Predominant role of gut-vagus-brain neuronal pathway in postoperative nausea and vomiting: evidence from an observational cohort study

Background Postoperative nausea and vomiting (PONV) as a clinically most common postoperative complication requires multimodal antiemetic medications targeting at a wide range of neurotransmitter pathways. Lacking of neurobiological mechanism makes this ‘big little problem’ still unresolved. We aim to investigate whether gut-vagus-brain reflex generally considered as one of four typical emetic neuronal pathways might be the primary mediator of PONV. Methods Three thousand two hundred twenty-three patients who underwent vagus nerve trunk resection (esophagectomy and gastrectomy) and non-vagotomy surgery (hepatectomy, pulmonary lobectomy and colorectomy) from December 2016 to January 2019 were enrolled. Thirty cases of gastrectomy with selective resection on the gastric branch of vagus nerve were also recruited. Nausea and intensity of vomiting was recorded within 24 h after the operation. Results PONV occurred in 11.9% of 1187 patients who underwent vagus nerve trunk resection and 28.7% of 2036 non-vagotomy patients respectively. Propensity score matching showed that vagotomy surgeries accounted for 19.9% of the whole PONV incidence, much less than that observed in the non-PONV group (35.1%, P < 0.01). Multivariate logistic regression result revealed that vagotomy was one of underlying factor that significantly involved in PONV (OR = 0.302, 95% CI, 0.237-0.386). Nausea was reported in 5.9% ~ 8.6% vagotomy and 12 ~ 17% non-vagotomy patients. Most vomiting were mild, being approximately 3% in vagotomy and 8 ~ 13% in non-vagotomy patients, while sever vomiting was much less experienced. Furthermore, lower PONV occurrence (10%) was also observed in gastrectomy undergoing selective vagotomy. Conclusion Patients undergoing surgeries with vagotomy developed less PONV, suggesting that vagus nerve dependent gut-brain signaling might mainly contribute to PONV.

DETERMINANTS OF PARENT’S DECISIONS IN IMMUNIZING MEASLES RUBELLA (MR) VACCINE

Background: The government’s effort to reduce measles and rubella transmission are by increasing MR immunization coverage. The immunization coverage was influenced by parent’s decisions. There were factors that related with parent’s decisions such as knowledge, perceived susceptibility, seriousness, benefit, barrier, self-efficacy, and cues to action. This study aimed to analyze factors related with parent’s decisions in giving MR immunization. Methods: This was a cross sectional study using questionnaire among parents of children aged 10-30 months at working area of Kenjeran public health center, Surabaya. Data of knowledge, perceived susceptibility, seriousness, benefit, barrier, self-efficacy, and cues to action regarding MR immunization then analyzed using chi-square and logistic regression. Result: From 206 parents, 56.3% were giving MR immunization to their children. Parent’s knowledge (p=0.023; OR=18.08), perceived barrier (p=0.002; OR=46.79), and self-efficacy (p=0.033; OR=7.66) were related with parent’s decisions. Conclusion: Parent’s decisions in giving MR immunization was related with knowledge, perceived barrier, and self-efficacy.

Failure of Lactational Amenorrhea Method (LAM) in Yogyakarta

Background: The lactational amenorrhea method (LAM) is modern contraceptives that rely on exclusive breastfeeding for six months without additional food or beverage. The mother is in a state of amenorrhea and delays arranging birth to a quality family. Aim: The study aimed to determine the cause of the failure of LAM. Method: Study design with the cross-sectional analytic survey, conducted on mothers who have babies 6-24 months of age as 79 respondents. The sampling technique using purposive sampling, data analysis chi-square, and logistic regression. Result: This study showed parity (OR = 4.861; 95% CI = 0.991 - 23.852), education (OR = 0.525; 95% CI 0.073 - 3.758), work (OR = 2.087; 95% CI = 0.241 - 18.064), knowledge (OR = 20.481; 95% CI = 2.459 – 170.608), additional contraception other than LAM (OR = 2.894; 95% CI = 0.365 – 22.965), menstruation before six months (OR = 10.265; 95% CI = 1.283 – 82.150), breast pump ( OR = 1.843; 95% CI = 0.189 – 17.990) and socio-economic (OR = 9.843; 95% CI = 1.029 – 94.134). Conclusion: In conclusion, all variables influenced LAM's failure, but the most influential was knowledge, menstruation before six months, and social-economic. Keyword: LAM, breastfeeding, failure

