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Dyah Wulan Sumekar Rengganis Wardani
Bagian Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Lampung
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Hubungan Pengetahuan dan Sikap Dokter dengan Kesesuaian Peresepan Obat Berdasarkan Indikator WHO Saputra, Magdalena Yosefin; Oktarlina, Rasmi Zakiah; Wardani, Dyah Wulan Sumekar Rengganis; Larasati, TA
Jurnal Penelitian Perawat Profesional Vol 7 No 3 (2025): Juni 2025, Jurnal Penelitian Perawat Profesional
Publisher : Global Health Science Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/jppp.v7i3.6626

Abstract

Resep merupakan dokumen yang harus ditulis secara akurat dan jelas untuk mencegah salah baca. Resep yang salah dapat menyebabkan kerugian atau bahkan kematian bagi pasien. Pengetahuan merupakan pemahaman teoretis dan praktis yang dimiliki manusia. Sikap adalah konsistensi perasaan dan gagasan seseorang, serta perilakunya dalam berinteraksi sosial. Pengetahuan dan sikap memiliki peran yang penting dalam proses pengambilan keputusan yang rasional. Tujuan penelitian ini adalah untuk mengetahui apakah ada hubungan antara pengetahuan dan sikap dokter dengan kesesuaian peresepan obat berdasarkan indikator WHO. Jenis penelitian ini adalah analisis deskriptif dengan pendekatan cross-sectional. Sampel penelitian adalah 40 dokter umum di Puskesmas Kota Bandar Lampung. Variabel bebas penelitian ini merupakan pengetahuan serta sikap dokter. Variabel terikat adalah kesesuaian peresepan obat berdasarkan indikator WHO. Data yang dikumpulkan berupa data primer dan sekunder, yaitu kuesioner yang dibagikan ke dokter umum serta lembar resep. Data dianalisis secara univariat dan bivariat, serta uji chi-square dilakukan untuk uji statistik. Hasil penelitian didapati adanya pengaruh pengetahuan (p=0,011) dan sikap (p=0,004) terhadap kesesuaian peresepan obat berdasarkan indikator WHO.
The Relationship Between Spraying Frequency and Incidence of Anemia in Farmers Nainggolan, Hotman Natama; Saftarina, Fitria; Suharmanto, Suharmanto; Wardani, Dyah Wulan Sumekar Rengganis; Kurniawan, Betta
Indonesian Journal of Global Health Research Vol 7 No 5 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i5.7064

Abstract

Various types of pesticides commonly used by farmers and the public include insecticides, fungicides, and herbicides. Excessive pesticide use in agricultural settings can lead to adverse health effects, one of which is anemia. This study aimed to analyze the relationship between pesticide spraying frequency and the incidence of anemia among horticultural farmers in Gisting District, Tanggamus Regency, in 2025. A quantitative, case-control design was employed. The study was conducted in Gisting District, Tanggamus Regency, Lampung Province, from August 2024 to January 2025. The study population consisted of 41 anemic farmers with hemoglobin levels below 13 g/dL, and 41 non-anemic farmers as the control group. Purposive sampling was used, with the case group comprising anemic farmers and the control group including non-anemic respondents. The independent variable was spraying frequency, and the dependent variable was anemia. Data on spraying frequency were collected via questionnaire, while anemia was assessed through laboratory analysis. Data analysis included univariate and bivariate methods, with the Chi-Square test applied for inferential statistics. Results showed that the majority of farmers in the case group (73.2%) sprayed pesticides more than twice per week, whereas 53.7% of the control group sprayed less than twice per week. The analysis yielded a p-value of 0.024, indicating a significant association between spraying frequency and anemia incidence. The odds ratio (OR) of 3.158 (95% CI: 1.253–7.957).
Hubungan Faktor Individu Dan Pekerjaan Terhadap Keluhan Work-Related Musculoskeletal Disorders (WRMSDs) Pada Petugas Kebersihan Ramadhan, Yasmine Aulia; Wardani, Dyah Wulan Sumekar rengganis; Komala, Ramadhana; Berawi, Khairunnisa
Malahayati Nursing Journal Vol 7, No 10 (2025): Volume 7 Nomor 10 (2025)
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/mnj.v7i10.20636

