Abstrak: This study took place in eastern Massachusetts and included respondents from the Harvard Study of Moods and Cycles Cohort 1, enrolled between 1995 and 1997, and the Harvard Study of Moods and Cycles Cohort 2, enrolled between 2005 and 2009. In prospectively assessing rates of new-onset depression in 2 populations of late-reproductive-aged women with no Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) lifetime history of depression, we were surprised to find far lower rates of depression in the population with greater racial diversity and lower socioeconomic status, contrary to what had been reported in the scientific literature. To better understand why these disparate results occurred, we assessed confounding and outcome misclassification as potential explanations for the discrepancy. After determining that these were unlikely explanations for the findings, we explored 2 potential sources of selection bias: one induced by self-referral of healthy participants into the study and the other induced by the design of the study itself. We concluded that both types of selection bias were likely to have occurred in this study and could account for the observed difference in rates.

Abstrak: Di Indonesia, kanker serviks adalah kanker kedua paling sering yang ditemukan pada perempuan. Sebagai upaya pencegahan primer, Kementerian Kesehatan telah mengintroduksi imunisasi HPV dalam Program Demonstrasi imunisasi HPV bagi siswi perempuan kelas 5 dan 6 SD di Provinsi DKI Jakarta sejak tahun 2016. Studi ini adalah kohort retrospektif dengan pendekatan kuantitatif yang bertujuan untuk mengetahui gambaran KIPI vaksin HPV kuadrivalen beserta pengaruh faktor-faktor independen terhadap timbulnya KIPI dan model prediksi dengan menggunakan metode analisis survival. Total 500 laporan surveilans aktif KIPI yang didapat pada tahun 2017 dan dianalisis dengan SPSS. KIPI vaksin HPV kuadrivalen yang terjadi dalam program BIAS HPV di provinsi DKI Jakarta tahun 2017 adalah reaksi nyeri lokal di tempat suntikan (59,6%), bengkak (17,2%), kemerahan (40,8%) dan demam (1,6%). Tidak ditemukan KIPI serius. Variabel independen yang signifikan adalah nomor batch vaksin dan riwayat imunisasi lain dalam waktu 4 minggu sebelum imunisasi HPV. Semua KIPI bersifat ringan dan sembuh sendiri tanpa intervensi. Dapat disimpulkan bahwa vaksin HPV kuadrivalen memiliki gambaran keamanan yang baik. Keputusan untuk melanjutkan dan memasukkan vaksin HPV ke dalam program imunisasi nasional harus didukung oleh analisis lebih lanjut seperti aspek biaya, cost-effective analysis, ketersediaan vaksin, tingkat penerimaan vaksin serta aspek kapasitas dan manajemen cold chain.

Abstrak:

ABSTRAK Nama : R. Lita Ayuningdyah Program Studi : Magister Ilmu Kesehatan Masyarakat Peminatan : Kesehatan Reproduksi Judul : Penerimaan orangtua terhadap vaksinasi Human Papilloma Virus (HPV) melalui kegiatan Bulan Imunisasi Anak Sekolah (BIAS) di Kecamatan Tanah Abang Tahun 2017 Penelitian ini dimaksudkan untuk mengetahui penerimaan orangtua terhadap vaksinasi HPV melalui kegiatan Bulan Imunisasi Anak Sekolah (BIAS) di DKI Jakarta Tahun 2017. Metode penelitian yang digunakan adalah  Mix Methods, yaitu secara kuantitatif dengan pengisian kuesioner dan kualitatif dengan wawancara mendalam. Hasil penelitian kuantitatif didapatkan 92,7% orangtua menerima vaksinasi HPV yang diberikan melalui kegiatan BIAS. Sementara itu, pada hasil penelitian kualitiatif ditemukan bahwa penolakan orang tua merupakan salah  satu  kendala yang ditemui dalam pelaksanaan BIAS HPV tahun 2016. Kurangnya pengetahuan orang tua terkait manfaat vaksin HPV, sangat berkaitan dengan kurangnya dukungan dari petugas kesehatan, terutama perihal sosialisasi program BIAS HPV. Kata Kunci : Penerimaan, Orangtua, Vaksinasi HPV, BIAS.

