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Frans Liwang; Pembimbing: Nurhayati Adnan; Penguji: Syahrizal Syarif, Helda; Rocky Hendrawan
Abstrak:
Perdarahan saluran cerna (PSC) merupakan salah satu komplikasi COVID-19 dengan angka mortalitas yang tinggi, namun hingga kini besaran kasusnya belum pernah dilaporkan di Indonesia. Selain itu, hasil penelitian sebelumnya mengenai faktor yang mempengaruhi kejadian PSC juga masih bervariasi. Penelitian ini bertujuan untuk menghitung proporsi kejadian PSC pada COVID-19 serta mendapatkan faktor-faktor yang mempengaruhinya. Penelitian merupakan studi potong-lintang dengan subjek pasien dewasa COVID-19 derajat sedang hingga kritis di RS Rujukan COVID-19 Pertamina Jaya dan RS Darurat Wisma Haji Pondok Gede, Jakarta, selama periode Juni-September 2021. Dari 414 subjek yang memenuhi kriteria inklusi dan eksklusi didapatkan kejadian PSC sebesar 17,63%. Mayoritas subjek memiliki komorbid hipertensi (51%), diabetes melitus tipe 2 [DMT2] (43,2%), penyakit serebrokardiovaskular [PSKV] (31,4%), serta riwayat penyakit ulkus peptikum dan PSC sebelumnya (23,9%). Median nilai neutrofil absolut ialah 4.842,5[1.116-70.000], kadar CRP 65,5[9-275] mg/dL, dan kadar D-dimer 890[200-5010] μg/L. Berdasarkan uji bivariat, terdapat tujuh variabel yang bermakna secara statistik, namun pada analisis multivariat generalized linear model menggunakan family regresi Poisson dan fungsi link log dengan robust error variance diperoleh empat variabel akhir yang bermakna secara statistik, yaitu hipertensi (aRR 2,67; IK95% 1,52-4,41; p<0,001), PSKV (aRR 1,90; IK95% 1,27-2,84; p=0,002), terapi kortikosteroid dosis tinggi (aRR 1,82; IK95% 1,22-2,73; p=0,004), dan terapi proton pump inhibitor (PPI) dosis tinggi (aRR 0,41; IK95% 0,27-0,60; p<0,001). Uji Pearson goodness-of-fit menunjukkan nilai p=0,999 dan nilai AUC 0,755 (IK95% 0,694-0,815; p<0,001). Sebagai kesimpulan, proporsi kejadian PSC pada COVID-19 derajat sedang-kritis ialah 17,63% (IK95% 14,1-21,6%). Faktor yang dapat mempengaruhi kejadian PSC ialah hipertensi, PSKV, serta penggunaan kortikosteroid dan PPI.
Gastrointestinal bleeding (GIB) is a COVID-19 complication with high mortality rate whose magnitude and impact have not been reported in Indonesia. Moreover, the resutls of previous studies on factors influencing GIB in COVID-19 still varied widely. This study aimed to measure the proportion of GIB cases in COVID-19 and investigate the factors influencing GIB in COVID-19. This was a cross sectional study on adults with moderate to critical COVID-19 in Pertamina Jaya Referral Hospital and Wisma Haji Pondok Gede Field Hospital, Jakarta from June to September 2021. We found that out of 414 subjects that met the inclusion and exclusion criteria, 17.63% had cases of GIB. Most subjects had comorbidities, including hypertension (51%), type 2 diabetes mellitus [T2DM] (43.2%), cerebrocardiovascular disease [CCVD] (31.4%), and history of peptic ulcer and previous GIB (23.9%). Median[min-max] number of absolute neutrohil was 4,842.5 [1,116-70,000], CRP levels was 65.5 [9-275] mg/dL, and D-dimer levels was 890 [200-5,010] ug/L. Bivariate analysis showed that there were seven variables that were statistically significant. However, according to generalized linear model analysis with Poisson regression family and log link function with robust error variance, there were four final variables that were statistically significant. There variabels as follow hypertension (aRR 2.67; 95%CI 1.52-4.41; p<0.001), CCVD (aRR 1.90; 95%CI 1.27-2.84; p=0.002), high dose corticosteroid therapy (aRR 1.82; 95%CI 1.22-2.73; p=0.004), and high dose proton pump inhibitor [PPI] therapy (aRR 0.41; 95%CI 0.27-0.60; p<0.001). Pearson goodness-of-fit test showed p=0.999 and AUC value of 0.755 (95%CI 0.694-0.815; p<0.001). In conclusion, the proportion of GIB incidence in moderate-critical COVID-19 was 17.63% (95%CI 14.1-21.6%). Factors that influence GIB were hypertension, CCVD, the use of corticosteroid, and PPI.
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Gastrointestinal bleeding (GIB) is a COVID-19 complication with high mortality rate whose magnitude and impact have not been reported in Indonesia. Moreover, the resutls of previous studies on factors influencing GIB in COVID-19 still varied widely. This study aimed to measure the proportion of GIB cases in COVID-19 and investigate the factors influencing GIB in COVID-19. This was a cross sectional study on adults with moderate to critical COVID-19 in Pertamina Jaya Referral Hospital and Wisma Haji Pondok Gede Field Hospital, Jakarta from June to September 2021. We found that out of 414 subjects that met the inclusion and exclusion criteria, 17.63% had cases of GIB. Most subjects had comorbidities, including hypertension (51%), type 2 diabetes mellitus [T2DM] (43.2%), cerebrocardiovascular disease [CCVD] (31.4%), and history of peptic ulcer and previous GIB (23.9%). Median[min-max] number of absolute neutrohil was 4,842.5 [1,116-70,000], CRP levels was 65.5 [9-275] mg/dL, and D-dimer levels was 890 [200-5,010] ug/L. Bivariate analysis showed that there were seven variables that were statistically significant. However, according to generalized linear model analysis with Poisson regression family and log link function with robust error variance, there were four final variables that were statistically significant. There variabels as follow hypertension (aRR 2.67; 95%CI 1.52-4.41; p<0.001), CCVD (aRR 1.90; 95%CI 1.27-2.84; p=0.002), high dose corticosteroid therapy (aRR 1.82; 95%CI 1.22-2.73; p=0.004), and high dose proton pump inhibitor [PPI] therapy (aRR 0.41; 95%CI 0.27-0.60; p<0.001). Pearson goodness-of-fit test showed p=0.999 and AUC value of 0.755 (95%CI 0.694-0.815; p<0.001). In conclusion, the proportion of GIB incidence in moderate-critical COVID-19 was 17.63% (95%CI 14.1-21.6%). Factors that influence GIB were hypertension, CCVD, the use of corticosteroid, and PPI.
