ANALISIS KONDISI INDIVIDU DAN LINGKUNGANNYA DI PEMUKIMAN LAHAN BASAH PADA DELAPAN KOTA/KABUPATEN BERBEDA: Analysis of Individual Conditions and Their Environment in Wetland Settlements in Eight Different Cities/Districts

Survei ke rumah-rumah warga yang ada di permukiman lahan basah yang berbeda daerah dan diberikan kuesioner atau pertanyaan-pertanyaan seputar kondisi rumah kondisi lingkungan rumah. Tujuan penelitian ini untuk mengetahui kondisi pemukiman lahan basah di lokasi survei sudah sesuai dengan standar atau belum. Penelitian ini merupakan penelitian kuantitatif dengan metode survei dan observasi. Studi ini dilakukan dengan cara mendatangi rumah-rumah yang tinggal di tempat lahan basah, yang tiap- tiap orang dari kelompok kami melakukan survei untuk enam orang responden dan akan dilakukan kuesioner terhadap responden tersebut. Serta, kami gunakan aplikasi GPS essencial untuk keabsahan survei dan observasi. Diperoleh berbagai jawaban atas kuesioner dari 54 responden. Jawaban kuesioner disajikan dalam delapan tabel, sesuai dengan judul setiap kuesionernya. Dimana, dihasilkan terkait karakteristik responden, karakteristik observasi lingkungan rumah, karakteristik sumber air bersih, dan lima karakteristik lainnya. Keunggulan lahan basah bila dijadikan daerah pemukiman yaitu kandungan air yang cukup banyak, kaya akan hewan dan tumbuhan, serta memiliki potensi dalam meningkatkan kesejahteraan manusia. Banyaknya permasalahan yang berkaitan dengan lahan basah adalah timbul dari manusia itu sendir

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

IDENTIFIKASI DAN UJI RESISTENSI BAKTERI DI KAMAR OPERASI RSUP DR. M. DJAMIL PADANG

Infeksi Luka Operasi (ILO) masih merupakan jenis infeksi nosokomial yang sering terjadi. Laporan dari RSUP Dr. M. Djamil Padang menunjukkan kasus ILO tercatat sebanyak 16,52% sejak bulan Januari – Juni 2014. Hal ini akan meningkatkan angka mortalitas dan morbiditas di rumah sakit. Keadaan lingkungan rumah sakit khususnya ruang operasi mempunyai peranan penting untuk terdapatnya bakteri penyebab ILO dan mengingat sudah banyak bakteri yang resisten dengan berbagai antibiotik. Penelitian ini dilakukan untuk mengetahui bakteri dan resistensi antibiotik yang terdapat di kamar operasi, RSUP Dr. M. Djamil Padang. Penelitian ini merupakan studi deskriptif yang menggunakan teknik total sampling yang dilakukan pada 142 sampel di ruang operasi. Isolat diambil dari swab lantai, dinding, pintu, udara, loteng meja operasi, meja bowel, meja mayo, selang suction, lampu operasi dan mesin anastesi di empat belas (14) kamar operasi, lalu pada bakteri yang ditemukan dilakukan uji resistensi menggunakan 16 disk antibiotik. Hasil penelitian didapatkan koloni bakteri Staphylococcus aureus pada 16 sampel (11,2%), Klebsiella spp pada 5 sampel (3,5%) dan Basillus spp pada 58 sampel (40,8%). Uji resistensi dilakukan pada bakteri Staphylococcus aureus yaitu (68,75 %) resistensi terhadap ampicilin, (87,5%) resistensi terhadap nalidixic acid, (12,5%) resisten terhadap tetracycline, (43,75%) resisten terhadap chloramphenicol, (50%) resisten terhadap erythtomycin, (18,75%) resisten terhadap sulfamethroxazole/trimethropime, (12,5%) resisten terhadap ceftriaxone, dan (12,5%) resisten terhadap ceftazidime. Bakteri Klebsiella spp hampir seluruhnya mengalami resistensi terhadap 16 antiobiotik yang digunakan. Terdapatnya bakteri di kamar operasi menunjukkan pentingnya pembersihan ruang operasi secara berkala. Kata kunci : Staphylococcus aureus, Klebsiella, kamar operasi, SS

The Influence of E-System Implementation, Tax Knowledge, Fiscus Services on Individual Taxpayer Compliance

This research aims to test how E-Systems (e-filling, e-billing), Taxation Knowledge and Fiscal Services influence compliance with WPOP in KPP wonosari. The method used in this research is the quantitative method. This research data source uses a questionnaire distributed to WPOP-registered KPP Pratama Wonosari. Sampling technique using random sampling techniques, the population number of this research was obtained by calculating the population using the Slovin technique formula, after calculating the people using the Slovin formula, getting the sample number of as many as 100 respondents in the taxable population of the City of Wonosari. Double regression analysis was then used in this study. Research shows that KPP Pratama Wonosari's e-billing policy correlates with WPOP compliance levels. Still, the e-filing policy in KPP WonoSari does not correlate to the compliance of WP OP. WPop adherence is influenced by the understanding of taxation. In addition, compliance with the WPOP is affected by the services provided by the fiscal officer.

PENILAIAN PERKEMBANGAN ANAK DALAM PEMBELAJARAN DI TK SANTO AGUSTINUS NANGA MAHAP

This study aims to determine the assessment of children's development in learning at Santo Agustinus Nanga Mahap Kindergarten. The research method used is descriptive with a qualitative research form. The data source for this research was teachers who taught at the Santo Augustinus Nanga Mahap Kindergarten and the data consisted of interviews and observation sheets. The results of the study show that the teacher has carried out an assessment in accordance with existing procedures but has not done it thoroughly. Teachers have not planned according to existing procedures, teachers have carried out assessments of child development according to existing procedures but have not used assessment instruments and only one teacher used observation sheets in assessing child development. The teacher has processed the results of the assessment but has not been directed. Teachers have not used portfolios in filing children's assessments, only one teacher has used learning portfolios in archiving assessments. The teacher has reported the results of the child development assessment in accordance with existing procedures, namely by using a child development reportbook (report) and reporting the child's development to parents

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally