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ABSTRAK Nama : Ikke Yuniherlina NPM : 1506704434 Program Studi : Epidemiologi Komunitas Judul : Faktor-faktor yang berhubungan dengan keparahan DBD pada pasien studi demam akut di delapan rumah sakit di Indonesia Manifestasi klinis demam berdarah dengue (DBD) masih menjadi permasalahan dalam kesehatan masyarakat di Indonesia. Berdasarkan derajat keparahan DBD menurut kritera WHO 2011 terbagi atas DBD derajat I, DBD derajat II, DBD derajat III, dan DBD derajat IV. Di Indonesia insiden DBD meningkat walaupun angka kematiannya menurun, untuk itu penelitian ini bertujuan meneliti faktor-faktor yang berhubungan dengan keparahan DBD, dimana DBD derajat II, III, dan IV dikategorikan sebagai DBD parah. Penelitian cross-sectional yang menggunakan data sekunder dari studi etiologi demam akut dari delapan rumah sakit di Indonesia, didapatkan proporsi keparahan DBD sebesar 43,3%. Faktor-faktor yang berhubungan dengan keparahan DBD didapatkan faktor jenis serotipe virus DENV-2 (OR = 3,06 95%CI 1,43 – 6,55), DENV-3 (OR = 2,62 95% CI 1,33 – 5,15), faktor lama demam (OR = 1,91 95%CI 1,09 – 3,35), dan faktor jumlah leukosit (OR = 1,79 95%CI 1,02 – 3,16). Skoring didapatkan sebesar 67% kemampuan untuk memprediksi keparahan. Kata kunci: keparahan, demam berdarah dengue, faktor-faktor
ABSTRACT Name : Ikke Yuniherlina NPM : 1506704434 Study Program : Epidemiology Title : Prognostic factors associated with dengue hemorrhagic fever severity of the acute fibril illness study patients in eight hospitals in Indonesia Dengue hemorrhagic fever (DHF) as a clinical manifestasion of dengue infection remains a public health problem in Indonesia. According to WHO, DHF severity grade was divided into DHF I, DHF II, DHF III and DHF IV. In Indonesia, the incidence of DHF increased eventhough the mortality rate decreased. Therefore, the study aims to examine prognostic factors related to the severity of DHF, with the category of severe DHF is including DHF II, DHF III and DHF IV. This cross-sectional study using secondary data from the Acute Febrile Illness Etiology Study of eight Hospitals in Indonesia. The result as follow, the proportion of severe DHF category is 43.3%, the prognostic factors associated with DHF severity are DENV serotype (DENV-2, OR = 3.06 95% CI 1.43 - 6.55; DENV-3, OR = 2.62 95% CI 1.33 - 5.15), day of illness (OR = 1.91 95% CI 1.09 - 3.35), and leucocyte count (OR = 1.79 95% CI 1.02 - 3.16). The scoring with contributing of DENV serotype, day of illness, and leucocyte count as prognostic factors, has only 67% ability to predict DHF severity. Keywords: severity, dengue hemorrhagic fever, prognostic factors
The succesful of TB patient treatment most depends on patient compliance in
treatment process in term of medication regurally, cure, and repeated
laboratorium confirmation test. Failer in treatment could lead into multi drug
resistant. Hence, monitoring patient contracting the disease in early stages can
help to predict that dotb motivator roles very important. The focus of this study
is to understanding the influence of Muhammadiayh Aisyiyah TB motivator
activities in the patient compliance in treatment process at early stages. This
study takes place at koja and cilincing sub district, North Jakarta starts from
januari 2009 to mei 2010. The research method is using restrosfective cohort.
The subject of study group divides into two groups. One group accompanied
with TB motivators and another without TB motivators. The subject comes from
the same register. . Sample selected by total sampling with a total of 110 patiens.
