bluuebunny/crossref_metadata_2025 huggingface dataset:
Funktionen, Konstellationen und Mittel der Wiedergabe – Ein dreidimensionales textpragmatisches Modell
Authors: Steinseifer Martin
Published: April 2019

Starting out from examples of citing in scientific texts and based on the critical assessment of linguistic accounts, the paper argues for a domain specific pragmatic account of (speech) representation in texts. It introduces a new three-dimensional model that identifies different kinds of representation drawing on the linguisticmeansof presenting the speech of others, the specificfunctionsin narrative, reporting, and argumentative texts, and the varying communicativeconstellations – i. e. whether literal, oral, or mental, original or imagined sources are (re-)presented. By focusing on the different functions and constellations in domains like science, journalism and literature the model can serve as a framework for future comparative investigations of (speech) representation.
Investigation of Crack Initiation Behavior of Asphalt Mixtures: Fatigue through Dynamic Semicircular Bending Test
Authors: Saha Gourab , Biligiri Krishna Prapoorna
Published: April 2019

The objective of this study was to investigate the crack initiation behavior of asphalt mixtures and examine the fracture mechanism using dynamic semicircular bending (SCB) test. The scope of the study encompassed estimation of crack initiation parameter (Ni) and fatigue failure of six asphalt mixtures, including, conventional dense-graded (D) and rubber-modified gap-graded (AR) mixtures covering 144 SCB specimens. At 5°C, 15°C, and 25°C, D-mixes produced higher Ni than AR mixtures attributed to higher stiffness of D-mixes. Relative share analysis of Ni was found to be higher for D-mix than AR mixtures. Furthermore, correlation between |E*| and Ni indicated that higher stiffness of the mix resulted in brittle failure, which in turn increased the time for crack initiation to occur. Importantly, the stiffness of asphalt mixtures played a deciding role in contributing to the crack initiation phenomenon of these materials. Overall, the dynamic SCB test developed as part of the study was found to be a promising assessment technique to characterize crack initiation behavior of different types of asphalt mixtures.
The Rise of Soft Porn in Malayalam Cinema and the Precarious Stardom of Shakeela
Authors: Mini Darshana Sreedhar
Published: April 2019

This paper looks at the genre of soft pornography in the Malayalam-speaking south Indian state of Kerala and the precarious stardom of its female stars through a close look at the career of Shakeela, an actress who became the emblematic soft-porn star of the 1990s. It interrogates how Shakeela's outsider status and her heavyset body type foregrounded her as the locus of Malayali society's conflicted relationship with sex and desire while also creating a set of parallel film practices that challenged the hierarchies of the mainstream film industry. By 2001 more than 70 percent of the total films produced in Malayalam were soft porn, and a good number of them featured Shakeela. The mainstay of soft-porn productions was the strategic positioning of the female lead as a cultural outsider—a transient figure who is both a threat and a source of exoticized desire. Shakeela's emergence as a “liberated” woman who flaunts her sexuality despite social norms was so strong that it destabilized Kerala's hero-centric mainstream industry for a time, leading to what was popularly called Shakeela tharangam, the “wave of Shakeela.”
Application of modulation spectroscopy for defining band gap of Cd1-xMnxTe solid solution
Authors: Makhniy V.P. , Horley P.P. , Berezovskiy M.M.
Published: April 2019

The modulation spectroscopy was used for defining band gap of monocrystalline Cd1-xMnxTe solid solutions, the properties of which vary with molar composition x and the surface preparation quality. It was found that for such samples it is useful to measure differential transmission spectrum , the main peak of which is governed by the composition x and the substrate thickness d. Therefore, it is important to measure Eg(d) for at least three samples of the same composition and different thickness. Using these data, the band gap can be obtained by extrapolating Eg(d) dependence in a logarithmic scale up to intersection with the energy axis at lg d = 0, which corresponds to the sample thickness of 1 μm.
Lu-V-{Ge, Sn} ternary systems
Authors: Romaka L. , Konyk M. , Stadnyk Yu. , Romaka V. , Serkiz R.
Published: April 2019

The isothermal sections of the phase diagrams of the Lu–V–Ge and Lu-V-Sn ternary systems were constructed at 870 K over the whole concentration range using X-ray diffraction and EPM analyses. In the Lu-V-Ge system a formation of the substitutional solid solution Lu5Ge3-xVx based on the Lu5Ge3binary compound (Mn5Si3 structure type) was found up to 6 at. % V. Insertion of the V atoms in the structure of the LuGe2 binary germanide (ZrSi2structure type, up to 5 aт. % V) results in the formation of the LuV0,15Ge2 ternary phase (CeNiSi2 structure type, space group Cmcm, a=0.40210(4),b=1.5661(1), c=0.38876(3) nm), which corresponds to the limit composition of the interstitial solid solution LuVxGe2. The interaction between the elements in the Lu-V-Sn system results in the formation of one ternary compound LuV6Sn6 (SmMn6Sn6-type, space group P6/mmm, a=0.5503(2), c=0.9171(4) nm) at investigated temperature.
Arte e ideología en la estética abierta de Adolfo Sánchez Vásquez
Authors: Rojas Gómez Miguel
Published: April 2019

En el artículo, se sigue el objetivo de revisar los planteamientos del español radicado en México, Adolfo Sánchez, fallecido en 2011, luego de una destacada actividad investigativa en la Universidad Nacional Autónoma de México (UNAM). Sus reflexiones en torno a la estética de Marx llevaron a Sánchez a plantear asuntos como la praxis de la creación artística, en que el realismo socialista que busca el reflejo del mundo y la ideología en la obra resulta perjudiciales para la tarea estética e, incluso, pueden coartar la libertad del creador. Sánchez se preocupa por incluir en la praxis estética la acción interpretativa del lector en que el placer por una obra nos conecta con la significación de lo humano, raíz del sentido de la belleza. De tal modo, en la expresión estética de una obra, las mediaciones culturales e ideológicas no se dan ausentes, ya que las ideas culturales, políticas o filosóficas dejan huellas en la creación del artista.
Experimental method to predict avalanches based on neural networks
Authors: Zhdanov V. V.
Published: April 2019

