Peranan Prokalsitonin pada Pneumonia Komunitas

Keterbatasan dalam mendiagnosis infeksi respirasi dari klinis, gejala penyakit dan pemeriksaan mikrobiologis, keberadaan biomarker dapat dijadikan informasi tambahan dalam meningkatkan diagnosis dan prognosis yang membantu dalam keputusan pemberian terapi. Penggunaan prokalsitonin dapat membantu diagnosis membedakan dari infeksi yang disebabkan oleh virus, menilai derajat risiko pasien dan keputusan pemberian, penghentian dan durasi antibiotik yang optimal. Pneumonia komunitas masih menjadi masalah kesehatan. Prokalsitonin pada akhir-akhir ini menjadi perhatian prognosis pada pneumonia komunitas. , baik yang diakibatkan oleh bakter iatau pun bukan. Prokalsitonin juga mempunyai kemampuan yang lebih baik dari pada C-reaktif protein sebagai biomarker petanda inflamasi dan mempunyai hubungan yang signifikan dengan skor sistem yang menilai klinis dan angka kematian

Determinants of Latent Tuberculosis in Bandung, West Java

Background: TB remains a leading cause of morbidity and mortality in developing countries, including Indonesia. About 7% of all deaths in developing countries are attributed to TB. Latent tuberculosis infection (LTBI) is a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB. This study aimed to examine the determinants of latent tuberculosis in Bandung, West Java. Subjects and Method: This was a cross-sectional study conducted in Bandung, West Java. A total of 252 peoples were selected for this study, consisting of latent tuberculosis cases and controls. The dependent variable was latent tuberculosis. The independent variables were age, nutrition status, BCG scar, and smoking. The data were collected by laboratory test and questionnaire. The data was analyzed by a multiple logistic regression. Results: The risk of latent tuberculosis increased with occasional smoking (OR= 9.34; 95% CI= 4.23 to 20.67), frequent smoking (OR= 12.99; 95% CI= 2.49 to 67.94), poor nutrition status (OR= 2.64; 95% CI= 0.49 to 14.31), but decreased with BCG scar (OR= 0.45; 95% CI= 0.21 to 0.95). Conclusion: The risk of latent tuberculosis increases with occasional smoking, frequent smoking, poor nutrition status, but decreases with BCG scar. Keywords : latent tuberculosis, smoking, nutrition status, BCG scar

Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia

BACKGROUND: While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there is little evidence about their impact on TB treatment outcomes and adherence. We assessed their effect on treatment outcomes and adherence in Indonesia. METHODS: We interviewed 282 adult TB patients who underwent TB treatment in urban, suburban and rural districts of Indonesia. One year after the interview, we followed up treatment adherence and outcomes. We applied multivariable analysis using generalized linear mixed models. RESULTS: Follow-up was complete for 252/282 patients. Eighteen (7%) patients had unsuccessful treatment and 40 (16%) had poor adherence. At a threshold of 30% of annual household income, catastrophic costs negatively impacted treatment outcomes (adjusted odds ratio [aOR] 4.15 [95% confidence interval {CI} 1.15 to 15.01]). At other thresholds, the associations showed a similar pattern but were not statistically significant. The association between catastrophic costs and treatment adherence is complex because of reverse causation. After adjustment, catastrophic costs negatively affected treatment adherence at the 10% and 15% thresholds (aOR 2.11 [95% CI 0.97 to 4.59], p = 0.059 and aOR 2.06 [95% CI 0.95 to 4.46], p = 0.07). There was no evidence of such an effect at other thresholds. CONCLUSIONS: Catastrophic costs negatively affect TB treatment outcomes and treatment adherence. To eliminate TB, it is essential to mitigate catastrophic costs

Cost of seeking care for tuberculosis since the implementation of universal health coverage in Indonesia