Data analysis was descriptive, bi-variate, stratification and causal model by
multivariate. Exellent TB motivators in TB treatment process have a bigger
proportion (77,9%) than fair TB motivator (57,14%). Each motivator has a
relationship with compliance for example promoting, counseling, PMO, and
motivator assistance. Multivariate analysis result gives an information the
relationship between motivator role and high compliance treatment after
controlling confounding variables such as age and knowledge. An excellent
motivator has 2,11 times to increase compliance compare with fair motivator
(95% CI 0,87 – 5.11)
Keywords: Motivator, TB, Compliance,
Background: Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by the Dengue virus which is a health problem in Indonesia, including in the city of Mataram. DHF cases in Mataram City from 2016 to 2019 tend to fluctuate where most of the DHF patients are treated at the RSUD Kota Mataram. Death due to DHF infection occurred mostly in DSS and mortality from DSS was reported to be 50 times higher than in DHF patients without DSS. Prompt diagnosis and appropriate treatment are important determinants for dengue prevention and control, so knowing these risk factors can prevent/reduce mortality. Methods: This study is an observational study with a case-control design. Cases are DHF patients diagnosed with Dengue Shock Syndrome by the treating doctor, while the controls are DHF patients diagnosed not with Dengue Shock Syndrome by the treating doctor. The research data were obtained from medical records and KD-RS formular data treated at the RSUD Kota Mataram from January 2016 to December 2020. The design of the analysis was aimed at obtaining the odds ratio value followed by multivariate analysis to determine the risk factors that could detect DSS early. Results: The variables that were statistically significant in the prediction of the final model were the increase in hematocrit value > baseline with OR= 17.1 (95% CI: 4.03372.600), decreased platelet value < 100.000/µL with OR= 6 (95% CI : 2,306-15,699), and decreased leukocyte value < baseline with OR= 5.1 (95% CI: 2,209-11,838). While the most dominant variable is the increase in hematocrit value > baseline with OR = 17.1 (95% CI: 4.033-72.600) and p value = 0.000
Dengue Hemorrhagic Fever is an endemic disease in most parts of Indonesia, including in other tropical regions. Nutritional status is closely related to a person's immunological status related to immunopathogenesis of DHF. The purpose of this study was to determine the relationship of stunting with the incidence of DHF in toddlers in Sumbawa Regency. The study design that will be used in this study is an analytic study with a case control design. Case samples will be taken from all cases, and for control samples will be taken by using a random sample technique (Simple Random Sampling). So it can be concluded the number of cases 97 (total cases) of families who have toddlers with DHF diagnoses from 2018 to March 2020 (from 5 working areas of puskesmas with the highest number of DHFs in toddlers) while control of 194 families who have toddlers who are neighboring cases. From the bivariate results it can be concluded that there is a significant relationship between nutritional status and the incidence of DHF in children under five in Sumbawa Regency (p value = 0.0001) with OR = 3,269 (95% CI: 1,757-6,083). In multivariate analysis showed the same thing (p value = 0.0001) with OR = 3.22 (95% CI: 1,679-6,174). This shows that toddlers with short and very short nutritional status increase the risk of 3.22 times getting DHF.
