Severity and treatment level of acute gastroenteritis with rotavirus in children under 5 years in INDONESIA

Rotavirus diarrhea causing gastroenteritis in children under five years is an importantissue that urgently needs to be addressed globally. Delay in management of rotavirusdiarrhea can be fatal. Diagnostic tool for detecting rotavirus is, therefore, needed.However, until now the gold standard diagnostic tools are expensive, often not availableand affordable in health care settings. The aim of the study was to compare the Vesikariclinical severity score of rotavirus-positive with rotavirus-negative in hospitalized childrenwith acute gastroenteritis. Furthermore, the difference of the level of treatment betweenrotavirus-positive with rotavirus-negative was also evaluated. This was a cross sectionalstudy that using secondary data from medical records of five general teaching hospital inIndonesia. Subjects were children aged <5 years with acute watery diarrhea admitted tothe hospital. Statistical analysis used was chi square test, U-Mann Whitney, and KruskalWallis. The results showed that the patient with rotavirus positive have higher dehydration(80.2%) compared to rotavirus negative (70%). The severity level of clinical feature washigher in diarrhea due to rotavirus positive than non rotavirus (11.47± 2.89 vs 10.41± 2.70; p<0.000). The level of treatment was higher in rotavirus positive. The majorityhad treatment plan C (47.7%) higher than plan B and A (45.6% and 30.9%; p<0.050).This was opposite with patient with rotavirus negative that majority had treatment inplan A (69.1%) higher than plan B and C (54.4% and 52.3%) (p<0.001). In conclusion,the severity of gastroentrities in children under 5 years using vesikari score are higher indiarrhea due to rotavirus positive than non rotavirus. The treatment level plan C is higherthan plan B and A in diarrhea due to rotavirus. This is opposite with non rotavirus majorityhave treatment in plan A higher than plan B and C

THE USE OF THE THEORY OF PLANNED BEHAVIOR TO PREDICT FACTORS INFLUENCING PHYSICIANS' DECISION TO PRESCRIBE EXTEMPORANEOUS COMPOUNDING DOSAGE FORM FOR PEDIATRIC OUTPATIENTS

ABSTRACTObjective: To explore the potential utility of the theory of planned behavior (TPB) in predicting intentions to prescribe extemporaneous compoundingdosage form and to determine the salient beliefs associated with this intention.Methods: A cross-sectional survey design was utilized in this study. Participants of 249 physicians from Yogyakarta province completed a questionnairebased on the TPB. The questionnaires assessed TPB variables that are beliefs, attitude, subjective norm (SN), the perception of control, intention, andan additional variable of past behavior. The data were analyzed with multiple linear regressions.Results: Attitude, SN, and perception of control of the TPB components accounted for 58.6% of the variance in the prescribing intentions. The model wasstatistically significant (p&lt;0.001). Attitude had the strongest impact on intentions. The additional variable of past behavior increased 61.9% to the explainedvariance in intentions (p&lt;0.001). Participants' beliefs in the benefit of compounding prescription were the strongest predictor of the decision to prescribe.Conclusion: The TPB model provides information that attitudes, norms subektif, and perceived behavioral control were useful predictors forintentions to prescribe compounding. Past behavior variable increases the proportion to explain the variance of intention. The aAttitude was the mostpowerful predictor of physicians' intention to prescribe extemporaneous compounding dosage form for pediatric outpatient.Keywords: The theory of planned behavior, Extemporaneous compounding, Pediatric outpatients, Prescription

Top ten caring needs of emergency department patients in Banyumas, Central Java province, Indonesia: patient’s needs and cultural approach

