Abstrak: Prevention and treatment of common noncommunicable chronic diseases have been revolutionized by the development of therapies. Recently, several randomized controlled trials (RCTs) designed to assess the efficacy of new therapies targeted at well-established risk factors for noncommunicable chronic diseases have reported lower benefits than expected. Subsequent observational analysis of the same trial data has not clarified these unexpected findings. Mendelian randomization (MR) provides an approach for estimating causal effects from observational or trial data and thus provides information complementary to that from an RCT. An RCT assesses the efficacy of a therapy but does not usually confirm the underlying mechanistic pathway. In contrast, an MR study does not assess the efficacy of a therapy but rather assesses causal effects on an underlying mechanistic pathway. We suggest that incorporating an MR study into an RCT at the design stage would improve etiologic understanding of current therapies and enhance the search for therapies for the significant amount of noncommunicable chronic diseases that resists current treatments.

Abstrak: In this prospective cohort study, based on 1,505 mother-infant pairs in rural Bangladesh, we evaluated the associations between early-life exposure to arsenic, cadmium, and lead, assessed via concentrations in maternal and child urine, and children's weights and heights up to age 5 years, during the period 2001-2009. Concurrent and prenatal exposures were evaluated using linear regression analysis, while longitudinal exposure was assessed using mixed-effects linear regression. An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic. In the longitudinal analysis, multivariable-adjusted attributable differences in children's weight at age 5 years were -0.33 kg (95% confidence interval (CI): -0.60, -0.06) for high (≥ 95th percentile) arsenic exposure and -0.57 kg (95% CI: -0.88, -0.26) for high cadmium exposure, in comparison with children with the lowest exposure (≤ 5th percentile). Multivariable-adjusted attributable differences in height were -0.50 cm (95% CI: -1.20, 0.21) for high arsenic exposure and -1.6 cm (95% CI: -2.4, -0.77) for high cadmium exposure. The associations were apparent primarily among girls. The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (-0.67 kg, 95% CI: -0.82, -0.53) and height (-1.3 cm, 95% CI: -1.7, -0.89).

Abstrak: Berdasarkan hasil kajian literatur, aktivitas hauling, loading, dan dumping merupakan aktivitas berisiko tinggi di pertambangan (Kecojevic dan Radomsky, 2004; MSHA, 2018). Pada tahun 2015 sampai 2018, di PT. XYZ telah terjadi beberapa kecelakaan pada aktivitas tersebut, sehingga menyebabkan fataliti. Oleh karena itu perlu dilakukan kajian risiko mendalam terkait tiga kegiatan tersebut di PT. XYZ. Kajian risiko dilakukan dengan metode failure modes and effects analysis (FMEA). Ditemukan 71 mode kegagalan potensial di PT. XYZ, terdiri dari 7 temuan tahap persiapan, 18 temuan proses pemuatan, 35 temuan proses pengangkutan, dan 11 temuan proses pembongkaran. Dari 71 mode kegagalan, 25% mode kegagalannya memiliki tingkat risiko sangat tinggi, seperti kerusakan ban dumptruck akibat batu tajam, kegagalan fungsi rem, ban bocor saat berjalan, unit loader menabrak batu besar ketika manuver, unit loader terkena pentalan batu dan mengenai kabin ketika pengisian, ban unit loader mengalami sayatan besar akibat ceceran batu tajam, unit dumptruck terperosok di permukaan labil, kendaraan ringan terjatuh saat berjalan di tebing. Oleh karena itu, perlu dilakuan peningkatan perawatan pada unit alat berat, lingkungan kerja aman, dan peningkatan kompetensi operator.
Kata kunci: Failure modes and effects analysis (FMEA), Risiko keselamatan, Tingkat risiko, Loading, Hauling, Dumping.

