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Abstract Background Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals’ skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. Methods This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. Results An initial 13-item tool was developed using a 1–5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0–3 Likert scale. The scale was found to have a Cronbach’s α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). Conclusion The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals’ behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals’ skills in addressing adolescent behaviour-related health problems.

The aim of this research is to determine the mechanisms and obstacles to managing village property, as mandated in Article 77 paragraph (1) of Law Number 6 of 2014. The research method used is empirical juridical. The type of data, namely primary data, was obtained through interviews and discussions (group discussion forum) with several parties to provide information related to the management of village property. Secondary data is data obtained from library literature. Data collection techniques commonly used are literature studies, interviews, observations. Qualitative descriptive data analysis techniques. The results of the research show that the mechanism for managing village property as mandated by Article 77 paragraph (1) of Law Number 6 of 2014 is planning, procurement, use, utilization, security, maintenance, deletion, transfer, administration, assessment, guidance, supervision and control. . Inventory village assets in the SIPADES application, check the depreciation in the value of goods, including land, buildings and other assets. Providing information about village asset management to the general public so that village asset management is reported annually. Obstacles to managing village-owned assets include lack of knowledge of human resources regarding village asset management, SIPADES officers being disorganized in inputting data, the community not caring about maintaining village assets, lack of communication regarding the implementation of village asset management regulations. The conclusion of this research is that the village's wealth management mechanism is to inventory its assets in the SIPADES application and can reduce problems.

Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents. Objective To investigate the prevalence of burnout in pediatric residents in Indonesia during the COVID-19 pandemic and to identify potential risk factors associated with burnout. Methods This analytic observational study was conducted between April and June 2020. A questionnaire-based survey using an Indonesian translation of the Maslach Burnout Inventory-Human Services Survey was conducted online across 15 pediatric training institutions treating COVID-19 patients in Indonesia. Results were interpreted in accordance with the inventory guidelines. The chi-square test was used to analyze for possible associations between each subscale and gender, marital status, training stage, as well as institution of origin. One-way ANOVA of each subscale was performed on pediatric training institutions located in different regions. Results Of 983 respondents (82% average response rate), the prevalences of high emotional exhaustion and high depersonalization were 28.0% and 15.8%, respectively, while more than half of respondents (50.2%) had a low sense of personal accomplishment. Most respondents felt more exhausted than depersonalized. The location of pediatric training institution (Java or outside Java) was the only significant factor associated with burnout (P=0.003). Conclusion In the early stages of the pandemic, more than half of pediatric residents in Indonesia had a low sense of personal accomplishment. The only significant factor associated with burnout among was the location of training institution (Java or outside Java), suggesting a potential role of differences in hospital situation and clinical learning environment during the pandemic between Java and outside Java.

This research aims to obtain facts, data, and information about the results of the evaluation of the achievement coaching program for the women's softball sports of DKI Jakarta Province. This study used evaluative methods with the CIPP model. Data collection techniques use questionnaires, documentation, observations, and interviews. The subjects of this study are The Core Board, Coach, and Athlete. The results revealed that the context component of the Pengprov Perbasasi DKI Jakarta already has a long-term, medium, and short-term plan. However, the DKI Jakarta Provincial Women's Softball Team was only able to achieve the goal of the achievement coaching program at the 2018 Softball National Tournament. The input components, facilities, equipment, and equipment provided are enough to meet the needs of the DKI Jakarta Provincial Women's Softball Team. However, the need for supplements and vitamins for new athletes ahead of the implementation of PON. In the process component, the coaching staff implements a walking selection system and promotes and degrades athletes based on batting average data, left on base, running base in, accumulation of errors, & success in sacrifice. The training process was carried out face-to-face and virtually during the Covid-19 pandemic. In the product component, the results obtained by the DKI Jakarta Provincial Women's Softball Team during the period 2018 to 2022 were finalists in the 2018 Softball National Tournament. However, in the 2019 PON Qualification and PON XX Papua in 2021, the DKI Jakarta Provincial Women's Softball Team was only able to rank fifth

Abstract Background Obesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds. Method In-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10–18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning. Results Nineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings. Conclusions Healthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

Objectives: Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Methods: We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children’s Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. Results: The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. Conclusions: It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.

This study aims to determine and analyze liquidity, profitability, leverage, and operational cash flow on financial distress in tourism companies, restaurants, and hotels listed on the Indonesia Stock Exchange in 2021. By measuring the effect of liquidity, profitability, leverage, and operational cash flow on financial distress. Financial distress is measured using the X-Score. The method of analysis of this research uses the logistic regression analysis method. The results of this study indicate that liquidity harms financial distress, profitability harms financial distress, leverage has a positive effect on financial distress, and the operational cash flow ratio does not affect financial distress. Keywords: Financial ratios; Financial Distress; Leverage; Oprational Cash Flow X-Score; Profitability Abstrak Penelitian ini bertujuan mengetahui dan menganalisis liquidity, profitability, leverage dan operational cash flow terhadap financial distress pada perusahaan pariwisata, restoran dan hotel yang terdaftar di Bursa Efek Indonesia tahun 2021. Dengan mengukur pengaruh liquidity, profitability, leverage dan operational cash flow terhadap financial distress. Financial distress diukur menggunakan X-Score. Metode analisis penelitian ini menggunakan metode analisis regresi logistik. Hasil penelitian ini menunjukkan bahwa liquidity berpengaruh negatif terhadap financial distress, profitability berpengaruh negatif terhadap financial distress, leverage berpengaruh positif terhadap financial distress, operational cash flow ratio tidak berpengaruh terhadap financial distress. Kata Kunci: Rasio Keuangan; Rasio Arus Kas Operasional; Kesulitan Keuangan; Profitabilitas; Manfaat X-Score

Coral reef ecosystems carry out a wide range of ecological functions and sustain the livelihoods of coastal communities through fisheries, coastal protection, and tourism. However, the coral condition has declined recently due to climate changes and anthropogenic activities. This study was undertaken in May 2019 to assess reef health status in Takabonerate and Wakatobi Marine National Park based on three components: live coral cover, resilience component (macroalgae and rubble cover), and fish biomass. The highest coral cover was 45.53% (Wanci), with an average cover of 24.6% and 29.48% in Takabonerate and Wakatobi. The average biomass of reef fish in Wakatobi was higher in Wakatobi (1.26 kg/ha) than in Takabonerate (0.70 kg/ha). For the resilience score, the average cover of macroalgae and rubble was 0.11% and 6.35% in Takabonerate and 1.64% and 0.51% in Wakatobi. Based on the coral, resilience, and biomass fish score, the Coral Health Index scored 5 (fair) and 9 (good) for Takabonerate and Wakatobi. The data suggested that reefs in both locations could recover from disturbance. However, the low biomass of targeted fish in the Takabonerate shows high fishing activities, which might lead to a direct/indirect impact on coral health.

