Health development aims to improve community health status optimal. Environmental indicators, hygiene practices, and access to health services is an indicator both of the three indicators that have been formulated in the vision of healthy Indonesia 2010. Behavioral and environmental factors play an important role in improving the quality of health where disease incidence is the result of interaction between humans, the environment and cause disease (host, agent and environment). This factor, especially in developing countries the greatest influence on the emergence of health problems or health problems.
Relation to this, Director General of Disease Control and Environmental Health (PP & PL) said that the disease is not contagious and infectious (specific) is still a health problem that is getting a double weight (double Burden) health problems should be handled by health service institutions. Disease control Diabetes Mellitus (P2DM) and metabolic disease is one of the program activities within the directorate general of Diseases Control & Environmental Control of non communicable diseases (P2TM) (MOH, 2006).
According to the Directorate General of Community Health of the Republic of Indonesia (DG Binkesmas RI), Diabetes mellitus (DM) is one of the health problems that affect productivity and can reduce the human resources (HR). This disease affects not only individually, but also a country's health system and is expected to increase DM patients especially in adult age groups in all economic status. Currently DM disease prevention efforts have not occupied the priority scale in the health service despite known negative impacts caused significant chronic complications such as heart disease, hypertension, brain, nervous system, liver, eye and kidney (MOH, 2003).
According to data of the world health organization (WHO), Indonesia ranks sixth in the world as the country with the highest diabetes mellitus after India, China, Soviet Union, Japan and Brazil. In 1995, the number of diabetics in Indonesia reaches 5 million patients with increase of 230,000 patients per year, so that in the year 2005 is expected to reach 12 million people. While the research results Endocrinology Association of Indonesia (Perkeni) during the period from 1983 to 1993, obtained the number of DM patients is increasing. In 1983 the number of people with 1.6 percent of the population and ten years later, the sufferer increased to 5.69 percent of the total population. This was probably caused by changes in urban lifestyle that is influenced by the environment (www.kompas.com).
Several experimental studies show that many factors that contribute to the occurrence of type 2 diabetes. The results Waspadji (2000) identified that the risk factors of smoking provides DM 7 times than non-smokers. Research by Palestin et al (2006) in RSU Dr. Sardjito Yogyakarta, identified that there is influence of knowledge about the disease, physical activity, age and obesity are statistically significant impact of the illness in patients with diabetes mellitus.
Diabetes mellitus is a collection of symptoms that arise in a person susceptible to interference from the body in controlling blood sugar. Such interference can be caused by the secretion of the hormone insulin or adequat not insulin function may be disturbed or even a combination of both. DM outlines classified into two types, namely: the insulin-dependent DM (type 1 DM) and DM is not dependent on insulin (type 2 DM). In general, type 1 DM occurs at the age below 40 years even 50 percent of them were diagnosed at age less than 20 years, whereas some type 2 diabetes diagnosed at the age of 30 years and more commonly known as DM who attacked the adult (Palestin, B , 2007).
In Brebes, DM is a major health problem by the number of patients showed improvement in each year. Based on the 20 major diseases in the hospitals outpatient Brebes for all age groups in 2004, DM type 2 is not included in the 20 major diseases in the hospitals outpatient Brebes. In 2005, ranks fourteenth numbering 538 patients (2.17%) and in 2006, which ranks third as many as 1623 patients (6.05%). Distribution of cases by age group in mind that the number of new cases in 2005 for patients aged 15-24 years amounted to 3 patients (4.4%), aged 25-44 years amounted to 27 patients (39.7%), age 45-64 year amounted to 24 patients (35.3%) and age more than 65 years amounted to 14 penderia (20.6%). In 2006, patients aged 1-4 years which amounted to 2 patients (2.4%), aged 5-14 years amounted to 2 patients (2.4%), aged 25-44 years amounted to 22 patients (26.5%) , aged 45-64 years amounted to 53 patients (63.9%) and age more than 65 years amounted to 4 patients (4.8%). From the results rekapitulsi data from January to April 2007, people with type 2 diabetes by as many as 273 patients and 237 patients while 36 new cases. Distribution of cases according to age group is 1 patient (2.7%) aged 15-24 years, 13 patients (38.9%) aged 25-44 years, 21 patients (58.3%) aged 45-64 years and 1 patient (2.7%) aged more than 65 years. All patients with type 2 DM terebut residing in all work areas Brebes hospitals (hospitals Profile Brebes, 2006).
Based on reports of disease incidence in the Hospital Outpatient Brebes, type 2 diabetes disease from year 2004-2006 has increased. Distribution of DM patients for three years shown in the following table:
Table 1.1 Distribution of Case Type 2 DM Patients Outpatient Hospital Brebes from Year 2005 to Year 2007.
Year
Number of Cases
New Old Total
2005 68 470 538
2006 83 1540 1623
April s.d January 2007 36 237 273
Source: Hospital Brebes, 2006
From the table above shows that new cases in 2006 was 83 cases, higher in appeal in 2005 for 68 cases, whereas in January to April 2007 as many as 36 cases. Most type 2 diabetes occurred in 2006 that 83 new cases.
Based on the above data, it can be concluded that an increase in incidence of type 2 DM in the working area hospitals Brebes. With regard to the issue, the writer encouraged to do research on the factors associated with type 2 diabetes incidence in outpatients in hospitals Brebes.
