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In 2021, WHO Member States endorsed a global target of a 40-percentage-point increase in effective refractive error coverage (eREC; with a 6/12 visual acuity threshold) by 2030. This study models global and regional estimates of eREC as a baseline for the WHO initiative.The Vision Loss Expert Group analysed data from 565 448 participants of 169 population-based eye surveys conducted since 2000 to calculate eREC (met need/[met need + undermet need + unmet need]). A binary logistic regression model was used to estimate eREC by Global Burden of Disease (GBD) Study super region among adults aged 50 years and older.In 2021, distance eREC was 79·1% (95% CI 72·4-85·0) in the high-income super region; 62·1% (54·7-68·8) in north Africa and Middle East; 49·5% (45·0-54·0) in central Europe, eastern Europe, and central Asia; 40·0% (31·7-48·2) in southeast Asia, east Asia, and Oceania; 34·5% (29·4-40·0) in Latin America and the Caribbean; 9·0% (6·5-12·0) in south Asia; and 5·7% (3·1-9·0) in sub-Saharan Africa. eREC was higher in men and reduced with increasing age. Global distance eREC increased from 2000 to 2021 by 19·0%. Global near vision eREC for 2021 was 20·5% (95% CI 17·8-24·4).Over the past 20 years, distance eREC has increased in each super region yet the WHO target will require substantial improvements in quantity and quality of refractive services in particular for near vision impairment.WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, Brien Holden Vision Institute, Lions Clubs International Foundation.

BackgroundCataract is the leading cause of blindness globally. Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. The 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. To enable monitoring of progress towards this target, we analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to establish baseline estimates of eCSC and CSC.MethodsIn this secondary analysis, we used data from 148 RAAB surveys undertaken in 55 countries (2003–21) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). Eligible studies were any version of the RAAB survey conducted since 2000 with individual participant survey data and census population data for people aged 50 years or older in the sampling area and permission from the study's principal investigator for use of data. We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women.FindingsCountry eCSC estimates ranged from 3·8% (95% CI 2·1–5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8–74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6–65·4]; n=2 surveys; 2011–15) and lowest among low-income countries (14·8%; [IQR 8·3–20·7]; n=14 surveys; 2005–21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3–4·1] and pooled risk ratio of 1·20 [95% CI 1·15–1·25]).InterpretationeCSC varies widely between countries, increases with greater income level, and is higher in men. In pursuit of 2030 targets, many countries, particularly in lower-resource settings, should emphasise quality improvement before increasing access to surgery. Equity must be embedded in efforts to improve access to surgery, with a focus on underserved groups.

Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia.Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Indonesia betwee...

Objective: The aim of this study was to examine the role of NT-3 as a single neurotrophic factor in the expression of nestin in the neural differentiation of MSCs. Methods: MSCs were isolated from rat bone marrow and induced with NT-3 at concentrations of 20, 25, and 30 ng/ml for 7 and 14 d (the control was no NT-3). Nestin underwent immunocytochemical analysis on days 7 and 14. Five high-power random fields were documented. Results: A post-hoc analysis using LSD after one-way ANOVA test yielded a statistically significant difference in the percentage of nestin-positive cells in MSCs with NT-3 at concentrations of 20, 25, and 30 ng/ml for 7 d compared to the control group (p