The article presents results of experimental use of currently available statistical methods to classify the avalanche‑dangerous precipitations and snowfalls in the Kishi Almaty river basin. The avalanche service of Kazakhstan uses graphical methods for prediction of avalanches developed by I.V. Kondrashov and E.I. Kolesnikov. The main objective of this work was to develop a modern model that could be used directly at the avalanche stations. Classification of winter precipitations into dangerous snowfalls and non‑dangerous ones was performed by two following ways: the linear discriminant function (canonical analysis) and artificial neural networks. Observational data on weather and avalanches in the gorge Kishi Almaty in the gorge Kishi Almaty were used as a training sample. Coefficients for the canonical variables were calculated by the software «Statistica» (Russian version 6.0), and then the necessary formula had been constructed. The accuracy of the above classification was 96%. Simulator by the authors L.N. Yasnitsky and F.М. Cherepanov was used to learn the neural networks. The trained neural network demonstrated 98% accuracy of the classification. Prepared statistical models are recommended to be tested at the snow‑avalanche stations. Results of the tests will be used for estimation of the model quality and its readiness for the operational work. In future, we plan to apply these models for classification of the avalanche danger by the five‑point international scale.
VOLUNTADES ANTICIPADAS: DERECHO A DECIDIR
Authors: Jiménez Retana Randall
Published: April 2019

Nuestro problema de investigación nace de la preocupación por la carencia de un instrumento de voluntades anticipadas en el sistema de salud y legislación costarricense. Dicha laguna coloca a las personas, hombres y mujeres, en una situación de vulnerabilidad, al no poder autodeterminarse ante procesos de enfermedad y accidentes incapacitantes. Lo anterior compromete el consentimiento informado y las aspiraciones de dichos sujetos en relación con el proceso del fnal de la vida.
Modified Crystal Field Theory and its Applications
Authors:   Dоnetsk Institute for Physics and Engineering named after O.O.Galkin, Lamonova K.V. , Orel S.M. ,   Dоnetsk Institute for Physics and Engineering named after O.O.Galkin, Yu.G. Pashkevich ,   Dоnetsk Institute for Physics and Engineering named after O.O.Galkin
Published: April 2019

A new original approach to the study of coordination complexes with pa ra mag netic ions, the modified crystal field theory (MCFT), is represented in the monograph. The approach is based on a new parametrization of the problem by the effective nuc lear charge of a paramagnetic ion. Implicit accounting for ligand electrons signifi cantly enhances the predictive capability of the proposed method. The book gives some examples of the MCFT applications for the in terpretation of various experiments. To describe the spin state variations of pa ramagnetic ions under different coordination complex distortions the spin state diagrams are suggested for the first time.
Al-Yahūd fī mu’allafāt al-muslimīn bi Indonesia: Dirāsah awwalīyah
Authors: Ropi Ismatu
Published: April 2019

This article tries to map out more than 40 works of Indonesian Muslim writers regarding the Jews (as religion and communities), and the influences of those works in shaping understanding on Judaism and the Jews among Indonesian Muslim communities. This article focuses on examining how those writers interested to the themes they choose in their books, and what are the sources they refer to. In general, there are at least two models of Indonesian Muslim writers have developed in their works on Judaism and the Jews community. The first is the works that are normatively preferring to based their primary sources from the Quran and al-Hadith or classical Muslim scholarship traditions in their depiction on Judaism or the Jews. The second is the works that are mainly characterized to prove Jewish ‘hidden’ agendas as well as political, social, economic and cultural movements played by the Jews as a part of international Jewish connection.
La injuria al honor como motivación de guerra, según Vitoria, Molina y Suárez
Authors: Cruz Juan Cruz
Published: April 2019

Quando um grande pensador da Era de Ouro espanhola, tal qual Vitoria, Molina ou Suárez, questiona sobre a causa fundamental que justifica uma lícita declaração de guerra, a “injúria” é incluída como uma dessas causas. Aqui, “injúria” é entendida como uma infração de um direito, uma injustiça cometida e pela qual a reparação não foi feita. Dentre as injúrias que podem licitamente ser consideradas uma justificativa para a guerra, há o “insulto à honra”, especialmente à honra da Nação e à honra do Soberano. A dificuldade em aceitar essa justificativa para a guerra reside em fazer uma separação entre o interesse do Soberano e o interesse do povo, i.e., os homens que compõem a comunidade, que são os depositários imediatos do poder. Para esses pensadores, a honra é sempre possuída pelo povo. E isso porque um Estado, uma Nação, um povo tem o direito de desfrutar o respeito por suas instituições, leis e costumes, tal qual uma parte integral de sua própria vida.
Francisco Suárez – Se a lei natural é verdadeiramente lei divina preceptiva
Authors: De Boni Luis Alberto , Leite Thiago Soares
Published: April 2019

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Decolonizing Cultural Cooperation, Revitalizing Epistemologies of the South: Indigenous and Black Oral Traditions in Central America
Authors: Muñoz Muñoz Marianela
Published: April 2019

From 2009 to 2012, the “Cultural Revitalization and Creative Productive Development on the Caribbean coast of Nicaragua” program aimed to promote and revitalize cultural expressions, including oral traditions, of Indigenous and Black communities. This paper reflects some of its achievements, contradictions, and lessons. Building from experiences on the UNESCO team, and employing an ethnographic approach, I first expose how these processes underlie the daily struggle of Indigenous and Black people against colonization and Mestizo/Western hegemony in Nicaragua. Second, I delve into how the experience challenged our understanding of international cooperation in Central America, as well as my own positionality as an external and Mestiza researching with (not about) subaltern populations. My argument is that cultural revitalization processes of oral traditions not only entail the emergence of alternative epistemologies (from the South), but also destabilize the colonialist structure of cultural cooperation programs, and the identities of the collaborators.
Fungsi keluarga, dukungan sosial dan kualitas hidup lansia di wilayah kerja Puskesmas III Denpasar Selatan
Authors: Dewianti Dewianti , Adhi Kadek Tresna , Kuswardhani Raden Ayu Tuty
Published: April 2019