Abstract Background Pre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the utilization of emergency medical services by patients attending hospital emergency departments in Jakarta, Indonesia. Methods The study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). Each patient’s demographic profile, medical conditions, time to treatment, and mode of transport to reach the hospital were analysed using descriptive statistics. Results A total of 1964 (62%) patients were surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. Life-threatening conditions such as trauma and cardiovascular disease were found in 8.6 and 6.6% of patients, respectively. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). An ambulance was used by only 9.3% of all patients and 38% of patients reported that they were not aware of the availability of ambulances. Ambulance response time was longer as compared to other modes of transportation (median: 24 minutes and IQR: 12 to 54 minutes). The longest time to treatment was experienced by patients with neurological disease, with a median time of 120 minutes (IQR: 78 to 270 minutes). Patients who used ambulances incurred higher costs as compared to those patients who did not use ambulances. Conclusion The low utilization of emergency ambulances in Jakarta could be contributed to patients’ lack of awareness of medical symptoms and the existence of ambulance services, and patients’ disinclination to use ambulances due to high costs and long response times. The emergency ambulance services can be improved by increasing population awareness on symptoms that warrant the use of ambulances and reducing the cost burden related to ambulance use.

BackgroundObesity is a growing public health and clinical concern, worldwide. In many countries, including Indonesia, health professionals lack the capacity to promote behavior change around obesity prevention and management, especially with adolescents for whom a wider set of communication skills are required. This study describes the theoretical basis, approach to development of content, use and satisfaction of an internet-based educational intervention designed to improve the quality of health professional weight management counseling with adolescents in Indonesia.MethodsThis study is part of an exploratory sequential mixed methods design which was undertaken from 2020 to 2022. Following a needs analysis, an internet-based training resource was developed, informed by constructive alignment theory and active learning principles. Using both synchronous and asynchronous approaches over a four-week pilot study, a weekly interactive session was held online, using multifaceted training materials housed on a website (https://ramahremaja.id). The training resource was then tested in a two-arm study involving health professionals from 17 of 34 provinces across Indonesia.ResultsSixty-four primary health professionals were recruited for the two-arm study. The completion rate for reviewing all materials and assignments on the website was 72% and the online meeting participation rate was 78%. Participants were highly positive about the clarity of the training material and the appropriateness of the delivery methods. The main challenges related to poor internet literacy and interrupted internet connectivity.ConclusionDesigned to support weight management in adolescents, this internet-based training program shows potential for enhancing Indonesian health professional behavior-change counseling skills.

Latar belakang. Efusi pleura merupakan salah satu tanda kebocoran plasma pada pasien demam berdarah dengue (DBD) yang dapat dinilai dengan indeks efusi pleura (IEP). Nilai trombosit, hematokrit, dan IEP dapat digunakan untuk mengidentifikasi keparahan DBD. Tujuan. Mengetahui perbedaan nilai trombosit, hematokrit, dan IEP antara pasien anak yang didiagnosis dengan sindrom syok dengue (SSD) dan DBD tanpa syok. Metode. Penelitian ini merupakan studi observasional analitik dengan desain cross-sectional. Sampel penelitian ini adalah anak usia 1 bulan−14 tahun. Analisis statistik bivariat dilakukan untuk mencari hubungan antara nilai trombosit, persentase hemokonsentrasi, dan IEP dengan kejadian SSD. Selanjutnya, dilakukan analisis multivariat dengan uji regresi logistik. Hasil. Hemokonsentrasi berperan secara signifikan sebagai preditor SSD (p=0,001 dan OR 1,102). Nilai IEP tidak bermakna sebagai prediktor SSD (p=0,052), tetapi IEP tetap dimasukkan ke dalam analisis menurut pertimbangan klinis. Sementara itu, angka trombosit tidak terbukti sebagai prediktor SSD dengan p=0,549 dan OR 1,000. Pada kurva ROC didapatkan titik potong skor prediktor SSD adalah -1,6 dengan titik potong hemokonsentrasi 23% dan IEP 25%. Pada analisis diagnostik titik potong skor prediktor tersebut untuk menilai kejadian SSD didapatkan sensitivitas 92% dan spesifisitas 83%. Kesimpulan. Indeks efusi pleura (IEP) bersama dengan hemokonsentrasi dapat digunakan sebagai faktor prediktor kejadian SSD pada anak. Skor prediktor >-1,6 memiliki kemungkinan terjadinya SSD 15,6 kali lebih besar dibandingkan skor prediktor ≤ -1,6.

Background: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. Methods: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. Results: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. Conclusion: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Background Recurrent abdominal pain is 2-4% of all cases encountered by pediatricians. Risk factors vary among countries. There is no data on prevalence and risk factors of recurrent abdominal pain in adolescents in Indonesia. Objective To evaluate prevalence and risk factors of recurrent abdominal pain in junior high school students. Methods A cross-sectional study was performed among junior high school students in South Jakarta who experienced recurrent abdominal pain according to Roma III criteria. Students allowed by their parents to participate to this study were asked to complete a Roma III questionnaire. Data about sociodemographic and history of recurrent abdominal pain among the parents were also collected using a questionnaire. ResultsThree hundred ninety-six adolescents participated in this study, 17.2% among them experiencing recurrentabdominal pain. Irritable bowel syndrome (IBS) was the most common type (42.6%), followed by functional dyspepsia (30.9%), functional abdominal pain syndrome (11.8%), functional abdominal pain (10.3%), and abdominal migraine (4.4%). The risk factor most responsible was anxious personality (OR 3.86; 95%CI 2.05 to 7.29, P 13 years, and middle to lower family income. Conclusions Prevalence of recurrent abdominal pain in adolescents is 17.2%. Irritable bowel syndrome is the most common type. The risk factors are anxious personality, female, age > 13 years, and middle to lower family income.

This study aims to re-examine the Profitability Ratio, Liquidity Ratio, Profitability Ratio, Financial Leverage Ratio, Cash Position Ratio, Growth Ratio, Operating Activity Ratio. Second, to determine the effect of financial distress on the activities of companies in the manufacturing industry sector on the Indonesia Stock Exchange for the 2019-2020 period. Is there an effect of financial ratios on activities for companies experiencing financial distress for the 2019-2020 period. The analytical tool used is logistic regression statistical analysis, while to determine whether the company is experiencing financial distress or not, it uses Altman's Z Score analysis. After testing, it was found that the cash position ratio and activity ratio had a significant effect on companies experiencing financial distress. Keywords: Financial Ratios, Financial Distress, Logistics Regression Statistics. Penelitian ini bertujuan untuk menguji kembali Rasio Profitabilitas, Rasio Likuiditas, Rasio Profitabilitas, Rasio Financial Leverage, Rasio Posisi Kas, Rasio Pertumbuhan, Rasio Aktivitas Operasi. Kedua, untuk mengetahui pengaruh financial distress terhadap aktivitas perusahaan pada sektor industri manufaktur di Bursa Efek Indonesia periode 2019-2020. Apakah ada pengaruh rasio keuangan terhadap aktivitas bagi perusahaan yang mengalami financial distress periode 2019-2020. Alat analisis yang digunakan adalah analisis statistik regresi logistik, sedangkan untuk mengetahui apakah perusahaan mengalami financial distress atau tidak digunakan analisis Altman's Z Score. Setelah dilakukan pengujian diketahui bahwa cash position ratio dan activity ratio berpengaruh signifikan terhadap perusahaan yang mengalami financial distress. Keywords : Rasio Keuangan, Kesulitan Keuangan, Statistik Regresi Logistik.

