Onset of menarche: differences between urban and rural community in Tangerang District, Banten Province, Indonesia

The transition of physical and sexual maturation in becoming an adult occurs in adolescenceperiod. This transition runs in parallel with the development of cognitive, emotional, socialcultural and adaptation ability. Girls sexual maturity is marked by first menstruation (menarche)which is the most important phase of reproductive development. The relationship betweenmenarche and growth rate of body height is very close. The menarche occurs when the growthrate of the body height begins to decline. Many factors influence the onset of menarche i.e.physical activity, nutritional intake, socio economic and environmental conditions and availabilityof medical services. These factors vary between rural and urban area. Girls in urban area tend tohave modest life style compared with their counterpart in rural area. The purpose of this studywas to compare the onset of menarche of girls in urban and rural area, and to identify factorsthat influence the onset of menarche. This was a cross sectional study involving 220 girlsstudents of elementary school from both urban and rural area in Tangerang District, BantenProvince. The mean onset of menarche of all subjects was 11.46 ± 0.99 years, while the meanonset of menarche of girls who live in rural area (11.87±0.99 years) was significantly slowerthan girls who live in urban area (11.05±0.80 years) (p=0.01). The birth body weight and birthbody length, physical activity and environment condition significantly influenced the onset ofmenarche. The girls who live in urban areas had an earlier predictor factors to achieve for onsetof menarche than those who live in rural areas (OR: 3.34 [95% CI: 1.911 to 5.823] and aOR:2.95 [95% CI: 1.410 - 6.012]).Keywords: menarche - growth spurt - sexual maturity - urban - rural communit

The Readiness of Students to Learn Interprofessional Teamwork in Antenatal Care

Introduction: Indonesia as a developing country have a higher Maternal Mortality Rate (MMR). The prevention efforts is developing interprofessional collaborative practice (IPCP) in the level of health care. Collaboration attitudes should start from education level through interprofessional education training and simulation for student. The objective of this study was to analyze the effect of interprofessional education training toward the readiness of students to learn interprofessional teamwork in antenatal care. Methods: Quasi-experimental design (pre test and post test without control) with Time-Series Design. Participants used in this study were students of five semester in STIKes Karya Husada Kediri year of 2011/2012 and the number of samples are 60 students. Technique sampling using simple random. The data collected by used questionnaires Readiness Interprofessional Learning Scale (RIPLS) and checklist observations using Teamwork Score (TWS). Anova, Friedman test, and Kruskal Wallis was used to statistically analyzed the data. Results: Readiness to learn interprofessional teamwork indicates the value of p = 0.001 thats means there are significant differences between the readiness before and after training IPE. Delta test showed that p value > 0.05 so there is no difference between the three programs study on readiness to learn interprofessional teamwork in antenatal care. Discussion: Interprofessional education training using simulation methods can affect the readiness of nursing, midwifery and nutritionist students for learning interprofessional teamwork in antenatal care

DESAIN ALAT BANTU MAKAN UNTUK PENDERITA CEREBRAL PALSY

Motoric and sensoric disorders are commonly experienced by children with cerebral palsy, such as grasping, gripping, pinching, sitting, and standing, as well as walking. Thedeficiency of one or more of those basic functions could be the causes of dependency and decrease children\u27s quality of life. Upper extermity disorder is the most physical limitation which experienced by children with cerebral palsy. It has been experienced by 80% of them. The study on 84 children with cerebral palsy describes there are 1,075kinds of supporting devices, and 980of those devices are used to support mobility, individual care, and social functions. Moreover, the preliminary study on 20 children with cerebral palsy in age 2 -18 shown the percentage of their upper extremity function level which is 40% minimum, and 60% has low quality of life. The aim of this study was to develop a design of eating devices for cerebral palsy children. As many as 51 participants who have inclusion and exclusion criteria have been involved. Their fuction level of upper extremity have measured by The Action ResearchArm Test(ARAT). Thisstudy has produced twoprototypes of spoon (C model and F model) that can be used by children with cerebral palsy in age 3 - 18. Based on C and F model, then derived to several kinds of prototypes, such as big spoon C model for right and left hand, small spoon C model for right and left hand, big spoon F model for right hand, and small spoon F model for left hand. Twokinds of spoonprototypes, that can be used by children with cerebral palsy, have been produced. First prototype is C model for those who have good upper extremity function level. The other one is F model which can be used by those who have low level of upper extremity function. Both Cand F model have been developed to two sizes (big and small), and two sites (right and left). ). The angle of elbow when the CP\u27s children moved their fingers to the mouth was measured. It has found that the angle of elbow was4~ to 9(/, so that the curvature of the spoon was 13~, as thesum of the minimum angle and themaximum angle

Faktor risiko kematian neonatus di Instalasi Maternal Perinatal RS Dr. Sardjito, Yogyakarta

ABSTRACT Tri Yanti, Setya Wandita, Sunartini-Hapsara, Achmad Surjono - Risk factors of neonatal mortality in Maternal Perinatal Installation Dr. Sardjito Hospital, Yogyakarta Background: Neonatal mortality rate in Indonesia is still relatively high. There are many factors influencing the outcome of neonatal life. Identifying the risk factors is important to prevent neonatal mortality. The intervention could be done by avoiding or minimizing the risk factors. Objective: To know the risk factors of neonatal mortality in Maternal Perinatal Installation, Dr. Sardjito Hospital Yogyakarta, and the contribution of these risk factors. Methods: One hundred and twenty three newborns in Maternal Perinatal Installation Dr Sardjito Hospital from 1 February 2003 to 28 February 2004 were enrolled in this study, consisting of 41 infants birth alive and all died during hospitalization, and 82 infants alive when discharged from the hospital as control. The data was taken from medical records. Cases were infants those died and control were infants alive when discharged from hospital, and then risk factors were identified. Result: The risk factors that significantly related to neonatal mortality in univariate analysis were sepsis (OR=4.2695%C1:1.9-9.4), prematurity (OR=3.2695%C1:1.5-7.2), low birth weight (OR =3.4195%C1:1.6-7.5), major congenital anomaly (OR =4.2995%C1:1.6-11.5), low Apgar score at 5 minute (OR 4.6895% CI:1.8-11.9) and hyalin membrane disease (OR =12.9095% C1:2.7-62.3). By multivariate analysis, in order of higher contribution, major congenital anomaly (OR =34.8095% C1:6.7-182.2), hyalin membran disease (OR =15.0095% C1:2.3-96.5), low Apgar score at 5 minute (OR=9.1695% C1:1.8-48.0), and sepsis (OR 6.0495% C1:1.9-18.9) were significantly related to neonatal mortality. Conclusion: Major congenital anomaly, hyalin membrane disease, sepsis neonatorum and low Apgar score at 5 minute were risk factors of neonatal mortality. Key words: neonatal mortality - sepsis neonatorum - low birth weight - major congenital anomaly - low Apgar score at 5 minute - hyalin membrane disease

Mutation spectrum analysis of DMD gene in Indonesian Duchenne and Becker muscular dystrophy patients [version 3; peer review: 2 approved]

Background Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are allelic disorders caused by mutations in the DMD gene. The full mutation spectrum of the DMD gene in Indonesian patients is currently unknown. Mutation-specific therapies are currently being developed, such as exon skipping or stop codon read-through therapy. This study was conducted with the aim of identifying the mutation spectrum of the DMD gene in Indonesia to guide future development and application of feasible therapeutic strategies. Methods This study is a cross sectional study that enrolled 43 male patients with a clinical suspicion of DMD or BMD. Multiplex ligation-dependent probe amplification (MLPA) reaction was performed to screen for the common mutations in the DMD gene. Results Out of 43 subjects, deletions accounted for 69.77% (n=30) cases, while duplications were found in 11.63% (n=5) cases. One novel duplication spanning exons 2 to 62 was identified. Deletion mutations clustered around the distal (66.67%) and proximal (26.67%) hot spot regions of the DMD gene while duplication mutations were observed solely at the proximal region. Two false positive cases of single exon deletion detected through MLPA were attributed to sequence mutations affecting primer ligation sites, confirming the need to validate all single exon deletions when using this screening method. Analysis of available maternal DNA samples showed that the rate of de novo mutations (48.15%) appears higher than expected in this population. Out of 31 patients who were classified as DMD based on clinical and genotype characterizations, 60.47% (n=26) of cases were suitable for exon skipping therapy. Conclusion This is the first comprehensive study showing the feasibility of implementing the MLPA method for routine screening of DMD patients in Indonesia. This is also the first study showing the potential applicability of exon skipping therapy in the majority of DMD cases in the country

The duration of playing Play Station@ as a risk factor of obesity in school age children in Yogyakarta

Background Childhood obesity is a common health problem. There are multi-factors causing childhood obesity. One of them is lack of activity like watching television, playing computer, and playing Play Station@ . Objective The aim of this study was to find the duration of playing Play Station@ as a risk factor of obesity in school age children. Methods This study was a case–control study with individual matching, that was done since April 2004 until August 2004. Results Children who spent time for playing Play Station@ more than two hours per day had the risk of obesity 22 times higher than those who spent less than two hours per day with 95% confidence interval. These results were analyzed with chi square test. Conclusion Playing Play Station@ is a risk factor of obesity in school age children

Hubungan Antara Parameter Hematologi saat Perawatan Fase Induksi dengan Kejadian Demam Neutropenia pada Anak Leukemia Limfoblastik Akut

Latar belakang. Demam neutropenia yang terjadi, terutama fase induksi, merupakan keadaan yang mengancam jiwa serta membutuhkan penanganan yang cepat dan segera. Di RSUP Dr. Sardjito, tingkat mortalitas 11% dari 25% insiden demam neutropenia pada Leukemia Limfoblastik Akut (LLA) fase induksi. Parameter hematologi diduga berperan terhadap kejadian demam neutropenia pada anak LLA fase induksi. Tujuan. Mengetahui hubungan antara parameter hematologi terhadap kejadian demam neutropenia anak LLA pada fase induksi. Metode. Penelitian kasus-kontrol dengan besar sampel 100 anak. Penelitian dilakukan pada pasien yang sedang dan telah menjalani Indonesian Protocol Acute Lymphoblastic Leukemia (ALL) 2006 fase induksi, menderita demam neutropenia, dan berusia kurang dari 18 tahun. Sampel diambil secara konsekutif berdasarkan data rekam medik dan dilakukan matching berdasarkan usia, jenis kelamin, dan demam neutropenia yang terjadi pertama kali saat perawatan. Uji statistik dengan kai kuadrat dan analisis multivariat dengan regresi logistik. Hasil. Secara statistik, hasil analisis multivariat menunjukkan monositopenia dengan jumlah monosit ≤100/mm3 dan merupakan satu-satunya variabel yang berkaitan dengan kejadian demam neutropenia, OR 3,570 (p=0,005;95%CI=1,466-8,695). Kesimpulan. Monositopenia dengan jumlah monosit ≤100/mm3 berhubungan dengan kejadian demam neutropenia pada anak LLA fase induksi

Kejang Berulang dan Status Epileptikus pada Ensefalitis sebagai Faktor Risiko Epilepsi Pascaensefalitis

Latar belakang. Epilepsi pascaensefalitis merupakan salah satu komplikasi ensefalitis yang sering terjadi serta memerlukan tata laksana jangka panjang dan menurunkan kualitas hidup pasien. Kejang berulang dan status epileptikus pada ensefalitis dicurigai dapat meningkatkan risiko terjadi epilepsi pascaensefalitis. Tujuan. Mengetahui apakah risiko epilepsi pascaensefalitis lebih tinggi pada pasien yang mengalami kejang berulang dan status epileptikus pada ensefalitis. Metode. Penelitian kasus kontrol pada pasien pascaensefalitis usia 6 bulan-18 tahun dilakukan di bangsal anak RSUP Dr. Sardjito, Yogyakarta. Kelompok kasus terdiri dari 26 pasien dengan diagnosis epilepsi pascaensefalitis, 27 pasien pascaensefalitis dengan gejala sisa selain epilepsi atau tanpa gejala sisa sebagai kelompok kontrol. Data klinis subyek selama episode ensefalitis akut didapatkan dari rekam medis pasien saat dirawat. Kekuatan hubungan antara variabel independen dengan variabel dependen diketahui berdasarkan analisis bivariat dan analisis multivariat. Hasil. Kejang berulang ensefalitis akut meningkatkan risiko terjadinya epilepsi pascaensefalitis (OR 3,6;95 % CI 1,0-12,7; p0,05). Kesimpulan. Kejang berulang ensefalitis meningkatkan risiko terjadinya epilepsi pascaensefalitis. Status epileptikus pada ensefalitis secara klinis meningkatkan risiko terjadinya epilepsi pascaensefalitis, tetapi secara statistik tidak bermakna