Riwayat Konsumsi Makanan Penderita Strok Yang Masuk Rumah Sakit

Stroke is one of main contributing diseases to global death as well as in Indonesia. One of risk factors for stroke is food pattern while the post stroke food pattern affect on later survival. This study provided the food pattern of hospitalized stroke patient. Data were derived from Indonesia stroke registry 2011-2012 which covered 3999 patients from 17 main hospitals in Sumatera, Java, Bali and West Nusa Tenggara. Diagnosis of stroke followed ICD_X. A number 3401 out of 3999 patients were analyzed for the food pattern with complete data. Patients were interviewed for their food consumption using food frequency questionnaire (FFQ) method and then the result scored in five groups' i.e. every day was scored by 30.4; if consumed 4-6 days in a week was scored 21.7; and 2-3 days and 1-3 in a week were scored by 8,70 and 2,40 respectively. Scored 1 for food consumption 1-2 or never consumed at all in last 3 months. Different pattern of frequency distribution of food consumption adjusted by gender failed to detect the different food pattern, but when the pattern adjusted by ethnic and food group and ever happened in previous stroke, the differences were found. Hemorrhagic stroke patients especially 65 years or over whom consumed high sweetened, salty, fatty and high content cholesterol more frequent than ischemic one. An in-depth study should be conducted to confirm the result

Desain Video Pembelajaran yang Efektif pada Pendidikan Jarak Jauh: Studi di Universitas Terbuka

Penelitian ini bertujuan untuk mendesain video pembelajaran dan menentukan unsur-unsur yang terdapat dalam video pembelajaran pada pendidikan jarak jauh sehingga dapat efektif untuk meningkatkan pemahaman mahasiswa. Studi kasus dilakukan di Program Studi Administrasi Publik Universitas Terbuka Indonesia. Metode penelitian yang digunakan adalah desain penelitian evaluatif dengan pendekatan kuantitatif deskriptif. Melalui metode ini dilakukan penilaian sistematis terhadap kegiatan dan atau hasil dari suatu program perancangan video sebagai sarana untuk memberikan kontribusi untuk perbaikan perancangan video. Langkah-langkah dalam penelitian ini adalah pengukuran input (berupa perancangan video), pengukuran output, dan pengukuran outcome (berupa pengukuran peningkatan pemahaman mahasiswa). Teknik pengumpulan data yaitu pre test, post test, angket, wawancara, dan observasi. Hasil penelitian menunjukkan bahwa ketiga desain video yang telah dirancang mampu untuk meningkatkan pemahaman mahasiswa. Agar dapat efektif dalam meningkatkan pemahaman mahasiswa, unsur-unsur yang terdapat dalam video pembelajaran harus meliputi aspek konten, durasi video, bentuk media video, penggunaan warna, music dan ilustrasi, presenter, penggunaan bahasa, dan penugasan melalui video

Validation of Chest Radiograph Reading and Recording System (CRRS) in Three Sites in Indonesia

One of the main challenges in Tuberculosis (TB) management is the lack of tools for early and accurate diagnosis. Chest X-ray remains one of the most convenient ways for TB diagnosis. Even though chest X-ray result can be obtained quickly, it requires accurate interpretation from radiologist. Chest Radiograph Reading and Recording System (CRRS) can be used to standardize the interpretation process for TB diagnosis. This study aims to determine the validity of CRRS in hospital and primary health center. This is a cross-sectional observational study in Cipto Mangunkusumo Hospital, Jatinegara, and Matraman Healthcare Centers. The study was conducted from May to November 2015. Participants were recruited with consecutive sampling. The eligibility criteria were age ≥ 15 years old, new or previously treated patients with current TB treatment ≤ 1 months, and having symptoms consistent with TB, or having a contact history with patients with smear positive or having extra-pulmonary TB. Recruited patients underwent anamnesis, physical examination, morning sputum examination, and chest X-ray examination. Acid-fast bacilli smears and culture of the morningsputum was conducted in Microbiology Laboratory of Faculty of Medicine, Universitas Indonesia. Chest X-ray examination was conducted in Cipto Mangunkusumo Hospital. The radiologists filled the CRRS form that contains the scoring based on four features: Score 2 is given for Upper lobe large opacity (> 1 cm), cavity in any location, and adenopathy in any location, and score 1 for unilateral pleural effusion. The totalnumber of the score was then categorized using different cut-offs (≥ 1, ≥ 2, ≥ 3, and ≥ 4) to evaluate the validity of the method compared with the sputum examination. Two radiologists read the same chest X-ray, and when there was a disagreement, a senior radiologist made the final decision. The agreement between the two radiologists was determined using the Cohen’s kappa. As many as 210 chest Xx-ray results were readusing CRRS method. The highest Cohen’s Kappa coefficient between the two readers was 0.84 for large opacity feature, while the lowest was 0.52 for lymphadenopathy. The validity of the scoring with cut-off ≥ 1 showed the highest accuracy of 76% with sensitivity 76.2%; specificity 61.4%; positive predictive value 68.6%; and negativepredictive value 63.6%. The lowest accuracy showed on the cut-off ≥ 3 and ≥ 4, with accuracy of 60.8%. On each radiological feature, the best accuracy (almost 80%) was showed by large opacity feature. The interpretation using CRRS method has good inter-reader agreement. Keywords: Tuberculosis, CRRS, validity, agreemen