Abstract

ABSTRACT Work-Related Musculoskeletal Disorders (WRMSDs) are complaints of muscles, fascia, nerves, tendons, joints, and spine related to exposure to risk factors in the workplace, such as sprains, pain, and inflammation. Cleaners are one of the jobs that often experience WRMSDs. WRMSDs complaints can be influenced by several main factors, namely individual factors and work factors. The purpose of this study was to determine the relationship between individual and work factors and WRMSDs complaints in cleaners at the University of Lampung. This study used a cross-sectional approach, conducted at the University of Lampung from July 2024 to January 2025. The subjects of the study were 130 cleaners. Data were collected through filling in personal data, exercise habit questionnaires and Nordic Body maps, and measuring work posters using the OWAS method. Bivariate analysis used the Spearman and Mann-Whitney tests. There is a relationship between gender (p = 0,05) and WRMSDs complaints, and there is a relationship between age (p < 0,001 and r = 0,355), work duration (p = 0,001 and r = 0,283), work posture (p = 0,001 and r = 0,289), and WRMSDs complaints with a weak correlation strength and positive direction. There is a relationship between work period (p < 0,001 and r = 0,400) and WRMSDs complaints with a moderate correlation level and a positive direction. There is a relationship between exercise habits (p = 0,009 and r = -0,299) with a weak correlation level and a negative direction. There is no relationship between BMI (p = 0,717) and WRMSDs complaints. Factors related to WRMSDs complaints are age, gender, exercise habits, work period, work duration, and work posture. Factors not related to WRMSDs complaints are BMI. Keywords: Musculoskeletal Disorders, Individual Factors, Occupational Factors  ABSTRAK Work-Related Musculoskeletal Disorders (WRMSDs) merupakan keluhan pada otot, fascia, saraf, tendon, sendi, dan tulang belakang yang terkait dengan paparan faktor risiko di tempat kerja, seperti terkilir ,nyeri dan inflamasi. Petugas kebersihan merupakan salah satu pekerjaan yang sering mengalami WRMSDs. Keluhan WRMSDs dapat dipengaruhi oleh beberapa faktor utama, yaitu faktor individu serta faktor pekerjaan. Tujuan penelitian ini adalah mengetahui hubungan antara faktor individu dan pekerjaan terhadap keluhan WRMSDs pada petugas kebersihan Universitas Lampung. Penelitian ini menggunakan pendekatan cross-sectional, dilakukan di Universitas Lampung pada bulan Juli 2024-Januari 2025. Subjek penelitian adalah 130 petugas kebersihan. Data dikumpulkan melalui pengisian data diri, kuesioner kebiasaan olahraga dan Nordic Body map, serta pengukuran poster kerja dengan metode OWAS. Analisis bivariat menggunakan uji Spearman dan Mann Whitney. Terdapat hubungan antara jenis kelamin (p = 0,05) dan keluhan WRMSDs, serta terdapat hubungan antara usia (p < 0,001 dan r = 0,355), durasi kerja (p = 0,001 dan r=0,283),  postur kerja (p = 0,001 dan r = 0,289) dan keluhan WRMSDs dengan kekuatan korelasi lemah dan arah yang positif. Terdapat hubungan antara masa kerja (p < 0,001 dan r = 0,400) dan keluhan WRMSDs dengan tingkat korelasi sedang dan arah yang positif. Terdapat hubungan antara kebiasaan olahraga (p = 0,009 dan r = -0,299) dengan tingkat korelasi lemah dan arah yang negatif. Tidak terdapat hubungan antara IMT (p = 0,717) dengan keluhan WRMSDs. Faktor yang berhubungan dengan keluhan WRMSDs adalah usia, jenis kelamin, kebiasaan olahraga, masa kerja, durasi kerja, serta postur kerja. Faktor yang tidak berhubungan dengan keluhan WRMSDs adalah IMT. Kata Kunci: Gangguan Muskuloskeletal, Faktor Indiviu, Faktor Pekerjaan
Pentingnya Analisis Cluster Berbasis Spasial dalam Penanggulangan Tuberkulosis di Indonesia Wardani, Dyah Wulan Sumekar Rengganis; Lazuardi, Lutfan; Kusnanto, Hari
Kesmas Vol. 8, No. 4
Publisher : UI Scholars Hub

