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LAMPIRAN
Lampiran 1. Ethical clearance
52
53
Lampiran 2. Informed consent PERSETUJUAN SETELAH PENJELASAN (INFORMED CONSENT) Selamat pagi/siang/sore, Ibu/Bapak. Kami adalah mahasiswa Fakultas Kedokteran Universitas Diponegoro yang sedang mengadakan penelitian tentang gangguan metabolik. Penelitian ini bertujuan untuk mengetahui hubungan lingkar pinggang dengan arus puncak pengeluaran napas pada masyarakat dengan gangguan metabolik. Kami membutuhkan ketersediaan Ibu/Bapak untuk melakukan beberapa tes: Harvard step test (tes naik turun bangku), tes kekuatan genggaman tangan, arus puncak pengeluaran napas, dan laboratorium darah sebagai sampel penelitian yang akan kami periksa serta menjawab beberapa pertanyaan yang berhubungan dengan penelitian kami. Manfaat dari penelitian ini adalah Ibu/Bapak akan mendapatkan pemeriksaan laboratorium darah yang meliputi asam urat, gula darah puasa dan kolesterol tanpa dipungut biaya apapun. Selain itu, Bapak/Ibu juga akan mendapatkan penyuluhan tentang pencegahan faktor-faktor yang dapat menyebabkan gangguan metabolik. Kami menjamin bahwa penelitian ini tidak akan menimbulkan efek yang merugikan pada Bapak/Ibu. Penelitian yang kami lakukan ini bersifat sukarela dan tidak ada unsur paksaan. Dalam penelitian ini, kami menjamin kerahasiaan segala data yang kami peroleh, data hanya akan kami gunakan untuk kepentingan penelitian. Penanggung jawab penelitian ini adalah dr. Bahrudin, M.Si.Med, Ph.D, dosen Bagian Anatomi FK Undip. Alamat kantor: Jl. Prof. Dr. Soedarto, Tembalang, Semarang, nomor HP 081228000876. Demikian penjelasan dari kami. Terima kasih atas kerja sama Bapak/Ibu dalam penelitian ini.
Setelah mendengar dan memahami penjelasan penelitian, dengan ini saya menyatakan SETUJU / TIDAK SETUJU untuk menjadi subjek penelitian. Semarang, ……………………. 2015 Saksi Nama Terang
Nama Terang
Alamat:
Alamat:
54
Lampiran 3. Identitas Subjek Penelitian
IDENTITAS SUBJEK PENELITIAN “FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP SINDROM METABOLIK” I.
II.
IDENTITAS 1. Nama
:
2. Tempat, tanggal lahir
:
3. Jenis kelamin
:
4. Alamat
:
RT/RW
:
Kelurahan
:
Kecamatan
:
5. No. telepon/HP
:
6. Pendidikan ( ) Tidak sekolah ( ) Tidak tamat SD/sederajat ( ) Tamat SD/sederajat 7. Pekerjaan ( ) Tidak bekerja ( ) Petani ( ) Wiraswasta
:
Usia:
tahun.
( ) Tamat SMP/sederajat ( ) Tamat SMA/sederajat ( ) Tamat perguruan tinggi/sederajat : ( ) PNS ( ) Lain-lain, sebutkan ...........
Riwayat Penyakit 1. Riwayat DM
:
Ya Tidak Tidak tahu Jika Ya: . . . . tahun, terkontrol/tidak terkontrol
55
2. Riwayat Hipertensi
:
Ya Tidak Tidak tahu Jika Ya: . . . . tahun, terkontrol/tidak terkontrol
3. Riwayat Kolestrol tinggi : Ya Tidak (Dislipidemia) Tidak tahu Jika Ya: . . . . tahun, terkontrol/tidak terkontrol 4. Riwayat Stroke
:
Ya Tidak Tidak tahu Jika Ya: . . . . tahun, terkontrol/tidak terkontrol
5. Riwayat Merokok
: ( ) Tidak pernah ( ) Pernah, sudah berhenti sejak ….. bulan yang lalu ( ) Merokok aktif ……… batang/hari
6. Riwayat Keluarga
: -
7. Riwayat Obat-obatan II.
Siapa dari keluarga Bapak/Ibu yang menurunkan penyakit tersebut? Sejak umur berapa Bapak/Ibu mengidap penyakit tersebut?
