EXCLUSIVE BREASTFEEDING AMONG  ADOLESCENT MOTHERS

AbstractThe number of adolescent pregnancies in Indonesia is still very high. Sewon Subdistrict had the highest number of adolescent deliveries in Bantul District in 2015-2016. Adolescent mothers barely practice exclusive breastfeeding. This study aimed to determine factors influencing exclusive breastfeeding among adolescent mothers in Sewon Subdistrict, Bantul District. This study used cross-sectional study design was and a sample size of 45 that were adolescent mothers of 6-24- month-old infants. Data was collected using a structured questionnaire. Data analysis involved bivariate analysis using chi-square test and fisher’s exact test, while multivariate analysis used logistic regression. Results showed that 53.3% of adolescent mothers did not practice exclusive breastfeeding. Bivariate analysis showed that pregnancy status (p value = 0.029), perception of childbirth experience (p value = 0.045), perception of breastfeeding (p value = 0.005), husband support (p value = 0.009) and family support (p value = 0.000) were correlated to exclusive breasfeeding. Multivariate analysis showed that perception of breastfeeding (p value = 0.015; OR = 9.746) and family support (p value = 0.014; OR = 7.637) as the most influential factors to exclusive breastfeeding among adolescent mothers with a probability of 72.7%. There is low practice of exclusive breastfeeding among adolescent mother in Bantul, Yogyakarta and family support are most dominant factors influencing exclusive breastfeeding. AbstrakPersentase kehamilan remaja di Indonesia cukup tinggi. Kecamatan Sewon memiliki angka persalinan remaja tertinggi di Kabupaten Bantul pada tahun 2015-2016. Ibu usia remaja hampir tidak mempraktekkan pemberian ASI eksklusif, meski diketahui bemanfaat bagi bayi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi pemberian ASI eksklusif pada ibu usia remaja di Kecamatan Sewon, Kabupaten Bantul. Penelitian ini menggunakan desain potong lintang dan sampel penelitian berjumlah 45 orang ibu usia remaja yang mempunyai bayi usia 6-24 bulan. Pengumpulan data menggunakan kuesioner terstruktur. Analisis bivariat menggunakan kai kuadrat dan fisher’s exact test, sedangkan analisis multivariat menggunakan regresi logistik. Hasil penelitian menunjukkan bahwa 53.3% ibu usia remaja tidak memberikan ASI eksklusif. Analisis bivariat menunjukkan faktor status kehamilan (nilai p = 0.029), persepsi pengalaman melahirkan (nilai p= 0.045), persepsi menyusui (nilai p= 0.005), dukungan suami (nilai p= 0.009), dukungan keluarga (nilai p = 0,000) berhubungan dengan pemberian ASI eksklusif. Hasil analisis multivariat menunjukkan persepsi menyusui (p=0.015; RP=9.746) dan faktor dukungan keluarga (nilai p =0,014; RP = 7,637) sebagai faktor yang paling berpengaruh terhadap pemberian ASI eksklusif dengan probabilitas sebesar 72.7%. Masih rendahnya pemberian ASI ekslusif pada ibu remaja di Bantul, Yogyakarta, dan dukungan keluarga merupakan faktor paling dominan yang memengaruhi pemberian ASI eksklusif pada ibu usia remaja.

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Hubungan ASI Eksklusif dan Frekuensi Sakit Pada Bayi di Surabaya Barat

Amerta Nutrition ◽

10.20473/amnt.v4i1.2020.30-35 ◽

2020 ◽

Vol 4 (1) ◽

pp. 30

Author(s):

Dianatul Fitri ◽

Dian Shofiya

Keyword(s):