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Abstract

Pengendalian tuberkulosis telah meningkatkan angka kesembuhan dan menyelamatkan banyak jiwa, tetapi kurang berhasil menurunkan insiden tuberkulosis. Oleh karena itu, pengendalian tuberkulosis menekankan pada kebijakan determinan sosial karena determinan sosial secara langsung dan melalui faktor risiko tuberkulosis berpengaruh terhadap tuberkulosis. Hasil telaah literatur menunjukkan bahwa stratifikasi determinan sosial menyebabkan clustering tuberkulosis, berupa pengelompokkan penderita tuberkulosis menurut lokasi geografis yang secara statistik signifikan. Pengetahuan tentang clustering sangat bermanfaat dalam pengendalian tuberkulosis, khususnya untuk menurunkan insiden tuberkulosis karena dapat memberikan informasi tentang lokasi populasi yang berisiko. Selain itu, telaah literatur menunjukkan bahwa implementasi analisis spasial memerlukan dukungan sumber daya yang tidak sedikit. Oleh karena itu, sebelum analisis cluster berbasis spasial dapat diterapkan, perlu didukung oleh penelitian yang menunjukkan kesiapan sumber daya dan efektivitas biaya. Tuberculosis control has increased cure rate and saved million people, but has less success in reducing tuberculosis incidence. Therefore, tuberculosis control needs to put more emphasis on social determinants policy, since social determinants directly or through tuberculosis-risk factors affect tuberculosis. Literature reviews show that stratification of social determinants will cause tuberculosis clustering, a grouping of tuberculosis patients according geographical area that is statistically significant. Knowledge on the clustering is very useful to support tuberculosis-control program, especially for reducing tuberculosis incidence through highlighting the area of vulnerable population. On the other hand, literature reviews also show that implementation of spatial analysis requires adequate resources. Therefore, before tuberculosis cluster analysis can be implemented routinely, it shouldbe supported by researches that indicate resources readiness and cost effectiveness.
Peningkatan Determinan Sosial dalam Menurunkan Kejadian Tuberkulosis Paru Wardani, Dyah Wulan Sumekar Rengganis
Kesmas Vol. 9, No. 1
Publisher : UI Scholars Hub