Cardiovascular disease (PKV) is the most common non-communicable disease and is the leading cause of death globally. This study aimed to determine the description of cardiovascular disease in adult JKN patients who were treated at the hospital. This observational study with cross sectional design was carried out in a type A of government hospital in Jakarta. The sample was selected purposively using BPJS claim data for the period of January-December 2017. All hospitalized patients with aged ≥18 years and suffering from PKV according to Indonesia Case Base Groups (INA-CBG) code were included in the analysis. The results found that number of BPJS patients were hospitalized in the PKV group was 2,005 patients with with a total of 2,561 visits. More men than women, with the largest age range 56-65 years. More than half of BPJS patients utilize class 3 care facilities with an average length of stay of around 9 days. Mostly at desease I and II. The number of patients who died was 16.06%. Most cases and comorbidities were acute myocardial infarction with type 2 diabetes mellitus. Meanwhile the main cause of death was cardiac arrest with no known cause. In terms of financing, the average hospital tariff is higher than the average of INA-CBG tarrif. In conclusion, the most cases of PKV in hospitalized JKN patients were acute myocardial infarction with severity at level I and II in type A government hospitals, which should have been handled by a lower types of hospital. Diabetes mellitus is a major comorbid, and unknown cardiac arrest is the leading cause of death. The average of hospital tarif in PKV cases is higher than the INA-CBG tariff. Abstrak Penyakit kardiovaskular (PKV) merupakan penyakit tidak menular yang paling sering ditemukan dan menjadi penyebab utama kematian secara global. Penelitian ini bertujuan untuk mengetahui gambaran penyakit kardiovaskular pada pasien Jaminan Kesehatan Nasional (JKN) usia dewasa yang mendapatkan perawatan di rumah sakit (RS). Metode penelitian observasional dengan desain potong lintang di salah satu RS pemerintah tipe A di Jakarta. Sampel dipilih secara purposif menggunakan data klaim periode Januari-Desember 2017. Seluruh pasien yang dirawat inap, berusia 18 tahun ke atas, dan menderita PKV menurut kode Indonesia Case Base Groups (INA-CBG) diikutkan dalam analisis. Hasil penelitian menemukan jumlah pasien Badan Penyelenggara Jaminan Sosial (BPJS) yang dirawat inap pada kelompok PKV sebanyak 2.005 pasien, dengan total kunjungan sebanyak 2.561. Laki-laki lebih banyak dibandingkan perempuan, dengan rentang usia terbanyak 56-65 tahun. Lebih dari separuh pasien BPJS memanfaatkan fasilitas perawatan kelas 3 dengan rata-rata lama rawat sekitar 9 hari. Terbanyak pada tingkat keparahan penyakit I dan II. Jumlah pasien meninggal sebesar 16,06%. Kasus dan komorbid terbanyak adalah infark miokard akut dan diabetes melitus tipe 2. Sedangkan penyebab kematian utama adalah cardiac arrest tanpa diketahui penyebabnya. Dalam hal pembiayaan, rata-rata tarif RS lebih tinggi dari rata-rata tarif INA-CBG. Kesimpulan, kasus terbanyak PKV pada pasien JKN yang dirawat inap adalah infark miokard akut dengan tingkat keparahan pada level I dan II di RS Pemerintah tipe A, yang seharusnya ditangani oleh tipe RS lebih rendah. Diabetes melitus adalah komorbid utama dan cardiac arrest tanpa diketahui penyebabnya sebagai penyebab kematian tertinggi. Rata-rata tarif RS pada kasus PKV lebih tinggi dari tarif INA-CBG.

Induced Pluripotent Stemcell (iPS) are adult cells which the genetic information in the nucleus of those cells being reprogrammed (reprogram) by inserting exogenous pluripotential genes. The exogenous gene transduction is using vectors, such as lentivirus, retrovirus, or adenovirus, which suppressed the gene expression of the original cells, so they will express the transduced exogenous gene. Viral vectors are then used to reprogramming and producing iPS clones that are pluripotent. iPS derived from adult cells of patient with certain diseases will be used as a tool to study the mechanisms of those specific diseases and the effects of selected drugs against the diseases. Several previous studies have shown that iPS clones developed from specific genetic disease have its original genotype and retain the character of the response to the drug that similar as the original adult cells. Opportunities for the utilization of autologous iPS cell therapy in the future is wide open as expected iPS transplant will not be rejected when transplanted back to the patient. Behind all its potential, iPS production is still facing some problems to be applicable clinically. The use of viruses as vectors may cause problems due to virus gene sequences may be integrated into the genome of the DNA donor cell, thereby causing mutations of the iPS clones. Several subsequent studies have succeeded in replacing the use of viruses as vectors, but the level of efficiency obtained is still very low. Another problem that arises is that epigenetic changes may occur in iPS cultures. Many advanced research related to iPS may be developed in Indonesia and is necessary to improve the production efficiency of iPS and solve iPS clones epigenetic changes problems in the future.Keywords: iPS, pluripotency, transduction, transfection.AbstrakInduced Pluripotent Stemcell (iPS) adalah sel somatic dewasa yang informasi genetika dalam inti selnyadiprogram ulang (reprogram) dengan cara memasukkan gen-gen eksogen yang memberikan ciri pluripotensial. Transduksi gen eksogen ini menggunakan vektor, seperti lentivirus, retrovirus, atau adenovirus, yang ditekan ekspresi gen aslinya, sehingga akan mengekspresikan sel eksogen yang ditransduksikan.Virus vektor tersebut selanjutnya digunakan untuk reprogram dan membuat klon iPS yang bersifat pluripoten. Sel dewasa yang akan dijadikan iPS diambil dari penderita penyakit tertentu dan selanjutnya klon iPS dapat dimanfaatkan sebagai alat untuk mempelajari mekanisme terjadinya penyakit dan efek obat terpilih terhadap penyakit tersebut. Beberapa penelitian terdahulu telah membuktikanbahwa kloni PS yang dikembangkan dari penderita penyakit genetik tertentu tetap memiliki karakter genotip dan respon terhadap obat yang sama dengan sel dewasa asalnya. Peluang pemanfaatan iPS otologus untuk terapi sel dimasa mendatang terbuka lebar karena diperkirakan iPS tidak akan mengalami proses rejeksi saat ditransplantasikan kembali kepada penderita yang bersangkutan. Dibalik segala potensinya, iPS masih memiliki beberapa kekurangan untuk diaplikasikan secara klinis. Penggunaan virus sebagai vektor dapat menimbulkan masalah karena sekuens gen virus mungkin berintegrasi dengan genom DNA sel donor, sehingga akan menyebabkan risiko terjadinya mutasipada klon iPS yang dihasilkan. Beberapa penelitian selanjutnya berhasil mengganti penggunaan virus sebagai vektor, namun tingkat efisiensi yang didapat masih sangat rendah. Masalah lain yang timbul adalah perubahan epigenetik yang dapat terjadi pada kultur iPS.Banyak penelitian lanjutan terkait iPS yang dapat dikembangkan di Indonesia dan sangat diperlukan untuk meningkatkan efisiensi produksi iPS dan mengatasi masalah perubahan epigenetik klon iPS dimasa mendatang.Kata Kunci: iPS, pluripotensi, transduksi, transfeksi.