Abstrak: Jumlah penduduk lansia dari tahun ke tahun mengalami peningkatan seiring dengan bertambahnya usia harapan hidup. Peningkatan kuantitas lansia tidak diikuti dengan meningkatnya kualitas hidup lansia. Hasil wawancara dengan 10 orang lansia di wilayah kerja Puskesmas III Denpasar Selatan menunjukan bahwa mereka mengalami kesepian dan merasa tidak diperhatikan sehingga mempengaruhi kualitas hidup. Penelitian ini bertujuan untuk mengetahui hubungan fungsi keluarga, dukungan sosial (pasangan, keluarga dan masyarakat) dengan kualitas hidup lansia di wilayah kerja Puskesmas III Denpasar Selatan. Penelitian cross sectional telah dilaksanakan terhadap 125 orang lansia laki-laki yang masih memiliki pasangan dan dipilih secara systematic random sampling. Masing-masing sampel yang sudah memberikan pernyataan persetujuan (inform consent) kemudian diwawancarai untuk mendapatkan data fungsi keluarga, dukungan sosial (pasangan, keluarga dan masyarakat) serta kualitas hidup lansia. Data dianalisis secara univariat, bivariat dan multivariat dengan uji statistik chi square serta regresi logistik. Hasil penelitian menunjukkan bahwa sebagian besar lansia dengan kualitas hidup kurang (62,4%), fungsi keluarga kurang (72%), dukungan sosial keluarga rendah (54,4%) dan dukungan sosial masyarakat rendah (67,2%), sedangkan dukungan sosial pasangan sebagian besar dalam kategori tinggi yaitu 54,4%. Hasil uji chi square menunjukkan bahwa fungsi keluarga, dukungan sosial (pasangan, keluarga dan masyarakat) berhubungan secara bermakna dengan kualitas hidup lansia (p<0,05) dan hasil uji regresi logistik menunjukkan bahwa fungsi keluarga memiliki hubungan bermakna dengan kualitas hidup lansia (p<0,05). Fungsi keluarga yang baik meningkatkan kualitas hidup lansia, dengan demikian perlu upaya peningkatan fungsi keluarga oleh anggota keluarga yang memiliki lansia.
Ledakan pertumbuhan penduduk di Provinsi Bali dan solusinya
Authors: Wirawan Dewa Nyoman
Published: April 2019

Pertumbuhan Penduduk Provinsi BaliBerdasarkan hasil Sensus Penduduk 2010, penduduk Bali berjumlah 3.890.757 jiwa, sedangkan jumlah penduduk pada Sensus Penduduk 2000 adalah 3.146.999.Dengan demikian dalam 10 tahun jumlah penduduk Bali bertambah sebanyak 743.758 jiwa atau hampir sama dengan penduduk Kota Denpasar pada tahun 2010 yang berjumlah 788.589 jiwa. Secara rata-rata pertumbuhan penduduk Bali dalam periodeÂ  tahun 2000-2010 adalah 2,15% per tahun dan termasuk rangking 13 tertinggi di Indonesia dan jauh diatas rata-rata laju pertumbuhan penduduk tingkat nasional sebesar 1,49%.Bila dibandingkan dengan pertumbuhan penduduk Provinsi Bali sejak tahun 1961, terlihat bahwa pertumbuhan penduduk tahun 2000-2010 adalah paling tinggi (Grafik-1)
Persepsi Perempuan, Dukungan Keluarga dan Media Massa Berpengaruh pada Penggunaan Gurah Vagina Ratus, Bali, 2013
Authors: Widyastuti Widyastuti , Zuryani Nazrina , Karmaya I Nyoman Mangku
Published: April 2019

Latar belakang dan tujuan: Gurah vagina teknik ratus adalah perawatan dengan penguapan pada area genital yang ramuannya disebut dengan ratus. Ada beberapa kontroversi seputar teknik ratus, terutama mengenai manfaat dan aspek yang merugikan. Penelitian ini mengacu teori perilaku dari Green (2007) dengan fokus tiga faktor: penentu, pendukung dan pendorong, serta bertujuan untuk mengetahui hubungan antara persepsi, sosial ekonomi, dukungan keluarga dan media massa dalam penggunaan gurah vagina teknik ratus. Metode: Penelitian ini menggunakan pendekatan kuantitatif dengan rancangan observasi potong lintang analitik. Studi menggunakan sampel secara acak sebesar 63 orang yang merupakan klien diambil dari tiga tempat spa yang berbeda. Hasil: Sebanyak 44 responden (69,8%) melakukan gurah vagina teknik ratus dan 19 responden (30,2%) tidak melakukan gurah vagina teknik ratus. Hasil penelitian menunjukkan variabel persepsi, pengetahuan, dukungan keluarga dan media massa mempunyai hubungan yang signifikan (p<0,05). Analisis multivariat menunjukkan bahwa media massa memiliki pengaruh terbesar dengan OR=8,47 (95%CI: 1,21-59,42).Simpulan: Media massa memiliki pengaruh paling besar terhadap penggunaan gurah vagina ratus di Bali.
Hubungan Karakteristik Demografi, Klinis dan Faktor Risiko Terinfeksi HIV dengan Koinfeksi HIV/TB di Klinik Amertha Yayasan Kerti Praja Denpasar
Authors: Nyoko Yuneti Octavianus , Putra I Wayan Gede Artawan Eka , Sawitri Anak Agung Sagung
Published: April 2019

