Abstrak: According to several studies, infants whose mothers had a malaria-infected placenta (MIP) at delivery are at increased risk of a first malaria infection. Immune tolerance caused by intrauterine contact with the parasite could explain this phenomenon, but it is also known that infants who are highly exposed to Anopheles mosquitoes infected with Plasmodium are at greater risk of contracting malaria. Consequently, local malaria transmission must be taken into account to demonstrate the immune tolerance hypothesis. From data collected between 2007 and 2010 on 545 infants followed from birth to age 18 months in southern Benin, we compared estimates of the effect of MIP on time to first malaria infection obtained through different Cox models. In these models, MIP was adjusted for either 1) "village-like" time-independent exposure variables or 2) spatiotemporal exposure prediction derived from local climatic, environmental, and behavioral factors. Only the use of exposure prediction improved the model's goodness of fit (Bayesian Information Criterion) and led to clear conclusions regarding the effect of placental infection, whereas the models using the village-like variables were less successful than the univariate model. This demonstrated clearly the benefit of adequately taking transmission into account in cohort studies of malaria.

Abstrak: In the present study, we evaluated whether childhood differences in body height between singletons and twins persist into adulthood. Data from the Medical Birth Register of Norway were linked with data from the Norwegian National Conscript Service. This study used data on the 457,999 males who were born alive and without physical anomalies in single or twin births in Norway during 1967-1984 and who were examined at the mandatory military conscription (age 18-20 years; 1985-2003). For sibling comparisons, the authors selected the 1,721 sibships of full brothers that included at least 1 male born in a single birth and at least 1 male born in a twin birth (4,520 persons, including 2,493 twins and 2,027 singletons). An analysis of the total study population using generalized estimating equations showed that the twins were 0.6 cm (95% confidence interval: 0.4, 0.7) shorter than were the singletons after adjustment for a series of background factors. The fixed-effects regression analysis of the sibships that included both twins and singletons showed that the twins were 0.9 cm (95% confidence interval: 0.6, 1.2) shorter than were their singleton brothers. The study suggests that male twins born in Norway during 1967-1984 were slightly shorter in early adulthood than were singletons.

Abstrak:

ABSTRAK Nama : Anna Mardiana Ritonga Program Studi : Epidemiologi Judul               : Faktor-Faktor yang Mempengaruhi Mortalitas Pasien Stroke Associated Pneumonia di Stroke Care Unit Rumah Sakit Pusat Otak Nasional Tahun 2016-2018 Pembimbing   : dr. Syahrizal Syarif, MPH, Ph.D Stroke Associated Pneumonia (SAP) adalah komplikasi stroke yang paling sering terjadi dan memiliki angka mortalitas yang tinggi. Faktor-faktor yang mempengaruhi mortalitas pasien SAP belum sepenuhnya diselidiki. Pengetahuan tentang faktor-faktor yang mempengaruhi mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi mortalitas pasien SAP yang dirawat di Stroke Care Unit (SCU) Rumah Sakit Pusat Otak Nasional (RSPON) tahun 2016-2018. Desain penelitian ini adalah penelitian kohort retrospektif, pada 268 pasien di SCU RSPON yang didiagnosis SAP selama tahun 2016-2018. Variabel yang berhubungan bermakna dengan mortalitas pada pasien SAP adalah kesesuaian LOS dengan CP RSPON, didapatkan risiko 0,262 (95% CI : 0,138 – 0,501) yang berarti pasien dengan Length of Stay (LOS) tidak sesuai dengan Clinical Pathway (CP) RSPON memiliki hubungan protektif terhadap mortalitas pasien SAP yaitu sebesar 0,26 kali. Dengan menggunakan model prediktor, dapat dihitung probabilitas terjadinya mortalitas pada pasien SAP. Kata kunci: kohort retrospektif; mortalitas; Stroke Associated Pneumonia

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 ABSTRACT Name : Anna Mardiana Ritonga Study Program : Epidemiology Title                            : Determining Factors for Stroke Associated Pneumonia Mortality in the Stroke Care Unit National Brain Centre Hospital 2016-2018 Counsellor : dr. Syahrizal Syarif, MPH, Ph.D Stroke Associated Pneumonia (SAP) is the most common complication after stroke and has a high mortality rate. Determining factors for SAP mortality have not been fully investigated. Knowledge of its determining factors can help clinical decision making for patient management. The aim of this study was to determine the mortality factors of SAP who were treated in the Stroke Care Unit (SCU) National Brain Centre (NBC) Hospital. This study used retrospective cohort design, involving 268 subjects SAP obtained at SCU NBC who were diagnosed with SAP during 2016-2018. Variable that significantly related is suitability of Length of Stay (LOS) with Clinical Pathway (CP) NBC obtained the risk of 0.262 (95%CI : 0,138-0,501) which means has protective association with mortality. By using a predictor model, it can be calculated the probability of mortality in SAP patients. Keywords: mortality; retrospective cohort; Stroke Associated Pneumonia

