan dan bimbingan, sehingga dapat dimanfaatkan untuk meningkatkan pemerataan pelayanan kesehatan.Penelitian ini bertujuan untuk mendapatkan gambaran tentang bagaimana hubungan tingkat Sosial-Ekonomi masyarakat dengan pemanfaatan pengobatan tradisional di Kabupaten Subang, Pandeglang dan Kotmadya Bandung, Jawa Barat. Penelitian dilakukan ditempat-tempat ini oleh karena data-data menunjukkan bahwa masyarakatnya cukup banyak yang memanfaatkan pengobatan tradisional.Penelitian ini merupakan penelitian deskriptif analitik, dan data diambil secara "Kros seksional" dengan kepala keluarga sebagai responden. Jumlah sampel 301 yang dipilih secara random dari 10 desa di 5 Kecamatan. Hipotesis yang diajukan adalah : Tingkat Sosial-Ekonomi yang meliputi pendidikan, penghasilan dan jenis pekerjaan mempunyai hubungan negatip dengan pemanfaatan pengobatan tradisional, hubungan ini juga dipengaruhi oleh faktor jarak dari rumah ke tempat pelayanan kesehatan modern, umur, ketersediaan biaya kesehatan dan derajat sakit.Hasil penelitian membuktikan bahwa adanya hubungan negatip antara tingkat Sosial-Ekonomi dengan pemanfaatan pengobatan tradisional, dari hasil uji Chi-square didapatkan nilai p = 0.0481 untuk variabel pendidikan, p = 0.0036 untuk variabel penghasilan dan p = 0.0029 (nilai a = 0.05); hasil analisa logistik regresi juga menunjukkan bahwa hubungan negatip antara tingkat Sosial-Ekonomi dengan pemanfaatan pengobatan tradisional semakin lemah dengan semain dekatnya sarana pelayanan pengobatan modern dan semakin ringannya penyakit.

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ABSTRACT

There have been so many development in health, resulted in the availability of health services, where in every sub district there is at least one "Public Health Center". However, according to a household surveys on health (SKRT) in 1988 and 1992, some people still use the traditional treatment to overcome their health problems.

In this research, we want to know the relationship between economic and social status (education, income, job) and the use of traditional treatment. Furthermore, we also want to see how the distance of modern health services, age, degree of illness and cash availability affect the use of traditional treatment.

This research was done in two districts of Subang and Pandeglang, and in one municipality of Bandung in West Java. It was a descriptive and analytical research using "cross sectional " data where the respondent was the head of the household. We take 301 respondents randomly from, .10 villages in 5 sub district.

The hypothesis in this research is that social-economic factor, they are income, education and job have negative relationship with the use of traditional treatment. And the sub hypothesis is that the negative relationship will be weaker as the distance of modern health services becomes less, the degree of illness becomes higher, more money is available an the age becomes younger.

Statistic analysis we use to prove this hypothesis was Chi-Square, we selected influential variables in traditional treatment by looking at "p" value. If "p" value is less than 0.05 the independent variables is significant. From the Chi-Square we get p value of education = 0.0481, p value of income = 0.0036 and p value of job = 0.0029. The regression logistic analysis we get different OR value before and after interaction with distances of modern health services and degree of illness, from that different value are proved that the distances of modern health services and degree of illness are influence the relationship between social-economic degree and the using of traditional treatment.

From the result of analysis, hypothesis and sub hypothesis are proved, that the social-economic degree has a negative relationship with the using of traditional treatment and this relationship will be weaker as the distance of modern health services becomes less and the degree of illness becomes higher."