Relative Risk ◽

Exclusive Breastfeeding ◽

Primary Data ◽

P Value ◽

Fisher Exact Test ◽

Chi Square ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Quota Sampling

Background: Breast milk contains colostrum which is rich in antibodies, because it contains protein for immune system and is useful in preventing illness in high amounts. Exclusive breastfeeding coverage was 65.9% in Surabaya City. The Surabaya Health Profile, exclusive breastfeeding was 66.42% that distributed in 12 Puskesmas. Although West Surabaya was higher than average exclusive breastfeeding in Surabaya City, but it is still far enough to reach the national target of 80%.Objectives: To identify respondent characteristics and analyze the correlation between exclusive breastfeeding and the frequency of illness among infants Methods: This study was an observational study with a prospective cohort design. The source of the data derived from the primary data of assisting mothers in West Surabaya since the bride in 2016 to April 2019 by the Surabaya City Health Office and counting by quota sampling. The population was infants in West Surabaya. Sample are 65 infants in April 2019 those obtained from primary data on assisting mothers in West Surabaya. The analysis used was univariate and bivariate analysis (Chi Square Fisher Exact Test).Results: Coverage of exclusive breastfeeding was 43.1%. The results of the p-value of the chi square fisher's exact test (0.021) were smaller than the level of significant (0.05), the Phi-Crammer coefficient shows a value of 0.285 and a relative risk of 6.81 when Confidence of Interval was 0,915-50,669.Conclusions: There was significant correlation between exclusive breastfeeding and frequencies of illness among infant in West Surabaya. ABSTRAK Latar Belakang : ASI mengandung kolostrum yang kaya antibodi, karena terdapat kandungan protein untuk daya tahan tubuh dan bermanfaat mematikan kuman dalam jumlah tinggi. Di Kota Surabaya, cakupan ASI eksklusif sebesar 65,9%. Pada Profil Kesehatan Kota Surabaya tahun 2016, cakupan ASI eksklusif di Wilayah Surabaya Barat sebanyak 66,42% yang tersebar di 12 Puskesmas. Meskipun Surabaya Barat telah melebihi rata-rata cakupan ASI eksklusif Kota Surabaya, namun masih cukup jauh untuk mencapai target nasional yaitu 80%.Tujuan : Mengidentifikasi karakteristik responden dan menganalisis hubungan antara pemberian ASI eksklusif dan frekuensi sakit pada bayiMetode : Penelitian ini merupakan penelitian observasional dengan desain cohort prospective. Sumber data berasal dari data primer pendampingan ibu di Surabaya Barat sejak calon pengantin pada tahun 2016 hingga April 2019 oleh Dinas Kesehatan Kota Surabaya dengan cara quota sampling. Populasi merupakan bayi di Surabaya Barat. Sampel sebanyak 65 bayi pada Bulan April 2019 yang diperoleh dari data pendampingan ibu di Surabaya Barat. Analisis yang digunakan adalah analisis univariat dan bivariat (Chi Square Fisher Exact Test).Hasil : Cakupan pemberian ASI eksklusif adalah 43,1%. Hasil p-value uji chi square fisher’s exact test (0,021) lebih kecil dari level of siqnificant (0,05), Phi-Crammer Coefficient menunjukkan nilai 0,285 dan relative risk sebesar 6,81.Kesimpulan : Adanya hubungan antara pemberian ASI eksklusif dengan frekuensi sakit pada bayi berumur 0-12 bulan di Surabaya Barat.

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Efficacy of Trichloroacetic Acid (TCA) Compared to Cryotherapy in Treating Patients with Positive VIA Result

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v8i4.1382 ◽

2020 ◽

pp. 249-253

Author(s):

Suwartono Herdhana ◽

Andrijono

Keyword(s):

