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:

Penyakit ginjal kronis merupakan penyebab kematian nomor 12 pada tahun 2017 dan diprediksi menjadi penyebab kematian nomor 5 pada tahun 2040. Berdasarkan data SKI 2023, prevalensi penyakit ginjal kronis di Indonesia adalah 0,18%. Walaupun relatif relatif kecil, masalah yang dihadapi adalah deteksi dini risiko dari faktor risiko penyakit ginjal kronis. Permasalahan penanganan penyakit ginjal kronis di Indonesia adalah kurangnya edukasi mengenai deteksi dini penyakit ginjal kronik serta faktor risikonya kepada masyarakat. Berdasarkan permasalahan ini, dilakukan penelitian untuk melihat faktor-faktor penyebab ginjal kronis di Indonesia. Penelitian dilakukan dengan menggunakan data SKI 2023 dengan jumlah sampel sebanyak 22639 individu. Penelitian ini dilakukan dengan uji kai kuadrat dan dilanjutkan dengan regresi logistik. Dari hasil regresi logistik yang dilakukan didapatkan hasil bahwa variabel yang menjadi faktor terbesar penyebab penyakit ginjal kronis adalah diabetes ( p-value = 0,008 ; OR = 4.792 (1,52-15,14)). Karena hasil penelitian menunjukkan diabetes sebagai faktor terbesar penyebab penyakit ginjal kronis, maka peneliti menyarankan bahwa terdapat dua fokus kebijakan yang dapat dilakukan. Pertama untuk penderita diabetes dalam hal pengontrolan penyakit, dan kedua kepada orang sehat dalam hal skrining dan deteksi dini serta promosi kesehatan untuk penerapan pola hidup sehat.

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Chronic kidney disease was the 12th leading cause of death in 2017 and is predicted to be the  fifth leading cause of death in 2040. Based on SKI 2023 data, the prevalence of chronic  kidney disease in Indonesia is 0.18%. Although relatively small, the problem faced is early  detection of the risk of chronic kidney disease risk factors. The problem of handling chronic  kidney disease in Indonesia is the lack of education regarding the early detection of chronic  kidney disease and its risk factors to the community. Based on this problem, a study was  conducted to see the factors causing kidney chronicity in Indonesia. The study was conducted  using SKI 2023 data with a sample size of 22,639 individuals. This study was conducted  using the chi-square test and continued with logistic regression. From the results of the  logistic regression, it was obtained that the variable that was the most significant factor  causing chronic kidney disease was diabetes (p-value = 0.008; OR = 4.792 (1.52-15.14)).  Because the results of the study showed diabetes as the most significant factor causing  chronic kidney disease, the researcher suggested that there were two policy focuses that could  be implemented. Firstly, for people with diabetes in terms of disease control, and secondly,  for healthy people in terms of screening and early detection as well as health promotion for  implementing a healthy lifestyle. 

Abstrak: Epidemiologic studies often aim to estimate the odds ratio for the association between a binary exposure and a binary disease outcome. Because confounding bias is of serious concern in observational studies, investigators typically estimate the adjusted odds ratio in a multivariate logistic regression which conditions on a large number of potential confounders. It is well known that modeling error in specification of the confounders can lead to substantial bias in the adjusted odds ratio for exposure. As a remedy, Tchetgen Tchetgen et al. (Biometrika. 2010;97(1):171-180) recently developed so-called doubly robust estimators of an adjusted odds ratio by carefully combining standard logistic regression with reverse regression analysis, in which exposure is the dependent variable and both the outcome and the confounders are the independent variables. Double robustness implies that only one of the 2 modeling strategies needs to be correct in order to make valid inferences about the odds ratio parameter. In this paper, I aim to introduce this recent methodology into the epidemiologic literature by presenting a simple closed-form doubly robust estimator of the adjusted odds ratio for a binary exposure. A SAS macro (SAS Institute Inc., Cary, North Carolina) is given in an online appendix to facilitate use of the approach in routine epidemiologic practice, and a simulated data example is also provided for the purpose of illustration.

Abstrak: Kematian ibu di negara berkembang masih tinggi, selain faktor medis faktorpelayanan kesehatan ibu hamil merupakan salah satu penyebab kematian ibu.Cakupan pelayanan antenatal (K4) di Provinsi Aceh masih di bawah targetNasional. Tujuan penelitian untuk mengetahui gambaran pemanfaatan pelayananantenatal dan menganalisis determinan yang berhubungan dengan pemanfaatanpelayanan antenatal di Provinsi Aceh. Penelitian ini menggunakan data RisetKesehatan Dasar (Riskesdas) Tahun 2013, fokus pada wanita yang pernah hamilselama 3 tahun terakhir sebelum survei, dengan jumlah sampel adalah 2.081responden. Metode analisis menggunakan model regresi logistik, untukmemprediksi faktor penentu pemanfaatan pelayanan antenatal. Hasilmenunjukkan 66,12% ibu hamil memanfaatkan pelayanan antenatal minimal 4kali sesuai standar waktu yang ideal. Faktor-faktor yang secara konsisten danpositif berhubungan dengan pemanfaatan pelayanan antenatal (K4) adalah statusekonomi, kepemilikan buku KIA, keinginan hamil, umur, dan pendidikan. faktorkomplikasi kehamilan cenderung berhubungan positif apabila standar pelayananantenatal (K4) yang digunakan tidak ditentukan waktu pemeriksaan.Kata kunci: Kematian Ibu, Pelayanan Antenatal, Regresi Logistik, Aceh.

