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All Journal Saintika Medika: Jurnal Ilmu Kesehatan dan Kedokteran Keluarga. Jurnal Sistem Kesehatan Journal of Epidemiology and Public Health Indonesian Journal of Medicine Journal of Health Policy and Management Journal of Health Promotion and Behavior Journal of Maternal and Child Health Jurnal Kesehatan Islam : Islamic Health Journal
Didik Tamtomo, Didik
Bagian Anatomi, Fakultas Kedokteran, Universitas Sebelas Maret
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Recognizing Acupuncture Therapist and Services Wijanto, Chrise; Tamtomo, Didik; Joebagyo, Hermanu
Journal of Health Policy and Management Vol 4, No 2 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Acupuncture services in Indonesia keep developing. Law No. 36 of 2014 concerning health personnel has confirmed the status of acupuncture in Indonesia. The regulation includes acupuncture health personnel in the physical therapy group not as traditional ones. However, there are still scientific publications in 2018 which state that acupuncture services are traditional health services. This study aimed to describe the services of acupuncture and acupuncture health personnel.Subjects and Method: This was a qualitative descriptive one. It was conducted in Surakarta City in November 2018-January 2019. It employed a purposive sampling technique to determine informants. The informants in this study consisted of 5 informants, namely 1 executive board of the Indonesian therapist acupuncture association (HAKTI) center, 1 Central Java HAKTI adminis­trator, 1 Surakarta Ministry of Health Polytechnic lecturer at the Acupuncture Department, and 2 therapists and acupuncture service providers. The data collection in this study was done using the technique of in-depth interviews, observation, and document analysis. The data analysis was conducted using the method of Miles and Huberman.Results: Acupuncture service is an effort to restore non-pharmacological health using therapy or needle stabbing to help smooth the flow of energy and blood so that the body can be healthier by acupuncturists with a minimum of three diploma education. Minister of Health Regulation No. 34 of 2018 is a special regulation on licensing and the practice of therapist acupuncturists. The purpose of this regulation is to provide a legal protection for health care personnel who are acupuncturists who are about to practice, both practice independently and join health care facilities. This regulation is appropriate because it writes health centers as one of the acupuncture services. receiving acupuncture services, until now the acupuncture service has no definite provisions regarding service fees.Conclusion: Acupuncture service is health recovery efforts using needle puncture techniques. Acupuncture therapists are acupuncturists in the physical ignition group.Keywords: acupuncture therapist, acupuncture serviceCorrespondence: Chrise Wijanto. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: chrisewijanto@yahoo.com. Mobile: +628­572­5873639.Journal of Health Policy and Management (2019), 4(2): 128-138https://doi.org/10.26911/thejhpm.2019.04.02.08
Accreditation Status and Other Factors Affecting Patient Satisfaction in Hospital Sulistyo, Siwi Anggraini; Tamtomo, Didik; Sulaeman, Endang Sutisna
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Hospital accreditation is a systemic assessment to measure service quality according to standards. Hospital services focus on meeting patient needs and satisfaction. This study aimed to determine the status of accreditation and other factors that influence the satisfaction of hos­pitalized patients in the hospital.Subjects and Method: This was a cross sectional study conducted in four hospitals in Sleman, Yogyakarta, from March to April 2019. A sample 200 inpatients were selected for this study by proportional random sampling. The dependent variable was patient satisfaction. The independent variables