Abstract Background To date, there is limited evidence on the effect of antenatal exposure to non-organophosphate household pesticides on infant health. Our hypothesis is that antenatal exposure to non-organophosphate household pesticides will be associated with birth sizes and infant growth rate. Methods In this prospective cohort study, 284 mother-infant pairs were studied. Mothers were recruited at the third trimester in two primary care centers and one private hospital in Jakarta, Indonesia. Mothers filled out questionnaires about exposure to non-organophosphate household pesticides at the 3rd trimester of pregnancy. Birth weight and length were measured at birth. Afterwards, the weight, height, and head circumference (HC) were measured at 7 days, 1, 2, 4, and 6 months of age. Linear mixed modeling and linear regression was performed to calculate growth rate of each infant. Multivariable linear regression adjusted for confounders was used to assess the association between household pesticides exposure and birth sizes and infant growth rate. Results Based on self-report questionnaires, 133 (46.8%) mothers were exposed to household pesticides during pregnancy. The mean HC at day 7 in the exposed group was − 7.1 mm (95%CI -13.1;-1.2) lower than in the non-exposed group. The difference was more prominent in the non-mosquito pesticide group (linear regression coefficient: − 22.1 mm, 95%CI -36.5;-7.6). No material associations were found between antenatal exposure to household pesticides with other growth measures, including weight gain, length gain, HC increment and weight-to-length gain rates. No modification of effects by breastfeeding was found. Conclusions Our findings suggest that antenatal exposure to household non-organophosphate pesticides is associated with smaller head circumference at birth.

Objectives. To identify parameters that can improve the effectiveness of COVID-19 screening in the pediatric population according to the demographic, clinical, and epidemiological characteristics of pediatric patients screened for COVID-19 at our hospital. Methods. A cross-sectional study of suspected and confirmed pediatric patients (0–18 years old) with COVID-19 using data from the electronic medical records of Dr. Cipto Mangunkusumo Central Hospital from March to December 2020. Results. From 1,018 data of suspected COVID-19 pediatric patients, there were 94 (9.2%) confirmed cases of COVID-19. The proportions of children with travel history (p=0.022), positive contact history (p

The mathematical modelling of geological structures, i.e. magma intrusion or dyke, has been done, based on magnetic data with inversion techniques using MatLab. The magnetic equation is a non-linear equation, and completion is done using a linear approach to non-linear mathematical models of magnetic data using the Taylor expansion approach and Jacobi Matrix. The first step of this research is to make synthetic data forward modelling from the magnetic equation of magma intrusion or dyke cases without errors, and the next stepping then add errors to the data. The next step is to do an inversion to get the parameters sought, i.e. depth and angle of the magma intrusion, by giving initial guesses, and then re-correct iteratively until convergent results are obtained. Finally, parameters of slope dyke or thin magma intrusion and its depth can be determined. The results obtained indicate that this technique can be used to get physical parameters sought from magnetic data for simple geological cases, i.e. dyke and magma intrusion.

Latar belakang. Asupan kalori yang tinggi, terutama makronutrien, diduga merupakan salah satu etiologi obesitas. Penelitian pada remaja mengenai hal tersebut masih sangat jarang. Tujuan. Mengetahui hubungan antara asupan total kalori dan jenis makronutrien, terhadap IMT remaja obesitas usia 14-18 tahun. Metode. Studi potong lintang dengan menggunakan data sekunder. Kriteria subjek adalah usia 14-18 tahun, memenuhi kriteria obesitas menggunakan kurva CDC 2000, tidak menggunakan obat anti-obesitas atau anti-oksidan, serta informed consent telah diperoleh. Data asupan total kalori dan jenis makronutrien diperoleh menggunakan kuesioner 24-hour food recall. Hasil. Sebanyak 69 subjek masuk dalam penelitian ini. Nilai rerata IMT semua subjek adalah 33,76 kg/m2. Dengan menggunakan nilai tersebut sebagai cut-off, subjek dibagi dalam dua kelompok yakni kelompok derajat obesitas 1 (IMT kurang dari nilai rerata) sebanyak 35 subjek dan derajat obesitas 2 (IMT lebih dari nilai rerata) sebanyak 34 subjek. Tidak terdapat perbedaan rerata total asupan kalori yang signifikan antara kelompok derajat obesitas 1 (1950 ± 487,77) dan derajat obesitas 2 (2140 ± 2140,30), p=0,135. Jenis makronutrien yang dikonsumsi, baik itu karbohidrat, lemak, dan protein, juga tidak memengaruhi derajat obesitas secara signifikan. Kesimpulan. Asupan kalori total dan jenis makronutrien tidak berhubungan dengan derajat obesitas pada remaja usia 14-18 tahun.

BACKGROUND: Organ damage due to iron toxicity is one factor that increases the risk of getting cardiovascular and metabolic diseases in thalassemia patient. This study aims to determine glucose and lipid profiles in adolescents with thalassemia major and its association with iron overload in pancreas and liver. METHODS: This was a cross sectional study. Subjects were thalassemia major adolescents without any confounding factors that may affect glucose and lipid levels. Blood samples were collected to measure the glucose level, lipid profiles, ferritin level and transferrin saturation. T2-Magnetic Resonance Imaging was used to evaluate the iron overload in organs. RESULTS: From a total of 60 subjects, diabetes mellitus was diagnosed in 1 subject and impaired fasting glucose was diagnosed in 3 subjects. All subjects had high triglycerides/ high density lipoprotein-cholesterol (HDL-C) ratio, 59 subjects (98%) had low HDL-C, 18 subjects (30%) had hypertriglyceridemia, and none had abnormal high level of low density lipoprotein-cholesterol (LDL-C). The majority of subjects had ferritin ≥2,500 ng/mL (70%), mild pancreatic iron overload (56.6%), and moderate hepatic iron overload (43.8%). Degree of hyperferritinemia was not associated with glucose and lipid profiles. Blood glucose profiles were not associated with various degree of pancreatic iron overload. Similar result was also observed between lipid profiles and hepatic iron overload. CONCLUSION: Abnormal glucose and lipid profiles in thalassemia major can be found in adolescence. Normal blood glucose level isn’t necessarily associated with normal pancreatic iron deposition. Hepatic iron overload may worsen dyslipidemia in thalassemia major patients. KEYWORDS: glucose profile, lipid profile, pancreatic iron overload, hepatic iron overload, thalassemia major

Background Obesity causes adipocytokines dysregulation and enhances the pro-inflammatory response. Low-grade chronic inflammation is related to cardiometabolic diseases. Objective To evaluate the status of low-grade chronic inflammation in pre-pubertal, obese boys and its potential correlation to adipocytokines and body fat mass. Methods This cross-sectional study included pre-pubertal, male, superobese children as the subjects. We determined obesity status using the CDC 2000 BMI-for-age chart. Body fat percentage was measured using bioelectric impedance analysis (BIA). Fasting blood specimens were collected to evaluate hsCRP, leptin, adiponectin, and TNF-α levels. Results Eighty subjects were recruited into this study, with a mean age of 6.9 years. Ten subjects (12.5%) had low-grade chronic inflammation (hsCRP level ≥ 1 mg/L). The levels of hsCRP was not correlated with leptin, adiponectin, and TNF-α levels. A weak, but significant correlation was observed between hsCRP level and body fat mass (r= +0.383; P

