BackgroundThe contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners.MethodsWe conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time.ResultsThe following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1 – 3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0 – 4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0).ConclusionsEducation and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.

Background and purpose: Electronic cigarettes have been available globally since 2003 and first became for sale in Indonesia in 2010. Users tend to be predominately young people. The purpose of this study is to determine the proportion, characteristics and factors that influence the use of electronic cigarette among university students.Method: This research used a cross sectional survey with 351 undergraduate students from a variety of disciplines at Udayana University chosen by multistage sampling. In the first phase, 10 study programs were chosen randomly from 47 courses at Udayana University. The selection of respondents was influenced by the convenience of data collection, that is, questionnaire via the Survey Monkey application. Analysis with logistic regression was used to determine the factors influencing electronic cigarette usage based on several variables.Results: The proportion of students who used tobacco cigarettes was 14.53%. Respondents who reported using electronic cigarettes numbered 61 (17.38%, 95%CI: 13.46%-21.3%), and 40.98% of them were still current smokers. As many as 88.52% of respondents who had ever used electronic cigarette are male students, and 11.48% female students. Students who had ever used electronic cigarettes in the campus area totaled 22 people (36.07%). The reasons provided for using electronic cigarettes included a desire to stop using tobacco cigarettes (29.51%), the fact that electronic cigarettes are considered safer (26.23%), are considered “cool” (22.95%), experimental reasons, and other (26.23%). Multivariate analysis showed that the variables found to be associated with the use of electronic cigarettes were gender (AOR=14.72; 95%CI: 4.34-49.87), a history of smoking tobacco cigarettes (AOR=42.16; 95%CI: 13.56-131.08), had a history of consuming alcoholic beverages (AOR=5.72; 95%CI: 2.04-16.04) as well as coming from a smoking household (AOR=3.87; 95%CI: 1.33 - 11.21).Conclusion: The proportion of students who have ever used electronic cigarettes was found to be higher than cigarette tobacco users. In addition, use was found to be greater among male students than in female students. Influencing factors associated with the use of electronic cigarettes are gender, a history of tobacco smoking, a history of consuming alcoholic beverages as well as coming from a smoking household. There is a need for prevention efforts including education and regulations to reduce the use of electronic cigarettes among students and the general public.

The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.

Diabetes mellitus (DM) increases the risk of developing pulmonary tuberculosis (TB) disease. Therefore, pulmonary TB screening among DM patients is essential. This study aimed to identify factors associated with participation of DM type II patients in pulmonary TB screening using chest X-ray. This was a cross-sectional analytic study and was part of TB-DM screening study in Denpasar, Bali, Indonesia. The sample consisted of 365 DM type II patients selected by quota sampling among DM type II patients joining the screening program from January until March 2016 in 11 public health centres in Denpasar. Data were collected via structured interviews. The contributing factors were determined by modified Poisson regression test for cross-sectional data. From the findings, less than half (45.48%) of DM type II patients participated in chest X-ray examination for TB. Factors associated with participation in pulmonary TB screening were having a higher educational level [APR = 1.34, 95% CI (1.07–1.67)], having family member who developed pulmonary TB disease [APR = 1.47, 95% CI (1.12–1.93)], the travel time to referral hospital for screening being ≤ 15 minutes [APR = 1.6, 95% CI (1.26–2.03)], having health insurance [APR = 2.69, 95% CI (1.10–6.56)], and receiving good support from health provider [APR = 1.35, 95% CI (1.06–1.70)]. Therefore, training for health provider on providing counselling, involvement of family members in screening process, and improving the health insurance coverage and referral system are worth considering.

