PERBEDAAN TINGKAT KEPUASAN PASIEN PADA PUSKESMAS DENGAN STATUS AKREDITASI DASAR DAN MADYA DI KOTA MANADO

Akreditasi puskesmas dilakukan dengan tujuan dalam peningkatan mutu pelayanan kesehatan bagi puskesmas. Sehingga dengan demikian, dapat memberikan kepuasan kepada pasien yang menerima pelayanan kesehatan. Kualitas pelayanan kesehatan dapat dinilai dari beberapa dimensi yaitu reliabilitas, responsif, jaminan mutu yang baik, empati, dan bukti secara langsung. Penelitian ini bertujuan untuk mengetahui perbedaan tingkat kepuasan pasien pada puskesmas dengan status akreditasi dasar dan madya di Kota Manado. Jenis penelitian ini merupakan penelitian kuantitatif dengan metode penelitian survei analitik menggunakan desain studi cross sectional. Waktu penelitian sudah dilaksanakan selama bulan Februari-Desember pada tahun 2020. Sementara itu, penelitian ini diadakan pada dua tempat yaitu Puskesmas Ranomuut (akreditasi dasar) dan Puskesmas Wawonasa (akreditasi madya) di Kota Manado. Untuk sampel penelitiannya, diambil beberapa pasien yang berkunjung ke puskesmas dengan jumlah 100 responden untuk setiap puskesmas sehingga total sampel yang sudah diteliti adalah sebanyak 200responden. Pengambilan sampel pada penelitian ini yaitu menggunakan teknik purposive sampling. Untuk analisis yang dipakai yaitu uji Mann Whitney U Test dengan a=0,05. Penelitian ini mendapatkan hasiltingkat kepuasan pasien Puskesmas Ranomuut (akreditasi dasar) merasa puas dengan jumlah 63 responden dan kurang puas sebanyak 37 responden. Sedangkan tingkat kepuasan pasien Puskesmas Wawonasa (akreditasi madya) merasa puas berjumlah 55 responden dan kurang puas sebanyak 45 responden. Sesuai dengan hasil uji statistic Mann Whitney U Test diperoleh nilai p=0,000 maka dengan demikian dapat disimpulkan bahwa terdapat perbedaan tingkat kepuasan pasien pada puskesmas dengan status akreditasi dasar dan madya di Kota Manado. Hal ini membuktikan bahwa dibutuhkan peningkatan kualitas pelayanan kesehatan secara menyeluruh sehingga dapat memenuhi tingkat kepuasan pasien yang lebih baik lagi untuk selanjutnya.Kata kunci : Akreditasi, Kepuasan pasienABSTRACTHealth center accreditationis aimed to improve the quality of health services in health centers, so that the quality of better health services can provide satisfaction for patients or communities who receive health services. The quality of health services can be assessed from reliability, responsiveness, assurance, empathy and tangible. To find out the differences between the accreditation status of the health center and the level of patient satisfaction at Ranomuut Health Center and Wawonasa Health Center in Manado City. The type of this research is quantitative research with analytical survey research method using a cross sectional approach, which was conducted in February-December 2020 in two puskesmas namely Ranomuut Health Center and Wawonasa Health Center in Manado City. The study sample was taken from patients who visited the health center with the number of each sample per health center 100 respondents so that the number of respondents in this study as many as 200 respondents were taken by purposive sampling. The analysis used was the Mann Whitney U Test with α = 0.05. This study obtained the results of the patient satisfaction level of Ranomuut Health Center (basic accreditation) was satisfied with the number of 63 respondents and less satisfied as many as 37 respondents. While the level of patient satisfaction WawonasaHealth Center (intermediate accreditation) was satisfied numbered 55 respondents and less satisfied as many as 45 respondents. Then based on the Mann Whitney U Test the value of p = 0,000, so it is stated that the two variables are related. There is differences between the level of patient satisfaction and accreditation status of the health center in Manado City. There needs to be an increase in services for the two puskesmas, namely the Ranomuut Health Center (basic accreditation) and the Wawonasa Health Center (intermediate accreditation) which are not only limited to health services but as well as the timeliness and speed of serving patients at registration counters, medical records and poly so that patients do not wait too long and patients can feel more satisfied with the services obtained.Keywords: Accreditation, Patient satisfactio