Latar belakang. Obesitas pada anak masih menjadi masalah dunia, termasuk Indonesia. Obesitas abdominal, yang ditandai dengan besarnya ukuran lingkar pinggang, dapat meningkatkan risiko penyakit kardiovaskular, metabolik, dan kematian. Tujuan. Penelitian ini bertujuan untuk mendapatkan gambaran ukuran lingkar pinggang pada anak obes, serta hubungannya dengan masa lemak tubuh, profil lipid, dan kadar gula darah puasa. Metode. Penelitian ini merupakan studi potong lintang. Subjek penelitian adalah anak usia 14-18 tahun dengan obesitas. Pemeriksaan tinggi badan, berat badan, lingkar lengan atas, lingkar pinggang, dan bioelectric impedance analyzer (BIA) dilakukan untuk memperoleh gambaran antropometri subjek. Pemeriksaan darah puasa dilakukan untuk memperoleh data profil lipid dan gula darah puasa. Hasil. Sebanyak 69 subjek terlibat dalam penelitian ini. Semua subjek mempunyai lingkar pinggang ≥P80, dengan lingkar pinggang terlebar adalah 138 cm. Ukuran lingkar pinggang mempunyai korelasi yang bermakna dengan kolesterol high density lipoprotein (HDL), sedangkan korelasi dengan masa lemak tubuh, profil lipid lainnya, dan kadar gula darah puasa tidak bermakna. Kesimpulan. Obesitas pada anak umumnya disertai dengan ukuran lingkar pinggang yang melebihi P80. Ukuran lingkar pinggang mempunyai korelasi yang bermakna dengan kadar kolesterol HDL. Ukuran lingkar pinggang tidak boleh digunakan secara tunggal untuk memperkirakan masa lemak tubuh, profil lipid di luar kolesterol HDL, dan gula darah puasa.

Latar belakang. Infeksi saluran kemih (ISK) merupakan salah satu penyakit infeksi yang sering ditemukan pada anak usia 2 bulan hingga 2 tahun. Kondisi ini sulit dideteksi karena manifestasi klinis yang tidak spesifik. Kultur urin sebagai baku emas menegakkan diagnosis ISK membutuhkan waktu yang lama dan biaya yang mahal. Pewarnaan Gram urin adalah metode yang mungkin dapat digunakan untuk diagnosis dini ISK pada bayi dan anak. Tujuan. Membandingkan metode pewarnaan Gram dan kultur urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Metode. Penelitian ini merupakan uji diagnostik dengan metode potong lintang di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia, dari Mei 2016 -Desember 2017. Penelitian ini melibatkan 59 anak usia 2 bulan hingga 2 tahun yang dicurigai menderita ISK yang direkrut dengan metode consecutive sampling. Sampel urin diambil dengan kateterisasi uretra dan dilakukan pemeriksaan urinalisis, pewarnaan Gram, dan pemeriksaan biakan urin. Hasil. Prevalens ISK didapatkan sebesar 38,9%. Pewarnaan Gram urin memiliki sensitivitas 47,8% (95% IK 26,8-69,4%), spesifisitas 97,2% (95% IK 85,5-99,9%), nilai duga positif 91,7% (95% IK 60,3-98,8%), nilai duga negatif 74,5% (95% IK 60,3-98,8%), LR(+) 17,2 (95% IK 2,4-124,6), LR(-) 0,54 (95% IK 0,36-0,8), dan akurasi sebesar 78%. Kesimpulan. Terdapat korelasi yang baik antara pewarnaan Gram urin dan hasil biakan urin untuk mendiagnosis ISK pada anak usia 2 bulan hingga 2 tahun. Antibiotik dapat segera diberikan setelah pewarnaan Gram menunjukkan hasil positif.

This article discusses about the efforts of creeds religion flourished to maintain their existence since the 1950s until the late 2010’s in Indonesia. Using historical method, this article found the interesting facts about the struggle of creeds religion in political stage of Indonesia. In 1953, for example, the Ministry of Religion Affairs noted that there were 360 groups protected by the government according on the Constitutional Law 1945 Article 29. After the tragedy of 1965, migration of members to the religions took place. When Soeharto became president, these groups was allowed to flourish. However, they got discrimination and always being watched. The new hope was arose in 2006, when the government issued Law No. 23/2006 about Population Administration, although it still requires to fill the religious column in national identity card (KTP). In the end 2017, the Constitutional Court issued a fatwa related to the status of religious column in KTP of the creeds religion. This condition also encompassed to Aliran Kapribaden’s Romo Semono Sastrodiharjo in Purworejo, Central Java. This discrimination must be terminated, in the name of unity in diversity.

Background: Infection remains a major pediatric health problem in Indonesia and usually leads to longer hospitalization due to the need for extended intravenous antibiotic administration. In developed countries, pediatric outpatient parenteral antibiotic therapy (P-OPAT) is well-established and proven to be safe and effective at reducing the length of hospital stay; however, data on low- and middle-income countries such as Indonesia remain limited. This P-OPAT service is new and the first service in Indonesia.Methods: The medical records of patients attending Indonesia's first P-OPAT clinic between April 2015 and March 2017 were retrospectively investigated.Results: During the 24-month period, 32 patients received treatment at the P-OPAT clinic, saving a total of 258 bed days. The majority of patients (n = 16; 50%) were diagnosed with urinary tract infection, followed by cellulitis (n = 4; 12.5%) and osteomyelitis (n = 4; 12.5%). Ceftriaxone was the most commonly used antibiotic (n = 16; 50%). All patients used a peripheral intravenous catheter and were sent home with this device. Twelve patients (37.5%) needed to change IV access more than once. None of the patients used elastomeric infusor device. The median duration of OPAT was 5 days (range 1–27 days). All patients were successfully treated with no recurrence after 30 days. One patient (3.1%) experienced drug-related complication and another one (3.1%) was readmitted due to an underlying medical condition. All the patients complied with P-OPAT schedules.Conclusions: P-OPAT service offers a safe and effective option for the delivery of outpatient intravenous antibiotics in selected patients even in resource-poor settings.

