Konflik Peran Ganda dan Job Insecurity terhadap Subjective Well-Being

Tujuan dari penelitian ini adalah untuk melihat konflik peran ganda dan job insecurity terhadap subjective well-being pada perawat wanita di kota X. Hipotesis penelitian ini yaitu ada peran konflik peran ganda dan job insecurity terhadap subjective well-being pada perawat wanita di kota X Propinsi Bengkulu. Populasi penelitian ini adalah perawat wanita di kota X yang telah menikah dan memiliki anak. Jumlah populasi sebanyak 220 partisipan. Sampel penelitian sebanyak 135 orang dan untuk uji coba sebanyak 60 orang. Pengambilan sampel menggunakan teknik sampling purposive sampling. Komponen subjective well-being diambil dari Diener, dkk (1999), dimensi job insecurity sesuai dengan pernyataan dari Sverke, Hellgren dan Isaksson (1999) dan jenis-jenis konflik peran ganda diambil dari Netmeyer, Boles, Mcmurrian (1996). Metode penelitian menggunakan analisis data regresi linier berganda untuk uji hipotesis, yang sebelumnya dilakukan uji normalitas dan linearitas terlebih dahulu. Hasilnya menunjukkan R=0,636 R square=0,404 F=44,775 P=0,000 , (p<0,05), maka ada peran yang signifikan dari konflik peran ganda dan job insecurity terhadap subjective well-being. Dengan demikian hipotesis yang diajukan diterima.

The susceptibility pattern and distribution of blaOXA-23 genes of clinical isolate Acinetobacter baumannii in a tertiary hospital, Indonesia

INTRODUCTION

Acinetobacter baumannii, a pathogen of concern in hospitals worldwide, has diverse antimicrobial resistance mechanisms leading to limiting the antibiotic options and carbapenemase enzyme production is one of the common mechanisms in carbapenem resistance. The epidemiology and resistance pattern of clinical isolates are critical in developing a prevention and treatment strategy. The aim of this was to determine the prevalence and resistance pattern of carbapenem non-susceptible strains (CNS) A. baumannii at Arifin Achmad General Hospital, Pekanbaru, Indonesia.

METHODOLOGY

Data were retrieved from the culture and susceptibility test results from various clinical specimens from January 2015 to December 2019. A susceptibility test was conducted using Vitek 2 Compact following the manufacturer's protocol. To explore the genetic profile of CNS A. baumannii, we amplified the blaOXA-23 and blaOXA-51 genes, carbapenemase producing genes, using a duplex polymerase chain reaction (PCR) among 24 isolates Chi-squared was used to assess the factors associated with the presence of CNS A. baumannii.

RESULTS

Between 2015-2019, 1.263 A. baumannii isolates were tested and the prevalence of CNS A. baumannii was 50%. The trend decreased from 53% in 2016 to 45% in 2019. The proportion of CNS A. baumannii was higher among samples from patients treated in the Intensive Care Unit (ICU) compared to non-ICU (p < 0.001). The CNS A. baumannii was also more frequently detected from sputum than from non-sputum samples (p = 0.009). CNS A. baumannii were highly resistant to almost all antibiotics and the highest susceptibility was to amikacin, tigecycline, and trimethoprim/sulfamethoxazole with 64%, 53%, and 43%, respectively. The blaOXA-23 gene was detected in 92% of tested CNS A. baumannii isolates.

CONCLUSIONS

The prevalence of CNS A. baumannii is high at Arifin Achmad Hospital Riau, Indonesia. This is also supported by the high prevalence of the blaOXA-23 gene among tested isolates. Based on the antibiotic susceptibility pattern there are limited antibiotic choices for CNS A. baummannii urging the strengthening of antimicrobial stewardship programs in the country.

