Pengaruh Kualitas Pelayanan Dan Kualitas Produk Terhadap Loyalitas Pelanggan Dengan Pemasaran Relasional Sebagai Variabel Intervening : Studi Kasus Pada Dealer X Motor Yamaha Area Bogor

The purpose of this research is to find the influence of service quality and product quality to effect on customer loyalty with relationship marketing as a variable intervening (case study at dealer X on Bogor area). The research data collection uses the questioner spread to respondents. The population of this research is all customers of Dealer X Bogor area. The sampling method collection used in this research is non-probability sampling, with the collection technique is purposive sampling.  The total sample of this research is 240 respondence. Calibration instrument to verify validity and reliability of each item. For each statement calculated with coefficient product-moment, and reliability calculated with coefficient alpha Cronbach. The analysis used in this research is Structural Equation Modelling (SEM) analysis technique. The results of this research show that service quality has an impact on relationship marketing, and product quality have an impact on relationship marketing. The conclusion is product quality has a higher value impact on relationship marketing than service quality. Service quality has an impact on customer loyalty, and product quality has an impact on customer loyalty. The conclusion is customer value has a higher value impact on customer loyalty than service quality. Purchase decisions have an impact on customer loyalty. As a whole viewed, which has the most impact on customer loyalty is relationship marketing. Based on this result of research, to increase customer loyalty need good service quality and good product quality so that improve relationship marketing between Dealer X and customer, and increase customer loyalty

Impact of a Low-Intensity Physical Activity Intervention on Health Behavior Change in Pediatric Cancer Survivors

Objective: To assess the FitBit FlexTM as a low-intensity, low cost physical activity (PA) intervention for pediatric cancer survivors (PSCs). Additionally, we aimed to assess the impact of social support (SS) for PA on moderate to vigorous physical activity (MVPA), and the feasibility/acceptability of survivors wearing a FitBit FlexTM. It was hypothesized that wearing a FitBit FlexTM and increased SS would increase rates of MVPA/step count and that survivors and their families would report high feasibility/acceptability of FitBit FlexTM use. Methods: Utilizing an N-of-1 design, participants and one of their parents were randomized by day for 30 days to wear or not wear the FitBit FlexTM. SS for PA was measured using the Social Support for Exercise Survey. Acceptability and feasibility were assessed using a Feedback Questionnaire and examining protocol compliance. Results: Twelve PCSs (Mage = 13.6 years; 33% male; 67% Caucasian) completed the study. Participants engaged in less MVPA than recommended. Additionally, the FitBit FlexTM intervention negatively impacted rates of MVPA and step counts. SS did not have an impact on rates of MVPA. Participants were adherent to wear time and study protocol. Acceptability and feasibility were high. Conclusions: Rates of PA are a concern among PCSs and interventions are needed to promote positive behavior change. Future research should aim to better understand the role that electronic devices and SS can play within this specific population to help promote increased PAPsycholog

EDUKASI PENCEGAHAN DAN MANAJEMEN DIARE PADA BALITA BERBASIS PEMANFAATAN BAHAN DASAR RUMAH TANGGA PADA MASA PANDEMI COVID-19 DI RSUD ABEPURA

Diarrhea is still a major health problem among children in Indonesia and Papua. There is a lack of knowledge and skill of caregivers regarding the utilization of home-made solutions. This program aimed to increase the knowledge and skills of caregivers about diarrhea prevention and treatment for children during the COVID-19 pandemic. A health education with pre-test and post-test was conducted, involving parents/families of patients at the Children's Polyclinic of RSUD Abepura. The methods used included lectures, discussions, and demonstrations by implementing the Covid-19 health protocol. The results of the dependent paired t-test showed that there was a significant difference between the participants' knowledge before and after intervention (p-value = 0.001), with a medium level of increase (mean of N-Gain: 0,33). Furthermore, the majority of participants were able to demonstrate the steps of hand washing correctly (90%) and make a homemade solution and ORS independently (85%). Sustainable education programs need to be improved by multisectoral collaboration to reduce incidents of diarrhea and its complications in children. ---  Diare masih menjadi salah satu masalah kesehatan utama pada anak di Indonesia dan Papua. Namun, pengetahuan dan keterampilan orangtua/keluarga untuk mendayagunakan bahan rumah tangga masih terbatas. Kegiatan pengabdian ini bertujuan untuk meningkatkan pengetahuan dan keterampilan orangtua/keluarga tentang pencegahan dan penanganan diare dengan pemanfaatan bahan rumah tangga di masa pandemi Covid-19. Program pengabdian ini berbentuk edukasi kesehatan dengan pretest dan posttest yang melibatkan orangtua/keluarga pasien di Poliklinik Anak RSUD Abepura. Edukasi kesehatan menggunakan metode ceramah, diskusi dan demonstrasi dengan menerapkan protokol kesehatan Covid-19. Hasil uji dependent paired t-test menunjukkan terdapat perbedaan yang signifikan antara rerata pengetahuan peserta sebelum dan setelah diberikan edukasi (p value = 0.001), dengan peningkatan pengetahuan dalam kategori sedang (rerata N-Gain: 0,33). Selain itu, mayoritas peserta dapat melakukan simulasi mencuci tangan dengan benar (90%) dan membuat larutan gula garam dan oralit secara mandiri (85%). Program edukasi yang berkelanjutan perlu untuk ditingkatkan dengan melakukan kolaborasi dengan instansi terkait dan elemen masyarakat guna menekan kasus diare dan komplikasinya pada anak