Background: Nursing care based on characteristic and concept of caring will give positive impact to quality of care. Application of caring in nursing must correspond to local cultural value and patient’s needs. Objective this research explored the caring needs for patients in emergency unit of three district general hospitals (Rumah Sakit Umum Daerah/RSUD) in Banyumas area, Central Java Province, Indonesia.Methods: This need assessment research involved 50 emergency unit patients from three hospitals in Banyumas. Data was collected through interview to complete the list of patient’s caring needs in emergency department. Data were analysed through content analysis, validated by five emergency nursing experts and practitioners.Results: The ten most common caring needs of patients in emergency department included: prompt and responsive care; clear information delivery; friendliness, politeness and fairness; clarity and simplicity of administration; clean and comfortable room; short waiting time for care and admission to ward; competent in procedures; providing care, pray and motivation to patients; complete facility and devices; and room safety.Conclusions: Caring needs of emergency patients in Banyumas area district general hospitals encompass administration, behavioural and enviromental aspects. This result can be considered by hospitals to improve the quality of care in emergency department. Future researches shall be done to acquire more comprehensive measurement tool of caring, involving administration, behavioural and enviromental aspects in emergency department

Genotyping of Rotavirus by Using RT-PCR Methods

There is a great diversity of rotavirus genotypes circulating worldwide, with dominant genotypes changing from year to year. Rotavirus genotyping was performed by using reverse transcription PCR with type-specifi c-primers. Since rotavirus is a RNA virus that has high mutation rate, there was a possibility of technical diffi culty in genotyping due to mutation in the primer binding sites. During Indonesian rotavirus surveillance study 2006-2009, it was reported that 17% of samples subjected for G type and 21% of samplessubjected for P type were untypeable. The objective of this study was to identify genotypes of the samples that were untypeable previously using RT-PCR based on the method described by Das et al. (1994) and Gentsch et al. (1992). There were 30 samples subjected to G type and 61 samples subjected to P type to be re-typed using method described by Gouvea et al. (1990) and Simmond et al. (2008) for G and P typing, respectively. By using another set of primer, the genotype of all samples was identifi ed. This study highlights the importance of a constant reconsideration of primer sequences employed for the molecular typing of rotaviruses. Key words: rotavirus, G typing, P typin

SEMBILAN LANGKAH PENDIDIKAN KESEHATAN TENTANG PERAWATAN DAN PENCEGAHAN DIARE

Diare merupakan masalah kesehatan utama pada anak dan penyebab kematian kedua di dunia setelah pneumonia. Kejadian diare akut pada anak di rumah sakit di Wonosobo tahun 2013 menduduki urutan pertama dari keseluruhan penyakit anak. Salah satu faktor risiko terjadinya diare dan meningkatnya risiko anak untuk dirawat adalah kurang pengetahuan. Keterlibatan ibu dalam perawatan anak diare sangatlah penting, sehingga diperlukan pendidikan kesehatan. Tujuan penelitian mengidentifikasi pengaruh pendidikan kesehatan dengan 9 (sembilan) langkah terhadap pengetahuan dan sikap ibu dalam merawat pasien balita diare. Penelitian quasi experimental design dengan rancangan nonrandomized control group pre test post test. Responden berjumlahh 33 ibu dari balita penderita diare di dua rumah sakit di Wonosobo pada masingmasing kelompok (kelompok intervensi dan kontrol). Pengumpulan data menggunakan kuesioner. Pendidikan kesehatan menggunakan 9 langkah dari Gagne dengan media booklet dan video dari MTBS. Analisis data menggunakan Paired T test, T test independent. Hasil penelitian, karakteristik responden meliputi usia, pendidikan, pendapatan, pengalaman dan pernah mendapat informasi dari kedua kelompok adalah homogen. Hasil post test antara kelompok intervensi dan kontrol terdapat perbedaan yang bermakna (α=0,05) pada rata-rata nilai pengetahuan (p=0,007) dan sikap (p=0,047). Rata-rata peningkatan nilai pengetahuan dan sikap antara kelompok intervensi dan kontrol menunjukkan perbedaan bermakna (p=0,000). Pendidikan kesehatan dengan 9langkah, berpengaruh terhadap peningkatan pengetahuan dan sikap ibu dalam merawat pasien diare.Rekomendasi, Pendidikan kesehatan 9 langkah sebaiknya digunakan dalam memberikan pendidikan kesehatan di tempat pelayanan kesehatan agar terjadi peningkatan pengetahuan dan sikap.Kata Kunci : diare, pendidikan kesehatan, perawatan diare balita

