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Multilevel Analysis of Factors Affecting Depression Risk among the Elderly: Loneliness, Living Status, Physical Activity, Age, Gender, and Education Wicaksono, Emirza Nur; Tamtomo, Didik Gunawan; Prasetya, Hanung; Murti, Bhisma
Journal of Epidemiology and Public Health Vol. 9 No. 4 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2024.09.04.11

Background: There is still a high prevalence of depression in the elderly which is affected by loneliness, low physical activity, gender, last education, and residence status. Elderly people who live alone or have lost a life partner are more prone to depression. Although family support and public health services such as Posyandu are expected to protect against the risk of depression, there have not been many studies that have examined in depth the influence of Posyandu as a contextual factor in reducing the risk of depression in the elderly. This study aims to analyze the influence of these factors and the role of Posyandu in reducing the risk of depression.Subjects and Method: This study used a cross-sectional design conducted in 25 Posyandu Elderly in Grogol District, Sukoharjo Regency from August to September 2024. A total of 204 elderly respon-dents aged 60 years and above were selected using Stratified Random Sampling. The dependent variable in this study was depression collected using the PHQ-9 questionnaire, and loneliness was assessed by the UCLA Loneliness Scale. Other independent variables such as physical activity, gender, education, and life status were collected through structured interviews. Multilevel linear regression analysis is used to analyze the relationship between these factors and the risk of depression, taking into account the individual and contextual levels (Posyandu).Results: The average age of the respondents was 66.27 years old (Mean = 66.26, SD = 5.16), with 79.41% of them being female. Loneliness was significantly associated with an increased risk of depression (b= 0.05; CI 95%= 0.07 to 0.10; p=0.024), while living with family reduces the risk of depression (b= -6.33; CI 95%= -8.26 to -4.40; p<0.001). Physical activity did not show a significant association with depression. Gender, education level, and age are also not significant predictors of depression. Contextual speaking, posyandu has no effect as a contextual variable on the variable of depression in the Grogol sub-district (ICC=2.64%).Conclusion: Loneliness is a significant risk factor for depression in the elderly while living with family also reduces the risk of depression in the elderly.

Effects of Hypertension, Diabetes Mellitus, and Gender on Post Stroke Cognitive Impairment: Meta-Analysis Utami, Sukandriani; Wicaksono, Emirza Nur; Choirunnisa, Amalia; Veibiani, Nindita Arum; Murti, Bhisma
Journal of Epidemiology and Public Health Vol. 9 No. 1 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2024.09.01.07

Background: Post-stroke cognitive impairment is a serious problem that is often faced by indivi-duals who have experienced a stroke. This study aims to determine and estimate the effects of hypertension, diabetes mellitus, and gender on post-stroke cognitive impairment through meta-analysis of primary research conducted by previous researchers.Subjects and Method: This was a meta-analysis study using the PICO model which includes; P: post-stroke patients. I: hypertension, diabetes mellitus, and women. C: normotensive, without diabetes mellitus, and men. O: post-stroke cognitive impairment. A systematic search for primary studies was carried out in the PubMed database which was published from 2014 to 2023. The keywords used to search for primary studies were "Hypertension" AND "Diabetes Mellitus" AND "Post Stroke Cognitive Impairment". The inclusion criteria for the articles searched were primary studies with cross-sectional and cohort studies from 2014-2023 and reporting aOR values. Primary studies were selected using the PRISMA diagram and relevant primary studies were analyzed using Review Manager 5.3.Results: There were 18 primary studies with cross-sectional and cohort study designs. The total sample obtained through a systematic review and meta-analysis was 9,103 post-stroke patients from France, China, Singapore, the Netherlands, Egypt, Ethiopia, and Uganda. The results of the analysis showed that hypertension increased the risk 1.56 times (aOR= 1.56; 95% CI= 1.11 to 2.19; p= 0.010) and diabetes mellitus increased the risk 1.58 times (aOR= 1.58; 95% CI= 1.23 to 2.05; p< 0.001) post-stroke cognitive impairment compared to people without hypertension and diabetes. Meanwhile, the female gender increases the risk of post-stroke cognitive impairment by 1.28 times (aOR= 1.28; 95% CI=1.16 to 1.42; p<0.001). The data is statistically significant.Conclusion: hypertension, diabetes mellitus, and female gender increase the risk of post-stroke cognitive impairment. Keywords: Hypertension, diabetes mellitus, women, post-stroke cognitive disorders