Latar belakang dan tujuan: Infeksi HIV meningkatkan risiko terserang penyakit tuberkulosis (TB) dan sebaliknya infeksi TB meningkatkan progresifitas HIV. Di Bali, koinfeksi TB pada pasien HIV/AIDS mengalami peningkatan dari 26% di tahun 2012 menjadi 30% di tahun 2013. Penelitian tentang faktor yang berhubungan dengan terjadinya koinfeksi HIV/TB masih terbatas di Indonesia. Penelitian ini bertujuan untuk mengetahui hubungan karakteristik demografi, klinis dan faktor risiko terinfeksi HIV dengan koinfeksi HIV/TB di Klinik Amertha Yayasan Kerti Praja Bali. Metode: Disain penelitian adalah cross-sectional menggunakan data sekunder pasien HIV/AIDS yang menerima terapi antiretroviral (ARV) tahun 2002-2012. Variabel bebas adalah karakteristik demografi: jenis kelamin, umur, tingkat pendidikan, status bekerja, keberadaan pengawas minum obat; variabel klinis: kadar hemoglobin, berat badan, kadar CD4; dan faktor risiko terinfeksi HIV. Status koinfeksi HIV/TB sebagai variabel tergantung. Analisis data meliputi analisis univariat, bivariat (chi-square) dan multivariat (cox regression).Hasil: Dari 531 pasien yang dianalisis sebagian besar berjenis kelamin laki-laki (57,6%) serta berumur â‰¥31 tahun (50,8%). Kejadian koinfeksi HIV/TB dijumpai pada 5,5% pasien. Analisis multivariat menunjukkan variabel yang secara independent berhubungan terhadap terjadinya koinfeksi HIV/TB adalah kadar CD4 awal â‰¤200 cell/mm3 (PR=10,34; 95%CI: 1,39-76,69; p=0,022) dan faktor risiko terinfeksi HIV melalui IDU (PR=3,27; 95%CI:1,56-6,88;p=0,002). Simpulan: Pasien yang memulai terapi ARV dengan kadar CD4Â  â‰¤200 cell/mm3 dan terinfeksi HIV melalui IDU berhubungan dengan koinfeksi HIV/TB.
Pengaruh Langsung dan Tidak Langsung Beberapa Faktor terhadap Keputusan Pemilihan Penolong Persalinan di Kecamatan Gunungsari Lombok Barat
Authors: Aryaniti Ni Nyoman , Wulandari Luh Putu Lila , Karmaya I Nyoman Mangku
Published: April 2019

Latar belakang dan tujuan: Penelitian ini bertujuan untuk mengetahui faktor langsung dan tidak langsung yang mempengaruhi keputusan pemilihan penolong persalinan oleh ibu bersalin di Kecamatan Gunungsari Kabupaten Lombok Barat. Metode: Penelitian menggunakan desain cross-sectional analitik. Sebanyak 27 ibu bersalin ditolong tenaga bukan kesehatan dipilih secara purposive. Ibu bersalin yang ditolong tenaga kesehatan diambil secara proportional systematic random sampling dari Puskesmas Gunungsari dan Puskesmas Penimbung, masing-masing sebanyak 29 dari 916 ibu bersalin, dan 14 dari 437 ibu bersalin. Faktor eksogen yang diteliti adalah pendidikan ibu, kelas ibu hamil, pengetahuan ibu, sikap ibu, dukungan keluarga, dan akses. Keputusan pemilihan penolong persalinan sebagai faktor endogen. Data dikumpulkan dengan wawancara menggunakan kuesioner. Data dianalisis secara deskriptif, dan dilanjutkan dengan analisis jalur menggunakan regresi linier. Hasil: Kebanyakan responden berusia 21-35 tahun (87,4%), ibu rumah tangga (47,14%), berpendidikan menengah ke bawah (65,72%), dan kawin (88,57%). Hanya dua faktor eksogen yang berpengaruh yaitu dukungan keluarga mempunyai pengaruh langsung dengan koefisien 0,534 dan pengaruh total 35,54%. Kelas ibu hamil melalui dukungan keluarga mempunyai pengaruh tidak langsung dengan koefisien 0,520 dan pengaruh total 34,78%. Total pengaruh langsung dan tidak langsung terhadap keputusan pemilihan penolong persalinan oleh ibu bersalin 70,32%.Simpulan: Kehadiran suami/keluarga diperlukan dalam kelas ibu hamil melalui suatu kesepakatan jadwal pelaksanaan.
Hubungan antara Persepsi Daya Tanggap dan Persepsi Empati dengan Kepuasan Pasien di RSUD Wangaya Denpasar
Authors: Wira Dwidyaniti , Suarjana Ketut , Wijaya I Putu Ganda
Published: April 2019

Latar belakang dan tujuan: Penilaian terhadap mutu layanan dan kaitannya dengan kepuasan pasien di layanan rawat inap dan rawat jalan sangat penting untuk dilakukan. Penelitian ini bertujuan untuk mengetahui hubungan antara persepsi mutu pelayanan asuhan keperawatan dengan kepuasan pasien rawat inap kelas III di RSUD Wangaya Kota Denpasar.Metode: Penelitian ini adalah penelitian kuantitatif dengan menggunakan rancangan potong lintang. Besar sampel 111 orang yang diambil dengan tehknik simple random sampling. Data dianalisis secara bertahap meliputi analisis univariat, bivariat dan multivariat dengan regresi logistik.Hasil: Hasil penelitian menunjukkan tingkat kepuasan sebesar 45%. Persepsi daya tanggap dengan OR=2,404 (95%CI: 1,076-5,373) dan empati dengan OR=2,594 (95%CI: 1,165-5,779) mempunyai hubungan yang signifikan dengan kepuasan pasien.Â  Simpulan: Penelitian ini menemukan bahwa tingkat kepuasan pasien masih berada pada kisaran sedang dan memiliki hubungan yang signifikan dengan persepsi daya tanggap dan persepsi empati
Faktor Penghambat dan Pendukung Penggunaan Alat Kontrasepsi Implant di Wilayah Puskesmas I Denpasar Utara
Authors: Gustikawati Nida , Wulandari Luh Putu Lila , Duarsa Dyah Pradnyaparamita
Published: April 2019