Spontaneous Intestinal Perforation Associated with Premature Twin Infants

OBJECTIVE: Identify perinatal risk factors associated with SIP STUDY DESIGN: This was a retrospective case-control study of SIP in infants born at ≤28 weeks of gestation and admitted between 1995 and 2016 at a tertiary care NICU. Infants with NEC or other GI abnormalities were excluded. Cases of SIP were matched with gestational age-matched controls with the closest birth date. Maternal, infant and birth related factors were evaluated using univariate analyses and significant factors were evaluated using multiple logistic regression. RESULT: 25 cases of SIP were matched with 25 controls. No maternal factors reached statistical significance. Being one of twins increased the odds of SIP 29-fold. Birth-order or weight-discrepancy in twin had no association of SIP within twin pairs. CONCLUSION: Twins are at significantly higher risk for SIP. The association of SIP and twin gestation was independent of previously reported risk factors of perinatal indomethacin or magnesium sulfate and merits further study.

Investigating Patient Trust in Doctors: A Cross-Sectional Survey of Out-Patient Departments in Fiji

Background Despite evidence on the positive impact of trust in a doctor-patient relationship on health outcomes, there are limited studies conducted in Pacific Island Countries including Fiji. This study was conducted to assess the current level of patient trust in doctors and investigate its determinants in Fiji. Method: A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The response rate was 91% (N=375) and data was analyzed using descriptive statistics and analytic analysis using logistic regression. Result: Mean age of participants was 38years (±15yrs). The majority of patients had partial trust in their doctors compared to full trust (61.6% vs 38.4%). More than half of the participants perceived doctor’s communication behavior as fair rather than good (53.6% vs 45.6%). Those over 50 years (OR 1.96; p=0.007, 95% CI: 1.198–3.226) and those who perceived doctors’ communication behavior as good (OR 8.48; p=0.0001, 95% CI: 5.257–13.709) were significantly more likely to have full trust in the doctors. Conclusion: This study reveals that age and communication are determinants of trust in Fiji. In view of the current perception of the doctors’ communication behavior, Fiji’s Ministry of Health and Medical Services should implement policies to give equal importance to the communication skills of the doctors together with their clinical skills and enforce it in the medical schools.

Do Informal Sector Businesses Support Women’s Livelihood? A Case of Butwal Sub-Metropolitan in Nepal

Informal sector business is rapidly increasing in Nepal. This paper examines the effect of informal businesses on women’s livelihood, which is not documented in the literature. This study uses primary data collected from the Butwal sub-metropolitan, Nawalparasi District, Province 5 of Nepal. Sample size is 300 women entrepreneurs. There is a positive correlation between income level and married as well as migrated women entrepreneurs. Logistic Regression result shows more educated women entrepreneurs are more likely to earn from their businesses in comparison to the less educated women. Qualitative analysis shows women are learning business doing skills. Most important, old aged women (around/over 60 years) should not depend on their son or daughter for bread and butter and for pocket money after starting such business.

Analysis of Factors Affecting BPJS Patients Choosing a Class of Care to VIP Room

The increase of assurance participant, impact to increase inpatient at hospital. Some of participant choose to upgrade their treatman class, really if they don’t upgrade treatmen class they don’t need to pay more for their treatman. Purpose of this research are analysis factors that influence behaviour to upgrade class treatmen to VIP class at dr.Iskak hospital that include of perception, knowledge,income, and family support.This is a kuantitatif reseach with approch cross sectional. The population was all BPJS patient that treat at VIP dr. Iskak hospital Tulung Agung since 1st June until 31 of July 2018. Sample of research were some of BPJS patients that treated at VIP class dr.Iskak hospital Tulungagung = 182.The data collect by simple ramdom sampling. Independent variables are Perception, Income,Knowledge, Family Support. Dependent variable is Upgrade treatment class to VIP. Statistic analysis with logistic regression. Result of the research, all of independent variable are simultanetaneously influence BPJS patient choosing to upgrade treatmen class to VIP class at dr.Iskak hospital Tulungagung p value=0,008. In partial, perception p-value 0,956 ( >0,05 ), income p-value 0,001 ( <0,05 ), knowledge p-value 0,854 ( >0,05 ), family support p-value 0,021 (< 0,05).In this research, income and family support are influencing BPJS patient to upgrade treatmen class. But perception and knowledge are not influencing. And the dominan factor is income. Without good income, behaviour upgrade class treatmen not going to do