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Abstract

Upaya pengendalian tuberkulosis paru oleh World Health Organization telah meningkatkan angka kesembuhan dan menyelamatkan banyak jiwa, tetapi kurang berhasil dalam menurunkan insiden tuberkulosis. Oleh karena itu, pengendalian tuberkulosis akan lebih menekankan pada kebijakan determinan sosial karena determinan sosial secara langsung maupun melalui faktor risiko tuberkulosis berpengaruh terhadap tuberkulosis. Di Bandar Lampung, angka notifikasi tuberkulosis dari tahun 2009 – 2010 mengalami peningkatan walaupun angka kesembuhan sudah lebih dari 85%. Bandar Lampung juga merupakan bagian dari salah satu provinsi termiskin di Indonesia. Penelitian ini bertujuan untuk mempelajari pengaruh determinan sosial (yang diukur melalui indikator pendidikan, pendapatan dan kelas sosial) terhadap kejadian tuberkulosis. Penelitian dilakukan pada bulan Juli – Oktober 2012 di seluruh pelayanan kesehatan di Bandar Lampung yang telah melaksanakan strategi Directly Observed Treatment Shortcourse. Responden penelitian ini adalah 238 penderita tuberkulosis basil tahan asam positif dan 238 suspek yang tidak menderita tuberkulosis. Hasil penelitian menunjukkan bahwa determinan sosial yang rendah akan meningkatkan risiko untuk terkena tuberkulosis. Oleh karena itu, pengendalian tuberkulosis perlu disertai dengan peningkatan determinan sosial untuk menurunkan kejadian tuberkulosis. Tuberculosis control program conducted by World Health Organization, has increased tuberculosis cure rate and saved million people, but has less success in reducing tuberculosis incidence. Therefore, tuberculosis control program needs to put more emphasis on social determinants. It is obvious, since social determinants, directly or through its tuberculosis-risk factors, affect tuberculosis. In Bandar Lampung, notification rate during the period of 2009 - 2010 has increased although the cure rate of the period was more than 85%. Moreover, Bandar Lampung is located in Lampung, one of the poorest provinces in Indonesia. This research aimed to study the influence of social determinants (measured by indicators of education, income and social class) affecting tuberculosis incidence. The study was conducted during July - October 2012 at all health services, which has been implementing Directly Observed Treatment Shortcourse strategy, across the Bandar Lampung City. Respondents of this research consisted of 238 smear-positive tuberculosis patients and 238 suspects without tuberculosis. The result showed that the lower social determinants, the higher risk of suffering from tuberculosis. It can be learned that tuberculosis control should be accompanied by an effort of improving social determinants in order to reduce the incidence of tuberculosis.
Faktor-Faktor Penyebab Terjadinya Syndrome Dyspepsia Pada Remaja Putri Habsari, Maharani Kusuma; Angraini, Dian Isti; Yuningrum, Hesti; Wardani, Dyah Wulan Sumekar Rengganis
Medula Vol 14 No 8 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i8.1266

Abstract

One of the most common non-communicable diseases is dyspepsia syndrome. A collection of symptoms in the upper gastrointestinal tract known as dyspepsia syndrome includes pain or discomfort in the upper abdominal area, a burning sensation in the chest, a feeling of fullness and early satiety, nausea, and vomiting. Indonesia ranks third after the United States as the country with the highest prevalence of dyspepsia syndrome, reaching 40–50%. Various risk factors, such as age, gender, dietary patterns, breakfast habits, consumption of spicy and sour foods, fast food, irritative beverages (soda, coffee, alcohol), exercise habits, smoking, nutritional status, and socioeconomic factors, can lead to the occurrence of dyspepsia syndrome. Adolescence is one of the risk factors that influence the occurrence of dyspepsia syndrome. Adolescents who are at higher risk of developing dyspepsia syndrome are those of the female gender. Teenage girls are more likely to pay attention to body shape and have a desire to emulate their online idols, which can lead them to adopt strict diets and irregular eating habits. Excessive physical activity contributes to the poor eating habits and breakfast habits of teenagers. The consumption of unhealthy foods, such as spicy and sharp-flavoured dishes, will increase stomach acid production. Stress in adolescents can be one of the triggers for dyspepsia syndrome. Prolonged stress can disrupt the digestive system and cause symptoms in healthy individuals. Every teenager with a busy schedule must be able to manage their time and schedule to avoid dyspepsia syndrome by bringing a packed lunch during activities.
Hubungan Antara Jenis Kelamin dengan Tingkat Kecemasan pada Mahasiswa Kedokteran: Tinjauan Pustaka Firdausy, Daniatul; Wardani, Dyah Wulan Sumekar Rengganis; Larasati, Ratri Mauluti; Pramesona, Bayu Anggileo
Medula Vol 14 No 12 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i12.1413

Abstract

Anxiety is one of the mental disorders often experienced by medical students due to high academic pressure. Factors that influence anxiety include biological, psychological, and social aspects. This study aims to determine the relationship between gender and anxiety levels in medical students. The method used is a literature review with a total sampling technique, in which four selected journals from the period 2015–2025 were analyzed. The results showed that female students have higher levels of anxiety compared to male students. This is due to several factors, such as hormonal differences, where estrogen plays a role in the regulation of serotonin which affects anxiety, and differences in emotional responses, where women are more likely to use emotion-based coping strategies. In addition, greater social pressure on women also contributes to their high levels of anxiety. The impact of high anxiety on students can affect academic achievement, concentration, and overall mental health. Therefore, it is important for educational institutions to provide psychological support and effective stress management programs to help students, especially women, manage anxiety. With the right intervention, it is hoped that medical students can be better prepared to face academic and professional challenges without experiencing significant psychological disorders.
Penggunaan OAINS sebagai Faktor Risiko Dispepsia Wahidah, Putri Kamila; Wardani, Dyah Wulan Sumekar Rengganis; Iyos, Rekha Nova
Medula Vol 14 No 10 (2025): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i10.1414