Abstract Background Working mothers have a higher risk to terminate breastfeeding earlier than stay-at-home mothers. Researchers reported that support from the workplace by creating lactation facilities and develop supportive programs are necessary to increase the success of exclusive breastfeeding. The aim was to achieve expert consensus on developing a workplace-based lactation promotion model. Methods A three-round online survey using Delphi approach was conducted to reach consensus on to the development of a lactation program at a workplace. Results Twenty-two experts from Indonesian health authority, community medicine, child health and obstetrics were invited to join the Delphi study; 15 (68.2%) enrolled in the first round. The response rate in the second and third round was 80.0% (12/15) and 86.7% (13/15), respectively. The first round categorized the workplace-based promotion model into seven dimensions, i.e. policy and regulation, facility, education material, target participants, promotion approach, human resources, and time. In the final round, “maternity leave of 3-6 months” (median (Q1;Q3):2 (1, 4)) and “employees have the right to breast-pumping every 3 hours” (median (Q1;Q3):3 (2, 4)) ranked as the two most important indicators regarding policy and regulation. A dedicated lactation room (median (Q1;Q3):1 (1)) is the highest ranked indicator regarding facility dimension. Regarding education materials, benefits of breast milk for babies ranked as the highest indicator while for the education and delivering methods dimensions, social media and interactive counseling were two highest ranked indicators. The top management in the company and lactation counselor are the two highest-ranked indicators in human resources dimension. Conclusion In the view of experts, involvement of a dedicated policy maker in the company, a workplace-based lactation counselor, regular promotion with interactive education and dedicated facilities are necessary to develop an effective workplace-based lactation promotion model.

Latar belakang. Remaja merupakan kelompok risiko tinggi untuk mengalami defisiensi besi. Obesitas pada remaja meningkatkan risiko defisiensi besi akibat perbedaan pola asupan dan inflamasi kronik derajat rendah. Tujuan. Mengetahui status besi dan asupan besi remaja obes usia 15 -17 tahun. Metode. Penelitian potong lintang pada remaja usia 15 – 17 tahun di dua SMU Jakarta Pusat pada bulan September – November 2015. Subjek dibagi menjadi 2 kelompok berdasarkan indeks massa tubuh (IMT). Subjek dinyatakan obes bila IMT≥P95 dan non-obes bila IMT ≥P5 -

Purpose: Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient's outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 (IL-6) and interleukin-10 (IL-10). Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. Methods: This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score (ISS) ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome (MODS) and death. MODS evaluation was performed using sequential organ failure assessment (SOFA). Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient's outcome were examined with correlation test and statistical analysis. Results: The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-10 ratio with heavy trauma load (ISS > 30) showed that compensatory anti-inflammation response syndrome (CARS) state was more dominant than systemic inflammatory response syndrome (SIRS), indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. Conclusion: The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient's outcome.

Latar belakang. Malnutrisi merupakan masalah utama di negara berkembang dan berpengaruh pada tumbuh kembang anak. Malnutrisi terkait dengan penyakit infeksi, salah satunya tuberkulosis (TB). Terapi medikamentosa berupa pemberian obat anti TB (OAT) dan nutrisi adekuat diharapkan dapat meningkatkan status nutrisi. Penelitian spesifik yang mengamati perkembangan luaran status nutrisi pada pasien tuberkulosis paru anak belum pernah dilakukan di Indonesia. Tujuan. Mengetahui status nutrisi TB paru anak pada awal, lama, dan akhir pengobatan. Mengetahui hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi dan berat badan (BB) Metode. Penelitian kohort retrospektif dilakukan pada 62 anak dengan penyakit TB dan gizi kurang/buruk usia 1 bulan - 5 tahun yang terdiagnosis pertama kali pada 1 Januari 2010 - 31 Desember 2015. Status nutrisi dan BB saat awal diagnosis, bulan ke-2,4,6 dinilai setelah diberikan tata laksana medikamentosa dan nutrisi. Hasil. Proporsi pasien TB anak dengan gizi kurang 53/62 (85,5%). Sebagian besar berusia 2 tahun, lelaki, bertempat tinggal di DKI Jakarta dan sakit TB paru (42,8%). Seluruh subyek mendapat OAT yang sesuai, 1 yang minum OAT tidak teratur. Terapi OAT selama 6 bulan didapatkan pada 45,2% subyek . Proporsi subyek yang mendapat nutrisi enteral 15/62 (24,2%). Sebanyak 56/62 (90,3%) subyek dengan dosis OAT sesuai mengalami perbaikan status nutrisi dan 55/61 (90,1%) subyek yang minum OAT teratur mengalami perbaikan status nutrisi. Peningkatan BB 5% tiap 2 bulan dan 17% setelah 6 bulan terapi OAT terjadi pada 97% subyek. Tidak ada hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi (p=0,161). Kesimpulan. Perbaikan status nutrisi dan peningkatan BB terjadi pada sebagian besar subyek. Namun, hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi tidak bermakna secara statistik.

Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable. Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method. Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests. Results The cut-off for fever on axilla was 37.4oC and on tympanic membrane was 37.4oC, with sensitivity 96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively; specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69), respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85% (95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and 0.903, respectively). Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the body’s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements. Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA). Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed. Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers >20 years of age (93%). Subjects’ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 µg/dL, TIBC 329µg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5). Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.

Latar belakang. Terapi sinar adalah terapi utama dalam penanganan hiperbilirubinemia. Meningkatkan intensitas sinar terapi sinar dengan menambahkan kain putih sebagai pemantul dapat meningkatkan efektifitas terapi sinar dan menurunkan kadar bilirubin serum lebih cepat. Tujuan. Membandingkan efektifitas terapi sinar tunggal dengan dan tanpa kain putih pada bayi berat lahir rendah dengan hiperbilirubinemia. Metode. Uji klinis acak terkontrol terbuka yang dilakukan di Rumah Sakit Cipto Mangunkusumo dari bulan September sampai November 2012. Didapat 40 bayi berat lahir rendah dengan hiperbilirubinemia. Subjek dibagi dua kelompok secara random, yaitu kelompok terapi sinar dengan kain satin putih (kelompok intervensi, n=19) dan tanpa kain satin putih (kelompok kontrol, n=21). Tujuan utama adalah membandingkan perbedaan penurunan kadar bilirubin total dan indirek setelah 6 jam terapi sinar, lama penggunaan terapi sinar, dan efek samping dari terapi sinar. Hasil. Median (rentang) penurunan kadar bilirubin serum total setelah 6 jam terapi sinar 2,51 mg/dL (-0,61;5,18) pada kelompok intervensi dan 0,85 mg/dL (-1,67;5,50) kelompok kontrol, p=0,029. Sementara penurunan kadar bilirubin serum indirek setelah 6 jam terapi sinar 2,57 mg/dL (-0,42;5,63) pada kelompok intervensi dan 0,47 mg/dL (-1,63;6,00) kelompok kontrol, p=0,004. Penilaian secara Cox proportional hazard regression menunjukkan median dari penggunaan terapi sinar kelompok intervensi, yaitu 12 jam dan 28 jam pada kelompok kontrol. (perubahan chi-square 7,542; p=0,006; hazard ratio 0,565; IK95%: 0,197-0,762). Selama penelitian, tidak ditemukan efek samping hipertermia, diare, rashes, dan burns. Kesimpulan. Penggunaan kain satin putih meningkatkan efektifitas terapi sinar pada bayi berat lahir rendah dengan hiperbilirubinemia indirek tanpa efek samping.