Abstrak: Jumlah jamaah haji Indonesia yang menunaikan haji di Arab Saudi setiaptahun adalah yang terbanyak. Jumlahnya adalah seperlima dari seluruh jamaahdidunia yang berhaji di Arab Saudi dengan rata-rata per tahun setidaknya lebihdari 200.000 jamaah haji. Banyaknya jumlah jamaah haji diikuti juga tingginyainsiden kematian dibandingkan dengan negara islam lainnya. Studi ini bertujuanuntuk mengetahui insiden kematian jamaah haji reguler Indonesia tahun 2015 M/1436 H beserta faktor risikonya.Desain penelitian dengan cohort retrospektif dimana variabel independenberupa usia, jenis kelamin, pekerjaan, pendidikan, status risiko tinggi, menderitapenyakit sistem sirkulasi dan respirasi. Data dianalisis dengan analisis univariatuntuk mengetahui distribusi frekuensi variabel yang ada dan analisis bivariatmenggunakan chi square dengan nilai pengamatan di nyatakan dalam nilai pdengan tingkat kemaknaan () 5% dan CI 95%. Populasi dalam penelitian iniadalah seluruh jamaah haji reguler Indonesia tahun 2015 M/ 1436 H. Sampelmenggunakan seluruh populasi dengan kriteria inklusi terdaftar dalam SiskohatkesKemenkes RI pada pemeriksaan akhir di embarkasi keberangkatan serta data yangada terisi lengkap yaitu sejumlah 148.049 jamaah haji.Penelitian ini mendapatkan angka insiden kematian yang terjadi padajamaah haji reguler Indonesia tahun 2015 M/ 1436 H sebesar 4,3 per 1.000jamaah haji. Dimana usia lanjut (> 61 tahun) memiliki risiko 16,8 kali (95% CI:11,6-25,5), pensiunan 14,76 kali (95% CI: 10,8-20,2), pendidikan rendah 2,13 kali(95% CI: 1,67-2,71), berusia > 60 tahun dan memiliki paling sedikit satu riwayatpenyakit 9,62 kali (95% CI: 7,12-13,04), menderita penyakit sistem sirkulasi 2,52kali (95% C: 2,12-3,00), dan menderita penyakit sistem respirasi 3,20 kali (95%CI: 2,27-4,48) untuk mengalami kematian pada jamaah haji reguler Indonesia.Untuk itu diperlukan upaya yang lebih baik lagi untuk menurunkan insidenkematian dengan optimalisasi pembinaan kesehatan jamaah haji sebelumkeberangkatan terutama yang mempunyai status risiko tinggi seperti usia lanjut,pendidikan menengah kebawah, menderita penyakit sirkulasi atau respirasi.Disamping itu pentingnya edukasi agar jamaah haji mengoptimalkan pemanfaatanlayanan kesehatan yang ada serta berperilaku hidup bersih dan sehat.Kata Kunci : Jamaah Haji, Insiden Kematian, cohort retrospektif.

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: Use of the general population as a reference might cause serious underestimation of the risk of cancer in working populations because of the healthy worker effect. Using incidence rates, we studied how this underestimation varied according to subtypes of cancer by comparing a large cohort of randomly selected Norwegian workers hired between 1981 and 2003 (n = 366,114) with the general Norwegian population. The cohort was linked to the Cancer Registry of Norway, including all new cancer cases (n = 11,271) reported up to 2003. We found marked potential for the healthy worker effect for overall cancer incidence in male workers (standardized incidence ratio (SIR) = 0.91, 95% confidence interval: 0.89, 0.93) but not in female workers (SIR = 0.99, 95% confidence interval: 0.95, 1.03). A statistically significantly lower incidence was found among men for cancers of the head and neck (SIR = 0.78), lung (SIR = 0.81), prostate (SIR = 0.93), kidney (SIR = 0.83), and bladder (SIR = 0.77) and for leukemia (SIR = 0.80), whereas an increased incidence was found for malignant melanoma among both men (SIR = 1.09) and women (SIR = 1.29) and for ovarian cancer in women (SIR = 1.32). Depending on the type of cancer being studied, marked potential exists for both underestimation and overestimation of cancer risk when the general population is used as the reference for studies of worker populations.

Abstrak: Many adverse pregnancy outcomes differ by race. We examined the association between self-reported race and miscarriage (pregnancy loss at < 20 weeks) in a community-based pregnancy cohort. Women from the southeastern United States (North Carolina, Texas, and Tennessee) were enrolled in "Right from the Start" from 2000 to 2009. They were recruited while trying to conceive or during early pregnancy. Participants completed study ultrasound examinations, interviews, and consent forms for review of medical records. We used proportional hazard models to examine miscarriage risk among black women compared with white women, adjusted for confounders. There were 537 observed miscarriages among 4,070 women, 23% of whom self-identified as black (n = 932). The life table-adjusted cumulative risk of loss after gestational week 5 was 21.3%. With adjustment for age and alcohol use, blacks had increased risk of miscarriage compared with whites (adjusted hazard ratio = 1.57, 95% confidence interval: 1.27, 1.93). When risk of loss before gestational week 10 was dichotomized at the median gestational age, there was little difference, but black women had a greater risk thereafter compared with white women (adjusted hazard ratio = 1.93, 95% confidence interval: 1.48, 2.51). Early pregnancy ultrasound examinations did not differ by race. In summary, self-reported race is independently associated with risk of miscarriage, and the higher risk for black women is concentrated in gestational weeks 10-20.