Quality of life of patients with hemophilia treated in a hematology clinic

O objetivo deste trabalho foi caracterizar a qualidade de vida de pacientes hemofílicos em acompanhamento ambulatorial em serviço especializado. Foi feita abordagem quantitativa da qualidade de vida (QV) de pacientes hemofílicos acompanhados em ambulatório de hematologia de um hemocentro regional. A coleta de dados foi realizada por meio de entrevistas utilizando-se o Whoqol-bref e questionário adicional com variáveis sociodemográficas e clínico-epidemiológicas. Para análise dos dados utilizaram-se o Epi-info 6.04d e o SPSS, cujos resultados foram expressos através de distribuição simples, medidas de tendência central e dispersão, proporções e correlação de Pearson entre facetas e domínios. Foram entrevistados 23 pacientes, com média de idade de 21 anos; todos moravam com familiares, 47,8% eram residentes na cidade sede do hemocentro. Do total, 78,3% eram solteiros, 69,6% estudavam, sendo que 45,5% possuíam o 1º grau incompleto e 82,6% não trabalhavam. A maioria (91,3%) possuía hemofilia A. Quanto à avaliação da QV, 47,8% responderam ser boa e 55% possuíam um bom nível de satisfação com a saúde. O domínio psicológico apresentou o maior escore médio e o menor foi o do domínio meio ambiente. Com esse estudo conseguiu-se salientar a magnitude de alguns problemas dos hemofílicos.The objective of this work was to characterize the quality of life of hemophilic patients being followed up in a specialized service. A cross-sectional study of hemophilic patients in a Regional Blood Bank of Brazil was carried out to evaluate their quality of life. The data were obtained by interviews employing the WHO QOL-brief questionnaire, which was analyzed using SPSS and Epi-info 6.04d computer programs. Twenty-three male patients with a mean age of 21 years old were interviewed. All reported that they live with their families, 47.8% were residents in Uberaba, 78.3% were single, 69.6% were students with 45.5% having a low level of education and 82.6% did not work. Of the 23 cases, 91.3% had hemophilia A. In respect to quality of life, 47.8% responded that their quality of life was good and 55% had a good level of satisfaction with their health. The psychological dominion presented the highest average score and the environment presented the lowest. This study highlights the magnitude of some problems of hemophilic patients

Generation of ESTs for Flowering Gene Discovery and SSR Marker Development in Upland Cotton

BACKGROUND: Upland cotton, Gossypium hirsutum L., is one of the world's most important economic crops. In the absence of the entire genomic sequence, a large number of expressed sequence tag (EST) resources of upland cotton have been generated and used in several studies. However, information about the flower development of this species is rare. METHODOLOGY/PRINCIPAL FINDINGS: To clarify the molecular mechanism of flower development in upland cotton, 22,915 high-quality ESTs were generated and assembled into 14,373 unique sequences consisting of 4,563 contigs and 9,810 singletons from a normalized and full-length cDNA library constructed from pooled RNA isolated from shoot apexes, squares, and flowers. Comparative analysis indicated that 5,352 unique sequences had no high-degree matches to the cotton public database. Functional annotation showed that several upland cotton homologs with flowering-related genes were identified in our library. The majority of these genes were specifically expressed in flowering-related tissues. Three GhSEP (G. hirsutum L. SEPALLATA) genes determining floral organ development were cloned, and quantitative real-time PCR (qRT-PCR) revealed that these genes were expressed preferentially in squares or flowers. Furthermore, 670 new putative microsatellites with flanking sequences sufficient for primer design were identified from the 645 unigenes. Twenty-five EST-simple sequence repeats were randomly selected for validation and transferability testing in 17 Gossypium species. Of these, 23 were identified as true-to-type simple sequence repeat loci and were highly transferable among Gossypium species. CONCLUSIONS/SIGNIFICANCE: A high-quality, normalized, full-length cDNA library with a total of 14,373 unique ESTs was generated to provide sequence information for gene discovery and marker development related to upland cotton flower development. These EST resources form a valuable foundation for gene expression profiling analysis, functional analysis of newly discovered genes, genetic linkage, and quantitative trait loci analysis

