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Achmad Zaki; Promotor: Sudarto Rono admojo; Kopromotor: Ratna Djuwita, Nurhayati A Prihartono; Penguji: Sabarinah Prasetyo, Andri MT Lubis, Rimbawan, Agus Hadi Rahiman
Abstrak: ABSTRAK
 
 
Saat ini terdapat perbaikan Angka Harapan Hidup (AHH) penduduk Indonesia dan penambahan populasi penduduk lanjut usia. Pada tahun 2017, AHH mencapai 71,06 tahun, dan jumlah lansia 23,4 juta orang (8,97% dari seluruh penduduk Indonesia). Hal ini berisiko meningkatkan kejadian penyakit degeneratif. Osteoartritis (OA) adalah penyakit yang sering dikaitkan dengan kondisi degeneratif dan mengakibatkan ketidakaktifan fisik. Pada Riskesdas 2013, penyakit Artritis berada di urutan kedua penyakit terbanyak diderita lansia dengan prevalensi 45% (55-64 tahun), 51,9% (65-74 tahun) dan 54,8% (usia >75 tahun). Pengobatan simtomatik dengan OAINS yang berkepanjangan dapat mengakibatkan efek samping yang fatal. Terdapat berbagai faktor risiko berkembangnya OA lutut, di antaranya konsentrasi serum Vitamin D (25(OH)D. Proporsi perempuan lansia dengan defisiensi 25(OH)D pada penelitian di Jakarta dan Bekasi mencapai 35,1%. Terdapat hubungan antara kadar Vitamin D (25(OH)D) yang rendah dengan nyeri lutut dan perubahan kartilago sendi lutut pada OA. Serum Cartilage Oligomeric Matrix Protein (COMP) merupakan produk degradasi penting dari kartilago sendi dan dapat menjadi marker diagnosis untuk OA lutut. Penelitian ini bertujuan mengetahui pengaruh pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu terhadap derajat nyeri berdasarkan indikator WOMAC, dan kondisi obyektif kartilago sendi dengan perubahan marker serum COMP pada penderita OA lutut lansia. Disain penelitian uji klinis teracak, tersamar ganda, dan terkontrol plasebo. Subyek dengan OA lutut simtomatis direkruit secara consecutive sampling dan dilakukan anamnesis, diperiksa kondisi fisik, radiologi lutut, kadar serum Vitamin D (25(OH)D), serum Calcium dan marker COMP. Subyek dialokasikan secara acak (random allocation) pada kelompok perlakuan yang diberikan suplemen Vitamin D (Alphacalcidol) atau kelompok kontrol yang diberikan plasebo. Populasi sumber xviii Universitas Indonesia pada penelitian ini ialah pasien OA lutut lanjut usia yang berobat ke KPKM FKIK UIN Jakarta. Dari hasil pemeriksaan konsentrasi serum Vitamin D 25(OH)D sebelum dilakukan intervensi, 53,4% responden mengalami insufisiensi dan 12,3% responden mengalami defisiensi Vitamin D. Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan derajat nyeri berdasarkan indikator WOMAC pada penderita OA lutut lansia yang bermakna secara statistik dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibanding kontrol sebesar 2,174 (p=0,00). Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan konsentrasi serum COMP pada penderita OA lutut lansia, dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibandingkan kelompok kontrol sebesar 38,15 ng/ml namun tidak bermakna secara statistik (p=0,39)
 
ABSTRACT
 
 
At present there are improvements in the Life Expectancy (AHH) of the Indonesian population and the addition of the elderly population. In 2017, AHH reached 71.06 yo and the number of elderly people reached 23.4 million people (8.97% of the total population of Indonesia). This has the potential to increase degenerative diseases. Osteoarthritis (OA) is a disease that is often associated with degenerative conditions and physical inactivity. Riskesdas in 2013 stated that Arthritis was the second most common disease suffered by the elderly with a prevalence of 45% (55-64 yo), 51.9% (65-74 yo) and 54.8% (>75 yo). Symptomatic treatment with prolonged NSAIDs can cause fatal side effects. There are various risk factors for developing knee OA, including serum Vitamin D (25(OH)D) concentrations. The proportion of elderly women with 25(OH)D deficiency in studies in Jakarta and Bekasi reaches 35.1%. It has been found an association between low Vitamin D levels (25(OH)D) with knee pain in OA and changes in the knee joint cartilage. Cartilage Oligomeric Matrix Protein (COMP) is an important degradation product of joint cartilage and can be act as a diagnostic marker of knee OA. This study aims to determine the effect of Vitamin D supplementation (Alphacalcidol) for 12 weeks on the degree of pain based on WOMAC indicators, and the objective conditions of joint cartilage with changes in COMP serum markers in patients with knee OA in the elderly. The research design is a randomized, double-blind, and placebo-controlled clinical trials. Subjects with symptomatic knee OA will be recruited by consecutive sampling and continued with history taking, physical conditions examinatons, knee radiology, and blood test for serum vitamin D (25(OH)D), serum calcium and marker COMP. Subjects were then randomly allocated to the treatment group given Vitamin D supplements (Alphacalcidol) or the control group given a placebo. The source population in this study was elderly with knee OA patients xx Universitas Indonesia who went to Primary Health Care Clinic (KPKM) of FKIK UIN Jakarta. We found that before intervention was done, 53.4% of respondents had Vitamin D insufficiency and 12.3% of respondents had Vitamin D deficiency. The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, influenced the decrease in the degree of pain based on the WOMAC indicator in knee OA of elderly patients significantly, with differences in changes in pre and post intervention scores of 2.174 compare with control (p=0.00). The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, affected the decrease in the serum concentration of COMP in knee OA of elderly patients, with differences in changes in pre and post intervention scores in the intervention group compared to the control group of 38.15 ng/ml but not statistically significant (p=0.39).