Pengaruh Diabetes Melitus terhadap Gambaran Klinis dan Keberhasilan Pengobatan Tuberkulosis di Tujuh RSU Kelas A dan B di Jawa dan Bali

Diabetes mellitus (DM) may complicate tuberculosis (TB) treatment and control. The National Institute of Health Research and Development in collaboration with seven referral public hospitals in Java and Bali established a disease registry system for tuberculosis (TB) and diabetes mellitus (DM). Medical records containing data of ≥15 years old patients, diagnosed with TB (ICD-10 code A15-A19) in 2014, with or without DM (ICD-10 code E10-E14) were recorded into case report form (CRF). From January 1st 2014 to January 12th 2016, the registry recorded 1975 TB cases, 15% of cases were TB-DM. 73.6% TB-DM were ≥45 years old and 70,8% TB-non DM were <45 years old. Previously treated TB cases were higher than naïve in TB-DM (OR 2.588; 95%CI 2.0-3.4). In TB-DM, predominant symptoms were cough >2 weeks (76.4%), weight loss (72.6%), loss of appetite (65.9%), and night sweats (65.2%). In TB-non DM, predominant symptoms were weight loss (59.4%), loss of appetite (57.8%), cough >2 weeks (57.6%), and fever (56.9%). Higher chest X-rays abnormality in TB-DM (OR 7.249; 95%CI 3.2-16.5) and higher positive AFB smears (OR 2.568; 95%CI 1.8-3.8). TB treatment failure (death, defaulted, failure, or transferred out) were three times higher in TB-DM (aOR 3.042; 95%CI 1.7-5.4). TB-DM Registry showed negative effects of DM on clinical condition and the treatment success of TB. Abstrak Diabetes melitus (DM) menyulitkan pengobatan dan kontrol tuberkulosis (TB). Badan Penelitian dan Pengembangan Kesehatan bersama tujuh rumah sakit (RS) umum kelas A dan B di Pulau Jawa dan Bali mengembangkan Sistem Registri Penyakit TB-DM. Data pasien berusia ≥15 tahun, didiagnosis TB (kode A15-A19 ICD-10) mulai tahun 2014, dengan atau tanpa DM (kode E10-E14 ICD-10) diabstraksi ke dalam case report form (CRF). Mulai 1 Januari 2014 – 2 Januari 2016, terdapat 1975 kasus TB, 15% adalah TB dengan DM. 73,6% pasien TB-DM berusia ≥45 tahun dan 70,8% TB-non DM berusia <45 tahun. Pada kasus TB-DM, kasus TB sebelumnya pernah diobati lebih tinggi dibanding TB naïve (OR 2,588; KI95% 2,0-3,4). Pada TB-DM, gejala terbanyak adalah batuk lebih dari dua minggu, penurunan berat badan, penurunan nafsu makan, dan berkeringat di malam hari, berturut-turut sebanyak 76,4%; 72,6%; 65,9%; dan 65,2%. Pada TB-non DM, gejala dominan adalah penurunan berat badan, penurunan nafsu makan, batuk lebih dari dua minggu, dan demam, berturut-turut sebanyak 59,4%; 57,8%; 57,6%; dan 56,9%. Foto toraks abnormal lebih banyak pada TB-DM (OR 7,249; KI95% 3,2-16,5), demikian juga dengan BTA positif (OR 2,568; KI95% 1,8-3,8). Kegagalan pengobatan TB (meninggal, putus berobat, gagal pengobatan, atau pindah) tiga kali lebih besar pada TD-DM dibanding TB-non DM (aOR 3.042; KI95%1.7-5.4). Registri TB-DM menunjukkan efek negatif DM terhadap gambaran klinis dan keberhasilan pengobatan TB

Treatment-seeking behaviour and associated costs for malaria in Papua, Indonesia.

