Abstrak: A genetic variant within the CHRNA5-CHRNA3-CHRNB4 region (rs1051730), previously associated with smoking quantity, was recently shown to interact with smoking on obesity predisposition. We attempted to replicate this finding in the Gene-Lifestyle Interactions and Complex Traits Involved in Elevated Disease Risk (GLACIER) Study, a prospective cohort study of adults from northern Sweden (n = 16,426). We also investigated whether a similar interaction is apparent between rs1051730 and snus, a type of moist oral tobacco, to determine whether this interaction is driven by factors that cigarettes and snus have in common, such as nicotine. Main effects of smoking, snus, and the rs1051730 variant and pairwise interaction terms (smoking × rs1051730 and snus × rs1051730) were tested in relation to body mass index (BMI; calculated as weight (kg)/height (m)²) through the use of multivariate linear models adjusted for age and sex. Smoking status and BMI were inversely related (β = -0.46 kg/m², standard error (SE) = 0.08; P < 0.0001). Snus use and BMI were positively related (β = 0.35 kg/m², SE = 0.12; P = 0.003). The rs1051730 variant was not significantly associated with smoking status or snus use (P > 0.05); the T allele was associated with lower BMI in the overall cohort (β = -0.10 kg/m², SE = 0.05; P = 0.03) and with smoking quantity in those in whom this was measured (n = 5,304) (β = 0.08, SE = 0.01; P < 0.0001). Neither smoking status (Pinteraction = 0.29) nor snus use (Pinteraction = 0.89) modified the association between the rs1051730 variant and BMI.

Abstrak: We show that, in the presence of uncontrolled environmental confounding, joint tests for the presence of a main genetic effect and gene-environment interaction will be biased if the genetic and environmental factors are correlated, even if there is no effect of either the genetic factor or the environmental factor on the disease. When environmental confounding is ignored, such tests will in fact reject the joint null of no genetic effect with a probability that tends to 1 as the sample size increases. This problem with the joint test vanishes under gene-environment independence, but it still persists if estimating the gene-environment interaction parameter itself is of interest. Uncontrolled environmental confounding will bias estimates of gene-environment interaction parameters even under gene-environment independence, but it will not do so if the unmeasured confounding variable itself does not interact with the genetic factor. Under gene-environment independence, if the interaction parameter without controlling for the environmental confounder is nonzero, then there is gene-environment interaction either between the genetic factor and the environmental factor of interest or between the genetic factor and the unmeasured environmental confounder. We evaluate several recently proposed joint tests in a simulation study and discuss the implications of these results for the conduct of gene-environment interaction studies.

Abstrak: The authors investigated associations of serum phospholipid n-3 and n-6 polyunsaturated fatty acids (PUFAs) and trans-fatty acids with prostate cancer risk, and whether myeloperoxidase G-463A (rs2333227) modified the associations in the Carotene and Retinol Efficacy Trial (CARET) (Seattle, Washington; Irvine, California; New Haven, Connecticut; San Francisco, California; Baltimore, Maryland; and Portland, Oregon, 1985-2003). Prerandomization sera were assayed for fatty acids among 641 men with incident prostate cancer (368 nonaggressive and 273 aggressive (stage III/IV or Gleason score ≥ 7)) and 1,398 controls. Overall, dihomo-γ-linolenic (quartiles 4 vs. 1: odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.49, 0.95; P(trend) = 0.024) and docosatetraenoic (OR = 0.69, 95% CI: 0.46, 1.02; P(trend) = 0.011) acids were inversely associated with nonaggressive and aggressive prostate cancer risks, respectively. Among men with MPO GG, the genotype upregulating oxidative stress, quartiles 4 versus 1 eicosapentaenoic plus docosahexaenoic acids were suggestively associated with an increased risk of aggressive prostate cancer (OR = 1.66, 95% CI: 0.95, 2.92; P(trend) = 0.07). However, the association was the inverse among men with MPO GA/AA genotypes (P(interaction) = 0.011). Interactions were also observed for docosapentaenoic acid, total n-3 PUFAs, and arachidonic acid. MPO GA/AA vs. GG was associated with a 2-fold increase in aggressive prostate cancer risk among men with low (quartile 1) n-3 PUFAs. This study adds important evidence linking oxidative stress with prostate carcinogenesis.

Abstrak: Belum adanya gambaran kepuasan klien merupakan masalah di Poliklinik Penyakit Dalam lnstalasi Rawat Jalan RSMH Palembang. Kepuasan klien yang rendah akan berdampak kunjungan pasien pada rumah sakit, sehingga pada akhirnya akan menurunkan pendapatan rumah sakit.

Studi ini bertujuan untuk mendapatkan gambaran tentang kepuasan klien dan Faktor yang diduga herhubungan dengan kepuasan klien yaitu interaksi perawat-klien dan karakteristik klien. Penelitian ini dilakukan di Poliklinik Penyakit Dalam Instalasi Rawat Jalan RSMH Palembang dari tanggal 12 Maret sampai 17 Maret 2001 dengan pendekatan kuantitatif, crossc sectional pada 114 klien rawat jalan.

Hasil penelitian menunjukkan bahwa tingkat kepuasan klien sebesar 55,3 % yang merupakan gambaran komposit dari respon perawat, kecepatan pelayanan, keramahan dan kejelasan informasi yang dilakukan oleh perawat. interaksi perawat-klien dicerminkan dengan 4 komponen yaitu perilaku, tampilan emosional, waktu dan tahapan interaksi. Keempat komponen ini seluruhnya berhubungan dengan kepuasan klien dan salah satu diantaranya yaitu perilaku merupakan faktor yang paling dominan.

Dengan hasil penelitian ini disarankan kepada Kepala lnstalasi Rawat Jalan untuk lebih meningkatkan layanan kepada masyarakat melalui petugas kesehatan untuk dapat memperhatikan klien yang mempunyai harapan yang tinggi terhadap perilaku perawat dan cenderung tidak puas terhadap layanan perawat. Perlu penelitian lebih lanjut tentang kepuasan ini terutama menyangkut tentang kepuasan klien diruang-ruang rawat inap dan kualitas pelayanan keperawatan di Instalasi Rawat Jalan.

Abstrak: Merokok adalah penyebab morbiditas dan mortalitas. Perilaku merokok merupakanperilaku yang merugikan, tidak hanya bagi individu perokok tetapi juga bukanperokok. Determinan sosial budaya terkait merokok belum dipahami secara jelas,sehingga bisa lebih bermanfaat dalam penanggulangan tembakau. Untuk itu penelitiakan menyajikan hasil determinan apa saja yang berpengaruh terhadap kebiasaanmerokok di desa dan kota pada daerah produsen rokok.