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D-401
Depok : FKM-UI, 2019
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Abraham; Pembimbing: Hasbullah Thabrany; Penguji: Yovsyah
T-2055
Depok : FKM-UI, 2004
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Sukanda; Pembimbing: Rachmadi Purwana; Penguji: I Made Djaya, Laila Fitria, Endang Syarifuddin, Didik Supriyono
Abstrak:

Penyediaan air minum merupakan salah satu kebutuhan utama bagi manusia untuk hidup dan menjadi faktor penentu dalam kasehatan dan kesejahteraan manusia. Dalam memenuhi kebutuhan air minum masyarakat lebih meyukai air minum dalam kanasan(AMDK) yang ini adalah ada hubungan antara kualitas bakteriologis air minum depot dengan kejadian diare pada bayi di Kecamatan Cimanggis Kota Depok tahun 2008. Data yang dihasilkan dianalisa secara univarial, bivariat, multivariat dan uji interaksi. Secara staristik faktor berisiko yang menyebabkan terjadinya diare di Kecamatan Cimanggis Kota Depok adalah 1.) Higiene dan sanitasi makanan dan minuman 2). Perilaku cuci tangan ibu/pengasuh bayi, dan 3). Sumber air bersih lain, Pada multivaxiat faktor yang paling dominan yang berhubungan dengan kejadian diare Serta model akhir terjadinya diare pada bayi di Kota Depok tahun 2008 adalah "Faktor Perilaku Cuci Tangan Ibu yang berinteraksi dengan hygiene sanitasi makanan-minuman secara bersamaan", dengan OR sebesar 4,554 kali diproduksi oleh industri besar dan mewah melalui proses yang otomatis sem disertai pengujian laboratorium sebelum air tasebut diedarknn sehingga dianggap lebih praklis dan higienis. Namun AMDK semakin mahal dan masyarakat beralih pada air minum dari depot air minum yang harganya 1/3 dari AMDK walaupun masyarakat masih meragukan kualitasnya karena belum ada informasi yang jelas mengenai proses, perizinan dan peraturan tentang peredaran dan pengawasannya. Sedangkan pesyaratan kualitas air untuk keperluan minum dan rumah tangga haruslah memenuhi persyaratan fisik, kimia, bakteriologis dan radioaktif. Persyaraian bakteriologis mempunyai peranan yang sangat penting dalam menimbulkan gangguan kesehatan atau penyakit gangguan saluran pencernaan karena sifatnya yang akut seperti diare bila kualitas bakteriologis tidak tapenuhi. Penelitian ini bertujuan untuk mengkaji hubungan antara kualitas bakteriologis (Ecoly air minum depot, sarana sanitasi lingkungan (sarana air bersih, Jamban keluarga dan sarana pembuangan sampah), higiene dan sanitasi makanan/minuman, perilaku cuci tangan ibu/pengasuh bayi, karakteristik bayi (status gizi, stmus irnunisasi, ) dan karakteristik keluarga bayi (pendidikan ibu dan pmdapatan keluarga) dengan kejadian diare pada bayi di Kecamatan Cimanggis Kota Depok tahun 2008. Disain penelitian adalah kasus komrol, dengan jumlah sampel pada kasus sebesar 75 responden dan kontrol 75 responden. Hipomis dalam penelitian.