Indeks massa tubuh dan aktivitas fisik dengan tekanan darah pada pelajar SMA

Background:  A trend towards in increase of hypertension in adults and children. If criteria of hypertension according to JNC VII 2003 applied to the population aged 15-17 years in Indonesia, the prevalence of hypertension in adolescents was obtained 5.3% nationally. Examination of blood pressure and factors related to blood pressure are of particular importance in children due to the decline in physical activity and weight changes contributing to blood pressure elevations that occur at this point in maturation. Blood pressure levels begin to increase as children approach adolescence. Weight control and physical activity regularly are recommended to prevent blood pressure elevations in both adult and youth.Objective: Determine the relationship between body mass index and physical activity with blood pressure in high school students in Pekanbaru.Method: This is an analytic observational study with cross sectional design. This study was involved 353 high school students in Pekanbaru who meets inclusion and exclusion criteria through cluster sampling technique. Data collected by direct measurements such as weight, height and blood pressure whereas physical activity and characteristic of the subject was collected by questionnaire. The results of the data collection were analyzed using univariate, bivariate and multivariate analysis.Results: There is a correlation between body mass index with systolic (p=0.000; r=0.238) and diastolic blood pressure (p=0.010; r=0.136). Each increase in 1 kg/m2 body mass index was linked with an increase of 2.339 mmHg systolic blood pressure and 0.979 mmHg diastolic blood pressure. However, there is no correlation between physical activity with systolic (p=0.829) nor diastolic blood pressure (p=0,643). Multivariate analysis showed that sex and screen time activity were factors most dominantly affecting blood pressure.Conclusion: There is a correlation between body mass index with blood pressure. However, there is no correlation between physical activity with blood pressure

NEED ASSESSMENT PERENCANAAN PULANG ANAK DIARE

Diare merupakan masalah kesehatan yang sangat lazim terjadi pada anak dan menjadi penyebab utama angka kematian anak baik di dunia maupun di Indonesia. Kegiatan perencanaan pulang harus menjadi salah satu intervensi pada perawatan anak diare di rumah sakit karena denganpemberian perencanaan pulang, dapat mengurangi dampak dari suatu keadaan kesehatan, meningkatkan kepuasan sekaligus mencegah rehospitalisasi. Tujuan penelitian ini untuk mengeksplorasi kebutuhan pasien dan keluarga untuk perencanaan pulang anak diare ditinjau dariperspektif orang tua, dokter, perawat, dan ahli gizi di rumah sakit. Penelitian ini merupakan penelitian kualitatif dengan pendekatan exploratif single case study dengan holistic unit analysis. Penentuan responden dengan purposive sampling. Responden berjumlah 14 orang yang terdiri atas 6 orang tua, 2 dokter spesialis anak, 5 perawat dan 1 ahli gizi. Pengumpulan data dengan wawancara mendalam dan diskusi kelompok terarah. Analisis data dengan menggunakan analisis deskriptif terhadap kasus. Hasil: Kebutuhan yang teridentifikasi dalam penelitian ini terdiri atas tiga kategori utama yaitu kebutuhan terhadap informasi yang meliputi informasi tentang penyakit diare dan perawatannya, kebutuhan pelayanan oleh dokter, perawat dan ahli gizi serta kebutuhan metode pemberian perencanaan pulang yang meliputi waktu, tempat, metode dan media.Kata kunci: anak, diare, need assessment, perencanaan pulan