Latar belakang dan tujuan: Penelitian ini bertujuan untuk mengetahui secara mendalam faktor pendukung dan penghambat penggunaan alat kontrasepsi implant di Wilayah Puskesmas I Denpasar Utara.Metode: Penelitian ini menggunakan rancangan kualitatif dengan pendekatan fenomenologi. Pengumpulan data dengan focus group discussion (FGD) dan in-depth interview. FGD dilakukan pada informan kunci yaitu 10 akseptor implant dan 10 akseptor alat kontrasepsi lain. Wawancara mendalam dilakukan pada 11 informan lain yaitu bidan puskesmas, bidan praktek swasta, penyuluh KB, mertua dan suami dari informan kunci.Hasil: Persepsi dan sikap akseptor implant tergolong baik, tetapi persepsi dan sikap akseptor alat kontrasepsi lain kurang baik. Pengalaman akseptor implant bervariasi tentang efek samping dari penggunaan implant, namun hal ini tidak dianggap penghambat. Faktor pendukung yang dikemukakan oleh informan adalah ketersediaan dan keterjangkauan fasilitas pelayanan serta dukungan suami. Fasilitas dan sarana bukan menjadi faktor penghambat baik bagi pengguna maupun bukan pengguna sedangkan faktor penghambatnya adalah masih adanya keinginan untuk mempunyai anak, kurangnya tenaga kesehatan yang terampil dalam pemasangan alat kontrasepsi implant, dan kurangnya promosi tentang alat kontrasepsi implant.Simpulan: Faktor pendukung penggunaan implant yaitu: ketersediaan danÂ  keterjangkauan fasilitas pelayanan serta dukungan suami. Faktor penghambatnya adalah adanya keinginan untuk mempunyai anak, pelatihan tenaga kesehatan yang kurang memadai, dan kurangnya promosi tentang implant di masyarakat.
Evaluasi Tugas Kader Tuberkolosis Desa Adat dan Kader Tuberkolosis Bukan Desa Adat di Wilayah Kabupaten Gianyar
Authors: Suputra Anak Agung Gede , Putra I Wayan Gede Artawan Eka , Ani Luh Seri
Published: April 2019

Latar belakang dan tujuan: Salah satu strategi yang diterapkan untuk meningkatkan cakupan penemuan kasusÂ  tuberkolosis (TB) dengan bakteri tahan asam positif (BTA+) di Kabupaten Gianyar adalah dengan melibatkan kader TB desa adat (pakraman) dan kader TB yang dibentuk oleh Program Pemberantasan Tuberkolosis Indonesia (PPTI) denganÂ  tugas membantu petugas kesehatan untuk case finding penderita dengan suspek TB. Tujuan penelitian ini adalah untuk evaluasi pelaksanaan tugas kader TB desa pakraman dibandingkan dengan kader TB PPTI di Kabupaten Gianyar.Metode: Penelitian evaluasi ini dilakukan dengan mempergunakan data sekunder dan wawancara pada semua kader desa pakraman (29 orang) dan semua kader TB PPTI (88 orang). Data sekunder yang dikumpulkan adalah laporanÂ  kegiatan kader dan wawancara dilakukan untuk mengetahui identitas kader dan ajakan (supervisi) petugas pemegang program TB. Data dianalisis secara univariat, bivariat dan multivariat.Hasil: Hasil analisis menunjukan pelaksanaan tugas kader TB desa pakraman lebih baikÂ  dibandingkan kader TB PPTI dengan adjusted RP=6,1 (95%CI:3,3-11,2). Pelaksanaan tugas yang lebih baik pada kader TB desa pakraman terjadi pada keempat jenis tugas kader, yaitu membantu penyuluhan (adjusted RP=7,8; 95%CI: 4,2-14,2), menemukan suspek TB (adjusted RP=7,4; 95%CI: 1,7-33,1), mencari suspek TB mangkir periksa (adjusted RP=17,1; 95%CI: 1,8-166,4) danÂ  mencariÂ  penderita TB mangkir berobat (adjusted RP=3,8 x 108 (95%CI: 1,6-8,9 x 108).Simpulan: Dalam penelitian evaluasi ini dijumpai bahwa kader TB desa pakraman melaksanakan tugas dengan lebih baik dibandingkan kader TB PPTI.Â
Analisis Beban Kerja Dokter Umum di Puskesmas Kota Denpasar dengan Menggunakan Metode Workload Indicators of Staffing Need
Authors: Dharmayuda Anak Agung Ngurah Gede , Wulandari Luh Putu Lila
Published: April 2019