 

Dringking Water is one ofthe main needs for people to live and a key factor in the health and welfare of human, In meeting the needs of drinking water, more people like drinking water in the packaging (AMDK) produced by big industry and has been through automatic process and testing laboratory before distributed so that it is considered more practical and hygienic. However AMDK the more expensive and people move on drinking water from drinking water depot price of 1 / 3 of AMDK Although people are still doubting to the quality because there is no clear information about the process, licensing and regulation of circulation and control. While the requirements of water quality for drinking and household must meet the requirements of the physical, chemical, bacteriological and radioactive. Terms of bacteriological (E.eoli) has a "very important roie inthe cause health or disease interference charutel is due to the digestion such as acute diarrhea if the quality is not met. This study aims to examine the relationship between the quality of bacteriological (E.coIi) depot drinking water, environmental sanitation facilities (water, toilet facilities and household waste disposal), hygiene and sanitation, food / beverage, hand-washing behavior of U18 mother / baby sitter, characteristics baby (nutrition status, immunization status,) and family characteristics of infants (maternal education and family income) with diarrhea outbreak in infants in the District Cimanggis Depok City in 2008. Research design is the case with 75 cases and 75 control. Hypothesis in this research is: is there any relation between water quality (E. coli) &om water reilling station with incidence of baby diarrhea 7 Data taken from observation is analyzed by univariate, bivariate, interaction test and of multivariate. From statistical view the risk factors that cause diarrhea in District Cimanggis Depok are; 1). Hygiene and sanitation, food and beverages. 2). Hand-washing behavior ofthe mother/ baby sitter, and 3). Another source of clean water. The most dominant factor related to the diarrhea outbreak and the end of a model of diarrhea in infants in the city oflakarta in 2008 is a "factor ofwashirrg Hands with Mother of Hygiene, sanitation, food drink together" with the OR of 4.554 times.

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T-3071
Depok : FKM UI, 2009
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Mariani; Pembimbing: Mondastri Korib Sudaryo; Penguji: Ratna Djuwita Hatma
Abstrak:
Makanan modern seperti fried chicken, hamburger, pizza, spaghety,dll disukai oleh banyak kalangan terutama anak-anak dan remaja karena makanan modern mempunyai daya pikat selain praktis, cepat dalam penyajian dan mengandung gengsi bagi kalangan tertentu. Disisi lain makanan tersebut mengandung tinggi lemak, protein, gula dan garam tetapi miskin serat. Jika sering dikonsumsi secara berkesinambungan dan berlebihan dapat menimbulkan munculnya masalah gizi lebih yaitu obesitas. Bersamaan dengan itu, menurut hasil survei dan beberapa laporan penelitian di Indonesia menunjukan bahwa masalah obesitas sudah mulai tampak pada populasi usia sekolah dan prevalensinya cenderung meningkat. Penelitian ini bertujuan untuk mengetahui pengaruh pola konsumsi makanan modern terhadap kejadian obesitas pada remaja SLTP Kesatuan Kota Bogor Jawa Barat tahun 2003. Desain yang digunakan dalam penelitian ini adalah desain `case control'. Yang menjadi kasus (obes) adalah remaja kelas I - kelas III dengan IMT 95 percentil, sebagai kontrol (non obes) adalah remaja kelas I - kelas III dengan IMT 5 - 85 percentil, dengan jumlah sampel sebanyak 140 (70 kasus dan 70 kontrol), ditetapkan nilai kemaknaan dengan 95 % CI kemudian ditelusuri pengaruh paparan pola konsumsi makanan modern (variabel independen) terhadap kejadian obesitas (variabel dependen) dengan mengontrol covariat (jenis kelamin, aktifitas olah raga, asupan zat gizi, tingkat pendidikan ibu, status pekerjaan ibu, status gizi orang tua dan pendapatan orang tua. Penelitian ini menggunakan analisis bivariat dengan chi square Mantel Haenszel dan analisis multivariat dengan uji regresi logistik ganda. Secara statistik didapatkan nilai p < 0,05 yang artinya pola konsumsi makanan modern berpengaruh terhadap kejadian obesitas, didapatkan nilai OR 2,96 maka dapat disimpulkan bahwa remaja yang sexing mengkonsumsi makanan modern memiliki resiko 3 kali untuk mengalami obesitas dibanding remaja yang jarang mengkonsumsi. Diketahui pola bahwa jenis kelamin aktifitas olah raga, asupan zat gizi, tingkat pendidikan ibu, dan status gizi orang tua merupakan confounder, artinya variabel tersebut turut berperanan terhadap hubungan pola konsumsi makanan modern dan obesitas. Hasil analisis bivariat membuktikan makanan modern yang berpengaruh terhadap kejadian obesitas pada remaja SLTP Kesatuan adalah fried chicken dan chicken nugget. Ditemukan pula dose-response relationship pada analisis ini yaitu semakin tinggi frekuensi konsumsi semakin besar risiko untuk mengalami obesitas. Mengingat dampak obesitas yang terjadi, maka diperlukan perhatian yang serius dari pemerintah dalam upaya menurunkan prevalensi obesitas dikalangan remaja, melalui upaya promotif dengan memasang poster di sekolah tersebut berisi tentang makanan modern yang perlu diwaspadai dan dibatasi dan pedoman umum gizi seimbang untuk remaja. Penyuluhan pada guru perlu dilakukan. Sosialisasi pengukuran IMT pada tim UKS sekolah tersebut agar dapat mengidentifikasi obesitas. Peran orang tua khususnya ibu sangat penting dalam memilih atau menentukan jenis makanan yang baik untuk dikonsumsi. Perlunya penelitian lanjutan untuk mengetahui secara spesifik pengaruh tiap jenis makanan modern terhadap obesitas pada populasi remaja yang lebih luas, terutama untuk mengetahui masalah gizi yang terjadi pada populasi etnik Cina dengan melengkapi variabel dalam penelitian ini dan memilih desain yang lebih tepat.