Background: Although tuberculosis (TB) patients often incur high costs to access TB-related services, it was unclear beforehand whether the implementation of universal health coverage (UHC) in Indonesia in 2014 would reduce direct costs and change the pattern of care-seeking behaviour. After its introduction, we therefore assessed TB patients' care-seeking behaviour and the costs they incurred for diagnosis, and the determinants of both. Methods: In this cross sectional study, we interviewed adult TB patients in urban, suburban, and rural districts of Indonesia in July-September 2016. We selected consecutively patients who had been treated for TB in primary health centers for at least 1 month until we reached at least 90 patients in each district. After establishing which direct and indirect costs they had incurred during the pre-diagnostic phase, we calculated the total costs (in US Dollars). To identify the determinants of these costs, we applied a general linear mixed model to adjust for our cluster-sampling design. Results: Ninety-three patients of the 282 included in our analysis (33%) first sought care at a private clinic. The preference for such clinics was higher among those living in the rural district (aOR 1.88, 95% CI 0.85-4.15, P = 0.119) and among those with a low educational level (aOR 1.69, 95% CI 0.92-3.10, P = 0.090). Visiting a private clinic as the first contact also led to more visits (β 0.90, 95% CI 0.57-1.24, P < 0.001) and higher costs than first visiting a Primary Health Centre, both in terms of direct costs (β = 16.87, 95%CI 10.54-23.20, P < 0.001) and total costs (β = 18.41, 95%CI 10.35-26.47, P < 0.001). Conclusion: Despite UHC, high costs of TB seeking care remain, with direct medical costs contributing most to the total costs. First seeking care from private providers tends to lead to more pre-diagnostic visits and higher costs. To reduce diagnostic delays and minimize patients' costs, it is essential to strengthen the public-private mix and reduce the fragmented system between the national health insurance scheme and the National TB Programme

Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics Guidance

The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs

Effects of Introducing Xpert MTB/RIF on Diagnosis and Treatment of Drug-Resistant Tuberculosis Patients in Indonesia: A Pre-Post Intervention Study

<div><p>Background</p><p>In March 2012, the Xpert MTB/RIF assay (Xpert) was introduced in three provincial public hospitals in Indonesia as a novel diagnostic to detect tuberculosis and rifampicin resistance among high risk individuals.</p><p>Objective</p><p>This study assessed the effects of using Xpert in place of conventional solid and liquid culture and drug-susceptibility testing on case detection rates, treatment initiation rates, and health system delays among drug-resistant tuberculosis (TB) patients.</p><p>Methods</p><p>Cohort data on registration, test results and treatment initiation were collected from routine presumptive patient registers one year before and one year after Xpert was introduced. Proportions of case detection and treatment initiation were compared using the Pearson Chi square test and median time delays using the Mood’s Median test.</p><p>Results</p><p>A total of 975 individuals at risk of drug-resistant TB were registered in the pre-intervention year and 1,442 in the post-intervention year. After Xpert introduction, TB positivity rate increased by 15%, while rifampicin resistance rate reduced by 23% among TB positive cases and by 9% among all tested. Second-line TB treatment initiation rate among rifampicin resistant patients increased by 19%. Time from client registration to diagnosis was reduced by 74 days to a median of a single day (IQR 0–4) and time from diagnosis to treatment start was reduced by 27 days to a median of 15 days (IQR 7–51). All findings were significant with p<0.001.</p><p>Conclusion</p><p>Compared to solid and liquid culture and drug-susceptibility testing, Xpert detected more TB and less rifampicin resistance, increased second-line treatment initiation rates and shortened time to diagnosis and treatment. This test holds promise to improve rapid case finding and management of drug-resistant TB patients in Indonesia.</p></div

A novel diagnosis scoring model to predict invasive pulmonary aspergillosis in the intensive care unit