"ABSTRACTThe main purpose of the study was to determine which characteristics and factors affect the pattern of treatment-seeking behavior in the sub district. The achievement of this objective was intended to add knowledge of treatment-seeking behavior to existing knowledge on both behavioral epidemiology and health services research as well as to provide useful information to formulate interventions in extending treatment services from the Lilirilau Sub district Health Center to the whole sub district.In early 1982, the data were collected from a representative sample of 1347 households with 472 sick household members. The data were analyzed using univariate, bivariate and discriminant analysis.The main results of the study are: The decision maker who preferred the sick person to be treated at home was more likely to choose home treatment than to seek treatment, to seek treatment from traditional healers than modern health services, and from paramedical personnel than the health center. Those who knew about the medications needed for a sickness were more likely to conduct self-treatment than choose no treatment. Most of those living more than 3 km from the health center were more likely to choose the policlinic and health promoter in the village concerned than the sub district health center.Most of those from families with lower wealth and with occupations in the FHLN (farmers, housewives, laborers and no job) category were more likely to seek treatment from traditional healers than modern health services, and to seek treatment from paramedical personnel than at the health center when compared with those from families with higher wealth and with occupations in the GEMS (government employees, businessmen, merchants and skilled workers) category. The decision makers for under-fives were more likely to-seek treatment from traditional healers than modern health services. Most of those with occupations in the FHLN category and who were uneducated were more likely to seek treatment at the policlinic and health promoter in the village concerned than at the health center. The household head was most often the decision maker for sick persons of all ages, while the housewife had a more important role in making decisions for children under-five than older children.The preference to be treated at home that was associated with knowledge about the medication needed and may be related to the habits of the community, while that associated with the age of the sick person may be related to the beliefs in the community. In line with these habits and beliefs, the sick persons undertake home treatment or seek treatment from paramedical personnel and traditional healers. Thus, the health center should undertake interventions to make self-treatment safe and effective. In addition, the health center should consider and implement alternative interventions so that both paramedical personnel and traditional healers extend treatment services safely and effectively. This intervention should be directed especially toward the target population: those with occupations in the FHLN category in the community, and household heads and housewives at the household level."

"Prevalensi karies gigi yang ditunjukkan dengan decayed, missing dan filled teeth (DMF-T) masih merupakan masalah kesehatan masyarakat, termasuk di Indonesia. Penelitian ini bertujuan untuk mengetahui peran faktor individu, rumahtangga dan kabupaten/kota terhadap kejadian karies gigi guna menyusun model pengendalian karies gigi di Kepulauan Bangka Belitung (provinsi dengan riwayat karies gigi tertinggi). Desain penelitian ini campuran (hybrid) antara ecological study dan cross-sectional. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner, pemeriksaan kesehatan gigi, pengambilan sampel air dan wawancara mendalam. Analisis data menggunakan regresi logistik multilevel (dengan mixed-effect model). Hasil penelitian menunjukkan faktorfaktor pada tingkat individu (frekuensi menggosok gigi, kebersihan gigi dan mulut dan kebiasaan makan makanan asam/bercuka), tingkat rumahtangga (jenis sumber dan keasaman air) dan tingkat kabupaten/kota (ketersediaan perawat gigi dan dokter gigi, angka gizi buruk dan besar anggaran kesehatan per kapita) berpengaruh terhadap prevalensi karies gigi berat pada penduduk dewasa, dimana secara keseluruhan dapat menjelaskan variasi risiko karies gigi sebesar 73,6%. Model pengendalian karies gigi yang sesuai dengan kondisi Kepulauan Bangka Belitung adalah menggabungkan pengendalian faktor pada tingkat individu, rumahtangga dan kabupaten/kota.

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Dental caries prevalence, indicated by decayed, missing and filled teeth (DMF-T), remains a global public health problem, including Indonesia. The objective of this research was to address the role of individual factors, households, and regency/municipality in explaining dental caries incidence, in order to formulate a model to control dental caries in Kepulauan Bangka Belitung—the province with the highest dental caries prevalence in Indonesia. This research was designed as a combination (hybrid) of cross-sectional and ecological studies. Quantitative and qualitative data were collected through interview, dental health examination by dentists, water sampling, and in-depth interviews. A multilevel logistic regression (mixed-effect) model was fitted to the data. The results show that the explanatory variables at individual (frequency of teeth brushing, dental and mouth hygiene, and acidic food consumption), household (main water source and acidity), and regency/municipality (availability of dentist and dental nurse, malnutrition, and per capita health budget) levels influenced the prevalence of severe dental caries among adults; they all explained 73.6% of the variation in risk of dental caries. The appropriate disease control model, given the local conditions of Kepulauan Bangka Belitung Province, is one that integrates control of risk factors at individual, household, and regency/municipality levels. "