The Effect of Modern Food Consumption Pattern for Incidence of Obesity on Adolescent of SLTP Kesatuan in the Bogor City the Year of 2003 Modern food such as fried chicken, hamburger, pizza, spaghetti, etc. preferred by most people especially the children and adolescent since it is practical, fast served and had a relative prestige for some people. Even so, these sort of food present high fat, protein, sugar, and salt but less in fiber. When this condition done continually and in excessive way it might cause nutrition problem that is obesity. That simultenously, survey and researches conducted reveals that the problem of obesity in Indonesia arise in schooling age and it prevalence trends to rise. The purpose of this study was to know the effect of modern food consumption pattern for incidence obesity in adolescent of SLTP Kesatuan in the Bogor city, West Java, year of 2003. The method of research used is case control design, the case group are adolescent from the class 1 to 3 who have BMI > 95 percentiles, as control are adolescent class l to 3 who have BMI 5 - 85 percentiles, the size of samples are 140 (70 cases and 70 controls), determined meaning value with 95% .Cl then inspected the influence of modem food consumption (independent variable) for incidence of obesity (dependent variable) by controlling covariate (gender, exercises, nutrient intake, mother's level of education, mother's occupation status, nutrition status of parent's, and parent's income. This research used the bivariat analysis with Mantel Haenszei's Chi Square and multivariate with multiple logistic regression analysis. Statistically the p value < 0,05 obtained, meant that the modern food consumption pattern does have effect on obesity, adolescent that frequently consumed modern food had relative risk 3 times of getting obesity compared to those that consumed it rarely (value of Odds Ratio was 2,96). It is also obtained that the gender, exercises, nutrient intake, mother's level of education, nutrition status of parent's as a confounder; or means that then have implication on the relationship of modern food and the obesity an adolescent of SLTP Kesatuan. The bivariate analysis proved that the modern food which effected of obesity on adolescent of SLTP Kesatuan are fried chicken and chicken nugget it is also obtained that dose-response relationship in this analysis, which higher consumption frequency effect higher risk of becoming obesity. Concerning obesity effect that occurs, it would take serious concern from the government to decreased obesity prevalence on adolescent, such promotive effort can be done through wall poster in the school, about modern food must be limited and warn, and also contained the general guidelines of balanced nutrition for adolescent. Health promotion to teacher also need to be done, in other that the teacher can be role for giving information about nutrition, especially modern food which affected on obesity. Socialization regarding BMI Measurement to UKS team of schools for identify obesity. The role of parent, especially mother are very important in choosing and deciding good food to consumes. There is a need of further study to examine specifically the effect of each modem food on obesity toward a larger adolescent population, especially to know the nutrition problem on Chinese population by completing variables in this study and choosing a proper design method.
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T-1722
Depok : FKM-UI, 2003
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Retno Asti Werdhani; Pembimbing: Nurhayati Adnan, Mondastri Korib Sudaryo; Penguji: Muchtaruddin Mansyur, Ratna Djuwita, Ermita I. Ilyas
Abstrak:

Penelitian ini bertujuan untuk melakukan evaluasi program latihan Klub Jantung Sehat Pondalisa sekaligus mengetahui hubungan frekuensi dan keteraturan senam terhadap penurunan tekanan darah. Dengan demikian diharapkan akan didapatkan tekanan darah yang terkendali pada anggota KJS Pondalisa khususnya dan masyarakat usia dewasa tua umumnya. Studi kohort retrospektif dilakukan dengan menggunakan data yang terdapat pada buku anggota KJS Pondalisa. Digunakan pendekatan analisis Cox Regression untuk melihat efek frekuensi dan keteraturan senam yang telah dilakukan oleh para anggota KJS Pondalisa selama 1 tahun pertama keanggotaan terhadap penurunan tekanan darah. HR (hazard ratio) digunakan sebagai estimasi RR (risiko relatif) efek frekuensi dan keteraturan senam terhadap penurunan tekanan darah. Anatisis multivariat digunakan untuk mengendalikan variabel-variabel perancu. Sebanyak 132 data anggota K7S Pondalisa dianalisis dalam penelitian ini. Dalam 1 tahun pertama keanggotaan terdapat 11,36% anggota yang melakukan senam 2x1minggu, 39,39 % anggota yang melakukan senam > 8 minggu (9-15 minggu) berturut-turut, dan 11,36% anggota yang melakukan senam 2xlminggu selama > 8 minggu (9-15 