Abstract

Dyspepsia is a syndrome characterized by a collection of symptoms such as epigastric discomfort, burning sensation, nausea, vomiting, bloating and satiety. These symptoms can be chronic and recur frequently, requiring long-term therapy. If left untreated, dyspepsia can interfere with daily activities and increase medical costs. In Indonesia, the prevalence of dyspepsia is increasing significantly, with major risk factors including irregular diet, alcohol consumption, stress, and the use of non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use of NSAIDs can damage the gastric mucosa, increase gastric acid production, and cause gastrointestinal complications such as peptic ulcers and gastrointestinal bleeding. The main mechanism of NSAID side effects involves inhibition of the COX-1 enzyme which reduces the production of protective prostaglandins in the gastric mucosa. In addition, some patients with a history of gastric disease are more susceptible to side effects due to NSAIDs. Therefore, preventive strategies such as the use of selective COX-2 inhibitors and the combination of NSAIDs with proton pump inhibitors (PPIs) are effective approaches in reducing the risk of dyspepsia and related complications. The impact of dyspepsia is not only physical but also affects mental, social and emotional aspects. Sleep disturbances and anxiety are common in people with chronic dyspepsia, which can reduce productivity and quality of life.
Hubungan antara Postur Kerja dan Keluhan Muskuloskeletal pada Pekerja Kantoran : Literature Review Ramadhan, Yasmine Aulia; Wardani, Dyah Wulan Sumekar Rengganis; Komala, Ramadhana; Berawi, Khairunnisa
Medula Vol 14 No 11 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i11.1442

Abstract

Musculoskeletal disorders (MSDs) are commonly experienced by office workers, particularly those who spend long hours working in front of computers with non-ergonomic postures. Frequent complaints such as pain in the neck, back, arms, and wrists are often caused by unsupported sitting positions or the use of work equipment that does not adhere to ergonomic principles. An evaluation to understand the relationship between work posture and musculoskeletal complaints among office workers is necessary to assess its risk level for MSDs.. One effective method to assess MSD risk is the Rapid Office Strain Assessment (ROSA). This method evaluates three key aspects of the work environment: chair design, monitor position, and the placement of the mouse and keyboard, all of which significantly impact worker comfort and health. The assessment assigns scores to each element to determine the level of risk. Studies reveal that many workers face high risks due to non-ergonomic working postures, which directly contribute to musculoskeletal complaints. Implementing ergonomic principles, such as using chairs that support proper posture, adjusting desk height to match the worker's stature, and optimizing computer device arrangements, is crucial to reducing these risks. Additionally, incorporating breaks for stretching into work schedules is strongly recommended. These measures not only alleviate MSD complaints but also enhance workplace comfort and overall productivity.
Peningkatan Pengetahuan Masyarakat Desa Sungai Langka tentang Pola Makan yang Sehat untuk Mengurangi Risiko Hipertensi Wardani, Dyah Wulan Sumekar Rengganis; Pramesona, Bayu Anggileo; Sutarto, Sutarto; Wahono, Endro Prasetyo
Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM) Vol 8, No 5 (2025): Volume 8 No 5 (2025)
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v8i5.19782