T-6465
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Verry Adrian; Pembimbing: Ratna Djuwita; Penguji: Tri Yunis Miko Wahyono, Helda, Dwi Oktavia Tatri Lestari Handayani, Agus Fitri Atmoko
Abstrak:
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Infeksi SARS CoV-2 sebagai penyebab terjadinya pandemi Coronavirus Disease 2019 (COVID-19) kini menjadi perhatian kesehatan masyarakat. Pada kasus COVID-19 yang berat dapat menyebabkan pneumonia, sindrom pernapasan akut, gagal ginjal, dan bahkan kematian, sehingga tidak jarang membutuhkan perawatan intensif. Diduga komorbiditas akan memperberat kondisi tersebut. Penelitian ini bertujuan untuk mengetahui dampak komorbiditas yakni hipertensi, diabetes melitus, dan penyakit paru obstrktif kronis terhadap kejadian perawatan intensif pada pasien COVID-19 di DKI Jakarta. Penelitian ini menggunakan desain potong lintang dengan menggunakan data registri pasien COVID-19 milik Dinas Kesehatan Provinsi DKI Jakarta pada Maret-Juni 2020 yand diperoleh dari formulir pencatatan dan pelaporan COVID-19. Kriteria inklusi adalah usia lebih dari 18 tahun, terdiagnosis COVID-19 dari hasil pemeriksaan swab PCR positif, dan pasien dirawat di Rumah Sakit di DKI Jakarta. Kriteria eksklusi adalah memiliki kondisi imunodefisiensi (HIV, keganasan, sedang menjalani kemoterapi atau radiasi). Data dianalisis secara bivariat dan multivariat menggunakan regresi logistik multipel dengan mempertimbangkan kovariat berupa usia, jenis kelamin, jenis pekerjaan, jumlah gejala dan durasi gejala yang dialami. Berdasarkan 12 699 pasien terkonfirmasi COVID19 pada periode penelitian, terdapat 6 359 pasien yang memenuhi kriteria penelitian ini. Diketahui 623 (9,8%) mengalami hipertensi, 421 (6,62%) mengalami diabetes melitus, dan 133 (2,09%) mengalami PPOK. Sebanyak 166 (2,61%) diantaranya mendapat perawatan di ICU. Setelah dikontrol kovariat, ketiga komorbiditas tersebut secara independen meningkatkan risiko kebutuhan perawatan di ICU, tertinggi pada penderita hipertensi tanpa diabetes yang memiliki lebih dari 2 gejala OR 23,98 (IK95% 12,8344,83) diikuti penderita hipertensi yang disertai diabetes dan lebih dari 2 gejala OR 16,53 (IK95% 8,76-31,17). Penderita PPOK memiliki risiko OR 1,80 (IK95% 0,95-3,40) untuk dirawat di ICU. Disimpulkan bahwa hipertensi, diabetes melitus, dan PPOK meningkatkan risiko perawatan di ICU pada pasien COVID-19 di DKI Jakarta.
COVID-19 cases can lead to pneumonia, acute respiratory distress syndrome, acute kidney failure, and death. The presence of comorbidities are tought to worsen that condition. This study aimed to investigate impact of hypertension, diabetes mellitus, and chronic obstructive pulmonary disease to admission to intensive care unit (ICU) among COVID-19 patients in DKI Jakarta. This cross sectional study utilize COVID-19 patients registry data owned by DKI Jakarta Provincial Health Office from March to June 2020. Inclusion criteria are aged 18 years old or older, confirmed by positive PCR swab test result, and hospitalized in DKI Jakarta. Exclusion criteria are patients with immunodeficiency condition (HIV, malignancy, in chemotherapy or radiation therapy). Data were analyzed in bivariate and multivariate analysis using multiple logistic regression by considering covariates (age, sex, working status, number of symptoms, and duration of symptoms). Among 12 699 patients, 6 359 were included. Approximately 623 (9,8%) had hypetension, 421 (6,62%) had diabetes mellitus, and 133 (2,09%) had COPD. Among them, 166 (2,61%) were admitted to ICU. After controlling for covariates, those comorbidities are independently increase risk of ICU admission. The highest risk are found among hypertension patients without diabetes melitus and had more than two symptoms OR 23,98 (95%CI 12,83-44,83) followed by hypertension patients with diabetes melitus and had more than two symptoms OR 16,53 (95%CI 8,76-31,17). COPD patients had risk OR 1,80 (95%CI 0,95-3,40) for ICU admission. In conclusion, hypertension, diabetes mellitus, and COPD increase risk of ICU admission among COVID-19 patients in DKI Jakarta.