minggu) berturut-turut. Tidak ada anggota yang melakukan senam 3xlminggu sesuai program dan tidak ada anggota yang melakukan senam 2x1minggu selama < 8 minggu berturut-turut_ Keteraturan senam anggota maksimum selama 15 minggu. Didapatkan penurunan tekanan darah pada 32,58 % anggota dengan rata-rata penurunan tekanan darah sistolikldiastolik sebesar 6 mmHg/4 mmHg yang dapat dipertahankan minimal selama 1 bulan. Besarnya penurunan TD ini diharapkan dapat bermanfaat dalam menurunkan angka kesakitan dan kematian akibat hipertensi; sedikitnya dapat memperlambat perjalanan penyakit hipertensi serta bermanfaat dalam pencegahan primer. Efek frekuensi senam 2xlminggu terhadap penurunan tekanan darah meningkat sebesar 1 Va dibandingkan dengan frekuensi senam < 2xlminggu [RR 1,01;95%CI [0,43-2,38]. Efek senam teratur 9-15 minggu berturut-turut terhadap penurunan tekanan darah meningkat sebesar 36 % dibandingkan dengan senam teratur < 8 minggu berturut-turut [RR 1,36;95%CI [0,63-2,93]. Senam yang dilakukan 2xlminggu selama 9-15 minggu berturut-tunrt memberikan manfaat penurunan tekanan darah sebesar 34 % dibandingkan dengan senam

The aim of this research is to evaluate the performance of `Klub Jantung Sehat Pondalisa' as well as the association of frequency and regularity of exercise with blood pressure reduction. The long-term benefit achieved will be adequate control of blood pressure among members of the club and adults as a whole. Retrospective cohort study was conducted, using data found on the member's logbook. Cox Regression analysis approach was used to find the benefit of blood pressure reduction through exercise's frequency and regularity which have been done by all member of KJS Pondalisa during the first year of membership. HR (hazard ratio) was used to estimate the RR (relative risk) of both exercise's frequency and regularity to reduce blood pressure. Confounders were adjusted by multivariate analysis. There were 132 members analyzed in this research. In the first year of membership, there were 11.36% members doing exercise twice weekly, 39.39 % members doing exercise > 8 weeks (9-15 weeks) regularly, and 11.36% members doing exercise twice weekly in > 8 weeks (9-15 weeks) regularly. There were no member doing exercise thrice weekly as programmed. There were no member doing exercise twice weekly in < 8 weeks regularly. The maximum exercise's regularity was 15 weeks. There were 32.58 % blood pressure reduction among members. The mean systolic/diastolic reduction which can be maintained for at least I month were 6 mmHg/4 mmHg, This amount of BP reduction might reduce morbidity and mortality among hypertensives; at least might retard the natural history of hypertension and give benefit to primary prevention. The effect of twice weekly's exercise on blood pressure reduction increase 1 % as compared to less than twice weekly's exercise [RR 1,01;95%CI [0,43-2,38]. Effect of doing 9-15 weeks regular exercise on blood pressure reduction increase 36 % as compared to members doing 8 weeks regular exercise [RR 1,36;95%CI [ 0,63-2,93]. Members doing exercise twice weekly in 9-15 weeks regularly get benefit on blood pressure reduction 34 % more as compared to members doing exercise less than twice weekly in < 8 weeks regularly [RR 1,34;95% CI [0,50-3,60]. There were no difference in blood pressure reduction between members doing exercise less than twice weekly in 9-15 weeks regularly and members doing exercise less than twice weekly in < 8 weeks [RR 0,99;95% CI [ 0,42-2,32]. From this research, we conclude that there was no different effect of blood pressure reduction between twice weekly's exercise and less than twice weekly's exercise. The effect of exercise in 9-15 weeks regularly toward blood pressure reduction is bigger compared with effect of twice weekly's exercise. This fording shows the importance of maintaining exercise's regularity to get benefit of reducing blood pressure. The benefit of twice weekly's exercise for blood pressure reduction will be achieved when it is conducted in 9-15 weeks regularly. Although exercise has been conducted regularly up to 15 weeks, if done less than twice weekly, it will not yield the benefit of blood pressure reduction. There are still many factors which have not been considered such as the duration and intensity of exercise, the role of anti hypertensive drugs, and the presence of other diseases. All of those factors together with the wide range and inconsistent of confidence interval, make the results of this study fail to show the maximal effect of exercise's frequency and regularity to reduce blood pressure in population. Therefore, further research is needed using several degrees of exercise's frequency and regularity, considering also the above mentioned related factors and bigger number of sample size, to obtain the true benefit of blood pressure reduction and more accurate precision.