were accreditation status, service quality, length of care, source of funds, employment, age, and gender. The data were collected by questionnaire and analyzed by path analysis.Results: Patient satisfaction was directly and positively affected by age >18 years old (b = 2.34; 95% CI= 0.33 to 2.50; p= 0.023), gender (b = 1.02; 95% CI = 0.08 to 1.96; p = 0.034), length of care> 3 days (b= 0.99; 95% CI= 0.043 to 1.95; p= 0.041), independent funding sources (b= 1.50; 95% CI= 0.47 to 2.53; p= 0.004), good service quality (b = 3.42; 95% CI = 2.31 to 4.53; p <0.001), and good ac­cre­ditation status (b = 3.33; 95% CI = 2.12 to 4.54; p<0.001). Satisfaction is directly and ne­gatively influenced by work (b = -1.37; 95% CI = -2.32 to -0.41; p = 0.005). Patient satisfaction was in­fluenced indirectly and positively by accreditation status through good service quality (b = 0.70; 95% CI = -0.04 to 1.96; p = 0.037). Patient satisfaction was influenced indirectly by age> 18 years thro­ugh service quality (b = 1.50; 95% CI = 0.49 to 2.50; p = 0.036).Conclusion: Patient satisfaction was influenced directly and positively by age> 18 years, male sex, length of care >3 days, independent fund sources, good service quality and good accreditation status. Patient satisfaction is influenced directly and negatively by work. Patient satisfaction was in­directly affected by age >18 years and good accreditation status.Keywords: Patient satisfaction, accreditation status, path analysisCorrespondence: Siwi Anggraini Sulistyo, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: siwianggraini@ymail.com. Mobile: 082­330049892Journal of Health Policy and Management (2019), 4(3): 139-149https://doi.org/10.26911/thejhpm.2019.04.03.01
Factors Associated with Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes Mellitus in Surakarta, Central Java Azmiardi, Akhmad; Tamtomo, Didik; Murti, Bhisma
Indonesian Journal of Medicine Vol 4, No 4 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Peripheral neuropathy is the most common chronic complication and often occurs in diabetes mellitus. Peripheral neuropathy can cause morbidity, decreased quality of life,and mortality. This study aimed to analyze the determinants of peripheral neuropathy in patients with type 2 diabetes mellitus in Surakarta, Central Java.Subjects and Method: This study was an observational analytic with cross sectional design. This study was conducted at Surakarta Regional Hospital, Central Java on July 2019. A total of 200 type 2 diabetes mellitus outpatients was selected by simple random sampling. The dependent variable was peripheral neuropathy. The independent variables were age, education level, income, self-efficacy, diet, medication adherence, physical activity, health literacy, duration of illness, and fasting blood sugar. Peripheral neuropathy was measured using the Michigan Neu-black Screening Instrument (MNSI). Other variable data were obtained using questionnaires. Analysis of data used multiple logistic regression.Results: The risk of peripheral neuropathy increased with age of  ?55 years (b = 3.61; 95% CI = 1.51 to 5.70; p= 0.001), duration of illness ? 5 years (b = 2.78; 95% CI = 0.51 to 5.04; p = 0.016 ), and fasting sugar ?110 mg / dL (b= 1.64; 95% CI= -0.01 to 3.03; p= 0.052). The risk of peripheral neuropathy decreased with education level ?senior high school (b= -2.41; 95% CI = -4.31 to -0.51; p= 0.013), income ? Rp 1,800,000 (b= -1.58; 95% CI= -3.12 to -0.04; p = 0.044), high self-efficacy (b= -1.67; 95% CI= -3.26 to -0.07; p= 0.040), controlled diet (b= -1.89; 95% CI= -3.64 to -0.14; p= 0.034), high medication adherence (b= -2.34; 95% CI= -4.13 to -0.56; p= 0.010), high physical activity (b= -2.33; 95% CI= -4.17 to -0.49; p = 0.013), and high health literacy (b= -1.52; 95% CI = -3.18 to 0.14; p = 0.073).Conclusion: The risk of peripheral neuropathy increases with age of ?55 years, duration of illness ? 5 years, and fasting blood sugar ? 110 mg/dL. The risk of peripheral neuropathy decreases with a high education level, income of ?1,800,000, high self-efficacy, controlled diet, high medication adherence, high physical activity, and high health literacy.Keywords: peripheral neuropathy, diabetesCorrespondence: Akhmad Azmiardi. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java, Indonesia. Email: aazmiardi@gmail.com.Mobile: 085245412021 Indonesian Journal of Medicine (2019), 4(4): 300-312https://doi.org/10.26911/theijmed.2019.04.04.02