ANALISIS FAKTOR RESIKO KEJADIAN STUNTING PADA ANAK USIA 12–59 BULAN DI PROVINSI NUSA TENGGARA BARAT

Stunting among children under five can giving bad impact for chidren because it make less optimum of brain development. In 2017, there was 37,2% children under five years West Nusa Tenggara Province experience stunting.This study aimed to assess risk factor of stunting among children under five years in West Nusa Tenggara Province.This study was secondary data analysis from Indonesian Family Life Survey wave 5 (IFLS-5) in 2014-2015. Samples of this research were children age 12-59 months in West Nusa Tenggara Province. The number of the samples was 456 children. The relationship between variables were analyzed by chi-square test and the relative risk were analyzed by logistic regression. Result show that risk factor of stunting among children age 12-59 months in West Nusa Tenggara Province were weight of birth less than 2500 gram (p=0,001; OR = 3,303; 95% CI = 1,6-6,816), anemia of children (p=0,001; OR = 2,199; 95% CI = 1,469-3,291), age of mother at birth less than 18 years old (p=0,001; OR = 6,867; 95% CI = 1,481-31,834), age of mother at birth more or same with 35 years old (p=0,001 ; OR=0,515; 95% CI = 0,282 – 0,937), and education level of mother (p=0,6511; OR: 0,651; 95% CI = 0,439-0,966). The conclusion that the risk factor of stunting among children age 12-59 months in West Nusa Tenggara Province were weight of birth, anemia, age of mother at birth, and education level of mother. Keywords: stunting, risk factor, toddler

THE RISK FACTOR TOWARDS CHILDBIRTH WITH CAESAREAN (SECTION)

Caesarean (section) is one way of childbirth by giving the surgery acted. According to the Base of Heath Research (Riskesdas) 2010, the number of Caesarean (section) in Indonesia has passed maximal limit of WHO standard that is 5 – 15 %. Therefore, a research has been held to see the risk factor towards childbirth with Caesarean (section) at Sitti Khadijah mom and baby hospital, Gorontalo. Type of this research is analytic by using case control design with sample is that consist of 68 cases and 68 control. The data is analyzed by statistic analysis logistic regression. Result of the research shows that parity, distance between pregnancy, check-up of antenatal care and disease complication history have risk towards childbirth with Caesarean (section). The variable that is more risky towards childbirth with Caesarean (section) is the disease complication history with p value = 0,000 (Cl 95 %) and OR value = 9,430 (3,861 – 23,035). Suggested for health parties to be more active in promotion program about childbirth, check-up of antenatal care, etc. in the way of deciding the policy in selecting Caesarean (section).

Factors associated with oral biofilm in ICU patients with infectious diseases

Introduction Hospitalization may cause a decline in oral health and affect the entire body. The intensive care unit (ICU) may be a favorable environment for oral biofilm to accumulate in critically ill patients. Objective To identify factors associated with oral biofilm in ICU patients in a hospital for infectious diseases. Method This was a retrospective, descriptive and inferential study with a quantitative approach. Data were collected from 178 medical records of patients from January 2012 to July 2015. Biofilm presence was assessed according to the Greene and Vermillion index. Potential influential factors were analyzed by logistic regression. Result Among ICU patients, 69.1% were men, 60.7% had acquired immune deficiency (AIDS), 66.3% were ward patients, 50.6% were intubated, and 50.0% were sedated. The oral elements of the patients were mostly normal. The following characteristics were significantly associated with oral biofilm: changes in the lips, gums, cheeks, and palates and bleeding. Patients from the ward had a lower risk of biofilm. Conclusion Increased oral biofilm accumulation was observed in patients with oral changes, and patient origin was associated with the presence of biofilm.