Controlled Trial ◽

Bivariate Analysis ◽

P Value ◽

Exact Test ◽

Fisher's Exact Test ◽

Significant Difference ◽

Fisher’S Exact Test ◽

Random Block ◽

Block Sampling

Objective: To investigate the effectiveness TCA 85% compared to cryotherapy to treat patients with positive IVA result.Method: This is a non-inferiority randomized controlled trial study. Patients with positive VIA result referred to Jatinegara Primary Health Center were included in this study. Eligible samples were then treated with either TCA 85% or cryotherapy. The treatment was determined using a random block sampling method. Samples were then followed up 3 months after treatment in order to determine VIA result conversion.Result: Thirty-six patients were treated with TCA 85% and 36 others were treated with cryotherapy. 35 (97,2%) patients treated with TCA 85% converted to negative VIA, whereas all of the patients that were treated with cryotherapy converted to negative VIA. Bivariate analysis fisher’s exact test was then conducted with a result P-value of 1.00 (p > 0,05).Conclusion: There was no statistically significant difference of result between TCA 85% and cryotherapy for treating patients with positive VIA result.Keywords: cervical cancer, cryotherapy, TCA 85%, VIA test. Abstrak Tujuan: Mengetahui efikasi TCA 85% pada tatalaksana IVA positif dibandingkan dengan krioterapiMetode: Penelitian ini merupakan penelitian randomized control trial menggunakan metode non-inferiority study. Subyek penelitian ini merupakan pasien dengan hasil IVA positif yang dirujuk ke Puskesmas Kecamatan Jatinegara, Jakarta Timur. Tatalaksana yang diberikan ditentukan menggunakan metode random block sampling. Subyek diikuti selama 3 bulan setelah tindakan untuk menentukan hasil konversi pemeriksaan IVA.Hasil: Sbenyak 36 subjek diterapi dengan TCA 85% dan 36 lainnya diterapi dengan krioterapi. Sebanyak 35 (97,2%) pasien yang ditatalaksana dengan TCA 85% mengalami konversi menjadi IVA negatif pada follow-up bulan ke-3, sedangkan seluruh pasien yang ditatalaksana dengan krioterapi menjadi konversi menjadi IVA negatif. Dilakukan analisis bivariat fisher’s exact test dan didapatkan nilai p sebesar 1,00 (p>0,05).Kesimpulan:Tidak ada perbedaan bermakna dari efikasi penggunaan TCA 85 % dibandingkan dengan krioterapi pada terapi IVA positif.Kata kunci: kanker serviks, krioterapi, pemeriksaan IVA, TCA 85%.

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Correlation between Demographic Status and Nutritional Status against the Occurrence of Anemia toward Female Students in SMP Negeri 3 Kediri

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i1.274 ◽

2020 ◽

Vol 9 (1) ◽

pp. 111-118

Author(s):

Lumastari Ajeng Wijayanti ◽

Eny Sendra ◽

Ratih Novitasari ◽

Tanti Dwi Pujaningsih

Keyword(s):

Nutritional Status ◽

Sampling Technique ◽

Simple Random Sampling ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Kolmogorov Smirnov ◽

Smirnov Test

This research used cross sectional design. The population was 194 respondents and the sample was 54 respondents which are taken by using simple random sampling technique. Independent variable in this research was demographic status that was measured by questionnaire and nutritional status that was measured based on Body Mass Index (BMI). Meanwhile, dependent variable in this research was the occurrence of anemia that was measured by using spectrophotometry. Data analysis used Fisher's Exact test and Two-Sample Kolmogorov-Smirnov test (α = 0,05). Result of Fisher's Exact test was obtained that p value = 1,000 > 0,05, which meant that there was no significant correlation between demographic status and the occurrence of anemia. Meanwhile, result of Two-Sample Kolmogorov-Smirnov test was obtained that p value = 0,017 < 0,05, which meant that there was a significant correlation between nutritional status and the occurrence of anemia.

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Aktivitas fisik berhubungan dengan kejadian obesitas pada anak Sekolah Dasar

Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) ◽

10.21927/ijnd.2016.4(3).123-128 ◽

2017 ◽

Vol 4 (3) ◽

pp. 123

Author(s):

M Zamzani ◽

Hamam Hadi ◽

Dewi Astiti

Keyword(s):