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Loading, hauling, and dumping activities are high risk acitivities in mining, based on the literatur review (Kecojevic dan Radomsky, 2004; MSHA, 2018). During the period of 2015 to 2018, there were several accidents related to loading, hauling, and dumping activities that causing fatalities at PT. XYZ. Therefore, detail risk assessment need to be performed of these three activities at PT. XYZ. The failure modes and effects analysis (FMEA) method was used in this study. 71 potential failure modes were identified , consist of 7 failure modes at preparation step, 18 failure modes at loading process, 35 failure modes at the hauling process, and 11 failure modes at the dumping process. About 25% of the 71 potential failure modes were very high risk level. They were dumptruck tire failure due to scattered sharp stones, brake failure while operating dumptruck, tire damage while operating, loader unit crahsed with big stones while maneuvering, loader cabin hit by hanging stones while loading, scratched tire of the loader unit due to scattered sharp stones, the dumptruck caught in the labile surface, and light vehicle fell down from benches. As recommendation, it is important to strengthen maintenance of heavy equipment, improve safe environment, and increase operator competence.
Key words: Failure modes and effects analysis (FMEA), Safety risks, Risk level, Loading, Hauling, Dumping.

Abstrak: Penggunaan kontrasepsi Suntik dan Pil terus meningkat dibandingkan pengguna Implan dan IUD. Masalah alat kontrasepsi adalah kejadian putus pakai dan ganti cara salah satunya disebabkan oleh efek samping penggunaan alat kontrasepsi yang berdampak pada stagnan angka Total Fertility Rate, mortalitas morbiditas maternal neonatal serta kehamilan yang tidak diinginkan. Penelitian bertujuan untuk mengetahui pengaruh pengalaman efek samping alat kontrasepsi sebelumnya terhadap kejadian putus pakai alat kontrasepsi terakhir. Desain penelitian ini adalah desain penelitian cohort retrospectif, dengan menggunakan analisis survival dan jumlah sampel 12.467 responden. Hasil penelitian, pada pengguna IUD memiliki risiko kecepatan lebih rendah untuk putus pakai pada lebih 36 bulan dan pengguna Pil memiliki risiko kecepatan lebih rendah pada sosial ekonomi miskin pada pengguna dengan pengalaman efek samping alat kontrasepsi sebelumnya. Pada pengguna Suntik memiliki risiko kecepatan putus pakai lebih tinggi pada tahun ke dua. Pada pengguna Implan risiko lebih rendah pada tahun pertama, ketiga dan keempat namun secara statistik tidak bermakna. Perlu pencatatan kohor pengguna Implan setelah satu tahun, pengguna IUD setelah tiga tahun, pengguna Suntik setelah satu tahun dan pengguna Pil pada tingkat Sosial Ekonomi Miskin agar pengguna alat kontrasepsi tersebut tidak mengalami putus pakai. Kata kunci: Putus Pakai Kontrasepsi, Efek Samping Sebelumnya, Kelangsungan Kontrasepsi The use of Injectable contraceptives and Pills continues to increase compared to users of Implans and IUDs. The problem of contraception is the incidence of discontinuation and change the way one of them is caused by the side effects of contraceptive use that affect the stagnant number of Total Fertility rate, mortality of neonatal maternal morbidity and unwanted pregnancy. The study aims to determine the effect of previous contraceptive side effects experiences on the last use of contraceptive use. The design of this study was a cohort retrospectif study design, using survival analysis and sample number of 12.467 respondents. The results of the study, on IUD users had lower risk risk for breaking out at over 36 months and users of Pills had lower risk risk in poor socioeconomic in users with previous experience of contraceptive side effects. Injecting users have the risk of breaking speed is higher in the second year. In users of Implan risk is lower in the first year, third and fourth but statistically not meaningful. Recording of user cohorts Implans after one year, IUD users after three years, injection users after one year and users of Pill at the level of Poor Social Economics, so that users of contraceptive continuation. Keywords: Discontinued Contraceptives, Contraceptive Side Effects, Continuation Contraceptive