ANALISIS TINGKAT KECEMASAN IBU KEHAMILAN PERTAMA DALAM MENGHADAPI PERSALINAN

Kecemasan merupakan reaksi normal terhadap perubahan lingkungan yang membawa perasaan yang tidak senang atau tidak nyaman yang disebabkan oleh dugaan akan bahaya atau frustasi yang mengancam, membahayakan rasa aman, keseimbangan atau kehidupan seorang individu atau kelompok biososialnya. Data Puskesmas Meureubo 2015 jumlah ibu hamil 710 orang dengan jumlah ibu kehamilan pertama dari Juni sampai November 2015 sebanyak 125 ibu. Penelitian bersifat survey analitik dengan desain cross-sectional, penelitian untuk mengetahui hubungan Pengetahuan dan Sikap dengan Tingkat Kecemasan Pada Ibu kehamilan pertama. Total populasi 125 ibu pada kehamilan pertama dengan jumlah sampel 56, analisis data menggunakan univariat dan bivariat (Chi Kuadrat). Terdapat hubungan pengetahuan dan sikap (P. Value<α) dengan tingkat kecemasan pada ibu kehamilan pertama. Sikap memiliki hubungan yang sangat signifikan dengan tingkat kecemasan pada ibu kehamilan pertama dalam menghadapi persalinan. Kepada instansi terkait diharapkan dapat memberikan informasi terhadap ibu dengan kehamilan pertama, sehingga ibu dapat menjalani proses persalinan dengan baik. Kata Kunci: Pengetahuan, Sikap, Kecemasan, Kehamilan Pertam

Freud: memory and the metapsychological witch

In this study, I explore the connections between Freud’s metapsychology and the practice of psychoanalysis. Until his very last papers, Freud continued to assert that the specificity of the genuine psychoanalytic cure was the research of infantile memory. In 1937 he wrote: “What we are in search of is a picture of the patient’s forgotten years that shall be alike trustworthy and in all essential respects complete” (Freud, 1937b, p.258). In order to perceive how this picture of a patient’s forgotten years is to be found not in the discovery of an archive-memory but through the construction of an infantile mode of thinking, it is necessary to go back to a theory of memory that Freud elaborated during the first twenty years of his metapsychological work. Reminiscences are not faithful representations of the past but the outcome of a conflict between conscious and unconscious ideas. In the same way, memory is not an apparatus that registers the past but a system that inscribes contingent scenes of existence within a psychical destiny. Freud researched this psychical destiny through the description of an unconscious mode of thinking and through the invention of a new form of writing: a metapsychological writing. I propose to read the construction of a metapsychology as a grid on which one can write unconscious ideas. My focus throughout this work is to understand the functioning of the metapsychological grid and to answer the question of what it reveals in the clinical encounter. I discovered that the answer to this question could be located in Freud’s clinical paper A Child is Being Beaten (1919) and it involved the construction of a masochistic phantasy. A Child is Being Beaten stands, therefore, outside the timescale of this thesis, as an icon that captures the discursive argument of the whole

jurnal mengajar aljabar linear 22.A1 baru

jurnal mengajar aljabar linear 22.A1 bar

jurnal mengajar aljabar linear 22.A2 baru

jurnal mengajar aljabar linear 22.A2 bar

Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?

Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. Overview Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. Conclusion The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care

Drug resistance mutations and heteroresistance detected using the GenoType MTBDRplus assay and their implication for treatment outcomes in patients from Mumbai, India

<p>Abstract</p> <p>Background</p> <p>Only 5% of the estimated global multidrug resistant TB (MDRTB) load is currently detected. Endemic Mumbai with increasing MDR would benefit from the introduction of molecular methods to detect resistance.</p> <p>Methods</p> <p>The GenoType MTBDR<it>plus </it>assay was used to determine mutations associated with isoniazid and rifampicin resistance and their correlation with treatment outcomes. It was performed on a convenience sample comprising 88 onset and 67 fifth month isolates for which phenotypic drug susceptibility testing (DST) was determined by the Buddemeyer technique for an earlier study. Simultaneous presence of wild type and mutant bands was referred to as "mixed patterns" (heteroresistance).</p> <p>Results</p> <p>Phenotypically 41 isolates were sensitive; 11 isoniazid, 2 rifampicin, 2 pyrazinamide and 5 ethambutol monoresistant; 16 polyresistant and 78 MDR. The agreement between both methods was excellent (kappa = 0.72-0.92). Of 22 rifampicin resistant onset isolates, the predominant <it>rpoB </it>mutations were the singular lack of WT8 (n = 8) and mixed D516V patterns (n = 9). Of the 64 rifampicin resistant fifth month isolates, the most frequent mutations were in WT8 (n = 31) with a further 9 showing the S531L mutation. Mixed patterns were seen in 22 (34%) isolates, most frequently for the D516V mutation (n = 21). Of the 22 onset and 35 fifth month <it>katG </it>mutants, 13 and 12 respectively showed the S315T1 mutation with loss of the WT. Mixed patterns involving both S315T1 and S315T2 were seen in 9 and 23 isolates respectively. Seventeen of 23 and 23/35 <it>inhA </it>mutant onset and fifth month isolates showed mixed A16G profiles. Additionally, 10 fifth month isolates lacked WT2. Five onset and 6 fifth month isolates had both <it>katG </it>and <it>inhA </it>mutations. An association was noted between only <it>katG </it>but not only <it>inhA </it>resistance and poor outcome (<it>p </it>= 0.037); and additional resistance to ethambutol (<it>p </it>= 0.0033). More fifth month than onset isolates had mixed profiles for at least 1 gene (<it>p </it>= 0.000001).</p> <p>Conclusions</p> <p>The use of the assay to rapidly diagnose MDR could guide simultaneous first- and second-line DST, and reduce the delay in administering appropriate regimens. Furthermore, detection of heteroresistance could prevent inaccurate "cured" treatment outcomes documented through smear microscopy and permit more sensitive detection of neonascent resistance.</p

Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

<p>Abstract</p> <p>Background</p> <p>It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning.</p> <p>Methods</p> <p>A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007).</p> <p>Results</p> <p>One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems.</p> <p>Conclusion</p> <p>This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.</p