Determinants of the Difference between Actual Cost and Indonesian Case Based Groups (INA-CBGs) Reimbursement for Birth Delivery at Hospitals in Mataram, West Nusa Tenggara Sulaeman, Endang Sutisna; Ismiana, Baiq Holisatul; Tamtomo, Didik
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Health is the part of the economic and social development of the state. The application of the BPJS Health national social security system in Indonesia is one of the government's efforts to provide health financing protection for all citizens and prevent catastrophic health expenditures. Hospitals as providers of secondary or tertiary health services often suffer losses because the payment system from BPJS Kesehatan uses a case-based payment method or INA-CBGs. This study aimed to examine the factors that influence the difference in rates between INA-CBGs rates and real hospital rates in labor cases.Subjects and Method: This was an analytic observational study with a cross-sectional design.  The study was carried out in Mataram and Siti Hajar Mataram Islamic hospitals, Mataram, West Nusa Tenggara, in May 2019. A sample of 200 postpartum women was selected by stratified random sampling. The dependent variable was the difference between real cost and INA-CBGs reimbursement. The independent variables were the type of hospital, class of treatment, type of birth delivery, length of stay, and severity disease. The data were collected from the medical record and analyzed by a multiple linear regression run on Stata 13.Results: Difference between real cost and INA-CBGs tariff of birth delivery reimbursement was negatively affected by type III of class treatment (b = -390,725; 95% CI= -790,082 to 8,631; p= 0,055), section caesarean (b= -1,429,648; 95% CI= -1,811,275 to -1,048,022; p <0.001), length of stay (b= -211,912; CI (95%) = -427,786 to 3,960; p = 0.054), moderate severity (b= -114,028; 95% CIi= -507,057 to 279,000; p = 0.568), and the high level of severity (b = -1,735,612; CI (95%) = -3,482,347 to 11,123; p = 0.051). The INA-CBGs rate difference and RS real rates of labor cases decreased due to the classification of private hospitals (b = 281,021; CI (95%) = -73,054 to 635,097; p = 0,119), treatment class II (b = 8,736; CI (95 %) = -392,068 to 409,541; p = 0.966).Conclusion: The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases would increase if it serves treatment class III, type of cesarean delivery, care days which are longer, and moderate or severe severity. The difference in rates between INA-CBGs rates and hospital real rates in childbirth cases can decrease in services at private hospitals and serve treatment classes II.Keywords: INA-CBGs rates, hospital real rates, labor costs.                                                                            Correspondence: Baiq Holisatul Ismiana. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Jawa Tengah, Indonesia. Email: baiqholis26@gmail.com. Mobile: +6287739031046.Journal of Health Policy and Management (2019), 4(3): 161-169https://doi.org/10.26911/thejhpm.2019.04.03.03
Determinants of Cost Differences Between Indonesian- Case Based Groups Tariff and Hospital Tariff for Stroke Patients: A Path Analysis Evidence from UNS Teaching Hospital Sukoharjo, Central Java Wulandari, Dewi; Indarto, Dono; Tamtomo, Didik
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: In the scheme of the National Health Insurance System, the hospital must adapt to the newer financial system by regularly doing quality and cost assurance. Stroke, a catastrophic disease, has a high financial impact on hospital cost. This study aimed to examine the determinants of cost differences between Indonesian Case-Based Groups (INA-CBGs) dan hospital tariff for stroke patients in UNS Teaching Hospital, Sukoharjo.Subjects and Method: An analytic observation was performed in this study from April to May 2019 by with used the cross-sectional design. Recruitment of 113 stroke patients was determined using a fixed disease sampling. The dependent variable was the cost difference. The independent variables were the length of stay, intensive care use, medicine tariff, severity level, and type of class treatment. The data were obtained from the hospital medical record and analyzed by path analysis.Results: Medicine tariff was the strongest factor that influenced the difference of tariff (r=-0.65; p<0.001). Medicine tariff (b= -3.57; 95% CI= -4.34 to -2.80; p<0.001) and type of class treatment (b= 1508.70; 95% CI= 247.54 to 2769.87; p= 0.019) were directly influenced the difference of tariff. Length of stay (b= 122.18; 95% CI= 89.52 to 154.84; p<0.001), intensive care use (b= 1161.50; 95% CI= 844.01 to 1478.99; p<0.001), severity level (b= 375.58; 95% CI= 143.27 to 607.90; p= 0.002) positively influenced the difference of tariff through medicine tariff. Severity level also influenced medicine tariff (b=375.58), length of stay (b=1.55), and intensive care use (b=0.16).Conclusion: The UNS Hospital cost for stroke patients exceeds the INA-CBGs tariff, which is influenced by medicine tariff and intensive care use.Keywords: INA-CBG?s tariff, hospital tariff, stroke, UNS teaching hospital.Correspondence: Dewi Wulandari. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: dewulan0023@gmail.com.Mobile: 085335705757.Journal of Health Policy and Management (2019), 4(3): 176-181https://doi.org/10.26911/thejhpm.2019.04.03.05
Multilevel Analysis on the Contextual Effect of Community Health Center on Health Workers Performance Wardhani, Anindyah Tri Lhaksmi Kusuma; Tamtomo, Didik; Budihastuti, Uki Retno
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: One of the high maternal mortality rates is caused by bleeding factors. The imple­mentation of preventive effort that is less than optimal as well as the ability, understanding, and compliance of health personnel with Standard Operating Procedures (SPO) is still lacking and not in accordance with professional standards, allegedly a factor that affects the Maternal Mortality Rate (MMR). The performance of midwives in accordance with the SPO would have an impact on reducing mortality and improving the welfare of mothers and babies. This study aimed to analyze the factors that influence the performance of midwives in the early detection of bleeding.Subjects and Method: This was a cross sectional study conducted at 25 public health centers in Banyuwangi, East Java, from February to May 2019. A total sample of 200 midwives was selected for this study by simple random sampling. The dependent variable was midwife performance. The independent variables were training, skill, leadership style, incentive, work motivation, age, and human source. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression run on Stata 13. Results: Midwife performance increased with training (b= 1.46; 95% CI= 0.48 to 2.42; p= 0.003), skill (b= 2.32; 95% CI= 1.28 to 3.36; p= 0.001), high motivation (b= 1.66; 95% CI= 0.71 to 2.61; p= 0.001), incentive >Rp 1,000,000 (b= 2.59; 95% CI= 1.53 to 3.65; p= 0.001), positive leadership style (b= 1.95; 95 % CI= 0.93 to 2.96; p= 0.001), and human source>8 midwives (b= 1.05; 95% CI= 0.08 to 2.02; p= 0.033). Midwife performance decreased with age ?35 years (b= -1.16; 95% CI= -2.16 to -0.16; p= 0.023). Community health center had strong contextual effect on midwife performance with ICC= 25.74%.Conclusion: Midwife performance increases with training, skill, high motivation, incentive >Rp 1,000,000, positive leadership style, and human source>8 midwives. Midwife performance decreases with age ?35 years. Community health center has strong contextual effect on midwife performance.Keywords: work performance, midwives, multilevel analysisCorrespondence: Anindyah Tri Lhaksmi Kusuma Wardhani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: anin­dyah­tri@­gmail.com. Mobile: +6285258917339.Journal of Health Policy and Management (2019), 4(3): 182-194https://doi.org/10.26911/thejhpm.2019.04.03.06