Kekurangan suplai oksigen pada jaringan disebut hipoksia. Sel tumor sering mengalami hipoksia dan menjadi tidak responsif terhadap terapi. Keadaan hipoksia pada jaringan tumor perlu ditanggulangi agar keberhasilan terapi tumor dapat ditingkatkan. Pada keadaan hipoksia, factor Hypoxia Inducible Factor-1α (HIF-1α) berperan penting dalam pengendalian respon selular. Ekspresi gen HIF-1α sangat dipengaruhi oleh status redoks sel. Enzim MnSOD merupakan enzim antioksidan endogen yang berperan sebagai scavenger O2.-yang menghasilkan H2O2 dan O2 , sehingga aktivitas MnSOD akan mempengaruhi status redoks dari sel. Melalui O2.-dan H2O2, MnSOD memiliki peran biphasic terhadap regulasi ekspresi gen HIF-1α, sehingga dapat menekan dampak hipoksia pada jaringan. Sampai saat ini MnSOD belum dimanfaatkan sebagai terapi pendukung pada terapi tumor dan perlu dilakukan banyak eksperimen untuk mengeksplorasi potensi MnSOD sebagai terapi adjuvant alternative untuk terapi tumor.Kata Kunci : MnSOD, HIF-1α, Superoksida (O2.-), Hidrogen Peroksida (H2O2)AbstractInsufficient oxygen supply in tissue is named hypoxia. Tumor cells frequentlyexperience tissue hypoxia, therefore it becomes irresponsive to the main therapy. Hypoxia of tumor tissue needs to be solved to improve the tumor therapy succeed. In hypoxia, Hypoxia Inducible Factor-1α (HIF-1α) plays an essential role in controlling the cellular responses. HIF-1α gene expression is influenced by the redox stateof the cells. MnSOD enzyme is an endogenous antioxidant enzyme that acting as an O2.-scavenger that producing H2O2 and O2, so that MnSOD activity would affect the redox state of the cells. ViaO2.-and H2O2, MnSOD has a biphasic role for gene expression of HIF-1α regulation and reducing the tissue hypoxia effect. Recently, MnSOD is not an adjuvant therapy for tumor treatment yet, and some experiments are needed to explore MnSOD potential as an alternative adjuvant therapy for tumor treatment.Keywords : MnSOD, HIF-1α, Superoxide (O2.-), Hydrogen Peroxide (H2O2)