ABSTRAK Hipertensi adalah salah satu gangguan kesehatan yang disebabkan oleh berbagai faktor, salah satunya adalah paparan bising. Tenaga kerja di unit pembangkit listrik merupakan salah satu profesi yang berisiko mengalami hipertensi. Tujuan penelitian ini adalah untuk mengetahui gambaran kejadian hipertensi berdasarkan karakteristik (umur, pendidikan dan masa kerja), kepatuhan penggunaan APT, jarak paparan dan paparan bising. Desain penelitian yang digunakan adalah cross sectional study. Teknik pengambilan sampel menggunakan simpel random sampling, dengan jumlah sampel sebanyak 79 tenaga kerja di PT Indonesia Power UBP Bali. Alat yang digunakan tediri dari kuisioner, sphygmomanometer, dan sound level meter. Analisis data dilakukan secara deskriftif dengan menggunakan tabel distribusi yang disertai dengan penjelasan pada tabel. Hasil penelitian menunjukkan bahwa kejadian hipertensi lebih banyak ditemukan pada kelompok umur ?40 tahun (47,2%), responden dengan pendidikan tinggi (44,4%), masa kerja ?5 tahun (51,9%),  responden yang tidak patuh  dalam menggunakan alat pelindung telinga (83,3%), responden yang bekerja pada radius I dan II (43,6%), dan pada  paparan bising lebih dari atau sama dengan 85 dB(A) (45,8%). Kejadian hipertensi lebih tinggi secara bermakna pada kelompok umur ?40 tahun (p=0,028), masa kerja ?5 tahun (p=0.004), responden yang tidak patuh dalam penggunaan alat pelindung telinga (p=0,000) %), responden yang bekerja pada radius I dan II (p=0.008), dan pada paparan bising lebih dari atau sama dengan 85 dB(A) (p=0,000). Sedangkan tingkat pendidikan tidak menunjukkan perbedaan yang bermakna terhadap kejadian hipertensi (p=0,082). Perusahaan harus lebih meningkatkan pengendalian kebisingan baik pada sumber kebisingan (sillincer atau barrier), maupun pada penerima (penggunaan APT, meminimalisir faktor risiko hipertensi lainnya) Kata kunci: Hipertensi, Paparan Bising, Pembangkit Listrik   ABSTRACT Hypertension is one of the health problems caused by various factors, one of which is noise exposure. Labor in power generation units is a profession that is at risk of experiencing hypertension. The purpose of this study was to determine the description of the incidence of hypertension based on characteristics (age, education and years of service), compliance with the use of APT, exposure distance and noise exposure. The research design used was cross sectional study. The sampling technique uses simple random sampling, with a total sample of 79 workers at PT Indonesia Power UBP Bali. The tools used consist of questionnaires, sphygmomanometers, and sound level meters. Data analysis was carried out descriptive using a distribution table accompanied by an explanation in the table. The results showed that the incidence of hypertension was more often found in the age group ?40 years (47.2%), respondents with higher education (44.4%), tenure of ?5 years (51.9%), respondents who were not compliant in using ear protection (83.3%), respondents who worked at radius I and II (43.6%), and at noise exposure more than or equal to 85 dB (A) (45.8%). The incidence of hypertension was significantly higher in the age group ?40 years (p = 0.028), work period ?5 years (p = 0.004), respondents who were not compliant in the use of ear protection equipment (p = 0,000)%), respondents who worked at radius I and II (p = 0.008), and at noise exposure more than or equal to 85 dB (A) (p = 0,000). While the level of education did not show a significant difference in the incidence of hypertension (p = 0.082). Companies must further improve noise control both at the source of noise (sillincer or barrier), and at the recipient (use of APT, minimizing other risk factors for hypertension). Keywords: Hypertension, Noise Exposure, Power Plants

ABSTRAKKecelakaan lalu lintas merupakan masalah global dan banyak terjadi setiap harinya, sehingga perlu mengetahui kepatuhan pengendara khususnya pengendara kendaraan bermotor tentang keselamatan berkendara (safety riding) terkait pengetahuan safety riding. World Health Organization menyatakan kecelakaan lalu lintas merupakan penyebab utama kematian remaja di dunia pada rentang umur 15-29 tahun. Penelitian ini bertujuan untuk mengetahui gambaran kepatuhan remaja dengan kepatuhan safety riding di SMA Negeri di Kota Denpasar. Penelitian ini merupakan penelitian deskriptif kuantitatif dengan desain teknik cross-sectional. Sampel penelitian ini berjumlah 350 responden dengan menggunakan teknik pengambilan sampel secara multisage random sampling. Pengumpulan data dilakukan dengan cara wawancara menggunakan kuesioner dan studi dokumentasi kemudian data yang didapatkan diolah menggunakan software STATA. Hasil penelitian menunjukkan tingkat pengetahuan remaja terhadap kepatuhan safety riding termasuk dalam kategori tinggi, yaitu sebanyak 170 responden (69,96%) dan sikap responden terhadap kepatuhan safety riding memiliki sikap yang positif yaitu sebesar 157 responden (70,40%). Kepatuhan tentang safety riding termasuk dalam kategori patuh, yaitu sebanyak 241 responden (68,86%). Berdasarkan hasil uji statistik didapatkan bahwa terdapat hubungan bermakna antara jenis kelamin dengan kepatuhan safety riding (p=0,03). Responden dengan jenis kelamin perempuan yaitu sebanyak 147 responden (73,50%) lebih patuh terhadap safety riding daripada responden dengan jenis kelamin laki-laki. Perlu diadakannya sosialisasi dan edukasi mengenai safety riding oleh pihak sekolah dan juga pihak yang berwenang. Selain itu remaja perlu meningkatkan pengetahuan safety riding dan menumbuhkan perilaku safety riding melalui pembinaan disiplin berlalu lintas dan mencari informasi tentang safety riding di media massa dan internet.Kata Kunci : Tingkat Pengetahuan, Safety Riding, Kepatuhan, Remaja