BACKGROUND: Malaria remains a significant public health issue in Eastern Indonesia, where multidrug resistant Plasmodium falciparum and Plasmodium vivax are highly prevalent. The objective of this study was to describe treatment-seeking behaviour and household costs prior to a change to a unified treatment policy of dihydroartemisinin-piperaquine in Mimika district, Papua province in 2006. METHODS: In 2005 a randomized cross-sectional household survey was conducted to collect data on demographics, socio-economic status (SES), treatment-seeking, case management, and household costs. Information on the cost of illness was also collected from patients exiting health facilities, in order to compare the cost of episodes diagnosed as P. vivax compared with those diagnosed as P. falciparum. RESULTS: 825 households were included in the survey. Of the 764 individuals who sought treatment for fever outside the home in the last month, 46% (349/764) went to a public health facility. Of the 894 reported visits to healthcare providers, 48% (433) resulted in a blood test, of which 78% (337) were reportedly positive. Only 10% (17/177) of individuals who reported testing positive for P. falciparum or mixed infection received the first-line treatment of chloroquine with SP, and 38% (61/159) of those with a diagnosis of P. vivax reportedly received the first-line treatment of chloroquine and primaquine. Overall, public facilities were more likely to prescribe the correct prevailing first-line drug combinations than private providers (OR = 3.77 [95% CI 2.31-6.14], p < 0.001). The mean cost to the household of an episode of P. vivax was similar to the cost of P. falciparum [US$44.50 (SD: 46.23) vs US$48.58 (SD: 64.65)]. CONCLUSIONS: Private providers were a popular source of treatment for malaria, but adherence to the national guidelines was low and the economic burden of malaria for both P. falciparum and P. vivax infections was substantial. Engagement with the private sector is needed to ensure that patients have access to affordable good quality, effective diagnostics and anti-malarials for both P. falciparum and P. vivax

Malaria morbidity in Papua Indonesia, an area with multidrug resistant Plasmodium vivax and Plasmodium falciparum

BACKGROUND: Multidrug resistance has emerged to both Plasmodium vivax and Plasmodium falciparum and yet the comparative epidemiology of these infections is poorly defined. METHODS: All laboratory-confirmed episodes of malaria in Timika, Papua, Indonesia, presenting to community primary care clinics and an inpatient facility were reviewed over a two-year period. In addition information was gathered from a house-to-house survey to quantify the prevalence of malaria and treatment-seeking behaviour of people with fever. RESULTS: Between January 2004 and December 2005, 99,158 laboratory-confirmed episodes of malaria were reported, of which 58% (57,938) were attributable to P. falciparum and 37% (36,471) to P. vivax. Malaria was most likely to be attributable to pure P. vivax in children under one year of age (55% 2,684/4,889). In the household survey, the prevalence of asexual parasitaemia was 7.5% (290/3,890) for P. falciparum and 6.4% (248/3,890) for P. vivax. The prevalence of P. falciparum infection peaked in young adults aged 15-25 years (9.8% 69/707), compared to P. vivax infection which peaked in children aged 1 to 4 years (9.5% 61/642). Overall 35% (1,813/5,255) of people questioned reported a febrile episode in the preceding month. Of the 60% of people who were estimated to have had malaria, only 39% would have been detected by the surveillance network. The overall incidence of malaria was therefore estimated as 876 per 1,000 per year (Range: 711-906). CONCLUSION: In this region of multidrug-resistant P. vivax and P. falciparum, both species are associated with substantial morbidity, but with significant differences in the age-related risk of infection

Multidrug-Resistant Plasmodium vivax Associated with Severe and Fatal Malaria: A Prospective Study in Papua, Indonesia

Ric Price and colleagues present data from southern Papua, Indonesia, suggesting that malaria resulting from infection withPlasmodium vivax is associated with substantial morbidity and mortality

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Background. The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia

Human T cell recognition of the blood stage antigen Plasmodium hypoxanthine guanine xanthine phosphoribosyl transferase (HGXPRT) in acute malaria

<p>Abstract</p> <p>Background</p> <p>The <it>Plasmodium </it>purine salvage enzyme, hypoxanthine guanine xanthine phosphoribosyl transferase (HGXPRT) can protect mice against <it>Plasmodium yoelii </it>pRBC challenge in a T cell-dependent manner and has, therefore, been proposed as a novel vaccine candidate. It is not known whether natural exposure to <it>Plasmodium falciparum </it>stimulates HGXPRT T cell reactivity in humans.</p> <p>Methods</p> <p>PBMC and plasma collected from malaria-exposed Indonesians during infection and 7–28 days after anti-malarial therapy, were assessed for HGXPRT recognition using CFSE proliferation, IFNγ ELISPOT assay and ELISA.</p> <p>Results</p> <p>HGXPRT-specific T cell proliferation was found in 44% of patients during acute infection; in 80% of responders both CD4⁺and CD8⁺T cell subsets proliferated. Antigen-specific T cell proliferation was largely lost within 28 days of parasite clearance. HGXPRT-specific IFN-γ production was more frequent 28 days after treatment than during acute infection. HGXPRT-specific plasma IgG was undetectable even in individuals exposed to malaria for at least two years.</p> <p>Conclusion</p> <p>The prevalence of acute proliferative and convalescent IFNγ responses to HGXPRT demonstrates cellular immunogenicity in humans. Further studies to determine minimal HGXPRT epitopes, the specificity of responses for Plasmodia and associations with protection are required. Frequent and robust T cell proliferation, high sequence conservation among <it>Plasmodium </it>species and absent IgG responses distinguish HGXPRT from other malaria antigens.</p