Path Analysis on the Effectiveness of Chronic Disease Prevention Program using Health Belief Model Aprilia, Nafi?ah; Tamtomo, Didik; Sulaeman, Endang Sutisna
Journal of Health Promotion and Behavior Vol 4, No 2 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Chronic disease prevention program is a proactive health service system on chronic diseases which can affect hypertension control. This study aimed to determine the effect of the chronic disease prevention program and the construction of the Health Belief Model (HBM) on the prevention of elderly hypertension with path analysis method.Subjects dan Method: This study used observational analytical study with retrospective cohort study approach. This study was conducted in four community health centers in Ngawi Regency, East Java, in April-May 2019. The total sample of 200 elderly aged 60-74 years was divided into2 groups, such as group which participated in chronic disease prevention program(case) and the group which did not participate in chronic disease prevention program(control) based on fixed exposure sampling. The dependent variable of this study was hypertension control. The independent variables in this study were participants in a chronic disease prevention program, perceived vulnerability, perceived seriousness, perceived benefits, perceived barriers, cues to action, and self-efficacy. Variable data collection used questionnaires and analyzed using path analysis.Results: Hypertension control was directly and positively affected by chronic disease prevention program(b= ­­2.85­; ­95%CI= 0.48 to 5.22; p= 0.018), perceived vulnerability (b= 1.35; 95%CI= 0.16 hingga 2.53; p= 0.025), perceived seriousness (b= 0.83; 95%CI= 0.04 to 1.62; p= 0.039), and self-efficacy (b= 0.99; 95%CI= 0.14 to 1.85; p= 0.023). Hypertension control was indirectly affected by perceived benefits, perceived barriers, and cues to action.Conclusion: Hypertension control in the elderly is directly and positively affected by participation in chronic disease prevention program, perceived vulnerability, perceived seriousness, and self-efficacy. Hypertension control is indirectly affected by perceived benefits, perceived barriers, and cues to action.Keywords: Hypertension, chronic disease, prevention, Health Belief Model, path analysisCorrespondence: Nafi?ah Aprilia. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: nafiahlia@gmail.com. Mobile: 082230766393Journal of Health Promotion and Behavior (2019), 4(2): 85-97https://doi.org/10.26911/thejhpb.2019.04.02.01
Path Analysis: Application of Health Belief Model on the Determinants of Clean and Healthy Behavior among Elderly with Hypertension Imtichan, Septian Najib; Tamtomo, Didik; Sulaeman, Endang Sutisna
Journal of Health Promotion and Behavior Vol 4, No 2 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Lifestyle or behavioral factors critically determine high blood pressure in individuals. Elderly with hypertension in Indonesia aged 55-64 years by 45.9%, 65-74 years by 57.6%, and > 75 years by  63.8%. This study aimed to examine factors affecting healthy behavior in elderly with hypertension using the health belief model.Subjects and Method: This was a cross-sectional study conducted in Ngawi, East Java, from June to July 2019. A sample of 200 elderly was selected by multistage random sampling. The dependent variable was clean and healthy behavior. The independent variables were perceived susceptibility, perceived severity, perceived