"Masalah kesehatan maternal terutama masalah kematian ibu masih menjadi masalah prioritas Bangsa Indonesia dalam meningkatkan kualitas Sumber Daya Manusia (SDM). Angka kematian ibu yang tinggi sering dikaitkan dengan pemanfaatan layanan kesehatan ibu bersalin. Pemanfaatan pelayanan kesehatan ibu bersalin di Indonesia menunjukkan variasi antar wilayah regional, diduga berhubungan oleh faktor lingkungan dan perbedaan karakteristik dari populasi. Penelitian ini mengukur pemanfaatan pelayanan kesehatan ibu bersalin dan mempelajari besar hubungan lingkungan dan karakteristik populasi terhadap pemanfaatan pelayanan kesehatan ibu bersalin. Penelitian ini menggunakan data sekunder SDKI 2017 yang mencakup 3.586 wanita usia subur (15–49 tahun) yang pernah melahirkan dalam waktu satu tahun sebelum survei. Analisis regresi logistik multinomial digunakan untuk menguji hipotesis adanya perbedaan pemanfaatan pelayanan kesehatan ibu bersalin berdasarkan perbedaan kondisi lingkungan dan perbedaan karakteristik responden. Penelitian ini menunjukkan bahwa lingkungan dan karakteristik populasi berhubungan signifikan terhadap pemanfaatan pelayanan kesehatan ibu bersalin. Dari analisis multivariat wanita yang paling berpeluang bersalin di rumah dengan bukan tenaga kesehatan yaitu wanita dengan karakteristik suami bekerja di sektor pertanian / wirasuasta (aOR: 7,56 95% CI: 1,69-33,80), dan wanita yang paling berpeluang untuk bersalin di rumah dengan tenaga kesehatan yaitu wanita bertempat tinggal di Pulau Kalimantan (aOR: 11,43 95% CI: 6,13-21,28). Dari hasil analisis hubungan lingkungan dan karakteristik populasi pada penelitian ini disimpulkan bahwa adanya ketidakmerataan akses kesehatan maternal (inequitable access to maternal healthcare) khususnya pada pemanfaatan pelayanan kesehatan ibu bersalin di Indonesia. Untuk mewujudkan pemeratan akses kesehatan maternal perlu adanya komitmen pemerintah pusat dan daerah dengan memaksimalkan anggaran di daerah khususnya pada Pulau di luar Jawa-Bali.

Kata kunci: Pelayanan kesehatan Ibu bersalin, Lingkungan Wilayah Tempat Tinggal, dan Karakteristik Populasi, ketidakmerataan akses kesehatan maternal.

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Maternal health problems, specially maternal mortality, are one of the most important problems that need to be addressed for the Indonesian people in order to improve the quality of their human resources. Indonesia has a high mortality rate, which is often associated with the utilization of maternal health services. Utilization of maternal health services in Indonesia shows variations between regional areas, which might be influenced by environmental factors and differences in the characteristics of the population. This study examines the relationship between environmental factors and population characteristics with the utilization of maternal health services. This study used secondary data from the 2017 IDHS which included 3,586 women of childbearing age (15–49 years) who had given birth within one year prior to the survey. Multinomial logistic regression analysis was used to test the hypothesis of whether the use of maternal health services had significant differences between different environmental conditions and different respondent characteristics. This study showed that environmental factors and population characteristics are significantly associated with the utilization of maternal health services. Based on multivariate logistic regression analysis, women who are most likely to give birth at home with non-health workers are women whose husbands work in the agricultural sector / self-employed (aOR:7.56 95% CI: 1.69-33.80), and women who are most likely to give birth at home with health workers are women who live on the island of Borneo. (aOR: 11.43 95% CI: 6,13-21,28). Based on the analysis of the relationship between environmental factors and population characteristics in this study, it was concluded that inequality of access to maternal healthcare was evident, especially the utilization of maternal health services in Indonesia. To achieve equal / equitable access to maternal health services, commitment from the central and local governments to optimize their budget especially in provinces outside Java and Bali island is absolutely needed."