Physical Activity ◽

Elementary School ◽

Nutritional Status ◽

Univariate Analysis ◽

Energy Output ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test

ABSTRACTBackgrounds: The increasing prevalence of obesity is caused by imbalance between energy input to energy output. Physical activity in children both at school and at home plays an important role in determining the nutritional status of children, including the risk of obesity. Objectives: To determine the relationship between children physical activity with obesity in Ngebel Elementary School, Tamantirto Kasihan Bantul. Methods: This study was an observational study with cross sectional design. The study population is all children grades 3, 4, and 5 Ngebel Elementary School, Tamantirto Kasihan Bantul. These samples included 96 children who met the inclusion and exclusion criteria obtained with less total sampling technique. Weight children measured using digital bathroom scales to the nearest 0.1 kg and height was measured using the nearest 0.1 cm microtoice assisted by trained enumerators. Physical activity data were obtained using a physical activity questionnaire was adopted from previous studies. Nutritional status data is calculated using the WHO software Anthro 2005. Univariate analysis using frequency distribution and bivariate analysis using Fisher’s Exact Test. Data were analyzed using software statistic.Results: Results analisis showed physical activity had a significant relationship with the incidence of obesity in children, with p Value 0.015 (<0,05) with OR of 4.78 (95% CI: 1.36 to 16.82), in other words children who do moderate to severe activity ≤1 hour/day had 5 times higher chance to be obese than children with moderate to severe activity >1 hour/day.Conclusions: Physical activity has a significant association with obesity. KEYWORDS: physical activity, obesity, elementary school children ABSTRAKLatar belakang: Peningkatan prevalensi obesitas disebabkan oleh adanya ketidakseimbangan antara masukan energi dengan keluaran energi. Aktivitas fisik pada anak-anak baik di sekolah maupun di rumah berperan penting dalam penentuan status gizi anak, termasuk risiko terjadinya obesitas.Tujuan: Untuk mengetahui hubungan antara aktivitas fisik dengan kejadian obesitas pada anak Sekolah Dasar Negeri Ngebel, Tamantirto Kasihan Bantul.Metode: Penelitian ini merupakan penelitian observasional dengan rancangan cross sectional. Populasi penelitian adalah semua anak kelas 3, 4, dan 5 SDN Ngebel, Tamantirto Kasihan Bantul. Sampel penelitian berjumlah 96 anak yang memenuhi kriteria inklusi dan eksklusi diperoleh dengn teknik total sampling. Berat anak-anak diukur dengan menggunakan timbangan injak digital dengan ketelitian 0,1 kg, sedangkan tinggi badan diukur menggunakan microtoise dengan ketelitian 0,1 cm dibantu oleh enumerator terlatih. Data aktivitas fisik diperoleh menggunakan kuesioner aktivitas fisik yang diadopsi dari penelitian sebelumnya. Data status gizi dihitung dengan menggunakan software WHO Anthro 2005. Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan Fisher’s Exact Test. Data dianalisis dengan menggunakan program software statistic.Hasil: Hasil analisis menunjukkan aktivitas fisik memiliki hubungan yang signifikan dengan kejadian obesitas pada anak dengan nilai p value 0,009 (<0,05) dengan nilai OR 5,69 (95% CI: 1,42-22,65), dengan kata lain anak yang melakukan aktivitas sedang-berat ≤1 jam/hari berpeluang 5 kali lebih besar untuk mengalami obesitas daripada anak dengan aktivitas sedang-berat >1 jam/hari.Kesimpulan: Aktivitas fisik memiliki hubungan secara bermakna dengan obesitas.KATA KUNCI: aktivitas fisik, obesitas, anak SD

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Hubungan Umur dan Konsumsi Makanan Mengandung Zat Besi Dengan Anemia Pada Ibu Hamil Di Puskesmas Talise Palu

Jurnal Bidan Cerdas (JBC) ◽

10.33860/jbc.v1i1.81 ◽

2018 ◽

Vol 1 (1) ◽

pp. 1

Author(s):

Susan Elviyaningsih ◽

Rafika Rafika ◽

Putu Candriasih

Keyword(s):

Pregnant Women ◽

Health Center ◽

Statistical Tests ◽

Sampling Technique ◽

Bivariate Analysis ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Mother And Child

Anemia in pregnant women is called a potential that endangers the mother and child, therefore anemia requires serious attention from parties involved in health services. The purpose of this study is to know the relationship of age and consumption of iron-containing foods with the incidence of anemia in pregnant women in Talise Palu Health Center in 2017. The type of research is descriptive comparative using a cross sectional approach. The population of all pregnant women in the Talise Health Center area. The sample in this study amounted to 55 respondents with the sampling technique using consecutive sampling technique. The data collection is done through direct interviews and direct Hb measurements. Data analysis using univariate frequency distribution and bivariate analysis with Fisher's Exact Test. The results of the study of 55 respondents there were 96.4% of pregnant women who had anemia, with the age of pregnant women not at risk of 85.5% and pregnant women who rarely consumed foods containing iron there were 78.2%. The results of statistical tests using Fisher's Exact Test showed that there was a relationship between consumption of iron-containing foods (p = 0.04) with the incidence of anemia in pregnant women at Talise Palu Health Center in 2017 and no age relationship (p = 0.728) with anemia in pregnant women . Conclusion that age has no relationship with the incidence of anemia in pregnant women. Consumption of iron-containing foods is associated with the incidence of anemia in pregnant women. Suggestions for midwives who work at the KIA-KB Poli to continue to provide services according to operational standards during pregnancy examinations so that anemia in pregnant women can be treated and even prevented during pregnancy.Keywords: Pregnant, Anemia, consumption of foods containing iron

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TLR4 T399I Polymorphism and Endometriosis in a Cohort of Italian Women

Diagnostics ◽

10.3390/diagnostics10050255 ◽

2020 ◽

Vol 10 (5) ◽

pp. 255 ◽

Cited By ~ 2

Author(s):

Enrica Marchionni ◽

Maria Grazia Porpora ◽

Francesca Megiorni ◽

Ilaria Piacenti ◽

Agnese Giovannetti ◽

...

Keyword(s):

Molecular Mechanisms ◽

Categorical Variables ◽

P Value ◽

Genotype Distribution ◽

Exact Test ◽

Fisher's Exact Test ◽

Genotype Frequencies ◽

Significant Difference ◽

Fisher’S Exact Test ◽

Italian Women

Background: Endometriosis is a widespread multifactorial disease in which environmental, genetic, and epigenetic factors contribute to the phenotype. Single Nucleotide Polymorphisms (SNPs) in genes implicated in pivotal molecular mechanisms have been investigated as susceptible risk factors in distinct populations. Among these, Toll-like receptor 4 (TLR4) represents a good candidate due to its role in the immune/inflammatory response and endometriosis pathogenesis. Methods: The TRL4 gene T399I SNP (C/T transition, rs4986791) was investigated in 236 Italian endometriosis patients and 150 controls by using the PCR-RFLP method. One-tailed Fisher’s exact test was used to compare differences between categorical variables. T399I genotype distribution was evaluated for Hardy–Weinberg equilibrium in both groups using the Chi-squared test for given probabilities. Results: Fisher’s exact test comparing C and T allele frequencies showed a difference in the frequency of T alleles between patients and controls (OR = 1.96, 95% confidence interval 0.91–4.23; p-value = 0.0552). Genotype frequencies did not show any significant difference between patients and controls. The homozygous TT genotype was observed in 2% of endometriosis women and not in controls. Conclusions: Our results show that the TLR4 rs4986791 T variant may be considered a genetic risk factor for endometriosis in Italian women. More extensive studies in other populations are needed to confirm this result.

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Response to Neoadjuvant Chemotherapy in the Breast Predicts Axillary Nodal Status

The American Surgeon ◽

10.1177/000313481207800624 ◽

2012 ◽

Vol 78 (6) ◽

pp. 693-697

Author(s):

Alfred John Colfry ◽

Xu Zhang ◽

George M. Fuhrman

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Early Stage ◽

Nodal Status ◽

P Value ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Response To Neoadjuvant Chemotherapy

We hypothesize that the diminishing role of axillary node dissection (ALND) in early stage breast cancer could be further reduced in patients with advanced disease depending on the response to neoadjuvant chemotherapy (NC). We reviewed records of patients managed with NC and recorded demographics, tumor characteristics, pre/postoperative axillary nodal status, and NC response. We define a response to NC as follows: T2 tumors at least a 50 per cent reduction in the product of the length and width of the tumor and in T3–4 tumors a reduction in tumor size to less than 2 cm. We defined a negative axillary nodal status as either a negative sentinel node biopsy before or after NC or a negative ALND. We defined a positive axillary nodal status as clinical persistence of nodal disease despite NC or involved nodes determined by ALND. Fisher's exact test was used to evaluate the association between response to NC and nodal status. Over the past 4 years, 35 patients have completed NC and surgical treatment including lymph node assessment. Sixteen cancers demonstrated a response to NC and two (12.5%) had positive lymph nodes. Nineteen cancers failed to respond to NC and 13 (68.4%) had involved lymph nodes. Fisher's exact test shows a strong association between NC response and nodal status (two-tailed P value 0.0016). Patients with advanced locoregional breast cancer that respond to NC are unlikely to benefit from ALND. If this study's findings are confirmed in larger trials, ALND could be limited to patients with advanced locoregional breast cancer unresponsive to NC.

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HUBUNGAN PENGETAHUAN DAN POLA ASUH ORANG TUA DENGAN KEMAMPUAN TOILET TRAINING PADA ANAK USIA TODDLER DI PAUD ASYIYAH 2 PROVINSI SULAWESI TENGAH

GEMA KESEHATAN ◽

10.47539/gk.v10i2.42 ◽

2019 ◽

Vol 10 (2) ◽

Author(s):

Nurhayati Nurhayati

Keyword(s):

Toilet Training ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test

Toilet training sangat penting dalam membentuk karakter anak dan membentuk rasa saling percaya dalam hubungan anak dan orang tua. Keberhasilan toilet training dipengaruhi oleh pengetahuan dan pola asuh orang tua dalam mendorong anak mencapai tujuan yang diinginkan. Penelitian ini bertujuan untuk menganalisis hubungan pengetahuan dan pola asuh orang tua dengan kemampuan toilet training pada anak usia toddler di PAUD Asyiyah 2 Provinsi Sulawesi Tengah. Jenis penelitian ini adalah analitik dengan desain cross sectional. Populasi penelitian ini yaitu semua orang tua yang memiliki anak usia toddler di PAUD Aisyah 2 Provinsi Sulawesi Tengah sebanyak 32 orang. Sampel dalam penelitian ini adalah orang tua yang memiliki anak usia toddler di PAUD Aisyah 2 Provinsi Sulawesi Tengah sebanyak 32 orang dengan teknik pengambilan sampel total sampling. Data dianalisis menggunakan Fisher’s Exact test. Hasil uji Fisher’s Exact didapatkan nilai p=0,000 dan nilai p=0,001 (p Value < 0,05), ini berarti secara statistik ada hubungan pengetahuan dan pola asuh orang tua dengan kemampuan toilet training pada anak usia toddler. Berdasarkan hasil penelitian tersebut disarankan bagi orang tua (ibu) yang menerapkan pola asuh kurang baik agar dapat merubah atau menerapkan pola asuh yang tepat kepada anaknya agar mampu melaksanakan toilet training dengan baik. Kata kunci : Pengetahuan, pola asuh, toilet training.

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HUBUNGAN KADAR GULA DARAH SEWAKTU DENGAN GEJALA NEUROPATI PERIFER PENDERITA DIABETES MELITUS TIPE 2

Jurnal Penelitian Keperawatan ◽

10.32660/jurnal.v5i1.345 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Supriyadi Supriyadi ◽

Susmini Susmini

Keyword(s):

Random Sampling ◽

Simple Random Sampling ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Diabetes Melitus

Gangguan metabolik mampu menyebabkan beberapa penyakit salah satunya ialah diabetes melitus. Gejala umum yang sering muncul pada kasus diabetes melitus yaitu hiperglikemia. Hiperglikemia yang berkepanjangan dapat mengakibatkan berbagai macam komplikasi diantaranya komplikasi mikrovaskuler dan makrovaskuler. Tujuan penelitian ini untuk mengetahui hubungan kadar gula darah sewaktu dengan gejala neuropati perifer penderita diabetes melitus tipe 2. Desain penelitian ini menggunakan cross sectional. Jumlah sampel 32 penderita diabetes melitus yang dipilih melalui teknik simple random sampling, penelitian ini dilakukan di Desa Kedung Dowo Kecamatan Nganjuk. Berdasarkan uji statistik Fisher’s Exact Test didapatkan p value 0.002 (p value < 0.05) yang berarti terdapat hubungan antara kadar gula darah sewaktu dengan gejala neuropati perifer penderita diabetes melitus tipe 2.

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Διερεύνηση του ρόλου των κατασταλτικών αυτοαντισωμάτων έναντι του υποδοχέα της θυρεοτρόπου ορμόνης ως αίτιου αποβολών στις εγκύους με θυρεοειδική αυτοανοσία

10.12681/eadd/42287 ◽

2013 ◽

Author(s):

Κωνσταντίνος Τουλής

Keyword(s):