Populasi anak merupakan kelompok yang paling mempunyai risiko mengalami kematian di negara berkembang dan kematian tersebut sebagian besar disebabkan oleh penyakit yang dapat dicegah. Angka kematian balita menggambarkan factor-faktor yang lingkungan yang berpengaruh terhadap kesehatan anak. Balita seperti gizi, sanitasi, penyakit menular dan kecelakaan. Rumah merupakan salah satu lingkungan fisik yang mendukung anak dalam melakukan aktifitas fisik untuk mengembangkan kemampuan motorik dengan bermain dan rekreasi untuk mengembangkan kreasi dan menambah pengalaman. Masalah permukiman di perkotaan mempunyai hubungan langsung dan tidak langsung terhadap kesehatan anak. Keterbatasan dana yang dimiliki orang tua, menyebabkan banyak anak di kota besar terpaksa harus tinggal di pemukiman kumuh. Untuk mengatasi hal ini pemerintah memindahkan mereka dari pemukiman yang kumuh ke pemukiman yang layak huni. Karena keterbatasan lahan untuk pembangunan perumahan biasa, maka dibangun rumah susun. Penelitian di beberapa rumah susun melaporkan bahwa ditemukan beberapa factor yang berpengaruh bukan saja terhadap tumbuh kembang, tetapi juga morbiditas dan mortalitas balita. Penelitian cross sectional di rumah susun Kemayoran terhadap 213 balita menunjukkan bahwa prevalensi penyakit selama 1 bulan penelitian sebesar 45.9%. Penyakit-penyakit yang ditemukan pada balita yang tinggal di pemukiman biasa seperti seperti infeksi saluran napas akut, infeksi kulit, panas, batuk kronik berulang, campak, gastroenteritis akut dan kecelakaan juga ditemukan di rumah susun Kemayoran. Ditemukan pula bahwa kekerapan sakit tidak berhubungan dengan status gizi, melainkan dengan kepadatan hunian.

Nutrisi parenteral (NP) merupakan salah satu alternatif dukungan nutrisi yang telah terbukti dapat menunjang tumbuh kembang anak selama sakit. NP diindikasikan untuk anak sakit yang tidak boleh atau tidak dapat mengkonsumsi makanan secara oral/enteral. Mengingat komplikasinya maka pemberian NP harus benar-benar memperhitungkan risk and benefit. Langlah-langkah pada tatalaksana NP meliputi: penentuan status nutrisi (klinik, antropometrik & laboratorik), perhitungan kebutuhan nutrisi (energi, cairan dan nutrien), pemilihan dan perhitungan cairan yang akan digunakan serta cara pemberiannya (masing-masing atau all in one/three in one), penentuan akses NP (sentral atau perifer), pelaksaan pemberian dan pemantauan komplikasi.

Background: low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents. Methods: this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test. Results: a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another. Conclusion: in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels.

Cooperative of Government Employee of Bandung during some periods have decreased the added value of cooperative and members where as the loan capital have increase .This research aims to analyze the influence of loan capital and members towards the added value of cooperative. The method used in this research is descriptive verificati method, the sample used in this research is financial report in the last five years. The results of the research showed that the loan capital and members partially has significant influence to added value of cooperative. The loan capital and members simultaneously has significant influence to added value of cooperative. Keywords: Loan Capital, Members, and Added Value of Cooperative Koperasi “UPN†Veteran Yogyakarta dalam beberapa periode tertentu terjadi penurunan sisa hasil usaha (SHU) dan jumlah anggota sedangkan modal pinjaman mengalami kenaikan. Penelitian ini bertujuan untuk menganalisis pengaruh modal pinjaman dan jumlah anggota terhadap sisa hasil usaha (SHU). Metode yang digunakan dalam penelitian ini adalah metode deskriptif verifikatif, sampel yang digunakan dalam penelitian ini adalah 5 tahun terakhir data laporan keuangan. Hasil penelitian menunjukkan bahwa modal pinjaman dan jumlah anggota secara parsial berpengaruh signifikan terhadap sisa hasil usaha (SHU). Modal pinjaman dan jumlah anggota secara simultan berpengaruh signifikan terhadap sisa hasil usaha (SHU). Kata Kunci: Pinjaman Modal, Anggota, Nilai Tambah Koperasi

ObjectivesThere is limited evidence on the effect of exposure to second hand smoke (SHS) in non-smoking pregnant mothers and infant health. We assessed the effects of maternal antenatal exposure to SHS on infant growth rate, and secondarily, on birth weight, birth length and head circumference at birth.MethodsIn this prospective cohort, 305 mother-infant pairs were studied. Mothers filled out questionnaires about exposure to SHS in pregnancy at the 3rd trimester of pregnancy. Infant anthropometry was performed at birth, day 7, and months 1, 2, 4, and 6, postnatally. Linear mixed modeling and linear regression were used to calculate growth rates over the first 6 months. The association between SHS-exposure with growth rate and birth sizes was assessed using multivariate linear regression adjusted for confounders, with SHS as both number of cigarettes and as groups (no exposure, SHS < 23 cigarettes, SHS ≥ 23 cigarettes).ResultsSeventy-three mothers were not exposed and 232 were exposed. SHS exposure (per cigarette) was not related to gain in weight, length, head circumference, and weight for length. However, infants born to mothers exposed to ≥ 23 cigarettes/d had lower head circumference gain (-0.32 mm/m, 95% CI -0.60, -0.03) than those born to non-exposed mothers. SHS exposure (per cigarette) was not related to birth weight, length, and head circumference, but exposure to ≥ 23 cigarettes was related to lower head circumference at birth (-11.09 mm, -20.03, -2.16).ConclusionsHeavy antenatal exposure to SHS in non-smoking mothers results in reduced neonatal head circumference at birth and head circumference gain over the first 6 months of life. Our findings show no clear relations between exposure to SHS during pregnancy and other markers of neonatal growth and birth size.

Latar belakang. Terapi antiretroviral (ARV) kombinasi telah berhasil menurunkan angka morbiditas dan mortalitas pasien HIV, tetapi menimbulkan efek samping jangka panjang berupa sindrom lipodistrofi. Tujuan. Mengidentifikasi adanya lipodistrofi dan dislipidemia pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV jangka panjang. Metode. Penelitian potong lintang dilakukan pada 76 pasien HIV usia prepubertas di Poli Alergi Imunologi RSCM. Pemeriksaan klinis lipodistrofi dilakukan oleh tenaga klinis, tebal lipatan kulit (TLK) triceps dan subscapular, lingkar pinggang serta rasio lingkar pinggang-panggul. Data kadar CD4 awal, status gizi awal terdiagnosis, jenis terapi ARV, dan lama terapi ARV didapatkan dari rekam medis. Subyek juga dilakukan analisis diet, pemeriksaan profil lipid, dan gula darah puasa. Hasil. Subyek prepubertas dengan HIV yang mendapatkan terapi ARV yang mengalami lipodistrofi dan dislipidemia berturut-turut 47% dan 46%. Subyek lipodistrofi berupa lipohipertrofi 35%, lipoatrofi 5%, dan tipe campuran 7%. Mayoritas subyek lipodistrofi memiliki massa lemak tubuh, serta TLK triceps dan subscapular normal. Subyek lipohipertrofi dan tipe campuran seluruhnya memiliki rasio lingkar pinggang-panggul meningkat. Terdapat hubungan yang bermakna antara penggunaan regimen ARV 2NRTI + PI meningkatkan risiko 6,9 kali untuk terjadinya dislipidemia (p=0,001 IK95%: 2,03-23,7) dibandingkan regimen 2NRTI+ NNRTI. Kesimpulan. Prevalensi lipodistrofi dan dislipidemia cukup tinggi pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV. Mayoritas subyek yang mengalami lipodistrofi memiliki massa lemak tubuh, TLK triceps dan subscapular yang normal.