"ABSTRAKFaktor risiko, menurut Last (1983), adalah suatu terminologi yang dihasilkan oleh suatu penelitian epidemiologi yang mempunyai beberapa arti yang antara lain:1) suatu atribut atau pemajanan yang dapat dihubungkan dengan peningkatan probabilitas terjadinya suatu outcome seperti terjadinya suatu penyakit; yang tidak selalu merupakan faktor kausal. Ini sering disebut sebagai risk marker2) suatu atribut atau pemajanan yang meningkatkan probabilitas terjadinya suatu penyakit atau suatu outcome tertentu lainnya. Ini sering disebut penentu (determinant) atau faktor yang menentukan3) suatu penentu yang dapat dimodifikasi dengan intervensi sehingga dapat mengurangi probabilitas teijadinya penyakit atau suatu outcome tertentu. Ini Bering juga disebut sebagai faktor risiko yang dapat dimodifikasi.Dalam penelitian ini yang dimaksud dengan faktor risiko dari pneumonia pada bayi dan anak balita tercakup dalam tiga pengertian di atas.Pneumonia adalah penyakit dengan gejala batuk pilek disertai napas sesak atau napas cepat. Definisi pneumonia di atas adalah definisi kasus yang baru diperkenalkan oleh WHO pada tahun 1989 dan dipakai oleh Departemen Kesehatan Republik Indonesia dalam program penanggulangan Infeksi Saluran Pernapasan Akut (ISPA) secara nasional pada tahun 1991. Sebelumnya, istilah yang dipakai untuk kasus ini adalah ISPA. ISPA biasanya mengandung arti yang lebih luas karena di dalam ISPA juga termasuk saluran pernapasan atas, telinga, hidung, dan tenggorok, sedangkan pada pneumonia yang dimaksud adalah infeksi saluran pernapasan bawah yang akut dan penyakit ini mempunyai tingkat kematian yang tinggi. Sebenarnya, program penanggulangan ISPA yang mempunyai tujuan menurunkan mortalitas pada bayi dan anak balita ditujukan pada pneumonia ini. Oleh karena itu, sejak tahun 1989, WHO menggunakan istilah pneumonia dalam case managementnya sebagai pengganti ISPA dan hal ini pun dilaksanakan oleh Departemen Kesehatan RI sejak tahun 1991. Dalam telaah kepustakaan pun baru pada tahun-tahun terakhir ini lebih banyak muncul istilah pneumonia; sebelumnya cukup banyak dipergunakan istilah ISPA. Biasanya, yang dimaksud pneumonia sekarang adalah istilah yang dulunya dikategorikan sebagai "ISPA sedang" dan "ISPA berat"."

"ABSTRAKPenyakit 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.

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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."

"Measles immunization has been introduced since 1960, thereby markedly reducing the number of cases in developed countries. However, measles epidemics still occur even in developed countries. In the United States, in 1988-1992 an increase in the number of measles cases reaching 50,000 cases was reported. Some of these cases occurred in previously immunized patients. This was thought to be caused by genetic mutation of the measles virus, aside from weaknesses of the vaccine and low immunization coverage.Since measles immunization was employed in Indonesia, the number of measles patients has decreased. However, epidemics are still frequently reported. About 15-30% of reported cases occurred in those previously immunized, raising the question of whether a genetic difference exists between the wild-type measles virus circulating in Indonesia and the vaccine virus being used. Such a difference may lead to the differences in the antigenicity of the wild-type and vaccine viruses, rendering the resulting antibody incapable of neutralizing the wild-type viruses. Based on the above, this study is aimed to demonstrate the extent of genetic and antigenic differences between the wild-type and vaccine measles viruses.We conducted an experimental laboratory study to sequence the N, H, and F genes of the wild-type measles viruses (G2, G3, and D9) and the CAM-70 vaccine virus. To show antigenic differences, the wild-type viruses (G2, G3, and D9) and the CAM-70 and Schwarz viruses were injected to BALB/c mice. Serum antibodies of the mice were analyzed using ELISA, cross-neutralization test, and immunoblotting using antigens from the respective viruses.Results of this study showed that the wild-type and the vaccine viruses differ in the sequence of the N gene by 73-79 nucleotides, resulting in amino acid substitution of 17-24 residues; the H gene by 60-99 nucleotides, resulting in amino acid substitution of 13-29 residues; the F gene by 71-88 nucleotides, resulting in amino acid substitution of 4-3 I residues. Differences between the wild-type and the CAM-70 and Schwarz vaccine viruses were also found in the epitope site of the CTL and antibodies, which are important to virus antigenicity.We conclude that a significant difference in antigenicity exists between the wild-type measles viruses circulating in Indonesia with the CAM-70 measles virus. We also found the immunogenicity of the CAM-70 and Schwarz vaccine viruses to be lower than that of the wild-type viruses."