Development of Local Birth Weight Reference Based on Gestational Age and Sex in South Kalimantan Province, Indonesia

Purpose

Percentile reference of babies’ birth weight is an effective reference tool for early detection of the risk of neonatal morbidity and impaired growth. However, the lack of minimum local and national perinatal data makes its development in Indonesia difficult. This study aims to develop a local birth weight percentile reference for babies based on gestational age and sex by utilizing local data in South Kalimantan Province which is one of the provinces with the highest neonatal mortality rate in Indonesia.

Patients and Methods

All single live newborns who were born and were recorded in 20 primary healthcare centers, between 1 June 2016 and 30 June 2017, were included in the study. Birth weight percentiles of infants were calculated using the weighted average method. The study focused on neonates born with gestational age from 36 to 40 weeks.

Results

A local birth weight reference for babies has been developed. According to our local reference, the proportion of male newborns with a birth weight < 10th percentile was higher (7.0%) than the existing Indonesian (4.2–4.3%) and international references (3.3–6.2%). Similarly, the proportion of female newborns with a birth weight <10th percentile was higher (6.5%) than the existing Indonesian references (3.6–4.4%) and the global reference (5.8%) but lower than the Intergrowth 21st project (7.2%). The differences suggest that relative birth weight will likely be underestimated (overestimated) if other percentile references are used for the local population.

Conclusion

A local birth weight percentile reference for babies in South Kalimantan Province based on gestational age (36–40 weeks) and sex has been developed. Access to the local data, as baseline information, will allow the compilation and comparison of pregnancy-related outcomes across provinces in Indonesia. Consequently, reliable national perinatal data can be strengthened to establish the national references for newborns’ anthropometric measurements.

Distribution of Carbapenemase Genes among Carbapenem-Non-Susceptible Acinetobacter baumanii Blood Isolates in Indonesia: A Multicenter Study

Carbapenem non-susceptible Acinetobacter baumannii (CNSAB) is an important pathogen that causes nosocomial bacteremia among critically ill patients worldwide. The magnitude of antibiotic resistance of A. baumanii in Indonesia is expected to be significant; however, the data available are limited. The aim of this study was to analyze the genetic profiles of CNSAB isolates from patients with bacteremia in Indonesia. CNSAB isolates from blood cultures of bacteremia patients in 12 hospitals in Indonesia were included. The blood cultures were conducted using the BacT/Alert or BACTEC automated system. The CNSAB were identified with either Vitek 2 system or Phoenix platform followed by a confirmation test using a multiplex polymerase chain reaction (PCR) assay, targeting the specific gyrB gene. The carbapenemase genes were detected by multiplex PCR. In total, 110 CNSAB isolates were collected and were mostly resistant to nearly all antibiotic classes. The majority of CNSAB isolates were susceptible to tigecycline and trimethoprim-sulfamethoxazole (TMP-SMX), 45.5% and 38.2%, respectively. The bla_OXA-51-like gene was identified in all CNSAB isolates. Out of the total, 83.6% of CNSAB isolates had bla_OXA-23-like gene, 37.3% bla_OXA-24-like gene, 4.5% bla_NDM-1 gene, 0.9% bla_IMP-1 gene, and 0.9% bla_VIM gene. No bla_OXA-48-like gene was identified. The bla_OXA-23-like gene was the predominant gene in all except two hospitals. The presence of the bla_OXA-24-like gene was associated with resistance to tigecycline, amikacin, TMP-SMX and cefoperazone-sulbactam, while bla_OXA-23-like gene was associated with resistance to TMP-SMX and cefoperazone-sulbactam. In conclusion, the bla_OXA-23-like gene was the predominant gene among CNSAB isolates throughout Indonesia. A continuous national surveillance system needs to be established to further monitor the genetic profiles of CNSAB in Indonesia.

