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"ABSTRAKTujuan:Untuk mengetahui hubungan antara kadar kromium serum dengan kadar insulin, gula darah, HbAlc, profit lipid dan tingkat oklusi koroner pada penderita baru penyakit jantung koroner.Tempat : Bagian Cath-Lab RS Jantung Harapan Kita.Bahan dan Cara: Penelitian dilakukan pada laki-laki di atas usia 35 tahun yang memenuhi kriteria dikumpulkan data mengenai sosio-ekonomi, keadaan kesehatan, gaya-hidup, aktivitas, IMT, asupan makanan, proporsi zat dan pemeriksaan tekanan darah, kadar kromium serum, insulin, gula darah, HbAlc, profil lipid dan tingkat oklusi koroner.Karakteristik subyek disajikan secara deskriptif, sedangkan analisis dilakukan dengan uji statistik chi kuadrat, t, Mann Whitney, dan uji korelasi Spearman.Hasil: Dari 65 subyek penelitian yang diteliti, umur rata-rata 51.17 + 7.44 tahun, terbanyak (60 %) antara 40 - 55 tahun, 73.9% golongan ekonomi menengah atas, prevalensi DM 13.8%, Hipertensi 16.9%, Merokok 69.2%, olahraga 28%, Obese dan gemuk 52.3%, aktivitas ringan 100%. Asupan nutrisi secara kualitatif sesuai dengan anjuran diit Konsensus Nasional Pengelolaan Dislipidemia di Indonesia, secara kuantitatif subyek dengan tingkat oklusi > 50%, mempunyai asupan protein hewani dan kolesterol yang lebih besar secara bermakna (p<0,05) dibandingkan dengan subyek dengan tingkat oklusi < 50%, dan telah jauh di atas AKG. Nilai rata-rata kromium serum 8.08 ug/L. Nilai ini 431 lebih rendah dari nilai normal. Nilai insulin, gula darah puasa dan trigliserida masih berada dalam batas normal. Nilai HbAlc, LDL, HDL dan Total kolesterol berada dalam batas yang diwaspadai. Berdasarkan Triad Lipid 98.5% menderita Dislipidemia.Berdasarkan tingkat oklusi koroner, didapatkan 44 orang subyek dengan tingkat oklusi >50%, dan 21 orang dengan tingkat oklusi <50% . Subyek dengan tingkat oklusi >50% mempunyai kadar LDL dan total kolesterol yang lebih besar secara bermakna. Kadar kroaium, insulin, gula puasa, HbAlc, trigliserida dan HDL kolesterol tidak berbeda secara bermakna. Pada tingkat oklusi koroner <50%, tidak ada korelasi yang bermakna antara kromium serum dengan faktor-faktor resiko. Pada tingkat oklusi koroner >50% ada korelasi yang bermakna kromium serum dengan gula puasa, trigliserida dan HDL kolesterol.Kesimpulan: Tidak ada hubungan antara kromium serum dengan kadar gula puasa, profil lipid dan tingkat oklusi koroner. Pada tingkat oklusi > 50% ada korelasi yang bermakna antara kroaium serum dengan gula puasa, trigliserida dan HDL kolesterol."

"Female adolescents are vulnerable to iron deficiency anemia (IDA) and if it persists into their reproductive years has serious implications not only for the health of their offsprings but for their own as well. An iron supplementation is warranted in order to provide sufficient iron stores prior to pregnancy and to effect desirable birth outcomes. A communication component of the supplementation is regarded as essential for improving compliance. Therefore, an experimental community trial involving adolescent female students in two public high schools in Metro Manila was conducted between October-December 1997. The objective of the study was to asses the effect of communication on compliance to weekly iron supplementation. The students were assigned to three groups: iron plus communication (FeC group, n = 82), iron (Fe group, n = 89), and control group (n=78). The FeC and Fe groups received iron tablets containing 60 mg. Elemental iron and 250 mcg. Folic acid while the control group received placebo tablets from Physical Education Health and Music (PEHM) teachers once a week of eight subsequent weeks. Teachers assigned to the FeC group were trained communication. Comparison were made between the three groups on compliance as communication. Comparisons were made between the three groups on compliace as measured by attendance to tablet distribution and actual ingestion through stool test, record on index card and interview. Additionally, levels and prevalence of anemia were measured before and after intervention and a pre and post test about knowledge on IDA and possible causes and treatments were included. Data about side-effects, reaction from students, parents and teachers about the supplementation-communication activities and suggestions for futher improvements in conductiong such future undertaking were obtained from focus group discussions (FGDs). Comparisons of actual tablet ingestion between the three groups showed significantly higher compliance in the FeC group (P<0.001) than in the other two group as measured by record on index card and interview desoite more side effects felt. Changes from pre to post-test knowledge scores o iron were significantly greater for the FeC group (p<0.001) than in the Fe and control groups. However, hemoglobin levels improved significantly in the Fe group (p<0.05) but not in the FeC group and remained the same in the control group. Reactions obtained through focus group discussions from parent (as reported by students), teachers and the participants found the program beneficial and feasible for implementation on a larger scale. Compliance enhancing strategies and motivational approaches for adolescent female students must consider the potential influence of family, fiends and teachers as revealed by the Venn diagram in planning iron supplementation programs with communication for this target group."