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ABSTRACT Name : R. Lita Ayuningdyah Study Program : Magister of Public Health Peminatan : Reproductive Health Judul : Parental Acceptance of Human Papilloma Virus (HPV) Vaccination through School Students Immunization Month (BIAS) In Tanah Abang, In 2017 The study was designed to explore the Parental Acceptance of Human Papilloma Virus (HPV) Vaccination through School Students Immunization Month (BIAS) In DKI Jakarta in 2017. This study using quantitative method by filling questionnaires dan qualitative method with in-depht interview. The result from quantitative research found that  92,7% of parents accept the HPV vaccination that given through BIAS. Meanwhile, the result from qualitative research found that parental’s rejection is one of the obstacles encountered in the implementation of HPV BIAS 2016. The lack of parental knowledge regarding the benefits of HPV vaccine, is strongly related to the lack of support from healthcare workers, especially regarding the socialization of the HPV BIAS program. Keywords : Acceptance, Parental, Vaccination, HPV, BIAS

Abstrak: Prenatal exposures often are assessed using retrospective interviews. Time from exposure to interview may influence data accuracy. We investigated the association of time to interview (TTI) with aspects of interview responses in the National Birth Defects Prevention Study, a population-based case-control study of birth defects in 10 US states. Mothers completed a computer-assisted telephone interview 1.5-24 months after their estimated date of delivery. Proxy metrics for interview quality were whether certain exposures were reported, whether the start month of reported medication use or illness was reported, or whether responses were missing. Interaction by case status was assessed. Interviews were completed with 30,542 mothers (22,366 cases and 8,176 controls) who gave birth between 1997 and 2007. Mothers of cases were interviewed later than were mothers of controls (11.7 months vs. 9.5 months, respectively). In adjusted analyses, having a TTI that was greater than 6 months was associated with only a few aspects of interview responses (e.g., start month of pseudoephedrine use). Interaction by case-control status was observed for some exposures; mothers of controls had a greater reduction in interview quality with increased TTI in these instances (e.g., report of morning sickness, start month of acetaminophen use and ibuprofen use). The results suggest that TTI might impact interview responses; however, the impact may be minimal and specific to the type of exposure.