P Value ◽

Exact Test ◽

Whitney Test ◽

Fisher's Exact Test ◽

Mann Whitney Test ◽

Fisher’S Exact Test

Σκοπός Με βάση περιπτώσεις μοριακού μιμητισμού μεταξύ των γλυκοπρωτεϊνών και των υποδοχέων τους, διατυπώσαμε την υπόθεση ότι αυτοαντισώματα έναντι του υποδοχέα της θυρεοτροπίνης (TSH-Rab) κατασταλτικού τύπου (blocking) πιθανά να έχουν δραστικότητα αποκλειστή επί του υποδοχέα της ανθρώπινης χοριακής γοναδοτροπίνης (LH/hCG-R) στο ωχρό σωμάτιο, το τελικό βιολογικό αποτέλεσμα της οποίας θα ήταν η απώλεια κύησης κατά το πρώτο τρίμηνο. Ο σκοπός της μελέτης ήταν η κλινική διερεύνηση της παραπάνω υπόθεσης και συγκεκριμένα η διερεύνηση της παρουσίας και εκτίμηση των συγκεντρώσεων bTSH-Rab στις γυναίκες με θυρεοειδίτιδα Hashimoto και ιστορικό καθ’ έξιν αποβολών (ασθενείς) και η σύγκριση τους με γυναίκες με θυρεοειδίτιδα Hashimoto και φυσιολογικό αναπαραγωγικό ιστορικό (μάρτυρες). Ασθενείς και Μέθοδοι Συνολικά επιλέχθηκαν 86 γυναίκες (46 ασθενείς και 46 μάρτυρες με ηλικιακή εξομοίωση) από εξωτερικά ιατρεία και κλινικές του Νομού Θεσσαλονίκης στο πλαίσιο αναδρομικής μελέτης τύπου ασθενών-μαρτύρων. Για τη συμπερίληψη στην ομάδα των ασθενών, η γυναίκα έπρεπε να είχε ηλικία μικρότερη των 35 ετών στην τελευταία αποβολή και κάτω των 50 ετών κατά την επιλογή, χωρίς να εντοπίζονταν από το ιστορικό, την κλινική εξέταση και τον κατά περίπτωση παρακλινικό έλεγχο, δευτεροπαθείς αιτίες καθ’ έξιν αποβολών. Σε υπο-ομάδα των ασθενών (n=15) πραγματοποιήθηκε ορμονολογική εκτίμηση υποφυσιακής λειτουργίας, διακολπικό υπερηχογράφημα πυέλου, καρυότυπο, ανίχνευση μεταλλάξεων του παράγοντα V, μέτρηση επιπέδων ομοκυστεΐνης, αυτοαντισωμάτων έναντι της διπλής έλικας του DNA, αντιπηκτικού του λύκου, β2-γλυκοπρωτείνης και αντικαρδιολιπινικών αντισωμάτων. Η στατιστική ανάλυση πραγματοποιήθηκε με το λογισμικό Stata 10.0 Αποτελέσματα Δεν ανιχνεύθηκε σημαντική διαφορά στον επιπολασμό (Fisher’s exact test, p-value = 1.00) ή στους τίτλους TSH-Rab μεταξύ των ασθενών και των μαρτύρων (Mann-Whitney test, p = 0.59). Οι αναλύσεις ευαισθησίας με βάση τους ορισμούς των καθ’ έξιν αποβολών, των αυτόματων αποβολών, της θυρεοειδίτιδας Hashimoto και της θετικότητας των TSH-Rab δεν τροποποίησαν την κατεύθυνση των ευρημάτων. Η απουσία συσχέτισης μεταξύ TSH-Rab και αναπαραγωγικού ιστορικού επιβεβαιώθηκε σε μονομεταβλητό μοντέλο λογαριθμικής παλινδρόμησης [OR = 1.00, 95% CI = 0.19-5.25], είτε όταν χρησιμοποιήθηκε ο τίτλος των TSH-Rab (OR = 0.77, 95% CI = 0.29 - 2.08). Η παρουσία των TSH-Rab δεν προέβλεψε με στατιστικώς σημαντικό τρόπο τον αριθμό των αυτόματων αποβολών στις ασθενείς (Coef = -0.4, 95% CI = -1.15 - 0.34, p = 0.285) και απουσία συσχέτισης επιβεβαιώθηκε όταν χρησιμοποιήθηκε ο τίτλος τους (Coef = -.0.53, 95% CI = -1.08 - 0.10, p = 0.054). Τα παραπάνω ευρήματα παρέμειναν ανθεκτικά στην ιεραρχική στάθμιση με την ηλικία και το ΒΜΙ κατά την τελευταία κύηση ή αποβολή σε πολυμεταβλητά μοντέλα παλινδρόμησης. Συμπεράσματα Στην παρούσα μελέτη, δεν προέκυψαν ενδείξεις ότι τα TSH-Rab έχουν σημαντικό ρόλο στην παθογένεια των αυτόματων αποβολών και δεν μπορεί να υποστηριχθεί η κλινική και ερευνητική χρησιμότητα της ανίχνευσής τους στις γυναίκες με θυρεοειδίτιδα Hashimoto και ιστορικό καθ’ έξιν αποβολών.

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