Possible Cases of SARS-CoV-2 Reinfection In Pekanbaru, Indonesia

Confirmed and possible reinfection cases of SARS-CoV-2 have been reported from various countries. Here we present two cases of possible SARS-CoV-2 reinfection in Pekanbaru, Indonesia. A 26 years old female and a 27 years old male healthcare workers were first confirmed by PCR with high Ct-value (>35) while presenting no or mild symptoms, respectively. In more than one month since the last negative test results, both patients developed typical COVID-19 symptoms; fever and anosmia. RT-PCR results for SARS-CoV-2 were positive with Ct-value less than 30. The timeframe between 1st and 2nd episode, negative test result between episodes, and epidemiological risk factor strengthened the possibility of reinfection. However, we did not have whole genome sequence (WGS) or viral viability data to further confirm reinfection with different viable virus. The requirement of viral WGS data to confirm true reinfection cases calls for investment in whole genome sequencing platform in public health laboratories. We encourage standardized definition of SARS-CoV-2 reinfection case in order to be able to investigate and observe such cases.

APAKAH ORANG DENGAN CRITICAL THINKING DISPOSITIONS TIDAK AKAN BERPRASANGKA TERHADAP ANGGOTA DEWAN LEGISLATIF?

Penilaian buruk masyarakat terhadap anggota legislatif terlihat dari berbagai riset yang sudah dilakukan oleh beberapa lembaga riset publik. Pandangan dan penilaian masyarakat yang negatif terhadap lembaga legislatif dapat berubah menjadi prasangka terhadap dewan legislatif itu sendiri. Tujuan dilakukannya penelitian ini adalah untuk mengetahui lebih lanjut mengenai prasangka terhadap anggota dewan yang umum dimiliki oleh masyarakat dikaitkan dengan fungsi kognitif di dalam diri. Hipotesis dari penelitian ini adalah ada hubungan antara conceptual thinking dispositions dan prasangka masyarakat terhadap anggota legislative; apakah prasangka terhadap masyarakat terkait dengan factor kognitif di dalam diri atau tidak. Partisipan yang terlibat dalam penelitian ini sejumlah 200 orang yang sudah memiliki hak pilih. Sebelumnya, peneliti melibatkan 70 orang yang sudah memiliki hak pilih untuk uji coba alat ukur yang akan digunakan. Pemilihan subjek dilakukan dengan menggunakan teknik sampling insidental. Penelitian ini menggunakan dua buah skala sebagai alat ukur, yaitu skala conceptual thinking dispositions berdasarkan aspek conceptual thinking dispositions dari Facione, Giancarlo, Facione, dan Gainen (1995) dan skala prasangka yang mengacu pada komponen prasangka dari Aronson, Wilsom & Akert (2014). Hasil analisis korelasi menunjukkan nilai r = 0,018 dan p = 0, 804 (p> 0,05). Dengan demikian, hipotesis penelitian ditolak. Artinya, tidak ada hubungan antara conceptual thinking dispositions yang dimiliki dengan prasangka masyarakat terhadap anggota dewan.

The development of an alternative growth chart for estimated fetal weight in the absence of ultrasound: Application in Indonesia

A fetal growth chart is a vital tool for assessing fetal risk during pregnancy. Since fetal weight cannot be directly measured, its reliable estimation at different stages of pregnancy has become an essential issue in obstetrics and gynecology and one of the critical elements in developing a fetal growth chart for estimated fetal weight. In Indonesia, however, a reliable model and data for fetal weight estimation remain challenging, and this causes the absence of a standard fetal growth chart in antenatal care practices. This study has reviewed and evaluated the efficacy of the prediction models used to develop the most prominent growth charts for estimated fetal weight. The study also has discussed the potential challenges when such surveillance tools are utilized in low resource settings. The study, then, has proposed an alternative model based only on maternal fundal height to estimate fetal weight. Finally, the study has developed an alternative growth chart and assessed its capability in detecting abnormal patterns of fetal growth during pregnancy. Prospective data from twenty selected primary health centers in South Kalimantan, Indonesia, were used for the proposed model validation, the comparison task, and the alternative growth chart development using both descriptive and inferential statistics. Results show that limited access to individual fetal biometric characteristics and low-quality data on personal maternal and neonatal characteristics make the existing fetal growth charts less applicable in the local setting. The proposed model based only on maternal fundal height has a comparable ability in predicting fetal weight with less error than the existing models. The results have shown that the developed chart based on the proposed model can effectively detect signs of abnormality, between 20 and 41 weeks, among low birth weight babies in the absence of ultrasound. Consequently, the developed chart would improve the quality of fetal risk assessment during pregnancy and reduce the risk of adverse neonatal outcomes.