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T-2227
Depok : FKM-UI, 2006
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Rahma Dewi Handari; Pembimbing: Sudarto Ronoatmodjo; Penguji: Tri Yunis Miko Wahyono, Soewarta Kosen
Abstrak:
Tuberkulosis resistan obat (TB RO) menjadi tantangan utama kesehatan global, dengan Indonesia sebagai salah satu dari 7 negara dengan beban kasus TB RO tertinggi dengan insiden rate 10 per 100.000 orang-tahun. Keberhasilan pengobatan TB RO secara nasional rendah sebesar 51% dengan angka kematian pasien TB RO cukup tinggi sebesar 20%. Infeksi HIV pada pasien TB RO memperburuk kondisi klinis, meningkatkan risiko kegagalan pengobatan dan kematian. Penelitian ini bertujuan untuk mengetahui mortality rate dan perbedaan probabilitas survival antara pasien TB RO dengan komorbid HIV dan tanpa komorbid HIV, dan mengetahui hubungan komorbid HIV dengan kematian pasien TB RO dewasa di Indonesia tahun 2021-2022. Penelitian dilakukan dengan desain studi kohort restrospektif menggunakan data sekunder SITB Nasional Kemenkes tahun 2021-2022. Analisis data dilakukan menggunakan survival Kaplan Meier dan cox regression dengan ukuran asosiasi Hazard Ratio (HR). Terdapat 7172 pasien TB RO eligible yang dijadikan sampel penelitian. Hasil penelitian menunjukkan mortality rate pasien TB RO dewasa yang memiliki komorbid HIV (14,191 per 10.000 orang-hari) lebih tinggi dibandingkan pasien TB RO dewasa yang tidak memiliki komorbid HIV (4,776 per 10.000 orang-hari). Probabilitas kumulatif survival pasien TB RO dewasa yang memiliki komorbid HIV (41,89%) secara signifikan lebih rendah dibandingkan probabilitas kumulatif survival pasien TB RO dewasa yang tidak memiliki komorbid HIV (78,32%). Pasien TB RO dewasa dengan komorbid HIV yang menggunakan paduan pengobatan TB jangka panjang memiliki risiko kematian 6,66 kali lebih tinggi dibandingkan pasien TB RO dewasa tanpa komorbid HIV yang menggunakan paduan pengobatan TB jangka pendek (HR adjust:6,66, 95%CI:4,96-8,96). Pasien TB RO dewasa dengan komorbid HIV yang menggunakan paduan pengobatan TB jangka pendek memiliki risiko kematian 6,02 kali lebih tinggi dibandingkan pasien TB RO dewasa tanpa komorbid HIV yang menggunakan paduan pengobatan TB jangka pendek (HRadjust:6,02, 95%CI:3,89-9,31). Komorbid HIV secara signifikan meningkatkan risiko kematian pasien TB RO selama pengobatan. Tatalaksana pengobatan TB RO dan infeksi HIV yang tepat diperlukan untuk menurunkan risiko kematian pasien TB RO selama pengobatan.
Drug-resistant tuberculosis (DR TB) is a major global health challenge, Indonesia is one of 7 countries with the highest burden of DR TB cases with an incidence rate of 10 per 100.000 persons per year. The success of DR TB treatment nationally is low at 51% with the proportion of mortality high at 20%. HIV infection in DR TB patients worsens the condition, increasing the risk of treatment failure and death. The purpose of this study is to determine the mortality rate and the difference in survival probability between comorbid HIV patients and noncomorbid HIV patients and to determine the relationship between comorbid HIV and death in adult DR TB patients in Indonesia in 2021-2022. The design of this study was a retrospective cohort study using secondary data on SITB national DR TB cases that started treatment in 2021-2022. Data analysis was performed using survival Kaplan Meier and Cox regression to obtain hazard ratio (HR). There were 7172 patients as eligible patients who became the research sample. The results showed that the mortality rate for adult DR TB patients who had comorbid HIV (14,191 per 10,000 person days) was higher than adult DR TB patients without comorbid HIV (4,776 per 10,000 person days). The cumulative probability of survival of adult DR TB patients with comorbid HIV (41.89%) is significantly lower than the cumulative probability of survival of adult RO TB patients without comorbid HIV infection (78.32%). Adult DR TB patients with comorbid HIV who used long-term TB regimens have a 6,66 times higher risk of death than adult DR TB patients without comorbid HIV who used short-term TB regimens (adjusted HR: 6,66 95%CI: 4,96-8,96). Adult DR TB patients with comorbid HIV who used a short-term TB regimen have a 6.02 times higher risk of death than adult DR TB patients without comorbid HIV who used a short-term TB regimen (adjusted HR: 6.02, 95%CI:3.89-9.31).Comorbid HIV significantly increased the the risk of death during treatment. Appropriate DR TB and HIV treatment management is needed to reduce the risk of DR TB patient death during treatment.