A framework physical map for peach, a model Rosaceae species

A genome-wide framework physical map of peach was constructed using high-information content fingerprinting (HICF) and FPC software. The resulting HICF assembly contained 2,138 contigs composed of 15,655 clones (4.3× peach genome equivalents) from two complementary bacterial artificial chromosome libraries. The total physical length of all contigs is estimated at 303 Mb or 104.5% of the peach genome. The framework physical map is anchored on the Prunus genetic reference map and integrated with the peach transcriptome map. The physical length of anchored contigs is estimated at 45.0 Mb or 15.5% of the genome. Altogether, 2,636 markers, i.e., genetic markers, peach unigene expressed sequence tags, and gene-specific and overgo probes, were incorporated into the physical framework and supported the accuracy of contig assembly.This project was supported by the United States Department of Agriculture NRI Award # 2005-35300-15452.Peer reviewe

Construction of an almond linkage map in an Australian population Nonpareil × Lauranne

Background: Despite a high genetic similarity to peach, almonds (Prunus dulcis) have a fleshless fruit and edible kernel, produced as a crop for human consumption. While the release of peach genome v1.0 provides an excellent opportunity for almond genetic and genomic studies, well-assessed segregating populations and the respective saturated genetic linkage maps lay the foundation for such studies to be completed in almond. Results: Using an almond intraspecific cross between ‘Nonpareil’ and ‘Lauranne’ (N × L), we constructed a moderately saturated map with SSRs, SNPs, ISSRs and RAPDs. The N × L map covered 591.4 cM of the genome with 157 loci. The average marker distance of the map was 4.0 cM. The map displayed high synteny and colinearity with the Prunus T × E reference map in all eight linkage groups (G1-G8). The positions of 14 mapped gene-anchored SNPs corresponded approximately with the positions of homologous sequences in the peach genome v1.0. Analysis of Mendelian segregation ratios showed that 17.9% of markers had significantly skewed genotype ratios at the level of P < 0.05. Due to the large number of skewed markers in the linkage group 7, the potential existence of deleterious gene(s) was assessed in the group. Integrated maps produced by two different mapping methods using JoinMap® 3 were compared, and their high degree of similarity was evident despite the positional inconsistency of a few markers. Conclusions: We presented a moderately saturated Australian almond map, which is highly syntenic and collinear with the Prunus reference map and peach genome V1.0. Therefore, the well-assessed almond population reported here can be used to investigate the traits of interest under Australian growing conditions, and provides more information on the almond genome for the international community.Iraj Tavassolian, Gholmereza Rabiei, Davina Gregory, Mourad Mnejja, Michelle G Wirthensohn, Peter W Hunt, John P Gibson, Christopher M Ford, Margaret Sedgley, and Shu-Biao W

BAC-pool sequencing and analysis of large segments of A12 and D12 homoeologous chromosomes in upland cotton.