Abstract

ABSTRAK Hipertensi dipengaruhi oleh beberapa faktor risiko yang tidak dapat diubah dan yang dapat diubah. Faktor risiko yang dapat diubah diantaranya adalah pola makan. Masih kurangnya informasi mengenai pola makan untuk mencegah hipertensi membuat pengetahuan masyarakat tentang perbaikan pola makan masih rendah. Di Kabupaten Pesawaran jumlah penduduk yang berusia >55 tahun, yang merupakan golongan usia yang berisiko tinggi untuk menderita hipertensi, sebanyak 14,86%. Meningkatkan pengetahuan masyarakat Desa Sungai Langka, Kecamatan Gedong Tataan, mengenai pola makan untuk mengurangi risiko hipertensi. Kegiatan mencakup FGD yang bertujuan untuk penyusunan media informasi serta penyuluhan. Kegiatan diikuti oleh dua puluh orang perwakilan yang berasal dari semua dusun di Desa Sungai Langka. Sebelum dan sesudah penyuluhan dilakukan, diberikan pre dan post-test sebagai bentuk evaluasi. Pada pretest 30% peserta tidak paham, 35% peserta kurang paham dan 35% peserta paham mengenai pola makan untuk mencegah hipertensi. Pada post-test, pemahaman meningkat menjadi sebanyak 50% peserta paham dan 50% sangat paham. Kegiatan penyuluhan ini dapat meningkatkan pengetahuan masyarakat Desa Sungai Langka mengenai pola makan dalam mengurangi risiko hipertensi. Kata Kunci: Faktor Risiko, Hipertensi, Penyuluhan, Pola Makan  ABSTRACT Hypertension is influenced by several risk factors, both modifiable and uncontrollable. Modifiable risk factors include diet. Due to the lack of information about diet to prevent hypertension, the public's knowledge about improving diet is still low. In Pesawaran Regency, the number of residents aged >55 years, an age group at high risk for hypertension, is 14.86%. To increase the knowledge of the people of Sungai Langka Village, Gedong Tataan District, about diet to reduce the risk of hypertension. Activities include FGDs aimed at compiling information media and counselling. The activity was attended by twenty representatives from all hamlets in Sungai Langka Village. Before and after the counselling, pre- and post-tests were conducted as a form of evaluation. In pre-test, 30% of the participants did not understand, 35% of the participants did not understand, and 35% of the participants understood about diet to prevent hypertension. In the post-test, the understanding increased to 50% of the participants understood and 50% understood very well. This outreach activity can increase the knowledge of the people of Sungai Langka village about dietary patterns to reduce the risk of hypertension. Keywords: Risk Factors, Hypertension, Counselling, Diet
Co-Authors Adli, Farhan Kamali Ari Wahyuni Atmajaya, Yudhi Bagus Sapto Mulyatno Bayu Anggileo Pramesona Betta Kurniawan, Betta Dewi Nur Fiana Dian Isti Angraini Eka Putri Rahmadhani Endro Prasetyo Wahono Ety Apriliana Firdausy, Daniatul Fitria Saftarina Giska Tri Putri Habsari, Maharani Kusuma Hanna Mutiara, Hanna Hari Kusnanto Hendri Busman Ildha Rosendy Kurnianda Indriyani, Reni Intan Kusumaningtyas Khairun Nisa Larasati, Ratri Mauluti Lutfan Lazuardi Muhartono Muhartono Mulyasari, Rahmi Nainggolan, Hotman Natama Nasution, Rizqiani Astrid Nirwan, Qurratul Aina Novianty, Detty Oktadoni Saputra, Oktadoni Ramadhan, Yasmine Aulia Ramadhana Komala Rasmi Zakiah Oktarlina Ratna Dewi Puspita Sari Rekha Nova Iyos, Rekha Nova Reni Zuraida Rizki Hanriko Sa'diyah, Isma Fadlilatus Salsabila, Karina Adra Saputra, Magdalena Yosefin Septiani, Linda Shinta Nareswari, Shinta Soemarwoto, Retno Ariza S Sofyan Musyabiq Wijaya Suharmanto Suharmanto Suharmanto Susianti Susianti Susianti, Susianti Sutarto Sutarto Sutarto Sutarto Syazili Mustofa TA Larasati Tri Umiana Soleha Wahidah, Putri Kamila Winda Trijayanthi Utama, Winda Trijayanthi Wulandari, Marita Yuningrum, Hesti Zefanya, Ezekial