T-6097
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Nabela Atika Sofia; Pembimbing: Helda; Penguji: Soedarto Ronoatmodjo, Umi Zakiyati
Abstrak:
Pandemi Coronavirus Disease 2019 (COVID-19) telah mempengaruhi berbagai aspek kehidupan masyarakat, khususnya di Kota Depok yang pertama kali melaporkan kasus di Indonesia. Penambahan kasus yang masih terus meningkat serta adanya kebijakan kesehatan masyarakat untuk membatasi berbagai aktivitas sosial masyarakat selama empat bulan terakhir berpotensi menyebabkan kecemasan bagi masyarakat. Penelitian ini bertujuan untuk mengetahui gambaran dan faktor yang berhubungan dengan kecemasan masyarakat pada pandemic COVID-19 di Kota Depok. Desain penelitian yang digunakan adalah cross sectional. Data yang digunakan adalah data primer yang diperoleh dengan menyebarkan kuesioner online ke berbagai media sosial secara acak. Kecemasan diukur menggunakan kuesioner Generalized Anxiety disorder-7 (GAD-7). Hasil penelitian menunjukkan proporsi kecemasan di Kota Depok sebesar 36,6% serta faktor yang berhubungan dengan kecemasan pada Pandemi COVID19 adalah tingkat pendidikan (p-value = 0,004, OR 2,305 95% CI 1,295-4,105). Berdasarkan hasil yang diperoleh, maka disarankan bagi pemerintah untuk melakukan penilaian kecemasan di masyarakat umum serta terus memberikan edukasi mengenai COVID-19 kepada masyarakat baik melalui media sosial maupun media lainnya.
Kata kunci: COVID-19, kecemasan, Depok
The Pandemic of Coronavirus Disease 2019 (COVID-19) has affected various aspects of life, especially in Depok, where the first case was reported in Indonesia. The increasing cases and existence of public health policies to limit various social activities over the past four months potentially cause anxiety for the community. This study aims to determine the description and factors associated with anxiety during COVID-19 pandemic in Depok. The study design was cross sectional. The data used are primary data obtained by distributing online questionnaires to various social media randomly. The anxiety was measured with Generalized Anxiety disorder-7 (GAD-7) questionnaires. The results showed the proportion of anxiety in Depok was 36.6% and the factor associated with COVID-19 pandemic was level of education (p-value = 0.004, OR 2.305 95% CI 1,295-4,105). Based on the results, it is recommended for the government to conduct an anxiety assessment in the general public and continue to provide education about COVID-19 to the public both through social media and other media.
Key words: COVID-19, anxiety, Depok
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Kata kunci: COVID-19, kecemasan, Depok
The Pandemic of Coronavirus Disease 2019 (COVID-19) has affected various aspects of life, especially in Depok, where the first case was reported in Indonesia. The increasing cases and existence of public health policies to limit various social activities over the past four months potentially cause anxiety for the community. This study aims to determine the description and factors associated with anxiety during COVID-19 pandemic in Depok. The study design was cross sectional. The data used are primary data obtained by distributing online questionnaires to various social media randomly. The anxiety was measured with Generalized Anxiety disorder-7 (GAD-7) questionnaires. The results showed the proportion of anxiety in Depok was 36.6% and the factor associated with COVID-19 pandemic was level of education (p-value = 0.004, OR 2.305 95% CI 1,295-4,105). Based on the results, it is recommended for the government to conduct an anxiety assessment in the general public and continue to provide education about COVID-19 to the public both through social media and other media.
Key words: COVID-19, anxiety, Depok
S-10418
Depok : FKM UI, 2020
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Risma Yustiani Syarif; Pembimbing: Syahrizal Syarif; Penguji: Tri Yunis Miko Wahyono, Luqman Yanuar Rachman
Abstrak:
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ISPA (Infeksi Saluran Pernafasan Akut) masih menjadi masalah serius di seluruh dunia termasuk Indonesia. Pentingnya pencegahan dan penanggulangan ISPA tersirat dalam Sustainable Development Goals (SDGs) tujuan ke-3: Ensure healthy lives and promote well being for all at all ages. Pada tahun 2017 terdapat 289 kasus ISPA Bawah terkait influenza dengan 11 kematian yang dilaporkan di kota Mekah. 44 % kasus kematian tersebut berasal dari jamaah asal Asia Tenggara. Kasus ISPA pada tahun 2017 didominasi oleh Nasofaringitis Akut yang menjadi sebab 19% kunjungan rawat jalan jamaah haji pada tahun tersebut. Tahun 2018 Common Cold menjadi urutan kasus ISPA nomor 1 pada 10 penyakit terbanyak pada jamaah haji disamping 5 penyakit ISPA. Tujuan penelitian ini untuk engetahui faktor determinan ISPA pada Jemaah Haji Provinsi Jawa Barat Tahun 2018.Desain studi cross-sectional dari data sekunder dengan jumlah sampel 374 jemaah haji. Analisis faktor determinan kejadian ISPA pada penelitian ini menggunakan analisis multivariat cox regresi dengan besar pengaruh yang dinyatakan dalam prevalensi rasio (PR) dan Confidence Interval (CI 95%). Penelitian ini menunjukkan prevalensi ISPA pada Jemaah Haji Provinsi Jawa Barat Tahun 2018 mencapai 72,65%. Hasil analisis multivariat menunjukkan faktor determinan ISPA pada Jemaah Haji Jawa Barat adalah obesitas (PR 0.84), secara statistik dengan kemungkinan faktor komorbid lain secara substantif. Hasil penelitian menyarankan peningkatan pelayanan kesehatan haji holistik dan bersifat preventif sejak faktor risiko penyakit komorbid obesitas ditemukan dengan cara edukasi, pembinaan kesehatan haji sejak masa tunggu ibadah haji, bersamaan dengan pelaksanaan program UKP dan UKM di Puskesmas seperti Posbindu PTM, Prolanis dan Kesorga. Kata Kunci : ISPA, Jemaah Haji, Faktor Determinan, Jawa Barat