Acknowledgments “Dedicated to Dr. Ramesh Kantety, a mentor, colleague and friend”. We would like to acknowledge the support offered by Padmini Sripathi during data analysis and submissions. Author Contributions Conceived and designed the experiments: RVK JZY. Performed the experiments: RB ZX SM GBW. Analyzed the data: RB. Contributed reagents/materials/analysis tools: RVK RB JZY RJK BAR. Wrote the manuscript: RB. Revised the manuscript: RB RVK JZY RGP BAR GCS. Advised the research: RVK JZY RGP BAR GCS.Author Contributions Conceived and designed the experiments: RVK JZY. Performed the experiments: RB ZX SM GBW. Analyzed the data: RB. Contributed reagents/materials/analysis tools: RVK RB JZY RJK BAR. Wrote the manuscript: RB. Revised the manuscript: RB RVK JZY RGP BAR GCS. Advised the research: RVK JZY RGP BAR GCS.Although new and emerging next-generation sequencing (NGS) technologies have reduced sequencing costs significantly, much work remains to implement them for de novo sequencing of complex and highly repetitive genomes such as the tetraploid genome of Upland cotton (Gossypium hirsutum L.). Herein we report the results from implementing a novel, hybrid Sanger/454-based BAC-pool sequencing strategy using minimum tiling path (MTP) BACs from Ctg-3301 and Ctg-465, two large genomic segments in A12 and D12 homoeologous chromosomes (Ctg). To enable generation of longer contig sequences in assembly, we implemented a hybrid assembly method to process ~35x data from 454 technology and 2.8-3x data from Sanger method. Hybrid assemblies offered higher sequence coverage and better sequence assemblies. Homology studies revealed the presence of retrotransposon regions like Copia and Gypsy elements in these contigs and also helped in identifying new genomic SSRs. Unigenes were anchored to the sequences in Ctg-3301 and Ctg-465 to support the physical map. Gene density, gene structure and protein sequence information derived from protein prediction programs were used to obtain the functional annotation of these genes. Comparative analysis of both contigs with Arabidopsis genome exhibited synteny and microcollinearity with a conserved gene order in both genomes. This study provides insight about use of MTP-based BAC-pool sequencing approach for sequencing complex polyploid genomes with limited constraints in generating better sequence assemblies to build reference scaffold sequences. Combining the utilities of MTP-based BAC-pool sequencing with current longer and short read NGS technologies in multiplexed format would provide a new direction to cost-effectively and precisely sequence complex plant genomes.Yeshttp://www.plosone.org/static/editorial#pee

QTL mapping for brown rot (Monilinia fructigena) resistance in an intraspecific peach (Prunus persica L. Batsch) F1 progeny

Brown rot (BR) caused by Monilinia spp. leads to significant post-harvest losses in stone fruit production, especially peach. Previous genetic analyses in peach progenies suggested that BR resistance segregates as a quantitative trait. In order to uncover genomic regions associated with this trait and identify molecular markers for assisted selection (MAS) in peach, an F1 progeny from the cross "Contender" (C, resistant) 7 "Elegant Lady" (EL, susceptible) was chosen for quantitative trait loci (QTL) analysis. Over two phenotyping seasons, skin (SK) and flesh (FL) artificial infections were performed on fruits using a Monilinia fructigena isolate. For each treatment, infection frequency (if) and average rot diameter (rd) were scored. Significant seasonal and intertrait correlations were found. Maturity date (MD) was significantly correlated with disease impact. Sixty-three simple sequence repeats (SSRs) plus 26 single-nucleotide polymorphism (SNP) markers were used to genotype the C 7 EL population and to construct a linkage map. C 7 EL map included the eight Prunus linkage groups (LG), spanning 572.92 cM, with an average interval distance of 6.9 cM, covering 78.73 % of the peach genome (V1.0). Multiple QTL mapping analysis including MD trait as covariate uncovered three genomic regions associated with BR resistance in the two phenotyping seasons: one containing QTLs for SK resistance traits near M1a (LG C 7 EL-2, R2 = 13.1-31.5 %) and EPPISF032 (LG C 7 EL-4, R2 = 11-14 %) and the others containing QTLs for FL resistance, near markers SNP_IGA_320761 and SNP_IGA_321601 (LG3, R2 = 3.0-11.0 %). These results suggest that in the C 7 EL F1 progeny, skin resistance to fungal penetration and flesh resistance to rot spread are distinguishable mechanisms constituting BR resistance trait, associated with different genomic regions. Discovered QTLs and their associated markers could assist selection of new cultivars with enhanced resistance to Monilinia spp. in fruit