Abstrak: ABSTRAK Nama : Marisa Sasuwe Program Studi : Ilmu Kesehatan Masyarakat (Kesehatan Reproduksi) Judul : Gambaran Kesiapan Guru Pembina UKS SD Sebagai Fasilitator Vaksinasi HPV Dalam Program Bulan Imunisasi Anak Sekolah (BIAS) Di Jakarta Selatan. Vaksinasi HPV memiliki efektivitas paling tinggi bila diberikan pada anak usia 9-12 tahun. Sejak tahun 2016 Indonesia menjadi satu dari sekian banyak negara yang memberlakukan program vaksinasi HPV berbasis sekolah (BIAS), dimana saat ini program ini masih terbatas di DKI Jakarta.Penelitian terdahulu menunjukkan bahwa vaksinasi HPV berbasis sekolah memiliki angka cakupan paling tinggi. Namun, menurut data di Jakarta, vaksinasi HPV masih belum mencapai target cakupan 95%. Guru pembina UKS sebagai garda terdepan pelaksanaan vaksinasi HPV di sekolah berperan sanga penting dalam proses pengambilan keputusan orang tua untuk mengijinkan atau menolak pemberian vaksinasi bagi anak mereka. Guru adalah fasilitator yang akan berperan memfasilitasi orang tua dan petugas kesehatan dalam pelaksanaan vaksinasi HPV di sekolah. Penelitian ini bertujuan untuk mengetahui Gambaran Kesiapan Guru Pembina UKS SD Sebagai Fasilitator Vaksinasi HPV Dalam Program Bulan Imunisasi Anak Sekolah (BIAS) Di Jakarta Selatan menurut karakteristik jenis kelamin,umur, tingkat pendidikan, lama menjabat sebagai guru Pembina UKS dan riwayat pelatihan. Pengukuran kesiapan dilihat dalam enam dimensi yaitu peran, sikap, pengetahuan, kapasitas, kapabilitas dan tanggung jawab. Penelitian dilakukan pada 50 Guru pembina UKS SD di 10 Kecamatan Jakarta Selatan. Penelitian ini merupakan penelitian deskriptif dengan metode cross sectional dan menggunakan pendekatan kuantitatif. Hasil Penelitian menunjukkan 52% Guru Pembina UKS di Jakarta Selatan memiliki kesiapan rendah dan 48% memiliki kesiapan tinggi dalam menjalankan tugas sebagai fasilitator vaksinasi HPV BIAS. Dimensi pengetahuan merupakan dimensi kesiapan yang paling rendah, dengan 70% Guru pembina UKS memiliki pengetahuan kurang tentang vaksinasi HPV dan kanker serviks. Karakteristik Individu memiliki hubungan signifikan dengan kesiapan : umur (p= 0.036), lama menjabat (p=0.012) dan riwayat diklat ( p= 0.010). Sedangkan jenis kelamin (p=0.661) dan tingkat pendidikan (p=0.502) tidak ditemukan hubungan signifikan terhadap kesiapan dalam penelitian ini. Berdasarkan hasil penelitian ini, maka pelatihan tentang vaksinasi HPV dalam BIAS bagi Guru pembina UKS merupakan hal yang paling penting untuk dilaksanakan dalam rangka mendukung kesiapan Guru Pembina UKS sebagai fasiliatator vaksinasi HPV BIAS di Jakarta Selatan. Kata Kunci : Vaksinasi HPV. BIAS, Kesiapan Guru pembina UKS ABSTRACT Name : Marisa Sasuwe Study Program : Reproductive Health Judul : Overview of Elementary School Health Teacher (UKS) Readiness as HPV Vaccination Facilitator in the School Children Immunization Month Program (BIAS) in South Jakarta. HPV vaccination has the highest effectiveness when given to children aged 9-12 years. Since 2016 Indonesia has become one of few countries that has implemented a school-based HPV vaccination program (BIAS), which is currently limited to DKI Jakarta. Previous research has shown that school-based HPV vaccination has the highest coverage rates. However, according to data in Jakarta, HPV vaccination has not yet reached the 95% coverage target. UKS teachers as the frontline in implementing HPV vaccination in schools play an important role in the decision-making process of parents to allow or refuse vaccinations for their children. School Health Teacher is the facilitator who will play a role in facilitating parents and health workers in carrying out HPV vaccinations in schools. This study aims to determine the Readiness Overview of Elementary School Health Teacher (UKS) as Facilitators of HPV Vaccination in the School Children Immunization Month Program (BIAS) in South Jakarta according to the characteristics of gender, age, level of education, length of time serving as a UKS Teacher and training history. Measurement of readiness is seen in six dimensions, namely roles, attitudes, knowledge, capacity, capabilities and responsibilities. The study was conducted on 50 UKS elementary school teachers in 10 sub-districts of South Jakarta. This research is a descriptive study with cross sectional method and uses a quantitative approach. The results showed that 52% of UKS teachers in South Jakarta had low readiness and 48% had high readiness in carrying out their duties as facilitators of BIV HPV vaccination. The knowledge dimension is the lowest readiness dimension, with 70% of UKS teachers having less knowledge about HPV vaccination and cervical cancer. Individual characteristics have a significant relationship with readiness: age (p = 0.036), length of service (p = 0.012) and training history (p = 0.010). While gender (p = 0.661) and education level (p = 0.502) no significant relationship was found in readiness in this study. Based on the results of this study, the training on HPV vaccination in BIAS for UKS Teachers is the most important thing to do in order to support the readiness of the UKS Guidance Teacher as a facilitator for BIV HPV vaccination in South Jakarta. Keywords: HPV vaccination, BIAS, elementary school health teacher, readiness

Abstrak: Because of difficulties in finding, recruiting, and diagnosing dementia in the oldest old (ages ≥90 years), most incidence studies include few very elderly persons, and little is known about the characteristics of those who refuse participation. In a California longitudinal study of dementia and aging (The 90+ Study, 2003-2011), we compared nonresponders with responders with regard to information collected 20 years earlier and the impression of dementia as determined during telephone recruitment. Of 1,815 eligible subjects, 1,514 (83%) joined the study, 182 refused, and 119 could not be contacted. Responders did not differ from nonresponders by sex or previously collected medical history or lifestyle behaviors. Recruiters' impressions of dementia were similar in responders and nonresponders who refused (35% and 38%), and among responders, impressions of dementia showed high positive predictive value (95%) but low sensitivity (51%) for a diagnosis of dementia made during the study. Although epidemiologic studies among the very old have the potential for significant nonresponse bias due to a high proportion of frail, ill, and cognitively impaired persons, strategies can improve response rates to over 80%. Classifying nonresponders on cognitive ability at recruitment, though crude, will give some idea of the selective bias in dementia prevalence and incidence estimates introduced by nonresponse due to cognitive status.