Analisis Hukum Atas Kecurangan (Fraud) Rumah Sakit Dalam Penyelenggaraan Jaminan Kesehatan Nasional: Legal Analysis of Hospital Fraud in The Implementation Of The National Health Insurance Program Wicaksono, Emirza Nur; Khasanah, Dian Ratu Ayu Uswatun
Jurnal Hukum dan Etika Kesehatan VOLUME 5 NO 1
Publisher : Magister Ilmu Hukum - Universitas Hang Tuah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30649/jhek.v5i1.243

Law enforcement against fraud committed by hospitals in the implementation of the National Health Insurance (JKN) program is a crucial aspect in maintaining the integrity of the healthcare system in Indonesia. This study aims to analyze the legal framework governing hospital fraud and to assess the effectiveness of its implementation in practice. The research method used is normative with a statute approach and conceptual approach. The results of the study show that law enforcement regarding hospital fraud in the JKN program has been regulated by existing legislation. However, its implementation still faces several challenges. The current legal regulations are not fully effective in preventing and addressing fraud. Implementation is hindered by various obstacles, including a lack of coordination among law enforcement agencies, weak internal oversight, and minimal strict sanctions against fraud perpetrators. The conclusion of this study is that law enforcement on hospital fraud within the JKN program requires more effective and efficient efforts, as well as increased awareness and compliance with the applicable laws and regulations.

Penolakan Pasien Emergency oleh Rumah Sakit akibat Regulasi BPJS Kesehatan: Perspektif Hukum dan Etika Wicaksono, Emirza Nur
Jurnal Humaya: Jurnal Hukum, Humaniora, Masyarakat, dan Budaya Vol. 5 No. 1 (2025): JUNE
Publisher : LPPM Universitas Terbuka

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33830/humaya.v5i1.12602

The refusal of patients in emergency conditions by hospitals that they do not meet the emergency criteria as stipulated by BPJS Kesehatan regulations raises critical legal and medical ethical issues. This study aims to analyze the juridical aspects and professional medical ethics related to such practices by examining the Indonesian Medical Code of Ethics as well as the legal provisions in Law Number 17 of 2023 on Health and Law Number 24 of 2011 on the Social Security Administering Body (BPJS Kesehatan). The research method used is a normative juridical approach through literature study. The findings indicate that, from a legal standpoint, hospitals and medical personnel are obligated to provide medical services to all patients in emergency situations without delay regardless their administrative status. Refusal to provide such services may be classified as a legal violation and may be subject to criminal, civil, and administrative sanctions. From the perspective of medical ethics, such actions are contrary to the principles of beneficence and non-maleficence and violate the Medical Code of Ethics. Therefore, BPJS administrative regulations must be aligned with legal and ethical principles in handling emergency cases to ensure the protection of patients’ rights and the continuity of equitable and professional health services. The study concludes that the refusal of emergency patients by hospitals due to unmet BPJS Health emergency criteria contradicts Indonesia’s positive law and the fundamental principles of medical ethics.

Analisis Etis dan Yuridis Perundungan Terstruktur Dalam Sistem Pendidikan Kedokteran Spesialis: Ethical and Legal Analysis of Structured Bullying In The Specialist Medical Education System Lovinska, Arlyne Faza; Wicaksono, Emirza Nur; Khasanah, Dian Ratu Ayu Uswatun
Jurnal Hukum dan Etika Kesehatan VOLUME 5 NO 1
Publisher : Magister Ilmu Hukum - Universitas Hang Tuah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30649/jhek.v5i1.247

The phenomenon of bullying within the specialist medical education system is a serious issue rooted in the rigid and closed hierarchical structure of teaching hospitals. This form of bullying not only threatens the mental health of medical residents but also raises profound concerns from the perspective of medical professional ethics and applicable legal norms. This study examines the issue using a normative legal research method (doctrinal approach), by analyzing relevant legal norms both written in legislation, legal doctrines, court decisions, and fundamental legal principles. The findings indicate that systematic bullying violates core ethical principles, such as the principle of non-maleficence (do no harm), justice, and respect for individual dignity. Furthermore, these practices contradict the constitutional rights of learners as guaranteed under Indonesia’s legal system. The absence of specific regulations protecting residents further exacerbates the power imbalance within medical education. Therefore, this study advocates for comprehensive reform, including the establishment of a safe and reliable reporting system, stronger legal protections for residents, and the integration of ethical values education into the medical curriculum.