Mapping TB genotype of Mycobacterium tuberculosis (Mtb) is an important study to identify their distribution or characteristic and also may lead to improve control of the disease. This study conducted a preliminary mapping of the tubercle bacilli which had been circulating in Indonesia. Cultures of DNA isolated from TB patients at urban areas in 16 provinces in Indonesia, are chosen based on TB Case Detection Rate (CDR) 2006 from Indonesia Directorate General of Communicable Disease Control and Environment Health (Ministry of Health), were analyzed by spoligotyping for strain differentiation. In this first part, the analyzed result only came from urban areas in 10 provinces, i.e. Palembang, Bandar Lampung, Serang, Jakarta, Bandung, Surabaya, Banjarmasin, Makassar, Pontianak and Ambon. Sample were 269 DNA from 294 isolates collected from sputum of suspect TB patients with sputum-smear positive (SS+) and age above 15 years old. All samples were obtained from peripheral health laboratory in each province. The procedure collection is accordance to Indonesia DOTs guidelines (AFB smears) and samples were transported from those 10 areas to Bacteriology Laboratory at CBPRD. Sputum was taken for culture in liquid media MGIT Bactec 960 and solid media Lowenstein Jensen. The DNAs from positive liquid media MGIT Bactec 960 were isolated and analyzed by spoligotyping to identify the spoligo pattern. The spoligotyping results converted into octal format within Words & Excel spreadsheets and compared to International Spoligotype-database (SpolDB4). The previous study (Parwati et.al.) found some differences geographical distribution between Beijing genotype strain of tubercle bacilli in West Indonesia compare to East Indonesia, and the same pattern was also found in this study. Furthermore, the results in this study showed the differences in spoligo pattern of Mtb complex at 10 urban areas in West, Middle and East Indonesia. The percentage of Beijing strain family in the samples from West Indonesia showed around 26.61% (31.48% in Sumatra, 28.83% in Java and 16.98% in Kalimantan); from the Middle Indonesia around 25.93%; and none were found in samples from the East Indonesia. The SpolDB4 pattern also showed that the majority of isolates belonged to major clades of M.tuberculosis, i.e. the East African-Indian (EAI); Haarlem (H), Latin American-Mediterranean (LAM), the Central and Middle Eastern Asian (CAS); U = undefined; T = T family; and the MANU/ Manu family. We also found some isolates of Mycobacterium bovis. There were no significant association showed between genotype families and gender, but strong significant association found with ethnics and geography. Further confirmation of the results is still ongoing (k value; RFLP and MIRU-VNTR). As conclusion, this study constituted a first attempt to describe the preliminary mapping of genetic population structure of the tubercle bacilli circulating in Indonesia. Key words: preliminary mapping, Mtb complex, spoligotyping, Beijing genotype strain, SpolDB4

Background Highly pathogenic avian influenza A (H5N1) virus was detected in domestic poultry in Indonesia beginning in 2003 and is now widespread among backyard poultry flocks in many provinces. The first human case of H5N1 virus infection in Indonesia was identified in July 2005. Methods Respiratory specimens were collected from persons with suspected H5N1 virus infection and were tested by reverse-transcriptase polymerase chain reaction and viral culture. Serum samples were tested by a modified hemagglutinin inhibition antibody and/or microneutralization assay. Epidemiological, laboratory, and clinical data were collected through interviews and medical records review. Close contacts of persons with confirmed H5N1 virus infection were investigated. Results From July 2005 through June 2006, 54 cases of H5N1 virus infection were identified, with a case-fatality proportion of 76%. The median age was 18.5 years, and 57.4% of patients were male. More than one-third of cases occurred in 7 clusters of blood-related family members. Seventy-six percent of cases were associated with poultry contact, and the source of H5N1 virus infection was not identified in 24% of cases. Conclusions Sporadic and family clusters of cases of H5N1 virus infection, with a high case-fatality proportion, occurred throughout Indonesia during 2005-2006. Extensive efforts are needed to reduce human contact with sick and dead poultry to prevent additional cases of H5N1 virus infection.

Background Genotyping of Mycobacterium tuberculosis helps to understand the molecular epidemiology of tuberculosis and to address evolutionary questions about the disease spread. Certain genotypes also have implications for the spread of infection and treatment. Indonesia is a very diverse country with a population with multiple ethnicities and cultures and a history of many trade and tourism routes. This study describes the first attempt to map the molecular epidemiology of TB in the Indonesian archipelago. Method From 2008 to 2011, 404 clinical specimens from sputum-smear (SS+) TB patients, age ≥15 years, were collected from 16 TB referral primary health centers (PHC) in 16 provincial capitals in Indonesia. Susceptibility testing to first line drugs was conducted for 262 samples using the agar proportion method as per WHO guidelines. Spoligotyping was done on all samples. Results Ninety-three of the 404 samples (23 %) were from the Beijing family, making it the predominant family in the country. However, the geographic distribution of the family varied by region with 86/294 (29.3 %) in the western region, 6/72 (8.3 %) in the central region, and 2/72 (2.8 %) in the eastern region (p

PERANAN PEKERJAAN TERHADAP KEJADIAN KATARAK PADA MASYARAKAT INDONESIA RISET KESEHATAN DASAR 2007

DETERMINAN KEJADIAN KATARAK DI INDONESIA: RISET KESEHATAN DASAR 2007

Influenza A (H5N1) human cases started to he reported since 1997. In Indonesia, the first human cases were reported in July 2005, as a cluster consisted of a father and two daughters; two of them were fatal confirmed cases. As of 31 October 2006, 72 cases have heen identified (25 were classified into 10 cluster) with a case fatality rate (CFR) of 76.4%. The patients were from 9 (27%) of the 33 provinces in Indonesia. The ratio between male and female patients was 4 to 3. with an extremely high CFR of the women (87%). Most patients were of young adult ages, 39% of them were less than 15 years old. Indirect and direct contact with sick or dead poultry was reported from 81% of these confirmed cases.