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T-6937
Depok : FKM UI, 2024
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Gusni Rahma; Pembimbing: Nasrin Kodim; Ratna Djuwita; Penguji: Masdalina Pane, Firy Triyanti
T-5136
Depok : FKM-UI, 2018
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Siti Setiati;/ Pembimbing: Bambang Sutrisna; Penguji: Wiguno Prodjosudjadi
Abstrak:
Hipotensi ortostatik adalah turunnya tekanan darah sistolik (TDS) 20 mmHg atau turunnya tekanan darah diastolik (TDS) 10 mmHg pada saat perubahan posisi, dari posisi tidur ke posisi tegak. Berbagai faktor yang berhubungan dengan hipotensi ortostatik, seperti usia, obat anti hipertensi, hipertensi, strok dan diabetes melitus masih diperdebatkan. Sampai saat ini belum ada data mengenai prevalensi hipotensi ortostatik di Indonesia. Belum diketahui pula faktor prediktor hipotensi ortostatik. Sebagian besar penelitian hipotensi ortostatik yang ada di luar negeri dilakukan pada subjek berusia lanjut, Tujuan penelitian ini adalah untuk mendapatkan prevalensi hipotensi ortostatik di Indonesia dan faktor prediktor terjadinya hipotensi ortostatik pada orang berusia 40 tahun ke atas di Indonesia. Penelitian ini merupakan bagian penelitian survei epidemiology hipertensi di Indonesia. Empat ribu empat ratus tiga puluh enam subjek berusia 40-94 tahun didapatkan secara random dari berbagai praktek dokter di berbagai kabupaten di Indonesia. Data dikumpulkan dengan melakukan serangkaian anamnesis (riwayat penyakit diabetes melitus, hipertensi, dan strok serta penggunaan obat anti hipertensi) dan pemeriksaan tekanan darah pada posisi tidur dan duduk setelah 1-3 menit. Regresi logistik ganda dilakukan untuk mendapatkan faktor prediktor hipotensi ortostatik yang paling bermakna. Subjek yang mengalami hipotensi ortostatik sebesar 561 subjek (12,65%). Analisis bivariat menunjukkan bahwa riwayat diabetes melitus, riwayat strok, tekanan darah sistolik tinggi dan tekanan darah diastolik tinggi mempengaruhi terjadinya hipotensi ortostatik. Usia dan penggunaan obat anti hipertensi tidak mempengaruhi terjadinya hipotensi ortostatik. Obat agonis alfa-2 sentral dan kerja sentral lain merupakan satu-satunya obat anti hipertensi yang mempengaruhi terjadinya hipotensi ortostatik. Hasil analisis multivariat mendapatkan tekanan darah sistolik tinggi dan tekanan darah diastolik tinggi sebagai prediktor hipotensi ortostatik. Sedangkan riwayat diabetes melitus dan riwayat strok tidak mempengaruhi terjadinya hipotensi ortostatik. Penggunaan obat anti hipertensi merupakan faktor protektif terjadinya hipotensi ortostatik. Penelitian ini memastikan bahwa usia bukan merupakan prediktor terjadinya hipotensi ortostatik. Adanya komorbiditas seperti hipertensi (tekanan darah sistolik atau diastolik tinggi) merupakan prediktor terjadinya hipotensi ortostatik. Sedangkan obat anti hipertensi merupakan faktor protektif terjadinya hipotensi ortostatik. Penatalaksanaan hipertensi yang baik dan pemilihan obat anti hipertensi yang tepat amat diperlukan untuk mencegah terjadinya hipotensi ortostatik. Daftar bacaan : 32 (1978 - 2001)
The Prevalence And Predictor Of Orthostatic Hypotension Among 40 Years And Above Adult Population In Indonesia.Various factors associated with orthostatic hypotension such as age, drug induced hypotension, hypertension and diabetes mellitus have still been questioned and debatable with one another. No big scale population study done in this matter. Furthermore, most of previous studies were conducted in subjects 65 years or older, only a few were done in subjects from younger to older adults. The purpose of this study is to find the prevalence and predictor of orthostatic hypotension among 40 years and above adult population in Indonesia. This study is a part of Indonesian hypertension epidemiologic survey. A random sample of 4436 subjects aged 40-94 years was obtain from various municipilities in every big island in Indonesia. Orthostatic testing, as well as assesment of history of medical conditions (diabetes mellitus, stroke, and hypertension), blood pressure measurement and use of anti-hypertensive medications were performed. Blood pressure measurements were obtained by trained doctors with the subjects in supine position and after they had been seated for 1-3 minute. A stepwise logistic regression was used to determine significant predictor of orthostatic hypotension. A total of 561 persons (12.6%) experienced orthostatic hypotension. Bivariate analysis showed that orthostatic hypotension was influenced by history of diabetes mellitus, history of stroke, high systolic and diastolic blood pressure. Orthostatic hypotension was not influenced by age and the use of anti hypertension medicine. Central ccz-agonist and other centrally acting drug is the only anti hypertension medicine which influences orthostatic hypotension. Multivariate analysis showed that high systolic and diastolic blood pressure were predictor factors of ortostatic hypotension, while history of diabetes mellitus and stroke were not. The use of anti-hypertensive medicine was protective factor for orthostatic hypotension . This study confirms the conclusion that age by itself is not a predictor for orthostatic hypotension. In fact, the existence of comorbidities in the subjects such as hypertension (high systolic and diastolic blood pressure) is a predictor factor, while the use of anti-hypertensive medication is a protective factor. Proper management of hypertension and preference of anti hypertension medicine is a must to prevent orthostatic hypotension. References : 32 (1978 - 2001)