"Although iron is the most abundant element ¡n the universe , anemia is still the most prevalent nutritional disorders worldwide including in Indonesia. Among other approaches of combating iron deficiency anemia, iron supplementation is known to be the simplest and most effective way in improving iron status. This study is aimed to investigate the effect of iron supplementation given during menstruation as compared with weekly administration using the same dosage and number of iron tablets. The findings of this study are reported in three parts. Part I contains introduction which consists of background, problem statement and rationale, literature review, causal model, hypotheses, objectives, variables and indicators. This part supports the idea of the study. Manuscript for publication that covers main methods and findings of this study ¡s presented in part Il. The last part is appendices which comprise questionnaires, detailed methodology, detailed results, informed consent and ethical approval, references, Asia Pacific Journal of Chnical Nutrition?s guidelines for contributors, and curriculum vitae."

"Follow-up study of severely malnourished children during early chIldhood have been carried out in Bogor, Indonesia. The aim of the study is to investigate the long-term effects of severe malnutrition during early childhood on intelligence level and physical growth of school-age children. Fifty six children recovered from severe malnutrition after rehabilitation at NRDC outpatient clinic in Bogor for six months and fifty six well-nourished children matching for age, sex and some socioeconomic condition were included in the study.Weight and height measurement were conducted in 1991 when they were under-five years of age and in 1998 when they were nine to 13 years of age. Psychological test using the WISC were carried out in 1998.Intelligence level of the children suffered from severe malnutrition during early childhood were lower 11.34 1Q point compared to the children who did not Those who were rehabilitated at younger age had significantly higher 10 scores compared to those of older age before the age of 18 months. The more severe the children at admission to the clinic, the lower their IQ level. Previously malnourished group Were signifiCt1Y shorter than match control group. Only little catch-up were observed at 5fooI-ag6 among previously malnourished children. Those wto came to rehabilitation clinic at older age tend to have the better improvement on physical growth compared to those who came during infancy."

"Chitosan, a cationic polysaccharide derived from the cuticle of crustacean, ispromoted as a remedy to reduce fat absorption, might help reducing body weight andnormalizing lipid profile without any harmful effect. However, its clinical effectivenessfor this condition remains disputed. Therefore, study on that matters are required toinvestigate the effect of chitosan on human body weight and lipid profile. This research report is divided in three sequential parts. Part 1 contentscomprehensive reviews on the background and rationale of the study, problemstatements, literature review, causal model, objectives of the study and the hypotheses. Part 2 covers manuscript for publication entitled ?The effects of chitosan onbody weight, body fat and lipid profiles among Vietnamese overweight obesitydyslipdaemia female teachers? that presents the main findings of the study. Themanuscript is written in accordance with the ?Instructions for Authors? of PeerReviewed Journal ?Asia Pacific Journal of Clinical Nutrition?. Part 3 consists of detailed questionnaire, methodology, and other importantresults that are not included in manuscript. Form used for inform consent as well asreferences are also attached. Hopefully, this research report will give more information for better understandof the emerging issues and give benefit for future studies."

"Salt, is a potential vehicle and has extensively been used for delivery of iodine to the population, as an iodized salt. Many methods for assessing intake of salt have been applied in several studies in Indonesia, but all those methods were suspected to be relatively inaccurate. More precise method needed to define the amount of discretionary salt intake, which is salt added during cooking and at the table.Lithjum.marker technique is a relatively new method, has been established as a suitable, safe and biological reference for tracking the actual intake of individual salt. This method has been treated as a ?gold standard? method for assessing the discretionary salt intake. This result report deals with three methods: lithium-labeled salt technique, 24-hour salt recall and salt weighing, for assessing discretionary salt intake among children and mothers in an iodine deficient area of East Java-Indonesia.The research report has been organized under three major parts. The first part, the introduction, consists ofbackground, problem statement and rationale ofthe study, literature review, conceptual framework of research, objectives and variable and indicator matrix. Part two, the manuscript for publication to International Journal of Food Science and Nutrition. This part provides the abstract, introduction, subjects and methods, result, discussion, conclusion, and references. Part three is the last part of this report, the appendices, consists of questionnaires, detailed of the methodologies, detailed of the results, ethic application and ethical clearance, grand approval, references and curriculum vitae."