Touch and Massage on Labor Pain Intensity During First Stage of Active Phase

Introduction: Labor pain is a challenging issue for nurses designing intervention protocols. Touch and massage therapy is one of non-pharmacology approaches that they could do during labor process. The study was conducted to assess the effectiveness in reducing pain intensity scale on the labor during first stage of active phase. Methods: A quasi-experimental approach was conducted and a purposive sampling technique was used to recruit 56 women who expected to have normal childbirth at a public hospital in Jakarta, Indonesia. They randomly assigned to either received touch and massage intervention (experiment) or not (control). The labor pain intensity was using Verbal Description Scale (VDS) with descriptive statistics, paired, and independent t-test. Results: The result showed that touch and massage therapy had a significant impact on the experimental group (tcalI 2.839, p<0.05). A significant difference also showed among the experimental dan control group during pre-test (tcalI 1.817, p>0.05) and post-test (tcalI 10.77, p<0.05). The study found that a combination of touch and massage therapy was effective to reduce labor pain during active stage. Conclusions: Touch and massage therapy can reduce labor pain intensity, and at the same time serve as closeness and encouragement during the first stage of active phase. It is a cost-effective nursing intervention and can positively influence the quality of women’s birth experiences.

Improving the Information Availability and Accessibility of Antenatal Measurements to Ensure Safe Delivery: A Research-Based Policy Recommendation to Reduce Neonatal Mortality in Indonesia

Purpose

Assessing the risks and preventable causes of maternal and neonatal mortality requires the availability of good-quality antenatal information. In Indonesia, however, access to reliable information on pregnancy-related results remains challenging. This research has proposed a research-based policy recommendation to improve availability and accessibility to vital information on antenatal examinations.

Patients and Methods

Descriptive statistics were used to characterize midwives’ capabilities in routinely gathering and recording antenatal information during pregnancy. The investigation was carried out among 19 midwives in South Kalimantan, Indonesia, from April 2016 to October 2017. Antenatal data on 4946 women (retrospective study) and 381 women (prospective study) have been accessed through a scientific and technical training program.

Results

To date, lack of timely access to antenatal information has hampered the process of reducing neonatal mortality in Indonesia. The post-training statistical analysis showed that the training has significantly improved midwives’ scientific knowledge and technical abilities in providing more reliable data on antenatal measurements.

Conclusion

Consistent scientific and technical training among midwives is required to update their knowledge and skills, particularly those relating to documenting the results of antenatal examinations at different stages of pregnancy and using that information to assess potential risks and identify necessary interventions. This should also be followed by routine monitoring on the quality of collected antenatal data. This can be one of the enabling actions to achieve the 2030 Sustainable Development Goals target in reducing neonatal mortality in Indonesia.

Hubungan Kualitas Pelayanan Asuhan Persalinan Normal dengan Loyalitas Ibu Bersalin di Puskesmas Rawat Inap Lubuk Buaya Padang Tahun 2017