Pendahuluan. Artritis reumatoid (AR) adalah peradangan kronik autoimun yang terutama melibatkan persendian secara bilateral dan simetris. Walaupun memiliki prevalensi yang rendah namun jika tidak diterapi secara adekuat maka akan menimbulkan masalah persendian yang bersifat permanen, kecacatan dan gangguan fungsi sendi sehingga menimbulkan dampak secara ekonomi dan sosial pada individu yang mengalaminya. Penyakit AR ini tidak dapat disembuhkan namun penyakit ini harus tetap ditatalaksana untuk mencegah progresifitas dari penyakit itu sendiri dan saat ini prediksi kegagalan atau keberhasilan terapi MTX belum pernah dilakukan di Indonesia terutama pengembangan terhadap suatu sistem skoring yang aplikatif, hal ini menjadi landasan untuk melakukan analisis faktor-faktor yang memengaruhi kegagalan pengobatan metotreksat pada pasien AR dalam hal ini dalam skala rumah sakit yang menyesuaikan dengan kondisi di Indonesia dan melakukan pengembangan sistem skoring prediktor terhadap kegagalan monoterapi metotreksat. Metode. Penelitian menggunakan desain studi kohort retrospektif yang menggunakan data rekam medis elektronik (RME) pasien poli reumatologi penyakit dalam RSCM pada kurun waktu Oktober 2020 - September 2023. Dilakukan analisis deskriptif dan bivariat dengan menggunakan analisis chi-square yang dilanjutkan dengan analisis multivariat dengan analisis model Generalized Linear Model (GLM) dengan family Poisson untuk mendapatkan nilai koefisien, RR dengan interval kepercayaan 95% dari variabel independen terhadap kegagalan terapi monoterapi metotreksat yang dilanjutkan proses eliminasi variabel melalui metode backward. Hasil. Penelitian ini mendapatkan jumlah sampel sebanyak 215 subyek setelah melalui seleksi kriteria inklusi dan eksklusi, dan didapatkan hasil bahwa jumlah sendi nyeri ≥ 6 memiliki RR 1,52 (CI 95% 1,09-2,16), obesitas memiliki RR 1,41 (CI 95% 1,04-1,24), faktor peradangan LED memiliki RR 2,21 (CI 95%1,07-4,10) dan derajat aktifitas penyakit yang tinggi dengan RR 1,36 (CI 95% 1,03-1,79) adalah variabel yang memengaruhi kegagalan monoterapi metotreksat. Pada pembentukan skoring didapatkan skoring TOLD memiliki nilai kalibrasi dari Hosmer-Lemeshow goodness of fit sebesar 0,29 dan nilai diskriminasi area under curve (AUC) pada kurva receiver operating characteristics (ROC) sebesar 0,71 (CI 95% 0,65-0,78; p-value 0,03). Kesimpulan. Jumlah sendi nyeri ≥ 6, obesitas, faktor peradangan LED dan derajat aktifitas penyakit yang tinggi adalah variabel yang memengaruhi kegagalan monoterapi metotreksat dan pembentukan skoring prediksi TOLD memiliki nilai diskriminasi dan kalibrasi yang cukup baik
Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune inflammation that mainly involves the joints bilaterally and symmetrically. Even though it has a low prevalence, if it is not treated adequately, it will cause permanent joint problems, disability and impaired joint function, causing economic and social impacts on the individuals who experience it. RA disease cannot be cured but this disease must still be managed to prevent progression of the disease itself and currently predictions of failure or success of MTX therapy have never been carried out in Indonesia, especially the development of an applicable scoring system, this is the basis for conducting analysis of factors that influence methotrexate treatment failure in RA patients, in this case on a hospital scale that adapts to conditions in Indonesia and develops a predictor scoring system for failure of methotrexate monotherapy. Methods. The study used a retrospective cohort study design using electronic medical record (RME) data from patients in the RSCM internal medicine rheumatology clinic in the period October 2020 - September 2023. Descriptive and bivariate analysis was carried out using chi-square analysis followed by multivariate analysis using Generalized model analysis. Linear Model (GLM) with the Poisson family to obtain coefficient values, RR with a 95% confidence interval of the independent variable for failure of methotrexate monotherapy therapy, followed by a variable elimination process using the backward method. Results. This study obtained a sample size of 215 subjects after going through selection criteria for inclusion and exclusion, and the results showed that the number of painful joints ≥ 6 had an RR of 1.52 (CI 95% 1.09-2.16), obesity had an RR of 1.41 (CI 95% 1.04-1.24), inflammatory factor ESR had RR 2.21 (CI 95% 1.07-4.10) and high degree of disease activity with RR 1.36 (CI 95% 1.03 -1.79) are variables that influences the failure of methotrexate monotherapy. In forming the scoring, it was found that TOLD scoring had a calibration value from the Hosmer-Lemeshow goodness of fit of 0.29 and an area under curve (AUC) discrimination value on the receiver operating characteristics (ROC) curve of 0.71 (CI 95% 0.65-0 .78; p-value 0.03). Conclusion. The number of painful joints ≥ 6, obesity, ESR inflammatory factors and a high degree of disease activity are variables that influence the failure of methotrexate monotherapy and the formation of TOLD prediction scoring has quite good discrimination and calibration values.