Konstruksi Yuridis dan Implikasi Hukum PPPK Paruh Waktu dalam Sistem Kepegawaian Negara Indonesia Wicaksono, Emirza Nur
Journal of Contemporary Law Studies Vol. 3 No. 1 (2025): November
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/lawstudies.v3i1.4990

This study aims to analyze the juridical construction and legal implications of the part-time Government Employees with Work Agreements (PPPK) status within Indonesia’s national civil service system, based on the latest regulations, particularly Law No. 20 of 2023 on State Civil Apparatus and its implementing regulations. The study identifies normative ambiguities that result in legal uncertainty and potential violations of administrative law principles and employee rights protection. A normative juridical research method was used, involving the analysis of statutory documents and relevant legal literature. The findings reveal that part-time PPPK arrangements lack a clear and robust legal basis at the statutory level, hindering fair and consistent implementation. The absence of adequate regulation leads to weak protection of employee rights and disparities in implementation across the field. Therefore, this study recommends strengthening the legal framework through revisions to State Civil Apparatus Law and the issuance of comprehensive implementing regulations that explicitly govern the legal status and protections of part-time PPPK employees. This is essential to uphold the principles of legal certainty and justice in the national civil service system. The findings offer a new perspective for developing a more inclusive and responsive civil service policy in the era of bureaucratic reform

Effects of Hypertension, Diabetes Mellitus, and Gender on Post Stroke Cognitive Impairment: Meta-Analysis Utami, Sukandriani; Wicaksono, Emirza Nur; Choirunnisa, Amalia; Veibiani, Nindita Arum; Murti, Bhisma
Journal of Epidemiology and Public Health Vol. 9 No. 1 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2024.09.01.07

Background: Post-stroke cognitive impairment is a serious problem that is often faced by indivi-duals who have experienced a stroke. This study aims to determine and estimate the effects of hypertension, diabetes mellitus, and gender on post-stroke cognitive impairment through meta-analysis of primary research conducted by previous researchers.Subjects and Method: This was a meta-analysis study using the PICO model which includes; P: post-stroke patients. I: hypertension, diabetes mellitus, and women. C: normotensive, without diabetes mellitus, and men. O: post-stroke cognitive impairment. A systematic search for primary studies was carried out in the PubMed database which was published from 2014 to 2023. The keywords used to search for primary studies were "Hypertension" AND "Diabetes Mellitus" AND "Post Stroke Cognitive Impairment". The inclusion criteria for the articles searched were primary studies with cross-sectional and cohort studies from 2014-2023 and reporting aOR values. Primary studies were selected using the PRISMA diagram and relevant primary studies were analyzed using Review Manager 5.3.Results: There were 18 primary studies with cross-sectional and cohort study designs. The total sample obtained through a systematic review and meta-analysis was 9,103 post-stroke patients from France, China, Singapore, the Netherlands, Egypt, Ethiopia, and Uganda. The results of the analysis showed that hypertension increased the risk 1.56 times (aOR= 1.56; 95% CI= 1.11 to 2.19; p= 0.010) and diabetes mellitus increased the risk 1.58 times (aOR= 1.58; 95% CI= 1.23 to 2.05; p< 0.001) post-stroke cognitive impairment compared to people without hypertension and diabetes. Meanwhile, the female gender increases the risk of post-stroke cognitive impairment by 1.28 times (aOR= 1.28; 95% CI=1.16 to 1.42; p<0.001). The data is statistically significant.Conclusion: hypertension, diabetes mellitus, and female gender increase the risk of post-stroke cognitive impairment. Keywords: Hypertension, diabetes mellitus, women, post-stroke cognitive disorders

Multilevel Analysis of Factors Affecting Depression Risk among the Elderly: Loneliness, Living Status, Physical Activity, Age, Gender, and Education Wicaksono, Emirza Nur; Tamtomo, Didik Gunawan; Prasetya, Hanung; Murti, Bhisma
Journal of Epidemiology and Public Health Vol. 9 No. 4 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2024.09.04.11