Systems Engineering Lessons Learned for Class D Missions

One of NASA's goals within human exploration is to determine how to get humans to Mars safely and to live and work on the Martian surface. To accomplish this goal, several smaller missions act as stepping-stones to the larger end goal. NASA uses these smaller missions to develop new technologies and learn about how to survive outside of Low Earth Orbit for long periods. Additionally, keeping a cadence of these missions allows the team to maintain proficiency in the complex art of bringing spacecraft to fruition. Many of these smaller missions are robotic in nature and have smaller timescales, whereas there are others that involve crew and have longer mission timelines. Given the timelines associated with these various missions, different levels of risk and rigor need to be implemented to be more in line with what is appropriate for the mission. Thus, NASA has four different classifications that range from Class A to Class D based on the mission details. One of these projects is the Resource Prospector (RP) Mission, which is a multi-center and multi-institution collaborative project to search for volatiles in the polar regions of the Moon. The RP mission is classified as a Class D mission and as such, has the opportunity to more tightly manage, and therefore accept, greater levels of risk. The requirements for Class D missions were at the forefront of the design and thus presented unique challenges in vehicle development and systems engineering processes. This paper will discuss the systems engineering process at NASA and how that process is tailored for Class D missions, specifically the RP mission

In utero exposure to glucocorticoids and risk of anxiety and depression in childhood or adolescence

Glucocorticoid use is prevalent in pregnant women, but whether in utero exposure impacts mental health in the offspring has not been fully explored. The aim of this study was to investigate if in utero exposure to synthetic glucocorticoids increases the risk of anxiety and depression in childhood or adolescence. The study was conducted as a nationwide cohort study, including negative control exposure analyses and a sibling design to optimize control of confounding. The study population comprised 1,275,909 children born in 1996–2015 in Denmark (median follow-up of 13 years). Exposure was divided into systemic and local glucocorticoid exposure, levels of cumulative dose, generic type and according to trimester of exposure. The comparison cohort was children without exposure born to maternal never-users. Negative control exposures included children without glucocorticoid exposure born to: maternal users of non-steroidal anti-inflammatory drugs or immunotherapy during pregnancy, maternal former users of systemic glucocorticoids, maternal users of systemic glucocorticoids in the postnatal period, and fathers who were prescribed glucocorticoids. The sibling design compared siblings with and without exposure. 9307 (0.7%) children were exposed to systemic glucocorticoids and 116,389 (9.1%) children were exposed to local glucocorticoids. High-dose systemic glucocorticoids (≥500 mg prednisolone equivalents) increased the risk of anxiety compared to the comparison cohort [aIRR 1.79 (95% CI: 1.36–2.37), cumulative risk 16% vs. 7.8% by age 20]. A similar result was found for depression [aIRR 1.45 (95% CI: 0.80–2.63), cumulative risk 3.6% vs. 2.6% by age 20]. The association with anxiety was consistent in the sibling design [aIRR 1.83 (95% CI: 1.03–3.66), exposed siblings (≥ 500 mg) vs. unexposed]. Sex did not modify the associations. Negative control exposure analyses indicated robustness towards confounding from genetics and family environment. No association was found with low doses of systemic exposure or local use. In conclusion, potential adverse mental health effects of in utero exposure to high-dose glucocorticoids merit clinical attention

Prenatal exposure to glucocorticoids and the prevalence of overweight or obesity in childhood

Objective: Prenatal exposure to excess cortisol can affect postnatal metabolic health by epigenetic mechanisms. We aimed to investigate if prenatal exposure to pharmacological glucocorticoids increases the risk of overweight/obesity in childhood. Design: A nationwide population registry-based cohort study. Methods: We identified 383 877 children born in Denmark (2007-2012), who underwent routine anthropometric evaluation at 5-8 years of age. Prenatal exposure to glucocorticoids was divided into systemic and topical glucocorticoids, cumulative systemic dose, and use by trimester. The comparison cohort included children without exposure, born to maternal never-users. Negative control exposures were used to investigate confounding from an underlying disease or unmeasured characteristics. Such exposures included children without glucocorticoid exposure born to maternal users of non-steroidal anti-inflammatory drugs or immunotherapy during pregnancy, maternal former users of glucocorticoids, or paternal users of glucocorticoids during the pregnancy of their partner. We estimated sex-stratified adjusted prevalence ratios (aPR) of overweight/obesity at 5-8 years of age, as epigenetic modifications have shown to be sex-specific. Results: In the study, 21 246 (11%) boys and 27 851 (15%) girls were overweight/obese at 5-8 years of age. Overall, neither systemic nor topical glucocorticoids were associated with overweight/obesity. In boys, high-dose systemic glucocorticoids was associated with higher prevalence of overweight/obesity vs the comparison cohort (aPR: 1.41 (95% CI: 1.07-1.86), prevalence: 16% vs 11%). Negative control exposures indicated robustness to confounding. Conclusion: Overweight/obesity might be an adverse effect of prenatal exposure to high-dose systemic glucocorticoids in boys. We found no association for neither prenatal exposure to lower doses of systemic nor topical glucocorticoids. These results merit clinical attention

Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: protocol for a scoping review

Introduction: Childhood and adolescence are crucial life stages for health trajectories and the development of health inequalities in later life. The relevance of schools for health and well-being of children and adolescents has long been recognised, and there is some research regarding the association of contextual and compositional characteristics of schools and classes with health, health behaviour and well-being in this population. Little is known about the role of meso-level characteristics in relation to health inequalities. The aim of this scoping review is to retrieve and synthesise evidence about the mediating or moderating role of compositional or contextual characteristics of schools for the association between students' socioeconomic position and health in primary and secondary education. Methods and analysis We will conduct a systematic search of electronic databases in PubMed/Medline, Web of Science and Education Resources Information Center. Studies must meet the following inclusion criteria: (1) The population must be students attending primary or secondary schools in developed economies. (2) The outcomes must include at least one indicator for individual health, health behaviour or well-being. (3) The study must include at least one contextual or compositional characteristic of the school context and one individual determinant of socioeconomic position. (4) The study must also examine the mediating or moderating role of the contextual or compositional characteristic of the school context for the associations between socioeconomic position and health, health behaviour or well-being. (5) The study must be published since 1 January 2000 in English or German language. We will provide a narrative synthesis of findings. Ethics and dissemination We will not collect primary data and only include secondary data derived from previously published studies. Therefore, ethical approval is not required. We intend to publish our findings in an international peer-reviewed journal and to present them at national and international conferences

Alkohol-, Tabak- und Cannabiskonsum im Jugendalter – Querschnittergebnisse der HBSC-Studie 2017/18

Tabak, Alkohol und Cannabis sind psychoaktive Substanzen, die oftmals im Jugendalter zum ersten Mal ausprobiert und im späteren Leben weiter konsumiert werden. Die gesundheitlichen Folgen eines regelmäßigen Tabak- und Cannabiskonsums oder des Alkoholmissbrauchs sind gravierend. Im Sinne der Gesundheitsberichterstattung ist es das Ziel, aktuelle Prävalenzen für den Substanzkonsum bei Heranwachsenden nach sozialen Determinanten auszuweisen. Datenbasis bilden die für Deutschland repräsentativen Daten der „Health Behaviour in School-Aged Children (HBSC)“-Studie 2017/18 von Schülerinnen und Schülern im Alter von 11, 13 und 15 Jahren. Analysiert wird sowohl die Lebenszeit- und 30-Tages-Prävalenz des Tabak-, Alkohol- und Cannabiskonsums (letztere nur 15-Jährige) als auch alkoholbedingte Rauscherfahrungen (Binge Drinking). Tabak und Alkohol wird unter 11- und 13-Jährigen noch vergleichsweise selten konsumiert, die Prävalenz steigt bei den 15-Jährigen jedoch deutlich an. Auch Cannabiskonsum ist bei 15-Jährigen recht weit verbreitet. Schülerinnen und Schüler, die nicht das Gymnasium besuchen, haben ein höheres Risiko zu rauchen. Schülerinnen und Schüler mit einem hohen familiären Wohlstand haben ein höheres Risiko Alkohol zu konsumieren, vor allem Mädchen. Heranwachsende mit Migrationshintergrund haben einerseits ein geringeres Risiko für einen regelmäßigen Alkoholkonsum oder Binge Drinking, andererseits jedoch ein erhöhtes Risiko für Cannabiskonsum (Mädchen mit einseitigem Migrationshintergrund). Die Ergebnisse verweisen darauf, dass Präventionsmaßnahmen vor allem früh ansetzen sollten, da die Prävalenzen bei älteren Schülerinnen und Schülern für den Substanzkonsum deutlich höher ausfallen. Es lassen sich je nach betrachteter Substanz unterschiedliche Risikogruppen identifizieren, die besonderer Berücksichtigung bei Präventionsmaßnahmen bedürfen

Habituation of Distress and Craving During Treatment as Predictors of Change in PTSD Symptoms and Substance Use Severity

Objective—Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54). Method—Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session. Results—Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome. Conclusions—Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders