The National Health Insurance Implementation: Socialization and the Readiness of Health Facility in South Konawe Regency 2014

The National Health Insurance (NHI) in Indonesia has been starting from 1st of January 2014 to gradually achieve Universal Health Coverage (UHC) through Executor Agency of Social Assurance (BPJS) as mandated by the Act to facilitate public access to quality health services. Society needs to know NHI to utilize the appropriate rights and obligations. This research was to find out implementation NHI in South Konawe. Qualitative research method through in-depth interviews with five key informants and eight regular informants, observation and searching of documents related to the implementation of health institutions NHI. Research instruments were in the form of a list of questions, the voice recorder — primary data collected through interviews and secondary data in documents. Then carried Editing and Coding on the results of the interview transcript. Conclusion and validity of the data with a method of triangulation. By using content analysis. Dissemination has been carried out by government officials and health workers in the community directly and indirectly through print media such as posters and brochures and electronic media throughout the health centers in South Konawe. BPJS has worked with 23 community health centers and a hospital unit. The number of Participants NHI in South Konawe 2014 as many as 58.42% of 280.086 inhabitants. The facilities and health personnel were generally adequate.Implementation NHI in South Konawe still in the stage of stabilization towards UHC. Keywords: National Health Insurance; readiness of health facility; socializatio

Prediksi Kejadian Penyakit Tb Paru Bta Positif di Kota Kendari Tahun 2016-2020

Tuberkulosis (TB) adalah penyakit menular yang disebabkan oleh Mycobacterium Tuberculosis Bacillus.Penyakit ini menyebar di udara ketika orang yang tertular dengan bakteri TB misalnya batuk atau bersin.Tuberkulosis masih menjadi masalah kesehatan global utama karena menyebabkan gangguan kesehatan antarajutaan orang setiap tahun dan menjadi penyebab utama kedua kematian akibat penyakit menular di seluruhdunia setelah HIV/AIDS. Rendahnya kemampuan dalam mengantisipasi kejadian TB Paru BTA Positif di kotaKendari antara lain disebabkan karena waktu, tempat dan angka kejadian belum dapat diprediksi dengan baikdan belum tersedianya peta kerentanan wilayah berdasarkan waktu kejadian, sehingga kasus TB Paru BTAPositif khususnya yang terjadi di kota Kendari terus meningkat setiap tahunnya. Penelitian ini bertujuan untukmengetahui mengetahui trend penyakit TB paru BTA Positif tahun 2010-2014 berdasarkan umur, jenis kelamin,puskesmas se-kota Kendari, dan kejadian kasus keseluruhan tahun 2010-2014 kemudian diprediksi pada tahun2016 hingga tahun 2020. Jenis penelitian adalah penelitian studi deskriptif dengan menggunakan analisisrangkaian waktu. Populasi dan sampel dalam penelitian ini adalah seluruh data kasus TB Paru BTA Positif yangdidalamnya tercantum umur dan jenis kelamin penderita selama tahun 2010 – 2014 di kota Kendari. Hasilpenelitian ini menunjukan bahwa trend kasus TB Paru BTA Positif berdasarkan kelompok umur, jenis kelamin,puskesmas se-kota Kendari dan kejadian kasus keseluruhan di Kota Kendari diramalkan akan terus meningkat.Adapun rekomendasi dalam penelitian ini adalah perlu dilakukan upaya-upaya pencegahan dengan melibatkanpara pengambil kebijakan dan para kader-kader terlatih khususnya dalam pencegahan penyakit tuberkulosissehingga dapat mengurangi tingginya angka kasus prediksi kejadian TB Paru BTA Positif di masa depan

Muscle Fatigue Analysis Using OpenSim

In this research, attempts are made to conduct concrete muscle fatigue analysis of arbitrary motions on OpenSim, a digital human modeling platform. A plug-in is written on the base of a muscle fatigue model, which makes it possible to calculate the decline of force-output capability of each muscle along time. The plug-in is tested on a three-dimensional, 29 degree-of-freedom human model. Motion data is obtained by motion capturing during an arbitrary running at a speed of 3.96 m/s. Ten muscles are selected for concrete analysis. As a result, the force-output capability of these muscles reduced to 60%-70% after 10 minutes' running, on a general basis. Erector spinae, which loses 39.2% of its maximal capability, is found to be more fatigue-exposed than the others. The influence of subject attributes (fatigability) is evaluated and discussed

Evolution and Reversible Polarity of Multilayering at the Ionic Liquid/Water Interface

Highly correlated positioning of ions underlies Coulomb interactions between ions and electrified interfaces within dense ionic fluids such as biological cells and ionic liquids. Recent work has shown that highly correlated ionic systems behave differently than dilute electrolyte solutions, and interest is focused upon characterizing the electrical and structural properties of the dense electrical double layers (EDLs) formed at internal interfaces. It has been a challenge for experiments to characterize the progressive development of the EDL on the nanoscale as the interfacial electric potential is varied over a range of positive and negative values. Here we address this challenge by measuring X-ray reflectivity from the interface between an ionic liquid (IL) and a dilute aqueous electrolyte solution over a range of interfacial potentials from −450 to 350 mV. The growth of alternately charged cation-rich and anion-rich layers was observed along with a polarity reversal of the layers as the potential changed sign. These data show that the structural development of an ionic multilayer-like EDL with increasing potential is similar to that suggested by phenomenological theories and MD simulations, although our data also reveal that the excess charge beyond the first ionic layer decays more rapidly than predicted

Key features of puberty onset and progression can help distinguish self-limited delayed puberty from congenital hypogonadotrophic hypogonadism

Introduction: Delayed puberty (DP) is a frequent concern for adolescents. The most common underlying aetiology is self-limited DP (SLDP). However, this can be difficult to differentiate from the more severe condition congenital hypogonadotrophic hypogonadism (HH), especially on first presentation of an adolescent patient with DP. This study sought to elucidate phenotypic differences between the two diagnoses, in order to optimise patient management and pubertal development. Methods: This was a study of a UK DP cohort managed 2015-2023, identified through the NIHR clinical research network. Patients were followed longitudinally until adulthood, with a definite diagnosis made: SLDP if they had spontaneously completed puberty by age 18 years; HH if they had not commenced (complete, cHH), or had commenced but not completed puberty (partial, pHH), by this stage. Phenotypic data pertaining to auxology, Tanner staging, biochemistry, bone age and hormonal treatment at presentation and during puberty were retrospectively analysed. Results: 78 patients were included. 52 (66.7%) patients had SLDP and 26 (33.3%) patients had HH, comprising 17 (65.4%) pHH and 9 (34.6%) cHH patients. Probands were predominantly male (90.4%). Male SLDP patients presented with significantly lower height and weight standard deviation scores than HH patients (height p=0.004, weight p=0.021). 15.4% of SLDP compared to 38.5% of HH patients had classical associated features of HH (micropenis, cryptorchidism, anosmia, etc. p=0.023). 73.1% of patients with SLDP and 43.3% with HH had a family history of DP (p=0.007). Mean first recorded luteinizing hormone (LH) and inhibin B were lower in male patients with HH, particularly in cHH patients, but not discriminatory. There were no significant differences identified in blood concentrations of FSH, testosterone or AMH at presentation, or in bone age delay. Discussion: Key clinical markers of auxology, associated signs including micropenis, and serum inhibin B may help distinguish between SLDP and HH in patients presenting with pubertal delay, and can be incorporated into clinical assessment to improve diagnostic accuracy for adolescents. However, the distinction between HH, particularly partial HH, and SLDP remains problematic. Further research into an integrated framework or scoring system would be useful in aiding clinician decision-making and optimization of treatment.  

Burden of liver disease progression in hospitalized patients with type 2 diabetes mellitus

BACKGROUND AND AIMS: There are uncertainties on the burden of liver disease in patients with type-2 diabetes (T2D). METHODS: We measured adjusted hazard ratios of liver disease progression to hepatocellular cancer and/or decompensated cirrhosis in a 2010-2020 retrospective, bicentric, longitudinal, cohort of 52,066 hospitalized patients with T2D. RESULTS: Mean age was 64±14 years and 58% were men. Alcohol use disorders accounted for 57% of liver-related complications and were associated with all liver-related risk factors. Non-metabolic liver-related risk factors accounted for 37% of the liver burden. T2D control was not associated with liver disease progression. The incidence (95% confidence interval) of liver-related complications and of competing mortality were 3.9 (3.5-4.3) and 27.8 (26.7-28.9) per 1000 person-years at risk, respectively. The cumulative incidence of liver disease progression exceeded the cumulative incidence of competing mortality only in the presence of a well-identified risk factors of liver disease progression, including alcohol use. The incidence of hepatocellular cancer was 0.3 (95% CI, 0.1-0.5) per 1000 person-year in patients with obesity and it increased with age. The adjusted hazard ratios of liver disease progression were 55.7 (40.5-76.6), 3.5 (2.3-5.2), 8.9 (6.9-11.5), and 1.5 (1.1-2.1), for alcoholic liver disease, alcohol use disorders without alcoholic liver disease, non-metabolic liver-related risk factors, and obesity, respectively. The attributable fractions of alcohol use disorders, non-metabolic liver risk-related risk factors, and obesity to the liver burden were 55%, 14%, and 7%, respectively. CONCLUSIONS: In this analysis of data from two hospital-based cohorts of patients with T2D, alcohol use disorders, rather than obesity, contributed to most of the liver burden. These results suggest that patients with T2D should be advised to drink minimal amounts of alcohol. LAY SUMMARY: • There is uncertainty on the burden of liver-related complications in patients with type-2 diabetes • We studied the risks of liver cancer and complications of liver disease in over 50,000 patients with type-2 diabetes • We found that alcohol was the main factor associated with complications of liver disease • This finding has major implications on the alcohol advice given to patients with type-2 diabetes

Presence of optrA-mediated linezolid resistance in multiple lineages and plasmids of Enterococcus faecalis revealed by long read sequencing

Funding: This work was supported by the Chief Scientist Office (Scotland) through the Scottish Healthcare Associated Infection Prevention Institute (Reference SIRN/10). Bioinformatics and Computational Biology analyses were supported by the University of St Andrews Bioinformatics Unit, which is funded by a Wellcome Trust ISSF award [grant 105621/Z/14/Z].Transferable linezolid resistance due to optrA, poxtA, cfr and cfr-like genes is increasingly detected in enterococci associated with animals and humans globally. We aimed to characterize the genetic environment of optrA in linezolid-resistant Enterococcus faecalis isolates from Scotland. Six linezolid-resistant E. faecalis isolated from urogenital samples were confirmed to carry the optrA gene by PCR. Short read (Illumina) sequencing showed the isolates were genetically distinct (>13900 core SNPs) and belonged to different MLST sequence types. Plasmid contents were examined using hybrid assembly of short and long read (Oxford Nanopore MinION) sequencing technologies. The optrA gene was located on distinct plasmids in each isolate, suggesting that transfer of a single plasmid did not contribute to optrA dissemination in this collection. pTM6294-2, BX5936-1 and pWE0438-1 were similar to optrA-positive plasmids from China and Japan, while the remaining three plasmids had limited similarity to other published examples. We identified the novel Tn6993 transposon in pWE0254-1 carrying linezolid (optrA), macrolide (ermB) and spectinomycin [ANT(9)-Ia] resistance genes. OptrA amino acid sequences differed by 0–20 residues. We report multiple variants of optrA on distinct plasmids in diverse strains of E. faecalis . It is important to identify the selection pressures driving the emergence and maintenance of resistance against linezolid to retain the clinical utility of this antibiotic.Publisher PDFPeer reviewe