ARI (Acute Respiratory Tract Infection) remain as a serious problem globalliy. Indonesia also has the same burden either. Multiple effect of ARI in a pandemic scale surely results in devastation in health, economy, and other sectors. The importance of ARI prevention implied on the third aim of Sustainable Development Goals (SDGs) : Ensure healthy lives and promote well being for all at all ages. In 2017 we found 289 Acute Lower Respiratory Tract Infection cases related to influenza as viral agent with 11 mortality number reported in Mecca. 44 % of the mortality dominated by South East Asian pilgrims. At the same year, Acute Nasopharyngitis also dominated 19% inpatient cases of Pilgrims In 2018, Common Cold become the first rank of 10 diseases mostly happen in Pilgrims with 5 others ARI manifestation. The purpose of this study is to asses the determinant factors of ARI in West Java’s Pilgrims, 2018. A cross-sectional study was held with 374 samples from secondary derived from Siskohatkes. The analysis of ARI determinant factors in this study applied multivariate-Cox Regression analysis and expressed by the prevalence ratio (PR) with a 95% Confidence Interval (CI). Our study reveal that ARI prevalence in West Java’s pilgrims 2018 is 72,65%. The multivariate analysis result show that ARI determinant factor in West Java’s pilgrims is obesity (PR 0.84), even statistically unsignificant with other substantive factors that also important. The researcher suggest hajj treatment improvement programmes holistically, preventif as soon as obesity as comorbid factors found in pilgrims. The programmes include education, hajj health maintenace program since a pilgrim announce to do hajj. The program can be held in coordination with UKP and UKM by Posbindu PTM, Prolanis also Kesorga at a public health center. Key words: ARI, Pilgrims, Determinant Factor, West Java
T-7497
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Hadiki Habib; Promotor: Mondastri Korib Sudaryo; Kopromotor: Besral, Martin Rumende; Penguji: Evi Martha, Syahrizal, Soroy Lardo;Tri Martani, Syamsul Maarif
Abstrak:
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Rawat inap dan kematian di rumah sakit karena pneumonia meningkat pada saat pandemi COVID-19, baik karena COVID-19 maupun patogen lain dan perlu diidentifikasi faktor-faktor risikonya. Penelitian ini dilakukan untuk menganalisis secara bersamaan hubungan berbagai determinan biologi, gaya hidup, lingkungan dan pelayanan kesehatan terhadap sintas rawat inap pasien pneumonia pada masa pandemi COVID-19. Penelitian ini menggunakan disain campuran. Pertama, dilakukan studi kuantitatif kohort retrospektif menggunakan analisis regresi cox, analisis interaksi dilakukan dengan metode stratifikasi dan multiplikasi. Data subjek penelitian diambil secara sampling acak sederhana dari rekam medis pasien pneumonia yang dirawat pada masa pandemi COVID-19 Mei 2020-Desember 2021 di RS dr. Cipto Mangunkusumo, Jakarta. Kedua, dilakukan studi kualitatif sequential explanatory dengan disain studi kasus. Informasi dikumpulkan melalui wawancara mendalam bersama enam orang informan untuk menjelaskan dinamika determinan kesehatan dengan sintas rawat inap dari perspektif ketahanan rumah sakit. Terdapat 1945 subjek pneumonia, insiden kematian saat rawat inap 34,1%. Determinan biologi yang berhubungan dengan peningkatan risiko kematian adalah kondisi awal pneumonia berat (HR 1,8;IK95% 1,38-2,43), skor CCI ≥2 (HR 1,5;IK95% 1,16-2,08). komplikasi ≥2 (HR 5,9; 95%IK 2,9-11,9), tren kematian rawat inap meningkat seiring dengan bertambahnya usia. Risiko kematian lebih rendah ada pada subjek dengan infeksi utama organ selain paru (HR 0,4;IK95% 0,35-0,51). Determinan pelayanan kesehatan yang berhubungan dengan peningkatan risiko kematian adalah intubasi (HR 1,6;IK95% 1,27-2,05) dan lama tunggu di IGD ≥8 jam (HR1,4;IK95% 1,12-1,63), risiko kematian lebih rendah ada pada subjek yang mendapat perawatan intensif (HR 0,3;IK95% 0,25-0,41), terapi antikoagulan (HR 0,3;IK95% 0,27-0,44) dan terapi steroid pada pneumonia non-COVID-19 kondisi berat (0,7;IK95% 0,5-0,9). Pada subjek pneumonia COVID-19, risiko kematian selama rawat inap lebih rendah jika mendapatkan antibiotik empiris (HR 0,4;IK95% 0,26-0,58), terapi antikoagulan (HR 0,3;IK95% 0,23-0,4), dan terapi antivirus (HR 0,4;IK95% 0,3-0,5). Steroid (HR 0,4;IK95% 0,3-0,6), terapi plasma konvalesens (HR 0,2;IK95% 0,08-0,57), dan terapi anti interleukin-6 (HR 0,7; IK95% 0,46-1,03) menurunkan risiko kematian rawat inap pada pneumonia COVID-19 berat. Ketangguhan rumah sakit terjaga dengan adanya kebijakan zonasi, penerapan prinsip mitigasi risiko, dan modulasi layanan sesuai azas proporsionalitas, jejaring rumah sakit membantu mengurangi beban finansial melalui pemberian donasi atau hibah. Kerentanan rumah sakit antara lain kerapuhan infrastruktur, kecepatan kembali ke layanan reguler lebih lambat, rasa takut tenaga kesehatan dan triase pra-rumah sakit belum berjalan. Tidak terdapat ineraksi antara variabel etiologi pneumonia dengan fase lonjakan kasus, dan tidak terdapat interaksi antara variabel etiologi pneumonia dengan lama tunggu di IGD. Determinan biologi, lingkungan dan pelayanan kesehatan berhubungan dengan sintas rawat inap pasien pneumonia pada masa pandemi COVID-19. Ketahanan rumah sakit perlu dinilai dengan melihat dampak pandemi terhadap kematian pneumonia COVID-19 maupun pneumonia non-COVID-19. Pengelolaan lonjakan kasus akibat pandemi COVID-19 perlu mempertimbangkan prinsip zonasi, modulasi layanan yang proporsional, kesiapan psikologis tenaga kesehatan, kondisi finansial rumah sakit, dan kesiapan infrastruktur. Triase pra-rumah sakit merupakan faktor eksternal yang membantu meningkatkan ketahanan rumah sakit.
Hospital admissions and mortality due to pneumonia increased during the COVID-19 pandemic, both due to COVID-19 and other pathogens, Thus, risk factors need to be identified. The research was conducted to simultaneously analyze the relationship between various biological, lifestyle, environmental and health service determinants on the survival rate of pneumonia patients during the COVID-19 pandemic. This research uses mixed methods design. First, a quantitative retrospective cohort study was performed using cox regression analysis, interaction analysis was carried out using stratification and multiplication methods. Simple random sampling was done from medical records list of pneumonia patients who were treated during the COVID-19 pandemic in May 2020December 2021 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Second, a sequential explanatory qualitative study was performed with a case study design. Information was collected through in-depth interviews of six informants to explain the dynamics of health determinants and inpatient survival from a hospital resilience perspective. There were 1945 subjects, the incidence of mortality during hospitalization was 34.1%. Biological determinants associated with an increased risk of mortality were initial conditions of severe pneumonia (HR 1,8; CI95% 1,38-2,43), CCI score ≥2 (HR 1,5; CI95% 1,16-2,08), complications ≥2 (HR 5,9; 95%CI 2,9-11,9), the trend of inpatient mortality increases with increasing age. The risk of death was lower in subjects with primary infection of organs other than the lungs (HR 0,4; 95% CI 0,35-0,51). Determinants of health care that are associated with an increased risk of death are intubation (HR 1,6; 95% CI 1,27-2,05) and waiting time in the ER ≥8 hours (HR 1,4; 95% CI 1,12-1,63), mortality risk was lower in subjects who received intensive care (HR 0,3;95%CI 0,25-0,41), anticoagulant therapy (HR 0,3;95%CI 0,27-0,44) and steroid therapy in severe non-COVID-19 pneumonia (0,7; 95%CI 0,5-0,9). In COVID-19 pneumonia subjects, the risk of death during hospitalization was lower if they received empiric antibiotics (HR 0,4; 95%CI 0,26-0,58), anticoagulant therapy (HR 0,3; 95%CI 0,23-0,4), and antiviral therapy (HR 0,4;95% CI 0,3-0,5). Steroids (HR 0,4; CI95% 0,3-0,6), convalescent plasma therapy (HR 0,2; CI95% 0,08-0,57), and anti-interleukin-6 therapy (HR 0,7; IK95% 0,46-1,03) reduces the risk of inpatient death in severe COVID-19 pneumonia. Hospital resilience is maintained by having zoning policies, implementing risk mitigation principles, and modulating services according to the principle of proportionality. Hospital networks help reduce financial burdens through providing donations or grants. Hospital vulnerabilities include the fragility of infrastructure, slower process of return to regular services, fearness among health workers and pre-hospital triage not adequately performed. There was no interaction between the pneumonia etiology variable and the surge phase of cases, and there was no interaction between the pneumonia etiology variable and the length of stay in the ER. Biological, environmental and health service determinants are associated to the inpatient survival rate of pneumonia during the COVID-19 pandemic. Hospital resilience needs to be assessed by looking at the impact of the pandemic on mortality from COVID-19 pneumonia and non-COVID-19 pneumonia. Management of the surge capacity due to the COVID-19 pandemic needs to consider zoning principles, proportional service modulation, psychological readiness of health workers, financial condition of hospitals, and infrastructure readiness. Prehospital triage is an external factor that helps improve hospital resilience. Keywords : Pneumonia; COVID-19; Pandemic; survival; hospital resilience
D-526
Depok : FKM-UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Endang Widuri Wulandari; Pembimbing: Sudarto Ronoatmodjo; Penguji: Helda, Ngabila Salama, Muhammad Ikhsan Mokoagow
Abstrak:
Pendahuluan: Komorbid Diabetes Melitus (DM) merupakan salah satu faktor risiko kematian pada kasus konfirmasi Coronavirus Diseases (COVID-19). Tujuan penelitian ini adalah untuk mengetahui hubungan komorbid DM dengan kematian pada kasus konfirmasi COVID-19 di DKI Jakarta, periode Maret-Agustus 2020 setelah dikontrol dengan variabel perancu. Metode: Desain penelitian ini adalah kohort retrospektif. Kriteria inklusi adalah kasus yang terkonfirmasi COVID-19 dengan pemeriksaan Polymerase Chain Reaction (PCR) yang dilaporkan kepada Dinas Kesehatan (Dinkes) provinsi DKI Jakarta, dengan variabel yang lengkap. Kriteria eksklusi adalah wanita hamil. Dari total 41.008 kasus dalam laporan COVID-19 dinkes provinsi DKI Jakarta, terdapat 30.641 kasus yang memenuhi kriteria inklusi dan eksklusi. 1.480 sampel dalam penelitian ini diambil dari semua (740) kasus COVID-19 dengan komorbid DM dan 740 kasus COVID-19 tanpa komorbid DM yang diambil melalui simple random sampling dari 29.901 kasus COVID-19 tanpa komorbid DM. Data analisis menggunakan regresi cox proporsional hazard. Hasil penelitian menunjukkan besar hubungan kasar komorbid DM dengan kejadian kematian pada kasus COVID-19 Crude Hazard Ratio (CHR) 7,4 (95% CI 4,5-12,3, nilai p < 0,001). Besar hubungan komorbid DM dengan kejadian kematian pada kasus COVID-19 setelah dikontrol oleh kovariat (komorbid hipertensi dan kelompok usia (> 50 tahun dan < 50 tahun) adalah Adjusted Hazard Rasio 3,9 (95% CI 2,2-6,8 nilai p <0,001), yang berarti kasus COVID-19 dengan komorbid DM berisiko 3,9 kali untuk mengalami kejadian kematian. Diskusi: Hasil penelitian ini sejalan dengan penelitian lainnya yang menunjukkan komorbid DM meningkatkan risiko kematian COVID-19. Untuk menurunkan kejadian kematian pada kasus COVID-19 dengan komorbid DM, diperlukan strategi pencegahan dan tatalaksana COVID-19 dengan triase dan perhatian khusus untuk tatalaksana cepat dan tepat serta monitoring untuk kasus COVID-19 dengan komorbid DM.
Introduction: Comorbid Diabetes Mellitus (DM) is one of the risk factors for Coronavirus Diseases (COVID-19) mortality. Aim of this study is to determine the association of comorbid diabetes mellitus and COVID-19 mortality among COVID-19 confirmed cases in DKI Jakarta for period March-August 2020, after being controlled with confounding variables. Methode: The study design is a retrospective cohort. The inclusion criteria are confirmed cases of COVID-19 with Polymerase Chain Reaction (PCR) reported to the DKI Jakarta provincial health office, with complete variables. Exclusion criteria is pregnant women. Of the total 41,008 cases in the Jakarta provincial health office's COVID-19 report, there are 30,641 cases that met the inclusion and exclusion criteria. 1,480 samples in this study are taken from all (740) COVID-19 cases with comorbid DM and 740 COVID-19 cases without comorbid DM which are taken through simple random sampling of 29,901 COVID-19 cases without comorbid DM. The data were analyzed using cox proportional hazard regression. The study result indicates that the crude association between DM and mortality among COVID-19 confirmed cases is Crude Hazard Ratio (CHR) 7,4 (95% CI 4,5-12,3, pValue < 0,001). While association between DM and mortality among COVID-19 confirmed cases after being controlled by covariates (hypertensive comorbidities and age groups (> 50 years and < 50 years) is 3.9 (95% CI 2.2- 6.8, p Value <0.001), which means that COVID-19 cases with comorbid DM have a 3.9 times risk of death. Discussion: The results of this study are in line with other studies that indicate DM co- morbidities increase the risk of death from COVID-19. To reduce the incidence of death in COVID-19 cases with comorbid DM, a strategy for preventing and treating COVID- 19 with triage and special attention is needed for rapid and prompt management and monitoring for COVID-19 cases with comorbid DM.
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Introduction: Comorbid Diabetes Mellitus (DM) is one of the risk factors for Coronavirus Diseases (COVID-19) mortality. Aim of this study is to determine the association of comorbid diabetes mellitus and COVID-19 mortality among COVID-19 confirmed cases in DKI Jakarta for period March-August 2020, after being controlled with confounding variables. Methode: The study design is a retrospective cohort. The inclusion criteria are confirmed cases of COVID-19 with Polymerase Chain Reaction (PCR) reported to the DKI Jakarta provincial health office, with complete variables. Exclusion criteria is pregnant women. Of the total 41,008 cases in the Jakarta provincial health office's COVID-19 report, there are 30,641 cases that met the inclusion and exclusion criteria. 1,480 samples in this study are taken from all (740) COVID-19 cases with comorbid DM and 740 COVID-19 cases without comorbid DM which are taken through simple random sampling of 29,901 COVID-19 cases without comorbid DM. The data were analyzed using cox proportional hazard regression. The study result indicates that the crude association between DM and mortality among COVID-19 confirmed cases is Crude Hazard Ratio (CHR) 7,4 (95% CI 4,5-12,3, pValue < 0,001). While association between DM and mortality among COVID-19 confirmed cases after being controlled by covariates (hypertensive comorbidities and age groups (> 50 years and < 50 years) is 3.9 (95% CI 2.2- 6.8, p Value <0.001), which means that COVID-19 cases with comorbid DM have a 3.9 times risk of death. Discussion: The results of this study are in line with other studies that indicate DM co- morbidities increase the risk of death from COVID-19. To reduce the incidence of death in COVID-19 cases with comorbid DM, a strategy for preventing and treating COVID- 19 with triage and special attention is needed for rapid and prompt management and monitoring for COVID-19 cases with comorbid DM.
T-6249
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Lutfiani Fajrin; Pembimbing: Syahrizal; Penguji: Nurhayati Adnan, Helmi; Ahmad Hidayat
Abstrak:
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Reinfeksi Covid-19 didefinisikan sebagai telah sembuh dari infeksi COVID-19 kemudian terinfeksi kembali. Banyaknya laporan kejadian reinfeksi dibeberapa negara seperti Hongkong, Nevada, Amerika Serikat, Belgium, Ekuador, India, dan negara lainnya menunjukkan besaran masalah reinfeksi. Oleh karena itu, penelitian ini dilakukan untuk mengetahui faktor yang beresiko terhadap kejadian reinfeksi COVID-19. Studi ini menggunakan desain cross-sectional dalam mengetahui faktor resiko reinfeksi COVID-19. Subjek penelitian ini adalah pasien dengan riwayat reinfeksi yang memenuhi kriteria inklusi dan eklusi dari data surveilans epidemiologi di RSDC Wisma Atlet, Jakarta pada bulan Juli – Desember 2021. Hasil penelitian menunjukkan terdapat 7 variabel yang berhubungan dengan reinfeksi COVID-19 pada pasien RSDC WAK: usia 30-39 tahun (POR: 0.60, 95% CI: 0.47-0.77), usia ≥40 tahun (POR 0.41, 95%CI: 0.32-0.53), variabel pekerjaan; non-nakes (POR: 0.91, 95% CI: 0.68-1.22), nakes (POR: 1.80, 95% CI: 1.32-2.46), riwayat kontak erat (POR: 0.75, 95% CI: 0.59-0.97), penggunaan transportasi umum (POR: 1.36, 95% CI:1.02-1.79), perjalanan ke luar daerah (POR: 0.69, 95% CI: 0.51-0.96), bepergian ke fasilitas umum (POR: 2.01, 95% CI: 1.45-2.78), status vaksin; vaksin dosis 1 (POR: 0.56, 95% CI: 0.42-0.74), dan belum vaksinasi (POR:0.62, 95% CI: 0.48-0.78). Determinan atau faktor prediktor dominan reinfeksi COVID-19 pada pasien rawat inap RSDC WAK adalah variabel bepergian ke fasilitas umum.
