Background: Obesity and central obesity have become serious public health problems in developing countries such as Indonesia. Although 10 years have passed since the largest national health survey was conducted in 2007, no further analysis and publication concerning obesity and central obesity in Indonesia have been conducted based on the survey. The aim of this study is to determine the prevalence of obesity and central obesity, and its association with sociodemographic characteristics and comorbidities in Indonesia.Methods: A cross-sectional study was conducted based on the National Basic Health Survey 2007 using total sampling method from 33 provinces. Obesity is defined as body mass index ≥25 according to the Asia-Pacific standard for obesity. Central obesity is defined as waist circumference >90 cm for men and > 80 cm for women according to the Asia-Pacific standard for central obesity.Results: The prevalence of obesity and central obesity in the Indonesian adult population are 23.1% and 28%, respectively. Both rates are higher in females than in males. Obesity and central obesity are associated with the risk of diabetes and hypertension.Conclusion: Prevalence of obesity and central obesity is high in the Indonesian adult population. Interventional programs are important to promote awareness of obesity and healthy lifestyle changes in the community.
Objective. This study aims to identify predictors of 72-hour mortality in patients with diabetic ketoacidosis (DKA).Methodology. In this retrospective cohort study, data were obtained from medical records of adult patients with DKA in Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Associations of predictors (age, type of diabetes, history of DKA, comorbidities, level of consciousness, renal function, bicarbonate, potassium, lactate, betahydroxybutyrate levels, and anion gap status) and 72-hour mortality were analyzed. The mortality prediction model was formulated by dividing the coefficient B by the standard error for all variables with p<0.05 in the multivariate analysis.Results. Eighty-six of 301 patients did not survive 72 hours after hospital admission. Comorbidities (HR 2.407; 95% CI 1.181-4.907), level of consciousness (HR 10.345; 95% CI 4.860-22.019), history of DKA (HR 2.126; 95% CI 1.308-3.457), and lactate level (HR 5.585; 95% CI 2.966-10.519) were significant predictors from multivariate analysis and were submitted to the prediction model. The prediction model had good performance. Patients with total score less than 3 points were at 15.41 % risk of mortality, 3 -4 points were 78.01% and 5 -6 points were 98.22% risk of mortality. Conclusion.The 72-hour mortality rate in Cipto Mangunkusumo General Hospital was 28.57%. The mortality prediction model had a good performance and consisted of comorbidities, history of DKA, level of consciousness and lactate level.
Background: Chronic complications of diabetes mellitus have a significant role in increasing morbidity, mortality, disability, and health cost. In the outpatient setting, the availability of data regarding to the chronic complications of type 2 diabetes is useful for evaluation of prevention, education, and patient’s treatment. This study aimed to describe the characteristic of type 2 diabetes chronic complications in outpatient diabetes clinic.Methods: A cross-sectional study was done using 155 patients in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital (RSCM), Jakarta in 2010. Secondary data were used from medical record based on history taking, physical examination, diabetic foot assessment, laboratory, neurologic, cardiology, opthalmology, ankle brachial index, and electrography of the patients. Characteristic profiles of the subjects, prevalence of the chronic complications, and its association with diabetes risk factors, such as glycemic control using HbA1c, fasting blood glucose, duration of diabetes, and LDL cholesterol were analyzed using chi square test.Results: Among 155 subjects participated in the study, most of them were women (59%) and elderly (46%). The prevalence of diabetes chronic complications was 69% from all subjects. These chronic complications included microangiopathy, macroangiopathy and mixed complications, with prevalence of 56%, 7% and 27% respectively. Microangiopathy included nephropathy (2%), retinopathy (7%), neuropathy (38%) and mixed complications (53%). Macroangiopathy included coronary heart disease (46%), peripheral arterial disease (19%), stroke (18%), and mixed complication (17%). From the analysis, we found significant association between duration of diabetes and diabetic neuropathy (p = 0.003).Conclusion: Prevalence of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, mainly dominated by microvascular-related complications including nephropathy, retinopathy, neuropathy and mixed complications. There was statistical significance between diabetes duration and diabetic neuropathy.
