FAKTOR YANG BERHUBUNGAN DENGAN PEMANFAATAN ANTENATAL CARE DI WILAYAH PESISIR KECAMATAN MANDALLE

Angka Kematian Ibu (AKI) yang masih tinggi di Indonesia dapat dicegah melalui pemeriksaan kehamilan atau antenatal care (ANC) sesuai dengan standar pelayanan antenatal. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan pemanfaatan ANC pada ibu di wilayah pesisir Kecamatan Mandalle tahun 2013. Jenis penelitian yang digunakan adalah observasional analitik dengan rancangan cross sectional study. Analisis data menggunakan uji chi-square dan uji phi (??). Pengambilan sampel secara accidental sampling terhadap ibu yang memiliki anak berusia <1 tahun pada saat penelitian berlangsung sebanyak 95 orang sampel. Hasil penelitian menunjukkan bahwa terdapat variabel yang memiliki hubungan signifikan dengan pemanfaatan ANC di wilayah pesisir Kecamatan Mandalle tahun 2013 yaitu tingkat pendidikan (p=0,042) dengan kekuatan hubungan lemah (??=0,209), paritas (p=0,017) dengan kekuatan hubungan sedang (??=0,294), pengetahuan (0,007) dengan kekuatan hubungan sedang (??=0,274), dan kondisi kesehatan ibu hamil (0,036) dengan kekuatan hubungan lemah (??=0,215). Variabel yang tidak memiliki hubungan signifikan dengan pemanfaatan ANC yaitu umur (p=0,326), status pekerjaan (p=0,472), kepercayaan terhadap medis (p=0,091), waktu tempuh (p=0,659), dan jarak tempuh (p=0,391). Oleh karena itu, disarankan agar peningkatan pengetahuan dan kesadaran ibu tentang keteraturan pemeriksaan dan manfaat setiap jenis pelayanan ANC melalui sosialisasi dan konseling oleh petugas kesehatan melalui kerja sama antar pihak

Hubungan antara Fleksibilitas dan Kekuatan Otot Lengan dengan Kecepatan Renang

Kecepatan adalah aset utama atlet renang. Penelitian terbaru menunjukkan variabel fleksibilitas dan kekuatan otot lengan sangat memengaruhi kecepatan renang individu. Penelitian ini bertujuan mengetahui hubungan antara fleksibilitas dan kekuatan otot lengan pada atlet renang gaya bebas di Makassar. Desain penelitian ini adalah cross sectional dengan jumlah sampel 20 orang atlet yang berusia 12-18 tahun. Variabel independen yang diukur adalah fleksibilitas dan kekuatan otot lengan. Variabel dependen yang diukur adalah kecepatan renang melalui tes renang gaya bebas 25 meter. Analisis bivariat digunakan untuk menganalisis hubungan fleksibilitas dan kekuatan otot lengan dengan kecepatan pada atlet renang. Hasil penelitian menunjukkan adanya korelasi positif antara fleksibilitas dengan kecepatan (p=0,001; R2=0,512) dan kekuatan otot lengan dengan kecepatan (p=0,001; R2=0,746). Disimpulkan bahwa semakin tinggi nilai fleksibilitas, semakin tinggi kecepatan renang. Semakin besar nilai kekuatan otot lengan, semakin tinggi kecepatan renang

Laser surface modification of duplex stainless steel 2205 to modify the surface roughness

Laser surface modification is an emerging process that can produce texture on a work surface and effectively enhance surface topography while altering surface roughness. Laser surface modification is a sensitive process that depends on various laser processing parameters such as power, scanning speed, hatching distance. The significance of this work is to examine the influence of hatching distance on the surface characteristic of 2205 duplex stainless steel samples. The surface transformation and variation of the surface roughness properties of the materials were examined. The hatching distance was varied from 0.1 to 0.005 mm. Results indicate that, as the hatch spacing decreases, the overlap of laser track increases, thereby resulting in a decrease of surface roughness. Meanwhile, with the increase of hatch distance, the clear overlay tracks were transformed to irregular wavy surface. The best hatch distance parameter obtained was 100 μm that resulted in the highest roughness of 8.45 μm. Experimental results illustrate that, when the optimum hatch distance of 100 μm was adopted, the polished smooth surface of 2205 duplex stainless steel with initial average roughness value of 0.19 μm increased by 42 times of the polished surface roughness. A strong correlation between hatching distance and roughness was established in 2205 duplex stainless steel. High depth of the altered surface topography and increased roughness were linked to higher levels of hatching distance

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Kajian Pengelolaan Dampak Sedimentasi DAS Jeneberang terhadap Kelangsungan DAM di Sulawesi Selatan

DAS Jeneberang sangat penting dalam sistem tata air di Kabupaten Gowa, Kota Makassar dan Kabupaten Takalar. Kondisi penutupan lahan yang semakin terbuka dan tingginya sedimentasi telah mengakibatkan meluapnya sungai Jeneberang serta pendangkalan DAM Bili-Bili. Dampak yang akan ditimbulkan akibat adanya sedimentasi pada catchment area DAM Bili-Bili DAS Jeneberang khususnya terhadap keberlangsungan DAM Bili-Bili sangat besar. Oleh karena itu, perlu dilakukan kajian dampak sedimentasi terhadap keberlangsungan DAM Bili-Bili DAS Jeneberang sehingga dampak yang ditimbulkan akibat adanya sedimentasi terhadap DAM Bili-bili dapat diminimalisir.\ud \ud Kajian ini bertujuan untuk mengkaji kondisi lingkungan DAS Jeneberang, mengetahui besarnya laju erosi dan sedimentasi di DAS Jeneberang, menganalisis dampak erosi dan sedimentasi terhadap bendungan DAM Bili-Bili dan mendesai model kebijakan pengelolaan lingkungan DAS Jeneberang yang mengintegrasikan kepentingan wilayah hulu, tengah dan hilir dalam rangka pengamanan DAM Bili-Bili.\ud \ud Hasil penelitian menunjukkan bahwa nilai erosi pada Catchment Area DAM Bili-Bili pada tahun 2012 sebesar 121,37 ton/ha/tahun, Angka erosi ini telah jauh melampaui angka erosi pada desain awal bendungan, yaitu 18 ton/ha/th maka umur efektif bendungan kurang lebih 10 tahun. Dampak erosi dan sedimentasi sangat berpengaruh bagi keberlangsungan Catchment Area DAM Bili-Bili. Sehingga bendungan Bili-Bili pada saat sekarang ini tidak dapat secara optimal dimanfaatkan sesuai dengan peruntukan awal pembangunan Bendungan Bili-Bili dan keberlangsungan DAM Bili-Bili dimasa yang akan datang. Apabila tidak segera dilakukan perbaikan kondisi lingkungan Catchment Area DAM dapat berakibat tidak berfungsinya DAM Bili-Bili sebagaimana mestinya dan sebagai penyangga perekonomian wilayah