COVID-19 reinfection defined as a person who has recovered from infection with COVID-19 then re-infected. The number of reinfection report in several countries such as Hongkong, Nevada, Amerika Serikat, Belgium, Ekuador, India, and the other country shows the magnitude of the reinfection problem. Therefore, this study was conducted to determine risk factor of COVID-19 reinfection. This study is an analytical study with a cross-sectional to determine the risk factors of COVID-19 reinfection. The subjects of this study were patients with a history of reinfection who met the inclusion and exclusion criteria from secondary data (epidemiological surveillance data) at the RSDC Wisma Atlet Kemayoran, Jakarta (RSDC WAK) in July – December 2021. The results showed that there were 7 variables related to the incidence of reinfection of COVID-19 in RSDC WAK patients, including: age; age 30-39 years old (POR: 0.60, 95% CI: 0.47-0.77), age ≥40 years old (POR 0.41, 95%CI: 0.32-0.53), occupation; non-health workers occupation (POR: 0.91, 95% CI: 0.68-1.22), health worker occupation (POR: 1.80, 95% CI: 1.32-2.46), history of close contact (POR: 0.75, 95% CI: 0.59-0.97), public transportation uses (POR: 1.36, 95% CI: 1.02-1.79), travel outside the region (POR: 0.69, 95% CI: 0.51-0.96), visit public facilities (POR: 2.01, 95% CI: 1.45 -2.78), vaccine status; vaccinated doses 1 (POR: 0.56, 95% CI: 0.42-0.74), and unvaccinated (POR:0.62, 95% CI: 0.48-0.78). Predictor of COVID-19 reinfection in inpatients at RSDC WAK is visit public facilities.
T-6560
Depok : FKM UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Anggun Pratiwi; Pembimbing: Nurhayati Adnan; Penguji: Ratna Djuwita Hatma, Cut Putri Arianie
Abstrak:
Hipertensi merupakan masalah kesehatan utama karena berkontribusi pada angka kesakitan dan kematian dunia. Prevalensi hipertensi terus meningkat dan lebih banyak ditemukan pada kelompok wanita. Obesitas merupakan faktor risiko yang berpengaruh terhadap kejadian hipertensi. Masa menopause pada wanita diduga ikut berkontribusi terhadap kejadian hipertensi namun pengaruhnya masih menjadi perdebatan. Penelitian ini bertujuan mengkaji hubungan obesitas dengan kejadian hipertensi derajat 1 baik pada wanita premenopause dan postmenopause di Indonesia. Sebanyak 8.047 responden wanita yang berumur 18-57 tahun diteliti. Penelitian menggunakan desain cross sectional dengan sumber data dari Indonesian Family Life Survey (IFLS) 5 Tahun 2014.
Hasil analisis multivariat dengan modifikasi cox regression menunjukkan bahwa risiko wanita obesitas untuk menderita hipertensi derajat 1 sebesar 1,80 kali (95% CI 1,57-2,06) dibandingkan wanita yang tidak obesitas. Pada wanita premenopause, obesitas dapat meningkatkan risiko terjadinya hipertensi derajat 1 sebesar 1,67 kali (95% CI 1,43-1,94). Risiko yang lebih besar tampak pada kelompok wanita postmenopause dengan besar risiko obesitas terhadap kejadian hipertensi derajat 1 sebesar 2,32 kali (95% CI 1,69-3,19). Perlu dilakukan pencegahan dan pengendalian hipertensi melalui program GERMAS dan pemaksimalan peran posbindu PTM. Masyarakat khususnya wanita perlu menerapkan pola hidup sehat dengan perilaku CERDIK sejak usia dini.
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Hasil analisis multivariat dengan modifikasi cox regression menunjukkan bahwa risiko wanita obesitas untuk menderita hipertensi derajat 1 sebesar 1,80 kali (95% CI 1,57-2,06) dibandingkan wanita yang tidak obesitas. Pada wanita premenopause, obesitas dapat meningkatkan risiko terjadinya hipertensi derajat 1 sebesar 1,67 kali (95% CI 1,43-1,94). Risiko yang lebih besar tampak pada kelompok wanita postmenopause dengan besar risiko obesitas terhadap kejadian hipertensi derajat 1 sebesar 2,32 kali (95% CI 1,69-3,19). Perlu dilakukan pencegahan dan pengendalian hipertensi melalui program GERMAS dan pemaksimalan peran posbindu PTM. Masyarakat khususnya wanita perlu menerapkan pola hidup sehat dengan perilaku CERDIK sejak usia dini.
T-5682
Depok : FKM UI, 2019
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Masruroh; Pembimbing: Mondastri Korib Sudaryo; Penguji: Ratna Djuwita, Zolaiha, Nurpatmawati
Abstrak:
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Ibadah haji merupakan ibadah fisik, sehingga jemaah haji dituntut untuk mampu secara jasmani dan rohani agar dapat melaksanakan seluruh rangkaian ibadah haji dengan baik dan lancar. Hasil pemeriksaan kesehatan pada calon Jemaah haji Kabupaten Cirebon tahun 2022 menunjukkan bahwa hipertensi merupakan diagnosa penyakit tertinggi. Dislipidemia merupakan salah satu faktor risiko hipertensi yang ditandai dengan kadar LDL yang tinggi, HDL yang rendah dan/atau trigliserida yang tinggi. Tujuan penelitian ini untuk mengetahui hubungan dislipidemia dengan kejadian hipertensi derajat 1. Desain penelitian yang digunakan adalah Cross Sectional, menggunakan data sekunder hasil pemeriksaan kesehatan tahap kedua pada calon Jemaah haji yang diunggah pada Siskohatkes. Analisis data menggunakan uji Chi-Square dan Cox Regression. Hasil penelitian menunjukkan prevalensi hipertensi derajat 1 sebesar 24,28%, sedangkan prevalensi dislipidemia sebesar 43,9%. Calon Jemaah haji sebagian besar berusia kurang dari 60 tahun, berjenis kelamin perempuan, memiliki pendidikan tinggi dan bekerja, tidak merokok dan tidak minum alkohol, mengalami obesitas sentral dan tidak menderita DM. Hasil penelitian diperoleh bahwa calon Jemaah haji yang mengalami dislipidemia berisiko 1,5 kali (95%CI: 1,2-1,8) lebih tinggi untuk menderita hipertensi derajat 1 dibandingkan dengan calon Jemaah haji yang tidak mengalami dislipidemia setelah dikontrol obesitas sentral. Penelitian ini menyarankan kepada Jemaah haji untuk membatasi konsumsi makanan tinggi lemak jenuh dan lemak trans, melakukan senam aerobik, tidak merokok, dan menerapkan pola makan rendah karbohidrat untuk mencegah dislipidemia serta rutin cek kesehatan untuk deteksi dini PTM. Diharapkan Pusat Kesehatan Haji Kementerian Kesehatan dapat memperbaharui Siskohatkes dan mewajibkan pemeriksaan kesehatan tahap pertama. Dinas Kesehatan Kabupaten Cirebon diharapkan melakukan sosialisasi terkait petunjuk teknis pemeriksaan kesehatan kepada petugas pengelola haji di Puskesmas.