Latar belakang dan tujuan: Selama ini penentuan jumlah tenaga kesehatan termasuk dokter umum di puskesmas adalah berdasarkan rasio per jumlah penduduk dan bukan berdasarkan beban kerja. Penelitian analisis beban kerja dokter umum di puskesmas diIndonesia belum banyak dilakukan dan sama sekali belum pernah dikerjakan di ProvinsiBali. Penelitian ini bertujuan untuk mengetahui beban kerja, kebutuhan tenaga dokter umum serta distribusinya di puskesmas Kota Denpasar.Metode: Rancangan penelitian adalah deskriptif cross-sectional yang dilaksanakan di 11 puskesmas Kota Denpasar terhadap semua dokter umum fungsional. Pengumpulan data dilakukan dengan wawancara dan observasi langsung terhadapÂ  kegiatan dari masing-masing dokter umum. Selain itu juga dikumpulkan data sekunder dari masing-masing puskesmas. Analisis data dilakukan secara kuantitatif dengan menggunakan software WISN English Version 1.1.132.0.Hasil: Sebagian besar dari 34 dokter umum di puskesmas yang menjadi sampel penelitian adalah perempuan (73,5%), berumur 35-44 tahun (61,8%), status pegawai negeriÂ  (97,1%), masa kerja 6-10 tahun (55,9%) dan hampir semuanya (95,6%) mempunyai tugas tambahan selain memberikan pelayanan kepada pasien. Hasil analisis menunjukkan bahwa beban kerja dokter umum di puskesmas Kota Denpasar termasuk kategori tinggi dengan rasio 0,5-0,9. Beban kerja yang dianggap sesuai adalah bila rasio beban kerja sama dengan satu. Bila dilihat dari analisis beban kerja ditemukan bahwa semua puskesmas di Kota Denpasar mengalami kekurangan dokter umum dengan jumlah kekurangan yang bervariasi.Simpulan: Bila menggunakan perhitungan rasio per jumlah penduduk, jumlah dokter umum di puskesmas Kota Denpasar telah mencukupi, namun dari hasil analisis beban kerja dijumpai masih adanya kekurangan.
Hubungan Karakteristik Sosio Demografi dan Dukungan Sosial Suami dengan Partisipasi Ibu Mengikuti Kelas Ibu Hamil
Authors: Widiantari Ni Ketut  Nopi , Suariyani Ni Luh Putu , Karmaya I Nyoman Mangku
Published: April 2019

Latar belakang dan tujuan: Kelas ibu hamil diterapkan di tiga puskesmas Kota Denpasar untuk meningkatkan kesehatan ibu dan bayiÂ  dengan metodeÂ  belajar kelompok tentang kehamilan, persalinan, nifas, perawatan bayi dan lain-lain, namun tingkat kehadiran ibu hamil masih rendah. Penelitian ini dilakukan untuk mengetahui hubungan antara karakteristik sosio demografi dan dukungan sosial suami dengan partisipasi ibu mengikuti kelas ibu hamil.Metode: Rancangan penelitian adalah survei cross sectional pada 122 ibu hamil yang dipilih secara systematic random sampling dari buku register ibu hamil. Data dikumpulkan dengan melakukan wawancara di rumah ibu hamil atau pada saat berkunjung ke puskesmas. DataÂ  dianalisis secara univariat, bivariat dengan uji chi square dan multvariat dengan metode poisson regresi.Hasil: Partisiasi ibu mengikuti kelas ibu hamil di tiga puskesmas sebesar Â 29,5%.Â  Analisis bivariat menunjukkan bahwa variabel yang berhubungan dengan kehadiran ibu dalam kelas ibu hamil adalah paritas (p=0,036), dukungan sosial yangÂ  tinggiÂ  dariÂ  suami (p=0,001) yang terdiri dari dukungan emosional (p=0,001), dukungan instrumental (p=0,001), dukungan informasi (p=0,001) dan dukungan penghargaan (p=0,001). Hasil analisis multivariat menunjukkan bahwa satu-satunya variabel yang berhubungan dengan kehadiran dalam kelas ibu hamil adalah dukungan sosial suamiÂ  (PR=27,1; 95%CI: 8,13-90,46).Simpulan: Kehadiran ibu mengikuti kelas ibu hamil di tiga puskesmas masih rendah. Faktor yang mempengaruhi kehadiran ibu hamil adalah dukungan sosial suami.
Predictors of Loss To Follow Up and Mortality Among Children â‰¤12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali
Authors: Juergens Stefanie , Sawitri Anak Agung Sagung , Wati Ketut Dewi Kumara , Putra I Wayan Gede Artawan Eka , Merati Tuti Parwati
Published: April 2019

Background and purpose: Many HIV-infected children in Bali have started antiretroviral therapy (ART), but loss to follow up (LTFU) is a continuing concern, and the issue of childhood adherence is more complex compared to adults.Methods: This was a retrospective study among cohort of 138 HIV+ children on ART in Sanglah General Hospital, Denpasar, Bali from January 2010 to December 2015. Kaplan-Meier analysis was used to describe incidence and median time to LTFU/mortality and Cox Proportional Hazard Model was used to identify predictors. Variables which were analysed were socio-demographic characteristics, birth history, care giver and clinical condition of the children. Results: Mean age when starting ARV therapy was 3.21 years. About 25% experienced LTFU/death by 9.1 month resulting in an incidence rate of 3.28 per 100 child month. The higher the WHO stage, the higher the risk for LTFU/mortality along with low body weight (AHR=0.90; 95%CI: 0.82-0.99). Conclusion:Â  Clinical characteristics were found as predictors for LTFU/mortality among children on ART.
Hubungan antara Fungsi Sosial dengan Kualitas Hidup Lanjut Usia di Kota Denpasar
Authors: Supraba Nandini Parahita , Widarini Ni Putu , Ani Luh Seri
Published: April 2019

Latar belakang dan tujuan: Kualitas hidup yang baik pada penduduk lanjut usia (lansia) dapat mengurangi beban pada kelompok usia produktif. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas hidup lansia dengan aktivitas sosial, interaksi sosial dan fungsi keluarga. Metode: Survei cross-sectional dilakukan pada 144 orang lanjut usia di Kota Denpasar yang dipilih secara cluster sampling. Data dikumpulkan dengan wawancara terstruktur pada responden lanjut usia di Kota Denpasar. Data dianalisis secara bivariat dan multivariat. Analisis multivariat dilakukan dengan regresi logistik.Â  Hasil: Penelitian ini menunjukkan bahwa 64,58% lansia di Kota Denpasar mempunyai kualitas hidup yang kurang. Kualitas hidup yang kurang lebih banyak dijumpai pada lansia yang berumur lebih tua, perempuan, berpendidikan rendah, tidak bekerja, berpenghasilan rendah dan berstatus janda atau duda. Analisis multivariat menunjukkan bahwa ada hubungan antara kualitas hidup lansia dengan jenis kelamin (AOR=6,42; 95%CI: 1,79-23,0), pekerjaan (AOR=9,81; 95%CI: 2,45-39,1), status kesehatan (AOR=8,65; 95%CI: 2,57-29,02), aktivitas sosial (AOR=3,85; 95%CI: 1,22-12,1), interaksi sosial (AOR=5,59; 95%CI: 2,01-15,5) dan fungsi keluarga (AOR=21,7; 95%CI: 6,09-77,7).Simpulan: Kualitas hidup lansia dijumpai berhubungan dengan jenis kelamin, pekerjaan, status kesehatan, aktivitas sosial, interaksi sosial dan fungsi keluarga.
Prediktor Tercapainya Gizi Normal: Studi Longitudinal pada Anak Gizi Kurang yang Menggunakan Antiretroviral di Bali
Authors: Haryadi Haryadi , Sawitri Anak Agung Sagung , Wati Ketut Dewi Kumara , Putra I Wayan Gede Artawan Eka , Merati Ketut Tuti Parwati
Published: April 2019