Background: There is still a high prevalence of depression in the elderly which is affected by loneliness, low physical activity, gender, last education, and residence status. Elderly people who live alone or have lost a life partner are more prone to depression. Although family support and public health services such as Posyandu are expected to protect against the risk of depression, there have not been many studies that have examined in depth the influence of Posyandu as a contextual factor in reducing the risk of depression in the elderly. This study aims to analyze the influence of these factors and the role of Posyandu in reducing the risk of depression.Subjects and Method: This study used a cross-sectional design conducted in 25 Posyandu Elderly in Grogol District, Sukoharjo Regency from August to September 2024. A total of 204 elderly respon-dents aged 60 years and above were selected using Stratified Random Sampling. The dependent variable in this study was depression collected using the PHQ-9 questionnaire, and loneliness was assessed by the UCLA Loneliness Scale. Other independent variables such as physical activity, gender, education, and life status were collected through structured interviews. Multilevel linear regression analysis is used to analyze the relationship between these factors and the risk of depression, taking into account the individual and contextual levels (Posyandu).Results: The average age of the respondents was 66.27 years old (Mean = 66.26, SD = 5.16), with 79.41% of them being female. Loneliness was significantly associated with an increased risk of depression (b= 0.05; CI 95%= 0.07 to 0.10; p=0.024), while living with family reduces the risk of depression (b= -6.33; CI 95%= -8.26 to -4.40; p<0.001). Physical activity did not show a significant association with depression. Gender, education level, and age are also not significant predictors of depression. Contextual speaking, posyandu has no effect as a contextual variable on the variable of depression in the Grogol sub-district (ICC=2.64%).Conclusion: Loneliness is a significant risk factor for depression in the elderly while living with family also reduces the risk of depression in the elderly.

Legalitas Operasional Posyandu Berbasis Masyarakat dalam Perspektif UU No. 17 Tahun 2023 tentang Kesehatan Wicaksono, Emirza Nur
Jurnal Al Azhar Indonesia Seri Ilmu Sosial Vol 6, No 3 (2025): Oktober 2025
Publisher : Universitas Al Azhar Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36722/jaiss.v6i3.4753

Pos Pelayanan Terpadu (Posyandu) merupakan salah satu wujud pemberdayaan masyarakat dalam sektor kesehatan yang berperan penting dalam pelayanan promotif dan preventif, khususnya untuk kesehatan ibu dan anak. Namun, kajian yuridis mengenai legalitas operasional Posyandu, terutama dalam konteks Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan, masih sangat terbatas. Penelitian ini bertujuan untuk menganalisis legalitas operasional Posyandu berbasis masyarakat dalam perspektif regulasi terbaru tersebut serta mengkaji implikasi yuridisnya terhadap keberlangsungan Posyandu di masa mendatang. Metode penelitian yang digunakan adalah penelitian hukum normatif dengan pendekatan perundang-undangan dan konseptual, serta analisis kualitatif terhadap bahan hukum primer dan sekunder. Hasil penelitian menunjukkan bahwa UU No. 17 Tahun 2023 tentang Kesehatan memberikan pengakuan normatif terhadap keberadaan dan operasional Posyandu sebagai bagian integral dari sistem pelayanan kesehatan nasional berbasis masyarakat. Namun, masih terdapat kendala dalam hal pemenuhan legalitas formal, status kelembagaan, serta perlindungan hukum bagi kader Posyandu. Pengaturan ini membuka peluang penguatan regulasi teknis, dukungan kebijakan, serta perlindungan hukum yang lebih jelas untuk Posyandu, sehingga keberlangsungan dan penguatannya di masa depan dapat terjamin. Kata kunci: Posyandu, Legalitas Operasional, UU No. 17 Tahun 2023, Pelayanan Kesehatan Masyarakat, Analisis Yuridis

Normative Approach to the Prohibition of Euthanasia in Indonesian Law and Islamic Law Wicaksono, Emirza Nur; Azura, Dinda Maurizka
Ius Poenale Vol. 6 No. 1 (2025): Issue In progress (January 2025)
Publisher : Faculty of Law, Universitas Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25041/ip.v6i1.4411

Euthanasia is an issue in bioethics that remains debatable between medical ethics, human rights, and religious principles. In Indonesia, the lack of explicit regulation and the strong influence of moral and religious values create legal ambiguity and ethical uncertainty for healthcare providers. This study examines the normative foundations of euthanasia prohibition in Indonesian positive law and Islamic law, highlighting their shared commitment to the sanctity of life but differing philosophical bases. Indonesian law, rooted in constitutional and criminal provisions, treats euthanasia as an unlawful act, while Islamic law prohibits it on theological grounds, allowing limited withdrawal of treatment under strict conditions. The study underscores the need for a coherent national framework that harmonizes constitutional, ethical, and religious values to guide future health law and bioethics policy in Indonesia.

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