"Intrauterine growth retardation is still a problem in the world, and the cause are complex and multiple. Deficiency in vitamin A has been associated to low birth weight and intrauterine growth retardation. Nevertheless, the study about transfer of vitamin A from mother to fetus in intruterine growth retarded newborns is scarceThe study report is described in three parts.Part 1. Includes the background of the study, problem statement, rationale of the study, literature reviews, hypothesis, objectives, and variable-indicator matrix. The literature review is focusing on intrauterine growth retardation, and vitamin A in general and in pregnancy, nutrient transfer throug the placenta, as well as nutrition during pregnancy.Part 2. Is the manuscript for publication, which was prepared to be submitted to the Journal of Nutrtion. This study found thaht in a population where the mother do not have vitamin A deficiency, the condition of inadequate vitamin A status in intrauterine growth retarded newborns caused by problem in the transfer of the nutrient.Part 3. contains questionnaire used in data collection, form used in the placental abnormalities assessment, detailed methodology and result that have not been presented in the manuscript, references and curriculum vitae.With this preliminary research in the transfer of vitamin A, hopefully there will be more further research which can come to a recommendation as how to manage inadequate status of vitamin A in IUGR newborns."

"ABSTRAKIt is well known that iron and zinc deficiencies have negative consequences on growth and development; therefore combined iron and zinc supplementation has been proposed to be applied at community level. However, studies on zinc supplementation and infant's growth have shown inconsistent results. While physiological factors may partly explain the variation in findings, contribution of care specifically psychosocial care to the outcomes has been less discussed. This study aims to investigate whether effect of micronutrient (zinc, iron, vitamin A) supplementation in improving infants' growth and developmental outcomes is modified by levels of psychosocial care. The main hypothesis of the study is that zinc and iron supplementation improves growth and developmental outcomes of the infants and that the effect is improved with more favorable psychosocial care. The study involved 800 infants aged 3-6 months living in the rural area of East Lombok, West Nusa Tenggara. The main study was a double-blind community intervention study where syrup -consisting of zinc alone, Z (10 mg/d), zinc+iron, ZF (10 mg of each/day), zinc+ iron+ vitamin-A, ZFA (10 mg/d for each zinc and iron, 1,000 IU for vitamin-A), or placebo-- were given in daily dose for six months. The measured outcomes were growth, index on mental (MDI) and psychomotor (PDI) development using Bayley Scale of Infant Development II (BSID II), and micronutrient status (hemoglobin, serum zinc, ferritin, and retinol). Psychosocial care was assessed using Home Observation for Measurement of the Environment (HOME) Inventory scale. Other data included morbidity, food intake, childcare practices, resources for care, and socio-economic condition. Significant effect on serum zinc was observed in Z, ZF and ZFA groups and on serum retinol in ZFA group (p<0.05). Prevalence of anemia and low iron storage (ferritin <10 µg/L) remained the same in ZF and ZFA groups while increased (p<0.01 for hemoglobin, p<0.05 for ferritin) in Z and placebo groups. In general there was no significant effect of the supplementation on growth (HAZ, WHZ, WAZ). However, positive response on linear growth (HAZ) was observed among initially stunted infants, especially stunted boys who receive both zinc and iron (ZF and ZFA groups, p<0.05). There was an improvement of mental development in all groups, but only significantly in ZF group (p<0.05). In addition, subjects whose anemia remained uncorrected had significantly lower mental scores than those who were not/ no longer anemic (p<0.05). Better psychosocial care was associated with better growth, and the difference in growth among upper and lower levels of psychosocial care is minimal in the infants who received iron-zinc supplementation, suggesting that both supplementation and psychosocial care had an effect on growth. However, during the six-month supplementation, combination of both supplementation and better psychosocial care was not more significant than interaction of iron-zinc supplement and male sex (for HAZ) or levels of psychosocial care alone (for WAZ). Growth is determined not only by micronutrient intake and status but also by the contributing role of psychosocial care. Psychosocial care affected growth indirectly through better nutrient intake and health practices, and possibly through direct mechanism, which was not yet identified. The effect of zinc+ iron supplementation on mental development was stronger when combined with better psychosocial care and higher hemoglobin level. Accelerated mental performance was also observed in placebo, suggesting that factor(s) other than nutritional factor(s) may influence mental performance. On the other hand, psychomotor outcome was more predicted by nutritional status (WAZ), age, nutrient intake and illness. Results from this study concluded that mental development was determined both by micronutrient status and psychosocial care. Psychosocial care affected mental development partly through better initial mental performance, but mainly direct suggesting that environmental factor(s) had a stronger role than initial status in determining mental performance. Six months after the supplement was no longer given, growth (HAZ, WAZ, WHZ) remained better in infants having better psychosocial care. The association between growth (HAZ, WAZ) and HOME score at six months after the end of supplementation became stronger than during the intervention period, whereas positive benefit of the supplementation on -HAZ among boys -as observed by the end of the 6-month supplementation- was no longer maintained at this point of time. During the six-month supplementation, the subsequent six months, and over the total 12-month period, nutrient intake together with illness and psychosocial care were significant determinants of nutritional status (HAZ and WAZ). Results of this study suggest that incorporating care elements including encouragement of psychosocial care in supplementation/nutritional programs should improve its effectiveness and sustainability. The study also recommends further study to investigate more optimal iron: zinc ratio (probably more than 1:1) when given to anemic, iron deficient subjects and to investigate the mechanism connecting psychosocial care and nutrition/ health outcomes. "