"Measles immunization has been introduced since 1960, thereby markedly reducing the number of cases in developed countries. However, measles epidemics still occur even in developed countries. In the United States, in 1988-1992 an increase in the number of measles cases reaching 50,000 cases was reported. Some of these cases occurred in previously immunized patients. This was thought to be caused by genetic mutation of the measles virus, aside from weaknesses of the vaccine and low immunization coverage. Since measles immunization was employed in Indonesia, the number of measles patients has decreased. However, epidemics are still frequently reported. About 15-30% of reported cases occurred in those previously immunized, raising the question of whether a genetic difference exists between the wild-type measles virus circulating in Indonesia and the vaccine virus being used. Such a difference may lead to the differences in the antigenicity of the wild-type and vaccine viruses, rendering the resulting antibody incapable of neutralizing the wild-type viruses. Based on the above, this study is aimed to demonstrate the extent of genetic and antigenic differences between the wild-type and vaccine measles viruses. We conducted an experimental laboratory study to sequence the N, H, and F genes of the wild-type measles viruses (G2, G3, and D9) and the CAM-70 vaccine virus. To show antigenic differences, the wild-type viruses (G2, G3, and D9) and the CAM-70 and Schwarz viruses were injected to BALB/c mice. Serum antibodies of the mice were analyzed using ELISA, cross-neutralization test, and immunoblotting using antigens from the respective viruses. Results of this study showed that the wild-type and the vaccine viruses differ in the sequence of the N gene by 73-79 nucleotides, resulting in amino acid substitution of 17-24 residues; the H gene by 60-99 nucleotides, resulting in amino acid substitution of 13-29 residues; the F gene by 71-88 nucleotides, resulting in amino acid substitution of 4-3 I residues. Differences between the wild-type and the CAM-70 and Schwarz vaccine viruses were also found in the epitope site of the CTL and antibodies, which are important to virus antigenicity. We conclude that a significant difference in antigenicity exists between the wild-type measles viruses circulating in Indonesia with the CAM-70 measles virus. We also found the immunogenicity of the CAM-70 and Schwarz vaccine viruses to be lower than that of the wild-type viruses."

"Pelita V di bidang kesehatan merupakan suatu era di mana perhatian dan upaya ditujukan kepada peningkatan keselamatan dan kesehatan ibu (Gerakan Safe Motherhood). Tekad yang telah digalang adalah menurunkan kejadian kematian ibu di Indonesia yang sekarang ini masih relatif tinggi dibandingkan dengan negara-negara lain, terutama negara-negara di Asia. Telah pula dibuktikan oleh para ahli, bahwa angka kesakitan dan kematian ibu meningkat drastis selama kurun kehamilan, melahirkan dan pascalahir. Kehamilan, yang pada dasarnya merupakan suatu proses fisiologis, ternyata dapat terganggu oleh berbagai macam penyakit dan kelainan yang dapat membahayakan kesehatan ibu ataupun janin. Oleh karena itu, setiap keadaan selama hamil yang mengganggu kesehatan dan keselamatan jiwa ibu maupun janin haruslah diketahui sedini mungkin sehingga dapat dilakukan pencegahan ataupun pengobatan yang sebaik baiknya. Pemeriksaan kehamilan merupakan salah satu cara terbaik. Pemeriksaan kesehatan selama hamil, yang dalam dunia medis lebih dikenal dengan istilah "pelayanan antenatal", diartikan sebagai suatu rangkaian tindakan pengamatan, pemeriksaan, dan bimbingan kesehatan yang terencana bagi ibu yang sedang hamil (Ingalls:1975). Tujuan pelayanan antenatal adalah dicapainya keadaan-keadaan sebagai berikut: kehamilan dengan gejala dan keluhan fisik dan psikis minimal; persalinan dengan status kesehatan ibu dan bayi di dalam keadaan prima; lahirnya bayi sehat tanpa kelainan; tertanamnya kebiasaan hidup sehat yang memberi manfaat bagi anggota keluarga yang lain; penyesuaian yang baik terhadap keadaan pascamelahirkan. Harapan jangka panjang dari pemeriksaan kehamilan ini adalah membantu menurunkan angka kematian ibu dan bayi. Jellife (1976) secara lebih spesifik menjabarkan tujuan pelayanan antenatal sebagai berikut: 1. pengawasan dan pemeliharaan kesehatan ibu selama hamil melalui pemeriksaan kesehatan dan kehamilannya secara berkala; 2. penemuan sedini mungkin gejala atau kelainan yang diperkirakan dapat membahayakan kesehatan ibu dan janin; 3. perlakuan tindakan tepat guna termasuk pengobatan bila ibu hamil dideteksi masuk kedalam kelompok risiko tinggi; 4. penyediaan kesempatan penyuluhan kesehatan khususnya yang menyangkut pemeliharaan kesehatan ibu selama hamil (penyuluhan gizi, kebersihan perorangan, dan persiapan dalam pemeliharaan bayi); 5. perencanaan persalinan sehingga dilahirkan bayi yang sehat dan ibu berada dalam keadaan selamat. Pada awal abad ke-20, pelayanan antenatal yang dilakukan baik oleh dokter maupun oleh perawat hanya ditujukan pada kebutuhan fisik ibu saja. Dengan berjalannya waktu, makin diketahui bahwa suatu proses kehamilan dan kelahiran melibatkan faktor psikis sehingga pendekatan pelayanan antenatal yang modern berubah kearah pendekatan fisiopsikologi yang melihat ibu hamil dan keluarga sebagai suatu kesatuan yang utuh (Walker:1974)?"