Peran Gejala Depresi sebagai Faktor Prediktor Kematian dalam Enam Bulan pada Lansia yang Menjalani Hemodialisis

Pendahuluan. Depresi merupakan gangguan mental yang banyak ditemukan baik pada kelompok lansia maupun pada pasien yang menjalani hemodialisis. Depresi berdampak buruk terhadap kualitas hidup pasien. Penelitian yang menghubungkan depresi sebagai faktor prediktor kematian dalam enam bulan pada lansia yang menjalani hemodialisis belum pernah dilakukan di Indonesia. Penelitian ini bertujuan untuk mengetahui peran gejala depresi sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Metode. Penelitian dengan desain kohort prospektif dilakukan pada Februari – Agustus 2020 di Unit Hemodialisis Rumah Sakit Roemani Muhammadiyah Semarang. Adapun kriteria inklusi meliputi lansia (usia ≥60 tahun), menjalani hemodialisis ≥3 bulan, frekuensi hemodialisis 2 kali seminggu, bersedia mengikuti penelitian, dapat berkomunikasi dengan baik, dan tidak terdapat riwayat gangguan mental sebelumnya yang meliputi riwayat gangguan psikotik, dan gangguan mental akibat penggunaan zat. Sedangkan pasien dengan data tidak lengkap, pindah ke unit hemodialisis lain, HBsAg +, kadar Hemoglobin <7 mg/dl, skor RAPUH >2, dan memiliki stressor lain yang tidak terkait dengan hemodialisis atau Penyakit Ginjal Kronis (PGK) seperti faktor sosial, keluarga, dan pekerjaan dieksklusi dari penelitian ini. Depresi dinilai menggunakan kuesioner Beck Depression Inventory-II yang telah diterjemahkan ke dalam Bahasa Indonesia. Adapun pengisian kuesioner dilakukan oleh responden dengan panduan oleh peneliti dalam proses pengisiannya. Data yang terkumpul kemudian dianalisis menggunakan Kaplan Meier dan Cox Regression menggunakan SPSS 18.0.Hasil. Dari total 32 responden, mayoritas adalah laki-laki yaitu sebanyak 26 responden (81,3%). Rerata usia responden adalah 67,2 (simpang baku [SB] 7) tahun. Sebanyak 6 (18,7%) responden mengalami depresi dan 26 (81,3%) responden tidak mengalami depresi. Hasil analisis Cox Regression menunjukkan bahwa depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis (p=0.012), dan hazard ratio=10,149.Simpulan. Depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Kata Kunci: Depresi, geriatri, mortalitas, penyakit ginjal kronik, penyakit ginjal tahap akhirDepressive symptoms as a Predictor Factor of All-Cause Mortality within Six Months in Elderly Hemodialysis PatientsIntroduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency twice a week, willing to participate in this study, able to communicate well, and has no history of mental disorders include a history of psychotic disorders and mental disorders due to substance use. Meanwhile, patients whose data were incomplete, transferred to another hemodialysis unit, HBsAg +, hemoglobin level <7 mg/dl. FRAILTY score >2, and had other stressors not related to hemodialysis or chronic kidney disease (CKD) such as social, family, and work factors were excluded from this study. Depression was assessed using the Beck Depression Inventory-II questionnaire. The collected data was then analyzed using Kaplan Meier and Cox Regression.Results. Of 32 respondents, most of them were male (81.3%). The mean age was 67.2 (SD 7) years. There were 6 (18.7%) respondents categorized into a depression group and 26 (81.3%) respondents into a non-depression group. Cox Regression analysis showed that depression was a predicting factor of all-cause mortality within six months in elderly hemodialysis patients (p value=0.012, and Hazard ratio=10.149). Conclusion. Depression is a predictor factor of all-cause mortality within six months in elderly hemodialysis patients.

Confirmatory Factor Analysis of Determinants of Entrepreneurship Career Inclination among Entrepreneurship Club Members in Secondary School/ Analisis Faktor Pengesahan Bagi Peramal Kecenderungan Kerjaya Keusahawanan dalam Kalangan Ahli Kelab Keusahawanan Sekolah Menengah

Entrepreneurship is a tool that the Malaysian Governmentsed to uplift income from the middle-income trap. Therefore, this study aims to identify the predictor factors that influence the inclination of entrepreneurship club members towards the entrepreneurship career by using factor analysis to achieve the Government goal through the Ministry of Education Malaysia. In other words, this study uses several tests related to validation factor analysis to determine the predictor factors that influence the propensity of entrepreneurship club members towards entrepreneurship careers. This study involved 161 respondents who were members of secondary school entrepreneurship clubs in the State of Terengganu who were randomly selected. Data gathered were analyzed using Statistical Package for the Social Sciences (SPSS) involving factor analysis and descriptive test. The factor analysis has identified nine predictor factors. The first predictor factor is role model, followed by a barrier, social identity, personality, entrepreneurship skill, social norm, financial, entrepreneurship knowledge, and prosperity. Prosperity was the new predictor factor that was identified using factor analysis in this research. The descriptive test found that the most influenced predictor factor of the entrepreneurship career inclination was finance, followed by personality, social identification, role model, social norm, prosperity, and barrier. Meanwhile, entrepreneurship knowledge was found as a predictor factor which uncertain in influencing the entrepreneurship career inclination among secondary school entrepreneurship club members in the State of Terengganu. The results of this study imply that the Government should give financial factors the priority through the Ministry of Education in formulating policies towards producing more young generation of entrepreneurs in Malaysia because that predictor has a positive impact on secondary school students who were the members of entrepreneurship clubs.

Correlation between Blood Pressure and Obesity Parameter against Cystatin-C and Adiponectin Levels in Serum of Obese Adolescent

Background: Obesity contributes to the increased risk of chronic kidney and systemic inflammation. This condition can occur in obese adolescents. Most researches of cystatin-C (cys-C) and adiponectin have been carried out in adult and children subjects. The purpose of this research is to determine differences in serum cys-C and adiponectin levels between obese and normoweight adolescents and their correlation with blood pressure and obesity parameters.Materials and Methods: Twenty-eight obese adolescents and 22 normoweight adolescents aged 15-18 years old participated in this research. After the measurement of blood pressure and obesity parameters, we examined serum cys-C levels as a biomarker for decreased early stage renal function and adiponectin, an antiinflammatory adipokine. Estimated glomerular filtration rate (eGFR) based on serum cys-C is calculated using the eGFR-Chronic Kidney Disease Epidemiology Collaboration (eGFR-CKD EPI cys-C equation formula). Results: Cys-C levels in obese adolescents were higher than normoweight adolescents. In contrast, serum adiponectin levels in obese adolescents were lower than for normoweight adolescents. Interestingly, eGFR based on serum cys-C showed no difference, although eGFR in obese adolescents was lower than normoweight adolescent. Serum cys-C was positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC). Serum adiponectin was negatively correlated with SBP, DBP, BMI and WC. SBP is a predictor factor for the increase in serum cys-C and BMI is a predictor factor in the decrease in serum adiponectin levels. Conclusion: There is a decline in early stage kidney function and inflammation in obese adolescents as evidenced by increased serum cyst-C levels and decreased serum adiponectin levels. These two biomarkers correlate with blood pressure, BMI and WC and play a role in the pathomechanism of early stage impairment of kidney function and inflammation in obese adolescents.Keywords: adiponectin, body mass index, cystatin-C, early stage renal diseases, inflammation, systolic blood pressure