:
PEMERIKSAAN 1. Tekanan Darah (mmHg)
:
2. Tinggi Badan (cm)
:
3. Berat Badan (kg)
:
4. Lingkar Pinggang (cm)
:
S: x/menit
D:
mmHg.
HR:
56
Lampiran 4. Pemeriksaan fisik subjek penelitian
PEMERIKSAAN FISIK SUBJEK PENELITIAN “FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP SINDROM METABOLIK”
Kepala
: Konjungtiva anemis Sklera ikterik
( ) ( )
Lain-lain......................................................................
Leher
: JVP.......................................................................................
Dada
: Jantung (Bunyi jantung): .................................................... ................................................................................................ Paru: ...................................................................................
Abdomen
: ..............................................................................................
Ekstremitas
: ..............................................................................................
Rekomendasi
:
1. Peak flow meter 2. Hand Grip Dynamometer 3. Harvard Step Test
Ya ( ( (
Tidak ) ) )
( ( (
) ) )
Semarang, 18 Januari 2015
(………………………………………) Dokter
57
Lampiran 5. Hasil analisis statistik
Tests Of Normality Kolmogorov-Smirnova Statisti c Umur (tahun) Tinggi Badan (cm) Berat Badan (kg) GDP (mg/dL) HDL (mg/dL) TG (mg/dL) IMT (kg/m2) Tekanan Sistolik (mmHg) Tekanan Diastolik (mmHg)
df
.107 .072 .119 .258 .125 .143 .097 .129 .144
30 30 30 30 30 30 30 30 30
Sig.
Shapiro-Wilk Statistic
.200* .200* .200* .000 .200* .121 .200* .200* .115
df
.974 .987 .955 .718 .956 .939 .984 .961 .962
Sig. 30 30 30 30 30 30 30 30 30
*. This Is A Lower Bound Of The True Significance. A. Lilliefors Significance Correction
Descriptive Statistics N Umur (tahun) Valid N (listwise)
Minimum Maximum 30 30
41
76
Mean 56.93
Std. Deviation 8.233
Descriptive Statistics N Tinggi Badan (cm) Berat Badan (kg) IMT (kg/m2) Valid N (Listwise)
30 30 30 30
Minimum Maximum 137.0 41.0 18.7
173.0 80.0 34.6
Mean 154.323 65.183 27.365
Std. Deviation 8.4734 9.2861 3.3284
.657 .964 .236 .000 .250 .087 .926 .328 .346
58
Descriptive Statistics N
Minimum Maximum
Tekanan Sistolik (mmHg) Tekanan Diastolik (mmHg) HDL (mg/dL) TG (mg/dL) Valid N (Listwise)
30 30 30 30 30
124 60 29 62
218 125 61 350
Mean
Std. Deviation
161.43 88.17 41.70 161.23
22.538 13.249 7.340 67.108
Statistics GDP (mg/dL) Valid
N
30
Missing
0 102.50
Median
Jenis Kelamin Frequency Perempuan Valid Laki-Laki Total
Percent
Valid Percent
Cumulative Percent
22
73.3
73.3
73.3
8
26.7
26.7
100.0
30
100.0
100.0
Status Gizi Frequency
Percent
Valid Percent
Cumulative Percent
Normal
2
6.7
6.7
6.7
Berat Badan Lebih
5
16.7
16.7
23.3
17
56.7
56.7
80.0
6
20.0
20.0
100.0
30
100.0
100.0
Percent Valid Percent
Cumulative Percent
Valid Obestas 1 Obesitas Ii Total
Riwayat Merokok Frequency Tidak Valid Ya Total
28
93,3
93,3
93,3
2
6,7
6,7
100,0
30
100,0
100,0
59
Kategori Tekanan Darah Sistolik Frequency Prehipertensi Valid
Percent
Valid Percent
Cumulative Percent
5
16,7
16,7
16,7
Hipertensi derajat 1
12