EVALUASI TERAPI REHIDRASI DAN MENERUSKAN NUTRISI UNTUK DIARE AKUT TANPA DEHIDRASI PADA ANAK BALITA DI RSUD DI BANTUL

Background: Diarrhea is one of the leading causes of death in children under five (WHO, 2013 &amp; 2016). The main causes of infant and child deaths from diarrhea are severe dehydration (IDHS, 2012). Bantul Regency is one of the districts that has a high number of diarrhea cases in DIY. Diarrhea cases in Bantul district in 2014 were 20,729 cases or 26.87% of the total cases of diarrhea in DIY (DIY Profile, 2015). Objective: To evaluate the indicators of rehydration therapy and continue the nutrition for acute diarrhea without dehydration in children under five in Panembahan Senopati General Hospital. Method: This research is a case study with an explanatory descriptive design. The source of evidence used was documentation of medical records of patients with acute diarrhea without dehydration in children under five June-August 2016 as quantitative data, triangulation was carried out by observation, FGD and interviews as qualitative data. Results: Management of rehydration therapy and continuing food and / or breast milk still need to be improved (n = 30), namely 27% rehydration therapy and 23% continue to eat and / or breast milk no documentation due to limited documentation time but edited. Conclusion: There is a mismatch of management of rehydration therapy and continued eating and / or breast milk due to limited time in documentation.Latar belakang: Diare merupakan salah satu penyebab kematian utama pada anak balita (WHO, 2013 &amp; 2016). Penyebab utama kematian bayi dan anak akibat diare adalah keadaan dehidrasi yang berat (SDKI, 2012). Kabupaten Bantul merupakan salah satu kabupaten yang memiliki jumlah kasus diare yang tinggi di DIY. Kasus diare di kabupaten Bantul pada tahun 2014 sebanyak 20.729 kasus atau 26,87% dari total kasus diare di DIY (Profil DIY, 2015). Tujuan: Mengevaluasi indikator terapi rehidrasi dan meneruskan nutrisi untuk diare akut tanpa dehidrasi pada anak balita di RSUD Panembahan Senopati. Metode: Penelitian ini merupakan penelitian studi kasus dengan rancangan deskriptif eksplanatori. Sumber bukti yang digunakan adalah dokumentasi rekam medis pasien diare akut tanpa dehidrasi pada anak balita Juni-Agustus 2016 sebagai data kuantitatif, yang dilakukan triangulasi dengan cara observasi, FGD dan wawancara sebagai data kualitatif. Hasil: Tatalaksana terapi rehidrasi dan meneruskan makanan dan/atau ASI masih perlu ditingkatkan (n=30), yaitu 27% terapi rehidrasi dan 23 % meneruskan makan dan/atau ASI tidak ada dokumentasi karena keterbatasan waktu pendokumentasian tapi diedukasikan. Kesimpulan: Terdapat ketidaksesuaian tatalaksana terapi rehidrasi dan meneruskan makan dan/atau ASI yang disebabkan keterbatasan waktu dalam pendokumentasian

Risk of nutritional status on diarrhea among under five children

Background Diarrhea is still the leading cause of children’s mortality worldwide and the main cause of malnutrition. Meanwhile, malnourished children are proven to have more severe, prolonged, and frequent episodes of diarrhea, making them a vicious circle. Objective To investigate the risk of nutritional status on diarrheal severity and duration as well as length of hospital stay. Methods We conducted a cross sectional study involving 176 under five children who admitted to Mataram Province Hospital with acute diarrhea since January until December 2013. We analyzed data using logistic regression model. Results Most subjects were infants (median 12 months, range 1-53), male (56.8%), well-nourished (85.8%), admitted with acute watery diarrhea (97.2%), mild-to-moderate dehydration (71.6%), diarrhea severity score ≥11 (74.4%), duration of diarrhea ≤7 days (96.6%), and length of stay <5 days (73.3%). Logistic regression model indicated significant risk of nutritional status on length of hospital stay (adjusted OR 2.09, 95% CI 1.06 to 6.38), but neither diarrheal severity (adjusted OR 1.03, 95% CI 0.38 to 2.80) nor duration of diarrhea (adjusted OR = 1.17, 95% CI = 0.13 to 10.89) indicated significant risks. However, malnourished children had more severe (76% versus 74.2%) and longer duration (4% versus 3.3%) of diarrhea than well-nourished children. Conclusion Nutritional status is the risk for length of hospital stay in under-five children admitted with acute diarrhea.