OBJECTIVES: To improve the quality of invasive pulmonary aspergillosis (IPA) management for intensive care unit (ICU) patients using a practical diagnostic scoring model. METHODS: This nested case-control study aimed to determine the incidence of IPA in 405 ICU patients, between July 2012 and June 2014, at 6 hospitals in Jakarta, Indonesia. Phenotypic identifications and galactomannan (GM) tests of sera and lung excreta were performed in mycology laboratory, Parasitology Department, Faculty of Medicine, Universitas Indonesia in Jakarta, Indonesia. RESULTS: The incidence of IPA in the ICUs was 7.7% (31 of 405 patients). A scoring model used for IPA diagnosis showed 4 variables as the most potential risk factors: lung excreta GM index (score 2), solid organ malignancy (score 2), pulmonary tuberculosis (score 2), and systemic corticosteroids (score 1). Patients were included in a high-risk group if their score was greater than 2, and in a low-risk group if their score was less than 2. CONCLUSION: This study provides a novel diagnosis scoring model to predict IPA in ICU patients. Using this model, a more rapid diagnosis and treatment of IPA may be possible. The application of the diagnosis scoring should be preceded by specified pre-requisites

Culture and drug-susceptibility testing results following Xpert MTB/RIF testing within the same individuals at risk of multidrug-resistant TB in three provincial hospitals in Java, Indonesia.

<p><i>Abbreviations</i>: <i>DST</i>, <i>drug-susceptibility testing; TB</i>, <i>tuberculosis; RIF</i>, <i>rifampicin; NTM</i>, <i>non-tuberculosis mycobacteria</i>.</p><p>Culture and drug-susceptibility testing results following Xpert MTB/RIF testing within the same individuals at risk of multidrug-resistant TB in three provincial hospitals in Java, Indonesia.</p

Diagnosis and treatment of individuals at risk of multidrug-resistant pulmonary TB at three provincial hospitals in Java, Indonesia.

<p>The flowchart shows the number of tested, detected and treated individuals in two cohort years. From March 2011 to Feb 2012 (Year 1), individuals were tested with conventional culture and drug-susceptibility testing. From March 2012 to February 2013 (Year 2), individuals were tested with culture and drug-susceptibility testing or Xpert MTB/RIF. <i>Abbreviations</i>: <i>TB</i>, <i>tuberculosis; DST</i>, <i>drug-susceptibility testing; RIF</i>, <i>rifampicin; MDR-TB</i>, <i>multidrug-resistant TB; N</i>, <i>number</i>.</p

KOMUNIKASI KESEHATAN

Komunikasi merupakan salah satu bentuk interaksi antar individu untuk melakukan sosialisasi dalam hal menyampaikan informasi yang dapat mempengaruhi kehidupan individu dan masyarakat. Komunikasi juga dilakukan oleh tenaga professional yang bergelut di bidang kesehatan dalam memberikan pelayanan di fasilitas kesehatan. Tenaga kesehatan dituntut memiliki keahlian dalam berkomunikasi selama melakukan praktek sesuai profesinya, agar pesan medis yang telah disampaikan dapat diterima baik oleh pasien dan outcome therapy dapat tercapai. Selain itu, komunikasi dalam bidang kesehatan juga dapat berperan dalam konteks menyebarluaskan informasi tentang kesehatan kepada masyarakat. Hal ini dapat berupa upaya menciptakan kesadaran, perilaku, dan sikap, serta memberikan motivasi untuk menerapkan perilaku hidup bersih dan sehat. Untuk melengkapi pembahasan, buku ini diawali dengan pembahasan tentang pengertian, fungsi dan ruang lingkup komunikasi; model-model komunikasi; kemudian dilanjutkan tujuan dan peran strategis komunikasi kesehatan; revolusi budaya dan pelayanan kesehatan; memahami perilaku pasien; kelompok risiko dan masyarakat; sejarah perkembangan komunikasi kesehatan; peran komunikator dalam bidang kesehatan; serta memilih media, pesan di dalam komunikasi kesehatan; Selanjutnya akan dibahas juga mengenai audiens dalam komunikasi kesehatan; komunikasi efektif dalam peningkatan kualitas pelayanan; strategi interpersonal efektif dalam komunikasi kesehatan; perencanaan komunikasi kesehatan yang efektif; serta iklan dan komunikasi kesehatan