Latar belakang dan tujuan: Anak dengan HIV/AIDS sering memiliki gizi kurang. Antiretroviral terapi (ART) mempengaruhi peningkatan status gizi, namun informasi tentang prediktor yang mempengaruhi perubahan status gizi anak dengan HIV masih terbatas dan menunjukkan hasil yang tidak konsisten.Metode: Telah dilakukan penelitian analisis survival secara retrospektif dari data sekunder pada 84 anak gizi kurang yang menjalani ART di RSUP Sanglah tahun 2010-2015. Karakteristik demografi, klinis dan sosial-ekonomi saat memulai ART dihubungkan dengan tercapainya status gizi normal (nilai z-score â‰¥-2 SD). Kaplan-Meier digunakan untuk mendapatkan angka insiden dan median time tercapainya status gizi normal. Prediktor dianalisis dengan status gizi menggunakan cox proportional hazard model.Hasil: Sebanyak 73,81% anak mencapai gizi normal, insiden tercapainya gizi normal dijumpai 19 per 100 anak bulan dan median time 4 bulan 10 hari. Anak dengan berat badan lahir â‰¥2500 gr (AHR=5,41; 95%CI:1,76-16,61), tidak mengalami infeksi kandidiasis (AHR=3,72; 95%CI:1,27-10,93), Stadium Klinis III WHO dengan AHR=1,6 (95%CI: 1,08-4,24), Stadium Klinis II WHO dengan AHR 4,49 (95%CI 1,95-10,79); serta lag time ART yang lebih cepat (AHR=0,91; 95%CI:0,83-0,98) dijumpai sebagai prediktor tercapainya status gizi normal pada anak. Simpulan: Kondisi klinis anak merupakan prediktor tercapainya status gizi normal.
Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali
Authors: Astiti Cok Istri Sri Dharma , Sawitri Anak Agung Sagung , Merati Ketut Tuti Parwati
Published: April 2019

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.
Association of supplementary feeding with stunting among children in Kintamani, Bangli, Bali Province
Authors: Marfianti Istiana , Wirawan I Made Ady , Weta I Wayan
Published: April 2019

Background and purpose: The prevalence of stunting among under-five children in Indonesia and also in Bali is high. Studies on risk factors of stunting have been widely conducted in Indonesia, however association between stunting and diet pattern is still inconsistent. The aim of this study is to examine association of supplementary feeding pattern with stunting among children aged 1-3 years.Methods: A case control study was conducted in Bangli District. A total of 48 cases and 48 controls were selected to participate in the study. Age and sex variables between cases and controls were matched. Cases and controls were selected using a systematic random sampling method from 26 health post registers in Kintamani I Public Health Centre between November and December 2016. Data were collected in March 2017 by interviewing the mother at the health post. Data were analysed using bivariate and multivariate analysis. A logictic regression was performed to calculate adjusted odd ratio (AOR).Results: Cases and controls were comparable for age (p=0.773), sex (p=0.219), motherâ€™s education (p=0.673) and history of infectious diseases (p=0.584). Cases and controls differed in several variables: frequency, variability and type of supplementary feeding (p=0.002, <0.001 and <0.001), Â family income (p=0.038), poor personal hygiene (p=<0.001), environmental sanitation (p=0.022) and access to clean water (p=<0.001). Our analysis showed that several variables were associated with stunting among children aged 1-3 years, which included lack of supplementary feeding variability (AOR=12.45; 95%CI: 2.25-69.71), poor personal hygiene (AOR=3.52; 95%CI: 1.03-12.03), and poor access to clean water (AOR=6.49; 95%CI: 1.61-26.19). Other variables included supplementary feeding initiation, frequency of supplementary feeding, consistency or type of supplementary feeding, sex, and family income were not associated with stunting among children aged 1-3 years.Conclusions: Variability of supplementary feeding, personal hygiene, and access to clean water were all associated with stunting among children aged 1-3 years.
Predictors of treatment interruption among tuberculosis patients in public health centres in Bali, Indonesia
Authors: Farmani Putu Ika , Wirawan Dewa Nyoman , Sawitri Anak Agung Sagung , Putra I Wayan Gede Artawan Eka
Published: April 2019

Background and purpose: Tuberculosis treatment interruption (TB TI) is one factor that leads to treatment failure, tuberculosis (TB) drug resistance and drop out. The purpose of this study is to identify the incidence and the predictors of TB TI in public health centres (PHCs) in Bali.Methods: A retrospective longitudinal study was conducted using secondary data of 644 cohorts of TB patients on the first regiment who enrolled in 11 PHCs in Denpasar Bali during 2011-2012. Information from TB program officers in PHCs was also obtained to determine the differences within the practical implementation of TB treatment. Data were analysed using Kaplan Meier and Cox Proportional Hazard Regression.Results: The study revealed that 378 patients experienced TB TI with the total events of 535. The incidence rate of TB TI event was 5.1 per 1.000 person days and the median time was 56 days (IQR: 56-57). Predictors of the TB TI were male (AHR=1.22; 95% CI: 1.02-1.45; p=0.027) and a more flexible schedule to take the medicine (AHR=1.47; 95%CI: 1.22-1.76; p<0.0001).Conclusions: The implementation of fixed schedule and shortened time lapse for patients to take TB drug will enable more close contact between patients and health providers. Intensive adherence counselling especially tailored for male patients is also required.
Predictors of improved nutritional status among HIV/AIDS patients who received antiretroviral therapy (ART) at Sanglah General Hospital Denpasar
Authors: Utarini Gusti Ayu Eka , Sawitri Anak Agung Sagung , Merati Tuti Parwati
Published: April 2019