Nutrisi dan kesehatan gigi dan mulut memiliki kaitan yang erat terutama pada anak yang memiliki fase tumbuh kembang. Nutrisi yang baik dan tepat penting untuk menunjang kesehatan gigi dan mulut. Sebaliknya, kesehatan gigi dan mulut juga penting untuk asupan nutrisi yang adekuat. Karies gigi merupakan salah satu penyakit infeksi kronis yang paling sering terjadi pada anak dan memiliki kaitan erat dengan nutrisi. Berdasarkan sifatnya dalam memicu karies, bahan makanan dibagi menjadi tiga kelompok, yaitu anti-kariogenik, kariogenik, dan kariostatik. Beberapa penelitian menunjukkan bahwa pemberian ASI tidak terbukti memicu karies. Sebaliknya, kebiasaan konsumsi makanan/minuman berkadar gula tinggi, makanan cepat saji, dan makanan ringan diantara waktu makan meningkatkan risiko karies pada anak. Anak dengan gizi lebih dan obesitas juga memiliki risiko karies yang lebih tinggi. Peran suplemen fluoride dan silitol dalam pencegahan karies masih kontroversial. Sementara itu, konsumsi probiotik terbukti mampu mencegah karies dentis. Pencegahan karies dengan mengurangi kebiasaan konsumsi makanan manis, makanan cepat saji, makanan ringan, minuman soda, mencegah obesitas pada anak, serta didukung oleh kebiasaan menyikat gigi dengan teratur sangat penting dalam menjaga kesehatan gigi dan mulut anak.

Latar belakang. Permasalahan palsi serebral (PS) yang menjadi perhatian bagi orangtua adalah kemampuan berjalan. Tujuan. Mengetahui prevalens kemampuan berjalan pasien PS dan faktor prediktor yang berhubungan terhadap kemampuan berjalan pasien PS pada masa anak. Metode. Dilakukan penelitian terhadap 102 pasien PS berusia 6 tahun ke atas dengan pengisian kuesioner melalui wawancara orang tua dan melihat rekam medis di RSCM dan YPAC. Hasil. Duapuluh tujuh (26,5%) pasien berjalan tanpa alat bantu, 13 (12,7%) pasien berjalan dengan alat bantu, dan 62 (60,8%) pasien tidak berjalan walau dengan alat bantu. Faktor prediktor yang bermakna secara statistik adalah mampu duduk tanpa topangan sebelum usia 2 tahun (p

Latar belakang. Bayi berat lahir rendah (BBLR) memiliki pertumbuhan berat badan (BB), panjang badan (PB) dan lingkar kepala (LK) yang terlambat pada saat keluar dari rumah sakit, sehingga memerlukan nutrisi yang khusus. Tujuan. Mengetahui hubungan antara pemberian susu PDF modifikasi dan susu PDF komersial, dengan peningkatan BB, PB dan LK pada saat usia satu dan dua bulan. Metode. Penelitian ini bersifat studi uji klinis dengan randomisasi tanpa penyamaran. Hasil. Berat badan, panjang badan dan lingkar kepala bulan pertama dan kedua pada BBLR yang memperoleh susu PDF modifikasi tidak berbeda bila dibandingkan dengan yang memperoleh susu PDF komersial. Apabila diperhatikan secara seksama, tampak adanya kecenderungan peningkatan PB dan LK pada bulan pertama dan peningkatan BB, PB, LK yang lebih baik pada bayi yang memperoleh susu PDF modifikasi dibandingkan dengan susu PDF komersial. Pada penelitian kami tidak ada timbul reaksi simpang yang berarti. Kesimpulan. Pemberian susu PDF modifikasi dapat dijadikan alternatif untuk BBLR yang memerlukan susu PDF.

Latar belakang. Air susu ibu merupakan nutrisi ideal untuk bayi. World Health Organization (WHO) menganjurkan pemberian ASI eksklusif hingga 6 bulan. Data Survey Demografi dan Kesehatan Indonesia (SDKI) tahun 2003 dan 2007 menunjukkan angka ASI eksklusif di Indonesia cenderung turun. Beberapa penelitian menunjukkan terdapat beberapa faktor yang memengaruhi pemberian ASI eksklusif. Tujuan. Mengetahui proposi ASI eksklusif pada bayi yang dilakukan IMD, dan mengetahui faktor-faktor yang memengaruhinya. Metode. Penelitian potong lintang analitik dengan pengumpulan data melalui wawancara pada bulan Juni-September 2012. Subjek penelitian adalah ibu yang memiliki anak berusia 0-6 bulan yang datang ke Poliklinik Anak RS St. Carolus Jakarta. Analisis statistik dengan uji Kai kuadrat dan regresi logistik. Hasil. Dilakukan penelitian pada 120 subjek. Proporsi ASI eksklusif 75%, sebagian besar merupakan primipara (56,7%). Kelahiran secara spontan 65,8%. Subjek yang memiliki tingkat pendidikan tinggi 73,3% dan 59,2% merupakan ibu bekerja. Subjek yang termasuk ke dalam status sosial ekonomi tinggi 45%, sisanya berada di sosial ekonomi rendah (4,2%), dan menengah (50,8%). Sebagian besar subjek (73,3%) telah memperoleh konseling ASI. Faktor yang paling bermakna memengaruhi ASI eksklusif berturut-turut, yaitu faktor psikis ibu, dukungan keluarga, pengetahuan tentang ASI eksklusif, dan konseling ASI. Kesimpulan. Proporsi ASI eksklusif pada bayi cukup bulan yang dilakukan IMD di RS St Carolus adalah 75%. Faktor yang terbukti memengaruhi pemberian ASI eksklsusif adalah faktor psikis ibu (keyakinan ibu terhadap produksi ASI), dukungan keluarga, pengetahuan ibu yang benar tentang ASI eksklusif, dan konseling ASI.