benefit, cues to action, self-efficacy, knowledge, attitude, and access to health service. The data were collected by questionnaire and analyzed by path analysis.Results: Clean and healthy behavior was positively and directly affected by self-efficacy (b= 1.51; 95% CI= 0.29 to 2.74; p= 0.015), attitude (b= 2.37; 95% CI = 1.17 to 3.56; p<0.001) , cues for action (b = 2.48; 95% CI= 1.11 to 3.86; p <0.001), perceived susceptibility (b= 2.07; 95% CI= 0.89 to 3.26; p= 0.001), perceived severity (b= 1.76; 95% CI= 0.54 to 2.99; p= 0.005), perceived benefit (b= 1.47; 95% CI= 0.36 to 2.57; p = 0.009), and access to health services (b= 2.26; 95% CI= 1.00 to 3.53; p<0.001). Clean and healthy behavior was indirectly affected by knowledge.Conclusion: The clean and healthy lifestyle behavior of the elderly is directly affected by the perceived vulnerability, perceived severity, perceived benefits, cues to act, self-efficacy, attitudes, and access to health services. Clean and healthy behavior is affected by knowledge.Keywords: clean and healthy behavior, elderly, health belief model, path analysisCorrespondence:Septian Najib Imtichan. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 54176, Central Java. Email: septianimtichan@gmail.com.Mobile: +6285229799672Journal of Health Promotion and Behavior (2019), 4(2): 110-120https://doi.org/10.26911/thejhpb.2019.04.02.03
The Efficacyofantiscabies Medicinetohealing Scabiesin Patient Who Received Personal Hygiene Education Tunjungsari, Feny; Tamtomo, Didik; Murti, Bhisma; Aulia, Yusrin
Saintika Medika: Jurnal Ilmu Kesehatan dan Kedokteran Keluarga Vol 15, No 2 (2019): December 2019
Publisher : Universitas Muhammadiyah Malang

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Abstract

The prevalence of the scabies disease in a populated area (e.g islamic boarding schools)is still high .It is possible that disease skabies are still found here because the higiene individuals from the community .Skabies disease is easily treated , but to progress , the disease remains a big problem in the specific community health .This study attempts to analyze the effectiveness of an anti skabies permethrine comparedgameksanto healing patients whohas been getting an  individuals higiene educationSamples were 40 student the Islamic boarding in the malang district the age range of 12 - 18 years taken by random. The dependent variable was cure from scabies. The independent variable included anti-scabies (Gamexan and Permethrine). The sample taken as random.Research will be tested using chi-square to analized the data.The experimental work on chi square statistically from the analysis does not obtain a significant relation ( p = 1,000 ) between the provision of treatment antiscabies gameksan and permethrine with healing on the subjects of research get education higiene individuals.Although statistically no meaning, but can be concluded that clinically better to use gameksan and permethrine, if the subject of study get education nice about education higiene individuals, there is no different effect between the provision of gameksan with permethrine.
THE EFFECTS OF TAMOXIFEN AND CHEMOTHERAPY AFTER SURGERY ON THE RECURRENCE AND SURVIVAL OF BREAST CANCER PATIENTS WITH POSITIVE HORMONE RECEPTOR: A META-ANALYSIS Delimasari, Trisakti Halimah; Tamtomo, Didik; Murti, Bhisma
Indonesian Journal of Medicine Vol 4, No 4 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Breast cancer is the most common type of cancer suffered by women in the world. The combination of tamoxifen and chemotherapy significantly reduces the risk of recur­rence and mortality in breast cancer patients. This study aimed to analyze how effective the com­bination of tamoxifen and chemotherapy after surgery to reduce the risk of recurrence and mortality in breast cancer patients with positive hormone receptor.Subjects and Method: This study used systematic review and meta-analysis. The researcher collected articles from the Pubmed journal