"ABSTRAKKontrasepsi hormonal merupakan jenis kontrasepsi yang paling banyak digunakan di Indonesia. Pada wanita yang menggunakan kontrasepsi yang hanya berisi preparat progestin, sering terdapat gangguan pola menstruasi, yang berupa menoragia, bercak-bercak perdarahan, perdarahan tak teratur dan amenorea. Perdarahan endometrium yang berupa perdarahan lama dan perdarahan tak teratur merupakan alasan utarna peserta KB untuk menghentikan penggunaan kontrasepsi tersebut. Hal ini merupakan suatu problem penting bagi program Keluarga Berencana, terutama di negara yang sedang berkembang.Endometrium merupakan jaringan yang secara siklis mengalami perdarahan, hemostasis, dan regenerasi. Perubahan siklis ini dipengaruhi oleh hormon estrogen dan progesteron Estrogen merangsang pertumbuhan endometrium dan pembentukan reseptor progesteron. Progesteron merangsang sekresi kelenjar endometrium dan pertumbuhan pembuluh darah endometrium (Sherwood, 1993). Progesteron juga menghambat pembentukan reseptor estrogen, yang mengakibatkan hambatan pertumbuhan endometrium dan penurunan pembentukan reseptor progesteron.Lapisan fungsional endometrium dipendarahi oleh arteri spiralis dan cabang-cabangnya. Penurunan kadar progesteron secara mendadak pada endometrium yang telah terpapar estrogen ('estrogen primed') akan menimbulkan perdarahan menstruasi (Smith, 1990). Regenerasi endometrium setelah menstruasi dimulai pada hari ke-dua dan selesai pada hari ke 5-6. Regenerasi sistem pembuluh darah dimulai saat relaksasi arterial spiralis yang semula konstriksi. Pembentukan kapiler baru dimulai, pada bagian bawah lapisan fungsional endometrium dan dari pembuluh kapiler yang masih ada di lapisan epitel yang tidak ikut terkelupassaat menstruasi.Regenerasi endometrium merupakan salah satu mekanisme untuk menghentikan perdarahan menstruasi.Regenerasi dan pertumbuhan pembuluh darah sejalan dengan regenerasi jaringan endometrium .Mekanisme perdarahan endometrium pada penggunaan kontrasepsi progestin jangka panjang belum jelas. Beberapa faktor yang diduga menjadi penyebab antara lain: ketidak-seimbangan sekresi estrogen dan progesteron yang menyebabkan endometrium rapuh, kelainan faktor pembekuan darah di endometrium, dan gangguan regenerasi jaringan termasuk gangguan proses angiogenesis di endometrium."

"The study was a double-blind, controlled, randomized by episode in two sub-district rural areas ± 200 km from Jakarta, in which 1,185 children under three years of age were assigned to receive 4-5 mg element zinc/kg bw/day as a daily dose in two divided doses for the consecutive days during diarrhea Children were visited at their home every week for 12 months and they also underwent oral rehydration therapy. After 12 months observation there were 2, 410 episodes, 131 were excluded due to lack of information.Among children of zinc supplementation group there was 11% reduction (95% confidence interval, 3 to 18%) in the risk of continued diarrhea. In children with watery diarrhea there was a decreased of 12% (95% confidence interval, 3 to 21%) in the number of days in the zinc supplementation group. The reduction in the likelihood of diarrheal duration was 18% (95% confidence interval, 4 to 43%) in children who were given antibiotics before enrollment. Among children who had 3 episodes during 12 months observations there was a greater reduction in diarrheal duration (RR. in the zinc supplementation group = 0.79; 95% confidence interval, 0.64 - 0.97). Zinc supplementation in children with stunted growth was associated with 8% reduction of the risk of continued diarrhea, but statistically not significant (95% confidence interval, -9 to 21%). Children in zinc group had a lower proportion of persistent diarrhea (z 14 days) than control group zinc supplementation resulted in a 44% (95% confidence interval, 2 - 70%) reduction in the incidence of persistent diarrhea.These findings suggest that zinc supplementation in children with acute diarrhea significantly reduced the duration of diarrhea and the risk of persistent diarrhea. Zinc supplementation may have a significant effect on childhood diarrhea-related mortality."