Background Agriculture is a major economic sector in Indonesia. Chemical pesticides are widely being used in agriculture for controlling pest. There is a growing concern that pesticide exposure, particularly chlorpyrifos (CPF) exposure, combined with other occupational characteristics that determine the level of exposure, can lead to further health impacts for farmers. Our objective was to evaluate the cumulative exposure characteristics among farmers exposed to CPF by using a validated algorithm. Methods We conducted a cross-sectional study of 152 vegetable farmers aged 18–65 who actively used CPF for at least 1 year in Central Java, Indonesia. Subject characteristics were obtained using a structured interviewer-administered questionnaire, addressed for sociodemographic and work-related characteristics. The cumulative exposure level (CEL) was estimated as a function of the intensity level of pesticide exposure (IL), lifetime years of pesticide use and the number of days spraying per year. CEL was subsequently classified into two groups, high and low exposure groups. The difference in characteristics of the study population was measured using Chi-square, independent-t or Mann-Whitney test. Association between CEL and its characteristics variables were performed by multiple linear regression. Results Seventy-one subjects (46.7%) were classified as the high exposure group. The use of multiple pesticide mixtures was common among our study population, with 94% of them using 2 or more pesticides. 73% reported direct contact with concentrated pesticides product, and over 80% reported being splashed or spilt during preparation or spraying activity. However, we found that the proportion of proper personal protective equipment (PPE) use in our subjects was low. Higher volume of mixture applied (p < 0.001) and broader acres of land (p = 0.001) were associated with higher cumulative exposure level, while using long-sleeved clothes and long pants (p < 0.05) during pesticide spraying were associated with lower cumulative exposure after adjusted for age and gender. Conclusions These findings indicate an inadequate knowledge of using pesticides properly. Thus, we recommend comprehensive training on pesticide usage and encourage proper PPE to reduce the exposure level.
ABSTRAKPendahuluan. Penyakit arteri perifer (PAP) ekstremitas bawah merupakan salah satu komplikasi makrovaskular diabetes melitus (DM) tipe 2 yang memiliki angka morbiditas dan mortalitas yang tinggi. Proses inflamasi telah diketahui berperan dalam terjadinya PAP pada penyandang DM tipe 2. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio (NLR) telah digunakan sebagai penanda inflamasi kronik. Penelitian ini dilakukan untuk mengetahui hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta.Metode. Studi potong lintang dilakukan pada subjek penyandang DM tipe 2 yang menjalani pemeriksaan ankle brachial index (ABI) di poliklinik divisi Metabolik Endokrin RSCM periode Oktober 2015 -September 2016. Didapatkan 249 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pengambilan data sekunder dari rekam medis mengenai data ABI, NLR, data demografik serta faktor perancu. Subjek dinyatakan menderita PAP ekstremitas bawah jika memiliki nilai ABI ≤ 0,9 dengan pemeriksaan probe doppler. Data NLR kemudian dikategorikan berdasarkan median nilai NLR dan dicari hubungan nilai NLR dengan kejadian PAP ekstremitas bawah. Uji chi square digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat.Hasil. Penyakit arteri perifer ekstremitas bawah ditemukan pada 36 subjek (14,5%). Didapatkan nilai median NLR total sebesar 2,11. Nilai median NLR didapatkan lebih tinggi pada kelompok PAP daripada tanpa PAP (2,46 vs. 2,04). Terdapat hubungan yang bermakna antara nilai NLR ≥ 2,11 dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 (PR 2,46, IK 95% 1,23 -4,87; p=0,007). Dengan menggunakan uji regresi logistik, diketahui bahwa hipertensi merupakan variabel perancu.Simpulan. Terdapat hubungan antara rasio neutrofil limfosit dengan kejadian penyakit arteri perifer ekstremitas bawah pada penyandang DM tipe 2 di RSCM. Kata Kunci: Diabetes melitus tipe 2, Inflamasi kronik, Penyakit arteri perifer ekstremitas bawah, Rasio neutrofil limfosit ABSTRACT
Latar belakang: Penelitian diabetes di daerah rural Indonesia masih sangat sedikit. Hasil suatu penelitian epidemiologi komunitas diperlukan untuk pengambilan kebijakan penanggulangan penyakit di suatu daerah. Penelitian ini bertujuan untuk mengetahui prevalensi diabetes serta pengetahuan
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