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Maternal mortality in developing countries is still high, in addition to medicalfactors, factors of maternal health services is of the causes of maternal death.Coverage of antenatal care (K4) in the province of Aceh still below nationaltargets. The purpose of research to describe and analyze the utilization ofantenatal care determinants related to the utilization of antenatal care in theprovince. This study uses data from Riskesdas In 2013, focusing on women whohave been pregnant for 3 years prior was to the survey, with a sample size is 2,081respondents. The method of analysis using logistic regression model, which wasuseful for predicting the determinants of the utilization of antenatal care. Resultsshowed that 66.12% of pregnant women utilize antenatal care at least 4 times thecorresponding standard ideal time. Factors that consistently and positivelyassociated with utilization of antenatal care (K4) is the economic status, maternaland child health handbook, pregnant wishes, age, and education. pregnancycomplications factors tend to be associated positively if the standard antenatalcare (K4) used an unspecified time of the examination.Keywords: Maternal Mortality, Antenatal Care, Logistic Regression, Aceh.

Abstrak: Faktor penyebab tingginya AKI (346/100.000KH) yaitu belum tercapainyaindikator pertolongan persalinan di fasilitas kesehatan. Pertolongan persalinan difasilitas kesehatan dipengaruhi oleh faktor individu dan provinsi. Penelitian inibertujuan melihat pengaruh dan besar kontribusi faktor individu dan provinsiterhadap pertolongan persalinan di enam provinsi di Indonesia berdasarkan dataSDKI dan profil kesehatan Indonesia tahun 2012. Hasil analisis multilevel regresilogistik multinomial menunjukan, determinan pertolongan persalinan meliputiasuhan kehamilan, daerah, asuransi kesehatan, indeks kepemilikan, pekerjaansuami, pekerjaan, pendidikan ibu, paritas, umur, rasio bidan, rasio puskesmas, rasiotempat tidur rumah sakit dan kepadatan penduduk. Faktor provinsi menurunkan24.22% variasi pertolongan persalinan di Indonesia.Kata Kunci :Pertolongan persalinan, faktor individu, faktor provinsi, multilevel regresi logistikmultinomial

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The high maternal mortality rate (346 per 100.000 live birth) in Indonesia is causedby several factors, one of it is that Indonesia has not been achieved the indicator ofaid deliveries in health facilities. This study aims to look at the influence and thecontribution of individual factors and province factor on deliveries in six provincesin Indonesia based on data from Demographic and Health Survey and healthprofiles of Indonesia in 2012. Based on the analysis of multilevel multinomiallogistic regression, the determinant of delivery aid is the individual factors includethe antenatal care, regions, health insurance, household wealth index, husband'soccupation, employment and education of women of childbearing age, parity andthe age of them. The determinant factor of the province covers the ratio of healthcenters, the ratio of beds and population density. Contextual variables (provincefactors) decrease 24.22% variation deliveries at six provinces in Indonesia.Keywords :Maternal mortality, Deliveries, individual factors, provinces factors, multilevellogistic regression multinomial.

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Abstrak: Kekerasan perempuan merupakan masalah kesehatan masyarakat yang utama di seluruh dunia. Hasil pemetaan Komnas Perempuan tahun 2013 di seluruh Indonesia menunjukkan kekerasan terhadap perempuan persebarannya semakin luas, bentuknya beragam, menimbulkan bekas trauma yang dalam, dan jumlah terus berkembang mencapai 279.156 kasus. Berdasarkan Survei Demografi dan Kesehatan Indonesia (SDKI) 2012 sikap setuju terhadap kekerasan dalam rumah tangga (KDRT) meningkat menjadi 34,5% dari 30,8% (pada perempuan) dan 17,3% dari 16,3% (pada laki-laki) di tahun 2007. Penelitian ini bertujuan untuk mengetahui perubahan besaran sikap dan faktor individu, keluarga, dan masyarakat yang berhubungan dengan sikap setuju terhadap KDRT. Analisis data dilakukan pada responden laki-laki dan perempuan menikah; 38.873 orang pada SDKI 2007 dan 40.626 orang pada SDKI 2012. Penelitian ini menggunakan rancangan cross sectional dengan analisis statistik menggunakan regresi logistik berganda. Hasil penelitian menunjukan peningkatan sikap setuju terhadap KDRT dari tahun 2007 ke 2012. Sikap setuju lebih diterima secara luas pada faktor individu (perempuan, orang berusia lebih muda, orang berpendidikan rendah, menikah muda, status ekonomi rendah, tinggal di pedesaan, tinggal di wilayah timur) dan faktor keluarga (pernikahan yang singkat, pengambilan keputusan tunggal).