Hajj is a physical worship, so pilgrims are required to be able physically and spiritually so that they can carry out the whole series of pilgrimage properly. The results of medical examinations for prospective haj pilgrims in Cirebon district in 2022 show that hypertension is the highest disease diagnosis. Dyslipidemia is a risk factor for hypertension which is characterized by high levels of LDL, low HDL and/or high triglycerides. The purpose of this study was to determine the assocaition between dyslipidemia and the incidence of grade 1 hypertension. The research design used was Cross Sectional, using secondary data from the results of the second stage of health examinations on prospective hajj pilgrims uploaded on Siskohatkes. Data analysis used the Chi-Square and Cox Regression tests. The results showed that the prevalence of grade 1 hypertension was 24.28%, while the prevalence of dyslipidemia was 43.9%. Prospective pilgrims are mostly aged less than 60 years, female, have higher education and work, do not smoke and do not drink alcohol, have central obesity and do not suffer from DM. The results of the study showed that pilgrims who had dyslipidemia had a risk of 1.5 times (95% CI: 1.2-1.8) to suffer from grade 1 hypertension compared to pilgrims who did not dyslipidemia after controlling for central obesity. This study advises pilgrims to limit their consumption of foods high in saturated fat and trans fat, do aerobic exercise, not smoke, and adopt a low-carbohydrate diet to prevent dyslipidemia and routine health checks for early detection of NCDs. It is hoped that the Hajj Health Center, Ministry of Health can renew Siskohatkes and mandatory first stage of health examination. The Cirebon District Health Office can inform technical guidelines for health examination to haj management staff at the Puskesmas.
T-6629
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Dalima Ari Wahono Astrawinata; Pembimbing: Bambang Sutrisna; Penguji: Yefta Moenadjat, Bastaman Basuki, Tri Yunis Miko Wahyono, Siti Boedina Kresno
Abstrak:
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LATAR BELAKANG: Banyak faktor mempengaruhi prognosis luka bakar, data di Indonesia belum ada yang rinci. Dengan mengetahui faktor prognostik terpenting, akan dimungkinkan menetapkan penatalaksanaan yang tepat_ Perbaikan standar penatalaksana an membawa perbaikan nyata untuk menekan mortalitas.METODE: Penelitian kohort historikal menggunakan subyek penderita luka bakar rawat inap di RSCM Januari I998-Mei 2001. Semua yang memenuhi kriteria inklusi diambil. Analisis data dengan survival analysis menggunakan Cox proportional hazard untuk mencari perhitungan ketahanan hidup.HASIL: Dari 156 penderita didapat angka mortalitas 27,6%. Penderita terbanyak berusia 19 tahun, laki-laki lebih banyak 1,6 x dari perempuan. Penyebab tersering api (55,1%) dan terjadi dirurnah (72,4%). Ditemukan luka bakar terbanyak derajat 2° (76,9%) dengan Iuas terbanyak 27%, interquartile range 19-43%. Faktor prognostik terpenting dengan nilai hazard ratio (HR) dan 95% confidence interval (CI) masing-masing adalah syok-SIRS 12,05 (2,36;60,95), trombositopeni 10,78 (2,23;52,05), trauma inhalasi 5,20 (2,77;9,77), syok 4,87 (1,25;18,98) dan luas>50% 4,35 (1,22;15,59)KESIMPULAN: Penatalaksanaan resusitasi cairan yang tepat dan resusitasi jalan napas dapat menekan angka mortalitas penderita luka bakar. Trombositopeni merupakan salah satu petanda awal kemungkinan sepsis/SIRS.Prognostic factors in moderate and severe burn patients at Dr. Cipto Mangunkusumo National General Hospital Jakarta 1998-May 2001.
BACKGROUND: Several factors influence the outcome of burn injuries. Knowing the most important factors influencing the outcome of burn might be helpfull in developing new strategies for patient care. Improvement of burn patients management can reduce mortality rate.METHODS: Data from historical cohort were analyzed using Cox proportional hazard. One hundred fifty six burn patients hospitalized at Dr. Cipto Mangunkusumo National General Hospital from January 1998-May 2001 were selected consecutively according to inclusion criteria.RESULTS: From the 156 patients studied, mortality rate was 27,6%. Median patient age was 19 years , male : female ratio 1,6:1. The most common cause of thermal injury was flame (55,1%) and the majority occured at home (72,4%). Second degree burns were dominant (76,9%) with median burn size 27% Total Body Surface Area ( interquartile 19-43). The most important prognostic factors, hazard ratios and 95% confidence interval were shock with SIRS 12,05 (2,36;60,95), thrombocytopenia 10,78 (2,23;52,05), inhalation injury 5,20 (2,77;9,77), shock 4,87 (1,25;18,98) and burn size >50% 4,35 (1,22;15,59).CONCLUSIONS: Adequate fluid rescusitation and respiratory rescusitation can overcome important factors influencing burn patients outcome in order to reduce mortality rate. Thrombocytopenia can be use as an early sign of impending sepsis/SIRS.
T-1214
Depok : FKM-UI, 2002
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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