database. The subjects of the study were women with breast cancer after surgery. The dependent variable was recurrence and survival (mortality). The independent variables were tamoxifen and chemotherapy. Data were analyzed based on the fixed and random effects model using RevMan 5 software.Results: There were 3 articles with 3,761 women who were involved in the analysis process. The combination of tamoxifen and chemotherapy could reduce the risk of recurrence in women with positive hormone receptor (ER+) breast cancer (HR=0.68; 95%CI=0.58 to 0.80; p=0.001). The combination of tamoxifen and chemotherapy showed weak and non-significant decreasing trend in reducing the risk of mortality in women with ER+breast cancer (HR=0.87; 95%CI=0.73 to 1.03; p= 0.11).Conclusion: The combination of tamoxifen and chemotherapy in women with ER+ breast cancer is effective in reducing the risk of recurrence. However, it does not increase survival.Keywords: tamoxifen, chemotherapy, breast cancer.Correspondence:Trisakti Halimah Delimasari. Program Studi Ilmu Kesehatan Kesehatan, Universitas Sebe­las Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: tri­sak­ti­hd­1994­@g­mail.­com. Mobile: +6285 293 994 629.Indonesian Journal of Medicine (2019), 4(4): 346-353https://doi.org/10.26911/theijmed.2019.04.04.07
Co-Authors -, Mardhatillah A.A. Ketut Agung Cahyawan W Abdiani, Baiq Tuhu Abdiani, Baiq Tuhu Agung Kurniawan Akhmad Azmiardi Alfiasari, Fadila Ali Djamhuri Ambar Mudigdo Anak Agung Istri Sri Wiadnyani Andreza Anggraini, Yeni Aprilia, Nafi?ah Argyo Demartoto, Argyo Ari Natalia Prabandari, Ari Natalia Ari Natalia Probandari Ari Probandari Arief Suryono Ariwati, Valentina Dili Ariwati, Valentina Dili Aryoseto, Lukman Aulia, Yusrin Bhisma Murti Burhannudin Ichsan Cahyandaru, Zella Cahyaningrum, Hapsari Cahyono Widodo, Cahyono Ch Novita Indriani, Ch Novita Damayanti, Ana Delimasari, Trisakti Halimah Dewi Martha Indria Dian Rahmawati Diana, Tutut Okta Doloh, Nureesa Dono Indarto Dyanneza, Frieska Endang Sutisna Sulaeman Eskawati, Maria Yeny Fahrezi, Chattrin Feny Tunjungsari Fuad, Lu’luatul Ghufroni, Afif Gusti, Titis Eka Hapsari, Fara Rizky Punjung Harinto Nur Seha Harsono Salimo Hastuti, Heni Hendra Dwi Kurniawan, Hendra Dwi Hermanu Joebagyo Hery Widijanto I Gusti Agung Ngurah Putra Pradnyantara Imtichan, Septian Najib Ismiana, Baiq Holisatul Jayanti, Nicky Danur Kartikasari, Mayriyana Kristiani, Yunita Kusumaningtiyas, Zonna Aditiya Kusumaningtyas, Mei Kusumasari, Rizka Agnes Kusumastuti, Nurry Ayuningtyas Kusumawardana, Iin Kusumawardani, Dyah Ayu Laksono Trisnantoro Lestari, Dinta Lilik Anggar Sri Rahayuningsih Linda Widyaningrum, Linda Mahendra Wijaya Mardiah, Adriana Maulana, Moh Mirshanti, Farahdila Nagaring, Sulaiman Putra Ni'mah, Siti Luluk Khamidahtun Ningtyas, Ayunda Prisilia Kusuma Nugroho, Septyan Dwi Nunuk Suryani Nurjanah, Ahmitta Laila Nurlaili, Helmi Nurul Hakim, Ruliany Yuni Nurul Jannah Pranoto, Hosea Puspitasari Prasetya, Hanung Pratama, Tegar Wahyu Yudha Pratiwi, Dinda Ika Purwati - Puspita, Rumeyda Chitra Putri, Farahdilla Aribowo Rahayuningrum, Indriyati Oktaviano Rahmah, Aulia Siti Nur Rahmawati, Leny Ratna Dewi Permatasari Rita Adriani Benya Adriani Rosyida, Muslihatin Khuril Sapja Anantanyu, Sapja Saraspuri, Niken Putri Eka Selvia Febrianti Setiyaningsih, Ratna Setiyaningsih, Ratna Silfia Angela N Halu Simarmata, Imelda Dearni Simarmata, Imelda Dearni Sitepu, Fransiska Siti Marfuah, Siti Siwi, Ratna Purwani Soemanto, RB SUGIARTO - Sukma, Sukma Sulistyo, Anita Sri Sulistyo, Siwi Anggraini Tia Martha Pundati, Tia Martha Uki Retno Budihastuti Untari, Niken Yuliani Veftisia, Vistra Wardhani, Anindyah Tri Lhaksmi Kusuma Wardhani, Yeni Wibawa, Purwa Adrianta Widayati, Mulia Yuli Wigati, Dhiyan Nany Wijanto, Chrise Wijayanto, Masromi Hendria Winasandis, Brillia Firsti Wulandari, Ayu Novita Wulansari, Galuh Yeni Tri Utami Yulia Lanti Retno Dewi yulia lanti retno dewi Yuni Fitriani, Yuni Zaen, Nurussyifa Afiana Zulaikah, Rahayu