Abstrak: Outcome misclassification is widespread in epidemiology, but methods to account for it are rarely used. We describe the use of multiple imputation to reduce bias when validation data are available for a subgroup of study participants. This approach is illustrated using data from 308 participants in the multicenter Herpetic Eye Disease Study between 1992 and 1998 (48% female; 85% white; median age, 49 years). The odds ratio comparing the acyclovir group with the placebo group on the gold-standard outcome (physician-diagnosed herpes simplex virus recurrence) was 0.62 (95% confidence interval (CI): 0.35, 1.09). We masked ourselves to physician diagnosis except for a 30% validation subgroup used to compare methods. Multiple imputation (odds ratio (OR) = 0.60; 95% CI: 0.24, 1.51) was compared with naive analysis using self-reported outcomes (OR = 0.90; 95% CI: 0.47, 1.73), analysis restricted to the validation subgroup (OR = 0.57; 95% CI: 0.20, 1.59), and direct maximum likelihood (OR = 0.62; 95% CI: 0.26, 1.53). In simulations, multiple imputation and direct maximum likelihood had greater statistical power than did analysis restricted to the validation subgroup, yet all 3 provided unbiased estimates of the odds ratio. The multiple-imputation approach was extended to estimate risk ratios using log-binomial regression. Multiple imputation has advantages regarding flexibility and ease of implementation for epidemiologists familiar with missing data methods.

Abstrak: We employed the parametric G formula to analyze lung cancer mortality in a cohort of textile manufacturing workers who were occupationally exposed to asbestos in South Carolina. A total of 3,002 adults with a median age of 24 years at enrollment (58% male, 81% Caucasian) were followed for 117,471 person-years between 1940 and 2001, and 195 lung cancer deaths were observed. Chrysotile asbestos exposure was measured in fiber-years per milliliter of air, and annual occupational exposures were estimated on the basis of detailed work histories. Sixteen percent of person-years involved exposure to asbestos, with a median exposure of 3.30 fiber-years/mL among those exposed. Lung cancer mortality by age 90 years under the observed asbestos exposure was 9.44%. In comparison with observed asbestos exposure, if the facility had operated under the current Occupational Safety and Health Administration asbestos exposure standard of < 0.1 fibers/mL, we estimate that the cohort would have experienced 24% less lung cancer mortality by age 90 years (mortality ratio = 0.76, 95% confidence interval: 0.62, 0.94). A further reduction in asbestos exposure to a standard of < 0.05 fibers/mL was estimated to have resulted in a minimal additional reduction in lung cancer mortality by age 90 years (mortality ratio = 0.75, 95% confidence interval: 0.61, 0.92).

Abstrak: Systematic investigations into the structure of measurement error of physical activity questionnaires are lacking. We propose a measurement error model for a physical activity questionnaire that uses physical activity level (the ratio of total energy expenditure to basal energy expenditure) to relate questionnaire-based reports of physical activity level to true physical activity levels. The 1999-2006 National Health and Nutrition Examination Survey physical activity questionnaire was administered to 433 participants aged 40-69 years in the Observing Protein and Energy Nutrition (OPEN) Study (Maryland, 1999-2000). Valid estimates of participants' total energy expenditure were also available from doubly labeled water, and basal energy expenditure was estimated from an equation; the ratio of those measures estimated true physical activity level ("truth"). We present a measurement error model that accommodates the mixture of errors that arise from assuming a classical measurement error model for doubly labeled water and a Berkson error model for the equation used to estimate basal energy expenditure. The method was then applied to the OPEN Study. Correlations between the questionnaire-based physical activity level and truth were modest (r = 0.32-0.41); attenuation factors (0.43-0.73) indicate that the use of questionnaire-based physical activity level would lead to attenuated estimates of effect size. Results suggest that sample sizes for estimating relationships between physical activity level and disease should be inflated, and that regression calibration can be used to provide measurement error-adjusted estimates of relationships between physical activity and disease.