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T-1715
Depok : FKM-UI, 2003
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Muhammad Hatta; Pembimbing: Nasrin Kodim; Penguji: Krisnawati Bantas, Harmen Harun, C. Yekti Praptiningsih
Abstrak:
Infeksi Saluran Pernapasan Akut (ISPA) terutama Pneumonia merupakan penyebab utama kesakitan dan kematian pada bayi dan anak balita di negara berkembang, sekitar 4 juta kematian disebabkan oleh penyakit ISPA terutama Pneumonia. Di kabupaten Ogan Komering Ulu Sumatera Selatan penyakit Pneumonia masih menjadi masalah kesehatan masyarakat dimana pneumonia menempati urutan teratas dalam sepuluh penyebab kesakitan yang mempunyai kontribusi sebesar 53,42 %. Sementara angka cakupan imunisasi campak masih relatif rendah (70 %, tahun 1998). Penelitian ini dilakukan untuk mengetahui hubungan imunisasi campak dengan kejadian pneumonia pada balita dan faktor risiko lainnya di kabupaten Ogan Komering Ulu, Sumatera Selatan tahun 2000. Studi ini menggunakan desain kasus kontrol, dengan 141 sampel dimana kasus adalah balita umur 9-59 bulan, menderita pnemonia yang datang ke Puskesmas, sedangkan kontrol adalah balita umur 9-59 bulan yang datang ke Puskesmas, tetapi tidak menderita pnemonia ataupun ISPA. Data diperoleh dari basil wawancara dengan menggunakan kuesioner pada responden ibu balita dan dianalisa dengan analisis univariat, bivariat (Chi Square) dan multivariate (Logislic Regression). Hasil akhir uji multivariat menunjukkan adanya hubungan yang bermakna antara imunisasi campak dengan kejadian pnemonia pada balita umur 9-59 bulan (DR= 2,307; p~,003 ). Dapat dikatakan bahwa risiko terkena pneumonia pada balita umur 9-59 bulan yang tidak diimunisasi campak 2,3 kali lebih besar dibandingkan dengan balita umur 9-59 bulan yang telah diimunisasi campak. Disamping variabel imunisasi campak ada 5 variabel lain yang mempengaruhi kejadian pneumonia di kabupaten OKU, sebagai berikut: Pendidikan ibu (OR=2,037; p=0,013), pengetahuan ibu (OR=2,364: p=0,005), polusi asap dapur (OR=2,99; p=0,002), kepadatan rumah (OR= 3,247; p= 0,0005) dan jarak ke sarana kesehatan (OR=0,43 1; p= 0,007). Berdasarkan hasil penelitian ini dapat disarankan kepada pengambil keputusan guna lebih memberi perhatian kepada keluarga balita (9-59 bulan) yang belum diimunisasi campak, berpendidikan rendah, berpengetahuan rendah, keadaan rumah yang jelek (polusi asap dapur), rumah yang padat huni dan yang jauh dari pelayanan kesehatan.
The Relationship Between Measles Imunization and Pneumonia Insidens on Underfive Years Old Children in Ogan Komering Ulu (Oku) District, South Sumatera, in 2000.The Acute Respiratory Tract Infection (ARI) especially pneumonia is main cause of morbidity and mortality on infant and under five years old children in developing countries. There are 4 million death caused by ARI especially pneumonia. In Ogan Komering Ulu (OKU) district, South Sumatera province, the pneumonia still became Community Health Problem. Pneumonia was the first rank of ten cause of morbidity that contributed 53,42 %, while the measles immunization coverage still low(70 %, year 1998). This study was conducted to know the relationship between measles immunization and other risk factors with pneumonia on under five years old children in OKU district, South Sumatera province in 2000. The study design used in this study is Cases Control, with cases are 141 children age 9 - 59 month children suffered from pneumonia who attending health center. While the control was taken from age 9-59 month children without the diseases, who attending the some Health Center. The data was collected by interviewed from the children's mother using questioner. The analysis method of univariate, bivariate (Chi Square) and multivariate (logistic regression) was used in the study. The result of the study show that a statistical significance association between measles immunization with pneumonia on 9-59 month children (p= 0,003 ; 0R=2,307). It can be said that pneumonia risk on under five years old children without measles immunization arc 2,3 time larger than that of under five years old children with measles immunization. Beside measles immunization, there are 5 other variables that also associated with pneumonia risk in OKU district such as: mothers education(UR=2,307; p=0,013), mothers knowledge (OR=2,364; p=0,005), kitchens smoke pollution (OR= 2.99: p=4.002). house density(OR=3,247;p= 0,000) and the house distance to health services(CR=0,431; p=O,OO7. Based on the study result, it was suggested that the policy maker have to pay more attention to family with under five years old children who have not gotten yet the measles immunization, whose mother has low education, and low knowledge, who have bad condition and has high density of house, and whose house long far from health services.
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T-1140
Depok : FKM-UI, 2001
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Artha Budi Susila Duarsa; Promotor: Nuning Maria Kiptiyah; Ko-Promotor: Mondastri Korib Sudaryo, Anhari Achadi; Penguji: Sudarto Ronoatmodjo, Is Suhariah Ismid, Soewarta Kosen, Sudijanto Kamso
D-220
Depok : FKM-UI, 2007
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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:: Pengguna : Pusat Informasi Kesehatan Masyarakat
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