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The fatty acid DHA is one of the omega-3 fatty acids PUFA that plays a role in cognitive development. Sea fish and seafood is the main source of DHA. However, DHA and the prekusor is also found in other foodstuffs such as eggs, chicken meat, nuts or seeds. In addition to intake of DHA, cognitive development is also influenced by the intake of other nutrients and support environment. The purpose of this research is to get influence of PUFA and consumption of foods rich in omega-3 from marine fish/ seafood during pregnancy in third trimester, breastfeeding, Docosahexanoic acid (DHA)-Red Blood Cell of infants and its relation to cognitive development of infant at 4 months. Design study is prospective cohort study by the number of sample is 102 pairs of mothers with their newborn who checks into public health center (puskesmas)/ maternal and child health center (posyandu) in Panimbang and Majasari. The sample examined since the third trimester of pregnancy to childbirth and infants aged 4 months. Samples of breast milk and baby's cognitive development was measured at the time of a baby aged 4 months. The results showed that the intake of PUFA mothers during pregnancy and lactation is 549.45 (95% CI 491,48-607,42) mg and 240.86 (95% CI 228,06-103.02) mg. Most respondents baby has cognitive development of the appropriate chronological age or above (85,3%) and only 14.5% of the respondents have less cognitive development of infants age from chronological. Multivariate analysis of the effects of intake of PUFA and foods rich in omega-3 from marine fish / seafood in third tremester pregnant women and mother breastfeeding on cognitive development of infants aged 4 months after being controlled by the variable characteristics of respondents mothers and infants, mother consumption and environmental support (covariate variable) showed that the variables that could predict infant cognitive development is the consumption of foods rich in omega-3 from marine fish / seafood (OR=5,647 95% CI 1,45-21,986), intake of PUFA (OR= 1,862, 95% CI 0,5-6,935), aspects of emotional and verbal responsiveness (OR=7,52, 95% CI: 1,804-31,346) and fat intake (OR=0,204 CI 0,051-0,810). Mothers frequently consuming foods rich in omega-3 from fish has a chance 5,6 times get a baby with better cognitive development. Granting of stimulation in the form of hugs, kisses, attention, affection, and sensitive as well as the mother's responsiveness to the needs of the infant cognitive development increase gives the opportunity of baby 7.52 times.
KATA KUNCI: ANGKA KEMATIAN NEONTAL, BERAT BADAN LAHIR RENDAH, TABLET TAMBAH DARAH
Latar Belakang: Depresi merupakan masalah kesehatan mental yang sering terjadi pada lansia dengan persentase sebesar 12%-16%. Depresi dapat menurunkan fungsi kehidupan sehari-hari dan menurunkan kualitas hidup. Tujuan penelitian ini adalah mengetahui efektivitas terapi tawa dalam menurunkan depresi dan meningkatkan kualitas hidup pada lanjut usia serta evaluasi ekonominya. Metode: Penelitian ini merupakan penelitian true experimental dan times series dengan menggunakan desain crossover pada terapi tawa dan terapi puzzle. Lokasi penelitian dilakukan di Panti Werdha Jakarta Timur. Populasi lansia adalah 250 orang dengan jumlah subjek penelitian sebanyak 86 orang yang dipilih menggunakan proporsional random sampling dan randomnisasi untuk dijadikan dua kelompok. Pengumpulan data menggunakan kuesioner Geriatric Depression Scale (GDS) dan Older People’s Quality of Life (OPQOL) modifikasi. Analisis data untuk menilai efektifitas menggunakan uji Different in Different (DID) dan menilai efektifitas biaya menggunakan ICER. Hasil: Terdapat pengaruh terapi tawa terhadap depresi diawal intervensi sebelum crossover secara statistik( p= 0,011), sehingga terapi tawa menurunkan depresi lebih besar dibandingkan terapi puzzle. Setelah crossover tidak terdapat perbedaan terapi tawa dan terapi puzzle sama-sama dapat menurunkan depresi (P=0,347). Pada skor OPQOL tidak terdapat perbedaan pengaruh intervensi terapi tawa dan terapi puzzle secara statistik baik sebelum crossover (p=0,581) maupun setelah crossover (p=0,140), sehingga terapi tawa dan terapi puzzle sama-sama dapat meningkatkan kualitas hidup. Pada efektifitas biaya, terapi tawa lebih efektif (65,1%) dibandingkan terapi puzzle (37,2%) dalam menurunkan tingkat/kategori depresi. Untuk peningkatan efektivitas penurunan tingkat atau kategori depresi sebesar 1% pada kelompok terapi tawa diperlukan tambahan biaya sebesar Rp 5.640,-. Nilai tersebut dianggap sepadan (Worth spent) menurut para klinisi dan memiliki efektivitas penurunan tingkat atau kategori depresi dan efektivitas biaya dibandingkan terapi puzzle dalam menurunkan depresi. Kesimpulan: Terapi tawa dan terapi puzzle memiliki pengaruh pada penurunan tingkat/kategori depresi dan peningkatan kualitas hidup pada lansia namun pengaruh penurunan tingkat/kategori depresi pada terapi tawa lebih banyak dibandingkan dengan terapi puzzle. Biaya yang dikeluarkan sepadan (Worth spent) dengan penurunan tingkat/kategori depresi. Saran: Melakukan advokasi kepada Kementerian Sosial, Dinas Sosial, dan Panti Werdha agar dapat menambahkan program terapi tawa dalam upaya meningkatkan kesehatan lanjut usia khususnya menurunkan depresi.
Background: Depression is a mental health problem that often occurs in people over 65 years old with a percentage of 12%-16%. Depression can decrease the functioning of daily life. The purpose of this study is to determine the effectiveness and cost of laughter therapy in reducing depression and improving the quality of life in the elderly and its economic evaluation. Method: This study uses a crossover design and true experimental research with a time series. The location of the research was carried out at the East Jakarta Nursing Home. The elderly population was 250 with the number of 86 research subjects selected using proportional random sampling and randomization. Data were collected using modified Geriatric Depression Scale (GDS) and Older People's Quality of Life (OPQOL) questionnaires. Data analysis used the Different in Different (DID) test and the calculation of the cost-effectiveness of laughter therapy and puzzle therapy. Results: There was a statistically significant effect of laughter therapy on depression at the beginning of the intervention before crossover (p= 0.011), so that laughter therapy reduced depression more than puzzle therapy. After crossover, there was no difference between laughter therapy and puzzle therapy, both of which could reduce depression (P=0.347). In the OPQOL score, there was no statistically different effect of laughter therapy and puzzle therapy interventions both before the crossover (p=0.581) and after the crossover (p=0.140), so that laughter therapy and puzzle therapy could both improve the quality of life. In terms of cost-effectiveness, laughter therapy more effective (65.1%) than puzzle therapy (37.2%) in lowering the level/category of depression. For an increase in the effectiveness of reducing the level or category of depression by 1% in the laughter therapy group, an additional cost of Rp 5,640 is required, and the value is considered worth spent according to the clinicians and has the effectiveness of reducing the level or category of depression and cost-effectiveness compared to puzzle therapy in reducing depression. Conclusion: The effect of depression reduction on laughter therapy was more than puzzle therapy at the beginning of the intervention before the crossover. Laughter and puzzle therapy has an effect on improving the quality of life in the elderly. The costs incurred are commensurate with the decrease in the level/category of depression. Suggestion: Advocate to the Ministry of Social Affairs, Social Services, and Nursing Homes so that they can add a laughter therapy program in an effort to improve the health of the elderly, especially to reduce depression.