AbstrakAngka Kematian Ibu (AKI) dapat menggambarkan bagaimana kualitas pelayanan persalinan di puskesmas. Puskesmas rawat inap Lubuk Buaya Padang termasuk penyumbang jumlah kematian ibu kematian ibu di  kota Padang. Tujuan: Menentukan hubungan kualitas pelayanan Asuhan Persalinan Normal (APN) dengan loyalitas ibu bersalin. Kepuasan pasien sebagai confounding variable dan menganalisis kualitas pelayanan APN di Puskesmas Lubuk Buaya Padang tahun 2017. Metode: Penelitian ini menggunakan desain mixed method (kuantitatif dan kualitatif). Hasil: Pada analisis bivariat diketahui bahwa terdapat hubungan yang bermakna antara kualitas pelayanan asuhan persalinan normal (p = 0,004) dan kepuasan ibu (p = 0,001) terhadap loyalitas ibu bersalin. Pada analisis multivariat diketahui kepuasan ibu yang lebih dominan dibandingkan kualitas pelayanan APN dalam mempengaruhi loyalitas ibu bersalin (P=0,001, OR=8,867). Pada aspek input ditemukan bahwa pemerataan penempatan petugas di klinik bersalin puskesmas masih perlu diperhatikan, kemudian diberikan tambahan tenaga bidan untuk mengoptimalkan pelayanan di klinik puskesmas, dan untuk sopir ambulans, tidak selalu ada pada saat dibutuhkan. Aspek perencanaan belum direalisasikan dalam bentuk dokumen. Pelaksanaan pelayanan, langkah-langkah  APN tidak selalu semuanya dikerjakan. Pada pengawasan tidak ditemukan dokumentasi hasil pengawasan yang telah dilakukan oleh pihak puskesmas kepada petugas di klinik bersalin. Simpulan: Capaian ibu yang melakukan persalinan normal di puskesmas lebih rendah dibanding jumlah ibu yang melakukan pemeriksaan kehamilan. 

Foetal weight prediction models at a given gestational age in the absence of ultrasound facilities: application in Indonesia

BACKGROUND

Birth weight is one of the most important indicators of neonatal survival. A reliable estimate of foetal weight at different stages of pregnancy would facilitate intervention plans for medical practitioners to prevent the risk of low birth weight delivery. This study has developed reliable models to more accurately predict estimated foetal weight at a given gestation age in the absence of ultrasound facilities.

METHODS

A primary health care centre was involved in collecting retrospective non-identified Indonesian data. The best subset model selection criteria, coefficient of determination, standard deviation, variance inflation factor, Mallows Cp, and diagnostic tests of residuals were deployed to select the most significant independent variables. Simple and multivariate linear regressions were used to develop the proposed models. The efficacy of models for predicting foetal weight at a given gestational age was assessed using multi-prediction accuracy measures.

RESULTS

Four weight prediction models based on fundal height and its combinations with gestational age (between 32 and 41 weeks) and ultrasonic estimates of foetal head circumference and foetal abdominal circumference have been developed. Multiple comparison criteria show that the proposed models were more accurate than the existing models (mean prediction errors between - 0.2 and 2.4 g and median absolute percentage errors between 4.1 and 4.2%) in predicting foetal weight at a given gestational age (between 35 and 41 weeks).

CONCLUSIONS

This research has developed models to more accurately predict estimated foetal weight at a given gestational age in the absence of ultrasound machines and trained ultra-sonographers. The efficacy of the models was assessed using retrospective data. The results show that the proposed models produced less error than the existing clinical and ultrasonic models. This research has resulted in the development of models where ultrasound facilities do not exist, to predict the estimated foetal weight at varying gestational age. This would promote the development of foetal inter growth charts, which are currently unavailable in Indonesian primary health care systems. Consistent monitoring of foetal growth would alleviate the risk of having inter growth abnormalities, such as low birth weight that is the most leading factor of neonatal mortality.

Emergence of Melioidosis in Indonesia and Today's Challenges

A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.