Latar belakang. Dermatitis atopik (DA) merupakan manifestasi awal atopic marchyang berhubungan dengan alergi makanan. Alergen penyebab dan faktor risiko yang memengaruhi penting diketahui. Tujuan. Mengetahui sensitisasi dan faktor risiko alergi pada DA setelah usia 2 tahun. Metode. Penelitian deskriptif potong lintang terhadap 35 subjek DA sejak Januari-Maret 2011. Sensitisasi diketahui dengan uji tusuk kulit. Hasil. Sensitisasi terjadi pada 29 subjek dari 35 subjek, dengan faktor risiko pajanan asap rokok ditemukan pada 21 subjek, faktor risiko alergi sedang dan tinggi 19 subjek, tidak mendapat ASI eksklusif 9 subjek, dan makanan padat usia dini 21 subjek. Sensitisasi alergen makanan ditemukan pada 26 subjek. Kesimpulan. Sebagian besar subjek DA mengalami sensitisasi oleh alergen makanan. Faktor risiko pajanan asap rokok, faktor risiko alergi sedang dan tinggi, tidak mendapat ASI eksklusif, dan mendapat makanan padat usia dini ditemukan lebih sering pada anak DA

Latar belakang. Meningkatnya prevales obesitas pada anak menyebabkan meningkatnya komorbiditas akibat penyakit lain, salah satunya adalah penyakit kardiovaskular. Penyakit kardiovaskular merupakan salah satu penyakit penyebab kematian yang penting. Small Dense LDL (sdLDL) pada obesitas dewasa terbukti dapat dijadikan prediktor risiko penyakit jantung koroner. Penelitian serupa pada obesitas anak belum pernah dilakukan. Tujuan. Mengetahui faktor risiko PJK pada obesitas anak dengan menggunakan sdLDL, serta kaitan adipositokin dengan timbulnya faktor risiko penyakit jantung koroner (PJK). Metode. Penelitian potong lintang untuk mendeteksi risiko PJK dan peran indeks massa tubuh (IMT), masa lemak tubuh (MLT), leptin, adiponektin dan TNF-􀄮 terhadap risiko PJK pada anak lelaki obes prapubertal usia 5-9 tahun. Indeks massa tubuh ditentukan dengan menggunakan kurva CDC, massa lemak tubuh dihitung dengan alat body fat analyzer. Profil lipid, CRP, leptin, adiponektin, dan TNF-􀄮 diperiksa setelah subjek puasa selama 12 jam. Leptin, adiponektin, dan TNF-􀄮􀀃diperiksa dengan cara ELISA. Hasil. Seluruh subjek mempunyai IMT di atas nilai normal demikian pula MLT. Sebagian besar subjek mempunyai kadar TG, kolesterol total dan LDL meningkat dengan kadar kolesterol HDL menurun. Small dense LDL ditemukan pada sebagian kecil subjek. Kadar leptin dan TNF-􀁁 meningkat, sedangkan kadar adiponektin menurun. Hanya sebagian kecil subjek mengalami inflamasi kronik derajat rendah yang ditentukan dengan memeriksa CRP. Kesimpulan. Risiko PJK telah tampak pada anak lelaki obes pra-pubertal. Indeks massa tubuh, MLT, leptin, adiponektin dan TNF-􀁁 tidak berhubungan dengan terjadinya sd LDL.

Salah satu jalur penjaringan mahasiswa baru Universitas Negeri Semarang (UNNES) adalah melalui Seleksi Nasional Masuk Perguruan Tinggi Negeri (SNMPTN). Mekanisme seleksi melalui SNMPTN didesain dengan berbagai kemudahan karena berbasis laman yaitu melalui http://penerimaan.unnes.ac.id. Terdapat fenomena yang menarik terkait dengan kecenderungan jumlah pendaftar mahasiswa baru UNNES yang perlu diteliti menyangkut usability laman http://penerimaan.unnes.ac.id/. Hasil analisis data peminat SNMPTN dan SPMU UNNES selama lima periode terakhir terhadap jumlah mahasiswa yang diterima memperlihatkan jumlah penerimaan mahasiswa UNNES lebih besar berasal dari peminat SPMU dibandingkan dengan peminat SNMPTN. Hal tersebut menunjukkan usability laman http://penerimaan.unnes.ac.id/ optimal.

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels. Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children. Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay. Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children. Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency.

A valuation model was a mechanism that converted a set of forecast, a series of company and economic variablesinto a forecast of market value for the company’s stock. The purpose of this study was to examine relevance amongdividend yield, retained earnings, book value and total debt on stock price: approximation valuation model in theIndonesia Stock Exchange. Samples in this study were manufacture firms listed on the Indonesia Stock Exchangeperiod 2008–2011 and divided dividend. The results showed that few of samples were undervalue and the otherswere overvalue. It meant valuation model could be applicated in the Indonesian stock exchange. By using multipleregressions, this study found that: valuation model relevans used in investment decission in manufacturefirms in the Indonesia Stock Exchange could prove simultaneously dividend yield, retained earnings, book valueand total debt had significant effect to stock price and partially dividend yield had no significant effect to stockprice and whereas retained earnings, book value and total debt had significant effect in partial to stock price.

Introduction Despite the considerable number of children with Do\Vll syndrome in Indonesia, there is little data available on the success of intervention programs. This study was performed to define factors affecting the intelligence of young children with Do\Vll syndrome. Objective To determine factors associated Mth lower intelligence in children with Down syndrome, including growth parameters and participation in intervention programs. Methods This cross􀁃sectional study was undertaken from December 2010 to March 2011. Subjects were 60 children with Down syndrome aged 2􀁃6 years who were enrolled in an intervention program at both the Medical Rehabilitation Department, Cipto Mangunkusumo Hospital, and the Growth and Development Clinic, Harapan Kita Women's and Children's Hospital. Parents' data was obtained through self history􀁃taking and perusal of medical records. Subjects' anthropometric data (body weight, body height, and head circumference) was obtained through measurements using calibrated instruments. A psychologist administered IQ tests on the subjects. Results of the anthropometric and IQ tests were given to parents one week following the examinations. Results From the 111 children with Down syndrome registered in the intervention programs, 60 children (36 boys and 24 girls) met the inclusion criteria. The mean age of subjects was 4 years 6 months. Most subjects were well􀁃 nourished. Fifty􀁃five subjects had microcephaly. Eighty􀁃two percent of subjects participated in the program regularly and 70% of subjects had started in the program at less than 1 year of age. Subjects' mean IQ was 52.8. Analysis showed that girls, subjects who were overweight and obese, subjects with microcephaly, those with irregular attendance in the program, and those living under the poverty line were at highest risk for severe mental retardation. Conclusion Factors associated v.ith the intelligence in children with Down syndrome were female gender, overweight/obesity, severe microcephaly, below􀁃poverty line economic status, and irregular participation in the program. [Paediatr Indones. 2012;52:194-9].

Background Children \\lith frequent relapse and steroid dependent nephrotic syndrome (FRNS/SDNS) will experience frequent relapse v.ith many complications due to the disease and toxicity of steroid therapy. One of the most common complications is obesity which is associated \\lith significant health problems in childhood and important risk factor of adult morbidity and mortality. Objective To find out the prevalence of obesity in children 'With FRNS/SDNS. Methods A cross sectional study was conducted from November 2008 until March 2009. Data were collected from the medical records of children 'With FRNS/SDNS treated during the period of 2000-2008. Body weight, height and body fat mass measurement was performed on the subjects. The diagnosis of obesity was based on body mass index (BMI) and body fat mass measurement. Results Obesity was diagnosed in 10 of 43 children (23%). Most of them were 5􀀼9 years old (58%) 'With male􀀼predominance. Most patients (70%) had age of onset younger than 5 years. The median of total relapse was 7 (range 2􀀼24) and cumulative dose of prednisone was 12,240 (range 3,490 to 44,330) mg. Time since the last dose of prednisone until the study in majority was 0 to 6 months (53%). The prevalence of obesity based on BMI was 7% while based on body fat mass was 23 (el 95% 10 to 36) %. Conclusion The prevalence of obesity based on body fat mass was 23%. The median BMI of obese subjects is in the 90-95th percentile.