40,0
40,0
56,7
Hipertensi Derajat 2
13
43,3
43,3
100,0
Total
30
100,0
100,0
Kategori Tekanan Darah Diastolik Frequency
Percent
Valid Percent
Cumulative Percent
Normal
7
23,3
23,3
23,3
Prehipertensi
9
30,0
30,0
53,3
Valid Hipertensi derajat 1
10
33,3
33,3
86,7
Hipertensi derajat 2
4
13,3
13,3
100,0
30
100,0
100,0
Total
Kategori Lingkar Pinggang Frequency NORMAL
Percent
Valid Percent
Cumulative Percent
2
6,7
6,7
6,7
MENINGKAT
14
46,7
46,7
53,3
Valid MENINGKAT TAJAM
14
46,7
46,7
100,0
30
100,0
100,0
Total
Kategori Gula Darah Puasa Frequency Normal Valid Meningkat Total
Percent
Valid Percent
Cumulative Percent
19
63,3
63,3
63,3
11
36,7
36,7
100,0
30
100,0
100,0
60
Kategori HDL Frequency
Percent
Valid Percent
Cumulative Percent
Normal
6
20,0
20,0
20,0
Valid Rendah
24
80,0
80,0
100,0
30
100,0
100,0
Total
Kategori Trigliserida Frequency Normal Valid Meningkat Total
Percent
Valid Percent
Cumulative Percent
15
50,0
50,0
50,0
15
50,0
50,0
100,0
30
100,0
100,0
Tests Of Normality Kolmogorov-Smirnova Statistic Arus Puncak Ekspirasi (L/menit) Lingkar Pinggang (cm)
df
Shapiro-Wilk
Sig.
Statistic
df
Sig.
,080
30
,200*
,974
30
,643
,130
30
,200*
,962
30
,349
*. This is a lower bound of the true significance. A. Lilliefors significance correction Descriptive Statistics N Arus Puncak Ekspirasi (L/Menit) Valid N (Listwise)
Minimum Maximum 30 30
180
570
Mean
Std. Deviation
352.67
101.572
Descriptive Statistics N Lingkar Pinggang (cm) Valid N (Listwise)
Minimum Maximum 30 30
74
112
Mean 91.33
Std. Deviation 7.617
61
6,66% 2 Normal 46,67% 14
Meningkat
46,67% 14
Meningkat tajam
Kategori APE Frequency Normal
Percent
Valid Percent
Cumulative Percent
13
43.3
43.3
43.3
Valid Tidak Normal
17
56.7
56.7
100.0
Total
30
100.0
100.0
62
56,7% 17
43,3% 13
Normal Tidak Normal
63
Correlations Arus Puncak Ekspirasi (L/menit) Pearson Correlation Arus Puncak Ekspirasi (L/menit)
1
-.420*
Sig. (2-tailed)
.021
N Pearson Correlation Lingkar Pinggang (cm)
Lingkar Pinggang (cm)
30 -.420*
Sig. (2-tailed)
30 1
.021
N
30
30
*. Correlation is significant at the 0.05 level (2-tailed).
Kategori Lingkar Pinggang * KAT_APE Crosstabulation Kategori APE Normal
Normal
2
0
2
Expected Count
,9
1,1
2,0
100,0%
0,0%
100,0%
8
6
14
6,1
7,9
14,0
57,1%
42,9%
100,0%
3
11
14
6,1
7,9
14,0
21,4%
78,6%
100,0%
13
17
30
13,0
17,0
30,0
43,3%
56,7%
100,0%
Count Meningkat
Expected Count % within Kategori LP Count
Meningkat Tajam
Expected Count % within Kategori LP Count
Total
Tidak Normal
Count % within Kategori LP Kategori Lingkar Pinggang
Total
Expected Count % within Kategori LP
64
Chi-Square Tests Value
Pearson Chi-Square Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
a
6,438 7,384 5,956 6,200c
df
Asymp. Sig. (2sided) 2 2
,040 ,025
1
,013
Monte Carlo Sig. (2-sided) Sig.
95% Confidence Interval Lower Bound Upper Bound b
,027 ,027b ,027b ,014b
,024 ,024 ,024 ,011
,030 ,030 ,030 ,016
30
a. 2 cells (33,3%) have expected count less than 5. The minimum expected count is ,87. b. Based on 10000 sampled tables with starting seed 2000000. c. The standardized statistic is 2,490.