Background and purpose: Antiretroviral therapy (ART) is associated with improved nutritional status among HIV/AIDS patients. This study aims to examine proportion, median time, incidence rate, and predictors of improved nutritional status among HIV/AIDS patients who received ART at Sanglah General Hospital Denpasar.Methods: A restrospective cohort study was conducted in Denpasar City. A total of 207 medical records of HIV/AIDS patients who received ART between 1st of January 2012 and 30th of June 2015 were included in the study. Kaplan Meier analysis was performed to calculate incidence rate and median time of improved nutritional status among HIV/AIDS patients. Sociodemographic characteristics and clinical variables included body mass index (BMI), body weight, haemoglobin level, CD4 count, HIV clinical stadium, ART regiments, and opportunistic infections (OIs). Data were analysed using cox proportional hazard model to identify predictors of improved nutritional status among HIV/AIDS patients.Results: As many as 65.22% of HIV/AIDS patients who received ART experienced an improvement in their nutritional status with the incidence rate of 9.1 per 100 person months and median time of 6.1 months. Multivariate analysis showed that predictors of improved nutritional status were BMI at ART initiation (AHR=1.34; 95%CI: 1.16-1.5), HIV clinical stadium (AHR=1.45; 95%CI: 1.02-2.06), CD4 count at ART initiation (AHR=0.89; 95%CI: 0.81-0.99) and the presence of diarrhoea (AHR=1.83; 95%CI: 1.06-3.14).Conclusions: Predictors of improved nutritional status among HIV/AIDS patients who received ART were BMI, HIV clinical stadium, CD4 count and diarrhoea.
The role of communication contact in capitation implementation at public health centres in Denpasar
Authors: Purlimaningsih Ni Putu , Suarjana Ketut , Januraga Pande Putu
Published: April 2019

Background and purpose: One of the main indicators of quality in the provision of primary health care is the contact between the provider and the recipient (communication contact). Targets set regarding communication contacts are often not achieved which in turn results in consequent cuts in the capitation rates received by the public health centres (PHCs). The purpose of this research is to understand the implementation, inhibiting and enabling factors of supporting communication contact in the era of National Health Insurance (Jaminan Kesehatan Nasional/JKN).Methods: This study used a qualitative explorative design through in-depth interviews and focus group discussion (FGD) with 22 informants consisting of heads of PHCs, PHCs staff, Head of Denpasar Health Office, Head of Social Security Administering Agency (BPJS) Denpasar Branch and JKN members. This research was conducted at 11 PHCs in Denpasar City from April to July 2017. The informants were chosen purposively and the data were analysed thematically to explore aspects of implementation, the inhibiting and enabling factors of communication contact.Results: Communication contacts can be assessed both inside and outside the PHCs buildings. The inhibiting factor of communication contact implementation related to difference in understanding of the concept of PHCs working area, the absence of a standard operational procedure (SOP) for communication contact, heavy workload of PHCs service providers, lack of optimal means of supporting application of pcare convoluted and confusing information from BPJS, and lack of understanding from JKN enrolees on the particulars of the administration and desire for speedy service. Supporting factors are the availability of media, training and orientation for the implementing staff and the feedback from BPJS to PHCs staff. Driving factors are the effective authority of the PHCs head, commitment and motivation from government agencies and cross-sectoral support.Conclusions: Implementation of communication contact is influenced by both inhibiting and enabling factors, from the BPJS stakeholders and the members of the BPJS. Achieving the target of communication contact requires synergy of central government policy and BPJS managers.
Association between participation in a chronic disease management program, medication adherence and decrease of blood pressure
Authors: Indra Wiguna Cakera I Ketut , Nopiyani Ni Made Sri , Ady Wirawan I Made
Published: April 2019

Background and purpose:The prevalence of hypertension is increasing globally. A comprehensive approach is necessary including a community based chronic disease management program which has been implemented in public health centres in Indonesia. Only few studies have been published in Indonesia that evaluate the program, especially regarding the management of hypertension in primary care settings. This study aims to examine the association between participation in a chronic disease management program, medication adherence and decrease of blood pressure.Methods: A cross-sectional study was conducted in public health centres in Tabanan District. A total of 136 patients with hypertension were recruited at five groups that participate in the community based chronic disease management program called Program Pengelolaan Penyakit Kronis (Prolanis). The Prolanis groups were purposively selected based on the size of participants in the program. One group was selected at urban area and four groups at rural areas. Data were collected from May to June 2017 by conducting interviews, blood pressure measurements, and secondary data extraction from the medical record of the Prolanis database. The logistic regression analysis was used to determine the association between participation in a chronic disease management program, medication adherence and decrease of blood pressure.Results: As many as 75.7% of respondents actively participated in the Prolanis Program, and 81.6% were found with decreased blood pressure. Our study found a significant association between blood pressure decrease and active participation in the Prolanis Program with an adjusted odds ratio (AOR) of 6.38 (95%CI: 1.96â€“20.79), the good adherence towards medication with AOR=11.94 (95% CI: 3.60â€“39.56), and routine physical activities with AOR=3.84 (95%CI: 1.16-12.73). Conclusion: Active participation in the Prolanis Program, good adherence to medication and routine physical activities are independent factors of decreased blood pressure. These findings suggest the need for scaling up the Prolanis Program and increasing its coverage.