Prevalensi dan Pola Sensitivitas Enterobacteriaceae Penghasil ESBL di RSUD Arifin Achmad Pekanbaru

Resistensi antibiotik merupakan masalah besar baik di rumah sakit maupun di masyarakat, resistensi menyebabkan pilihan terapi infeksi menjadi terbatas. Prevalensi resistensi antibiotik cenderung makin meningkat, salah satu diantaranya adalah bakteri ESBL (extended spectrum beta lactamases), suatu kelompok bakteri penghasil enzim yang dapat menghidrolisis antibiotik beta laktam yang mengandung grup oxyimino seperti sefalosporin generasi satu sampai ketiga dan aztreonam. Penelitian ini  dilakukan secara deskriptif retrospektif yang bertujuan untuk mengetahui prevalensi ESBL pada Klebsiella pneumoniae dan Escherichia coli, serta pola sensitivitasnya di RSUD Arifin Achmad Pekanbaru. Data diambil dari hasil kultur bakteri dan uji resistensi antibiotik dari berbagai spesimen klinik yang diperiksa di Laboratorium Mikrobiologi RSUD Arifin Achmad selama tahun 2015. Uji ESBL dilakukan dengan alat VITEK 2 compact yang membandingkan antara proporsi penurunan pertumbuhan bakteri terhadap antibiotik sefalosporin saja dengan antibiotik kombinasi sefalosporin ditambah asam klavulanat. Hasil penelitian menunjukkan ESBL-K. pneumoniae sebesar 66,2%, dan ESBL-E. coli 62,2%, dan total rata-rata pada kedua bakteri 65,2%. Prevalensi ESBL-K. pneumoniae dan ESBL-E. coli paling tinggi berasal dari ruangan Instalasi Perawatan Intensif Anak dan berasal dari spesimen sputum dan pus, namun secara statistik tidak didapatkan perbedaan bermakna proporsi ESBL positif dan negatif berdasarkan asal ruangan dan jenis spesimen. Sensitivitas ESBL-K. pneumoniae dan ESBL-E. coli paling baik dengan antibiotik golongan karbapenem, amikasin dan tigesiklin. Penelitian ini menunjukkan tingginya prevalensi K. pneumoniae dan E. coli penghasil ESBL di RSUD Arifin Achmad dibanding beberapa rumah sakit rujukan nasional dii Indonesia. Saran untuk menurunkan angka ESBL dengan cara mencegah transmisi melalui penerapan kewaspadaan kontak dan kewaspadaan berbasis transmisi, aspek pencegahan dan pengendalian infeksi dan peningkatkan rasionalisasi penggunaan antimikroba harus dilakukan.

Pola Resistensi Bakteri Penyebab Sepsis Neonatorum di Instalasi Perawatan Neonatus RSUD Arifin Achmad Riau

Latar belakang. Sepsis neonatorum masih menjadi kendala utama di bidang pelayanan dan perawatan neonatus. Diperlukanpemberian antibiotik empirik yang tepat dapat menurunkan angka kematian. Namun, terapi empirik yang tepat harus berdasarkanpola resistensi di tempat tersebutTujuan. Mengetahui pola resistensi bakteri dari kultur darah pasien sepsis neonatal.Metode. Desain penelitian deskriptif retrospektif. Semua data hasil kultur dan uji resistensi antibiotik dari spesimen darah neonatustersangka sepsis yang dirawat di Instalasi Perawatan Neonatus RSUD Arifin Achmad Provinsi Riau periode Januari sampai Desember2014 dimasukkan dalam penelitian.Hasil. Didapatkan 568 pemeriksaan kultur darah neonatus yang diduga sepsis, dengan hasil kultur darah positif 196 (34,51%).Mikroorganisme terbanyak yang ditemukan yaitu Coagulase negative Staphylococci (CoNS) (29,08%), Candida sp (15,21%), B. cepacia(12,76%), A. baumanii (9,18%) dan K. pneumoniae (8,16%). Bakteri Gram positif paling sensitif dengan vancomycin dan linezolid,sedangkan bakteri Gram negatif paling sensitif dengan meropenem, amikacin dan tigecycline.Kesimpulan. Hasil kultur darah positif adalah 34,5%. Mikroorganisme yang paling banyak yaitu Coagulase negative Staphylococci,Candida sp, B. cepacia, A. baumanii dan K. pneumoniae. Bakteri Gram positif paling sensitif dengan vancomycin dan linezolid. BakteriGram negatif paling sensitif dengan meropenem, amikacin dan tigecycline