65
Correlations Kat APE Umur (tahun) Correlation Coefficient Kat APE
1.000
.436*
.
.016
30
30
.436*
1.000
.016
.
30
30
Sig. (2-tailed) N
Spearman's rho
Correlation Coefficient Umur (tahun)
Sig. (2-tailed) N
*. Correlation is significant at the 0.05 level (2-tailed).
Correlations Kat APE
Tinggi Badan (cm)
1.000
.101
.
.595
30
30
Correlation Coefficient
.101
1.000
Sig. (2-tailed)
.595
.
30
30
Correlation Coefficient Kat APE
Sig. (2-tailed) N
Spearman's rho Tinggi Badan (cm)
N
Chi-Square Tests Kat APE dengan Status Gizi Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases
7.538a 8.569 6.840
df
Asymp. Sig. (2-sided) 3 3 1
.057 .036 .009
30
a. 6 cells (75,0%) have expected count less than 5. The minimum expected count is ,87.
66
Chi-Square Tests Kat APE dengan JK Value Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
df
1.493a .649 1.558
Asymp. Sig. (2-sided) 1 1 1
1.443
1
Exact Sig. (2sided)
Exact Sig. (1sided)
.407
.212
.222 .421 .212 .230
30
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 3,47. b. Computed only for a 2x2 table Correlations Arus Puncak Ekspirasi (L/menit) Pearson Correlation Arus Puncak Ekspirasi (L/menit)
Berat Badan (kg)
Berat Badan (kg)
1
Sig. (2-tailed)
.052 .783
N Pearson Correlation
30 .052
Sig. (2-tailed)
.783
N
30 1
30
30
Chi-Square Tests Kat APE dengan Riwayat Merokok Value Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
2.802a .875 3.533 2.709
df
Asymp. Sig. (2-sided) 1 1 1 1
Exact Sig. (2sided)
Exact Sig. (1sided)
.179
.179
.094 .350 .060 .100
30
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is ,87. b. Computed only for a 2x2 table
67
Correlations Arus Puncak Ekspirasi (L/menit) Pearson Correlation Arus Puncak Ekspirasi (L/menit)
Berat Badan (kg)
1
.052
Sig. (2-tailed)
Berat Badan (kg)
.783
N Pearson Correlation
30 .052
Sig. (2-tailed)
.783
N
30 1
30
30
Variables in the Equation B
Step 1a
S.E.
Wald
df
Sig.
Exp( B)
95% C.I.for EXP(B) Lower
Upper
Umur
.118
.083
2.018
1
.155 1.126
.956
1.325
Kat LP
.419
.179
5.474
1
.019 1.521
1.070
2.160
-44.164
17.192
6.599
1
.010
Constant
a. Variable(s) entered on step 1: Umur, Kat LP.
.000
68
Lampiran 6. Dokumentasi penelitian
Gambar 11. Pendataan sampel penelitian
69
Gambar 12. Pengambilan data berat badan, tinggi badan dan lingkar pinggang
Gambar 13. Pengambilan data APE
70
Lampiran 7. Biodata mahasiswa
Identitas Nama
: Ihwanu Sholeh
NIM
: 22010111130087
Tempat Lahir : Cirebon Tanggal Lahir : 2 Juli 1991 Jenis Kelamin : Laki-laki Alamat
: Jl. Yudhistira No. 43 Desa Karangasem, Plumbon, Cirebon
Nomor HP
: 08977261640
Email
:
[email protected]
Riwayat Pendidikan Formal 1.
SD
: SD Negeri 1 Karangasem
Lulus tahun : 2003
2.
SMP
: SMP Negeri 1 Plumbon
Lulus tahun : 2006
3.
SMA
: SMA Negeri 1 Cirebon
Lulus tahun : 2009
4.
S1
: Pendidikan Dokter Fakultas Kedokteran Universitas Diponegoro
Masuk tahun : 2011
Keanggotaan Organisasi 1.
HIMA KU Universitas Diponegoro Tahun 2011-2013
2.
ROHIS Fakultas Kedokteran Universitas Diponegoro Tahun 2011-2013