ABSTRAK Upaya pemerintah dalam mengendalikan permasalahan rokok adalah dengan melakukan regulasi tentang peraturan pemerintahan. Kab. Klungkung merupakan salah satu Kabupaten di Bali yang telah mengadopsi Perda KTR yang ditetapkan dalam Peraturan Daerah Nomor 1 tahun 2014 tentang Kawasan Tanpa Rokok. Pemerintah Daerah Kab. Klungkung sangat berkomitmen untuk menurunkan angka perokok dengan mengadopsi Perda KTR dan membuat aturan mengenai larangan iklan rokok, namun kenyataannya tingkat kepatuhan masyarakat terhadap Perda KTR di tempat umum masih rendah. Tujuan penelitian ini adalah untuk mengetahui perilaku pengunjung Lapangan Puputan Kab. Klungkung dalam penerapan Perda Nomor 1 tahun 2014 tentang Kawasan Tanpa Rokok, dengan menggunakan metode penelitian kualitatif. Sampel dalam penelitian ini dipilih dengan metode purposive sampling dan jumlah informan dalam penelitian ini adalah 10 orang dan 2 orang informan kunci. Dari 10 informan tersebut terdiri dari 5 informan merupakan perokok dan 5 informan bukan perokok, pengumpulan data dilakukan dengan wawancara mendalam dan observasi. Berdasarkan hasil penelitian dapat diketahui bahwa pengetahuan informan terkait Perda KTR di Lapangan Puputan Kab. Klungkung masih kurang dan persepsi informan mengenai pelaksanaan Perda KTR di Lapangan Puputan Klungkung termasuk negatif. Selain itu ketersediaan tanda KTR masih minim, serta peran dari Dinas Kesehatan dan Satpol PP masih belum efektif dalam penerapan Perda tersebut. Disimpulkan bahwa pengetahuan, persepsi, ketersediaan tanda, dan peran Dinas Kesehatan dan Satuan Polisi Pamong Praja (Satpol PP) terkait Perda KTR di Lapangan Puputan Kabupaten Klungkung masih kurang sehingga mempengaruhi perilaku informan terhadap kebiasaan merokok di tempat umum, oleh sebab itu Dinas Kesehatan Kabupaten Klungkung disarankan untuk melaksanakan sosialisasi ke desa-desa dan Satpol PP agar lebih tegas melakukan pengawasan, dan untuk peneliti selanjutnya agar meniliti determinan-determinan lain. Kata kunci: Perilaku, Perda KTR, Kawasan Tanpa Rokok   ABSTRACT Government efforts in controlling the problem of cigarettes is to make regulations on government regulations. Klungkung is one of the regencies in Bali that has adopted a KTR Regional Regulation stipulated in Regional Regulation No. 1 of 2014 concerning No-Smoking Areas. Government of Klungkung District is very committed to reducing the number of smokers by adopting the KTR regulation and making rules regarding the prohibition of cigarette advertising, but in reality the level of public compliance with the KTR regulation in public places is still low. The purpose of this study was to determine the behavior of visitors Puputan Field in Klungkung District in the application of Perda No. 1 of 2014 concerning No-Smoking Areas, by using qualitative research methods. The sample in this study was selected by the method of purposive sampling and the number of informants in this study were 10 people and 2 key informants. Of the 10 informants consisting by 5 smokers and 5 non-smokers, data collection is done by in-depth interviews and observation. Based on the results of the study it can be seen that the informant's knowledge related to the Regional Regulation on KTR in Puputan Field in Klungkung is still lacking and informants' perceptions regarding the implementation of the Regional Regulation on KTR in Puputan Field in Klungkung are negative. In addition, the availability of KTR markings is still minimal, and the role of the Health Office and Satpol PP is still not effective in the application of the regulation. It was concluded that knowledge, perception, availability of signs, and the role of the Health Office and the Civil Service Police Unit (Satpol PP) related to the Regional Regulation on KTR in Puputan Field in Klungkung were still lacking so that it influenced the informant's behavior towards smoking habits in public places, therefore the Klungkung District Health Office It is recommended to carry out socialization to villages and Satpol PP to be more assertive in conducting supervision, and for further researchers to examine other determinants. Keywords: Behavior, Regional Regulation on KTR, Non-Smoking Area

Abstract:The major issue of Tuberculosis (TB) control program in Indonesia including Bali is the low cases detection rate (32%). An intensive presumptive TB finding through screening program and then followed by diagnosis procedure is important to conduct. Meanwhile, perceived stigma is a social determinant of health that strongly associated to health-seeking behaviour. This study aimed to assess the association of perceived stigma towards TB to diagnosis procedure implementation among presumptive TB casesscreened from diabetes mellitus (DM) patients. This was an operational research during the TB screening program among DM patients. The samples were collected consecutively from January until March 2016 at 11 public health centres (PHC) in Denpasar City, Bali Province. Data were collected via interview using structured questionnaire. Logistic regression was used for statistical testing. During 3 months implementation of screening program, there were 567 DM patients screened, 342 of them were presumptive TB cases and were recommended to follow TB diagnosis procedures. There were only 87(25,4%) who followed the procedure and 255 (74,6%) refused to participate. The refusal to diagnosis procedure was associated to the TB stigma (OR=1.7; 95%CI: 1.03-2.9). Meanwhile, perceivedstigma towards TB wasassociated to the lack knowledge of TB (OR=2.0; 95%CI: 1.3-3.2) and the lack of family support (OR=1.8; 95%CI: 1.1-2.7). The diagnosis procedure coverage among presumptive TB cases screened from DM patient was still low. The perceived stigma towards TB is contributed to the high proportion of presumptive TB cases who did not follow thediagnosis procedure. Therefore, a comprehensive education toincrease public awareness and supportto the TB program are necessary.