CHAPTER II
LITERATURE REVIEW
A. Understanding Diabetes Mellitus
According to the Directorate General of Community Health MOH, DM or diabetes is a disease caused by an increase in blood sugar (hiperglikemi) insulin deficiency due to either absolute or relative. Absolute means no insulin at all while the mean amount of insulin is relatively insufficient, but it works less power (MOH RI, 2003).
B. Anatomy and Physiology
Food processing begins from the mouth to the stomach and then next to the intestines. In the digestive tract, food consisting of carbohydrates broken down into glucose, protein is broken down into amino acids and fats into fatty acids. All three nutrients were distributed throughout the body to be used by the organs in the body as fuel and produce energy called metabolism.
In the process of metabolism, insulin plays an important role of glucose entering the cell which is used as fuel. Insulin is a substance or hormone produced by beta cells in the pancreas, where insulin is not there, then the glucose can not enter the cell, which causes glucose remains in the blood vessels which means blood glucose in the blood to rise.
Under conditions of food intake is different with the normal metabolism, one is able to maintain glucose levels between 70-110 mg / dl. In people with non-diabetic, blood glucose levels could rise between 120-140 mg / dl after meals. However, this state will return to normal quickly. while the excess glucose in the blood is stored as glycogen in the liver and muscle cells. Normal blood sugar levels maintained during the fasting state because sugar is released from body reserves, and the newly established sugar from amino acids, lactate and glycerol derived from triglycerides (C. Long, 1996).
C. Classification DM
According to the consensus of DM management in Indonesia in 1998, there are several types of DM are:
1. DM Type 1 / Insulin Dependent Diabetes Mellitus (IDDM) or DM-called insulin-dependent
DM is caused due to lack of insulin in the blood that occur because of damage from pancreatic beta cells (beta cells of Langerhans islands) so that the pancreas stops producing insulin. Usually these beta cell damage can occur at a young age and patients require insulin for life.
2. DM type 2 / Non-Insulin Dependent Diabetes Mellitus (NIDDM) or called the DM that is not dependent on insulin.
Type 2 diabetes occurs when insulin the pancreas does not produce enough or fat cells and muscles of the body become resistant to insulin, resulting in disruption of sugar delivery to body cells. As a result the blood sugar remains high, so there hiperglikemi. Usually known type 2 diabetes after age 30 years.
3. Gestational DM
Type of gestational DM in onset (attack) only during pregnancy, especially at the time of the mid-late pregnancy at the time of growth hormones in the increased amount. These hormones increase the supply of amino acids and glucose in the fetus which reduces the effectiveness of insulin. If the glucose in the blood remains high after passing the pregnancy disease was reclassified as DM type 1 or type 2 diabetes.
4. Other types of DM
In this type occurs glucose intolerance (the inability regulate blood sugar levels) associated with the state or certain diseases. Seen in people who have hyperglycemia as a complication of other diseases such as infection, genetic syndromes (Down syndrome, Turner and others), endocrine disease, pancreas, endokrinopati, Cirrosis hepatis. or as a result of drug treatment such as diuretics (thiazid, furosemid) and glucocorticoid.
D. Diagnosis DM
Symptoms of type 1 DM appears suddenly at the age of children (under age 20 years) as a result of genetic abnormalities, so the body can not produce insulin properly. The symptoms of type 2 diabetes appears gradually until it becomes clear interference (Octa, 2007).
Typical clinical symptoms of DM ie "Poly triad" that includes polidipsi (much to drink), poliphagia (lots of eating) and poliuri (lots of pee). Besides the complaints often accompanied by numbness, especially on the fingers, the body felt weak, itching and if there are wounds difficult to heal, sometimes weight declined significantly (MOH, 2003).
E. Aetiology of type 2 diabetes
The main cause of type 2 diabetes in the era of globalization is the change of lifestyle, especially in urban communities who tend to consume more foods containing carbohydrates and fats with high levels and not balanced with physical or kegitan of adequate physical exercise, hypertension with blood pressure above 140 mmHg , cigarettes, besides the stress, old age can also be a risk factor for diabetes incidence (Perkeni, 1993).
F. Complications / Penyulit
According to the Directorate General of Community Health, Ministry of Health of Indonesia that the disease can cause a variety of DM life-threatening complications and affect quality of life. Complications that occur can be acute and chronic:
1. Acute Complications
a. Acute complications of the most dangerous is the occurrence of hypoglycemia (low blood sugar), because it can lead to coma and even death if not quickly rescued. This condition is usually triggered hypoglycemia because patients do not comply with the schedule eating (diit) which has been set while the patient remained anti-diabetic medication or have insulin injections. The symptoms of hypoglycemia are hunger, weakness, headache, cold sweat and even convulsions.
b. Hiperglikemi coma in people with DM is caused due to high levels of sugar in the blood, which is usually triggered by infectious disease, DM patients do not take medication or receive appropriate insulin dose. Symptoms of hyperglycemia are thirst, dry warm skin, nausea and vomiting, abdominal pains, dizziness and poliuri.
Because it is difficult to distinguish complications due to hypo or hiperglikemi, it is recommended if there are symptoms like the above in DM patients, better be soon be helped with sugar water or candy, then the patient was sent to hospital.
2. Chronic Complications
Occurs when high blood sugar levels in a long time and will cause complications in nerve, eye, liver, heart, blood vessels and kidneys. In addition to efforts to lower blood sugar levels with anti-diabetic drugs or insulin therapy diit, need treatment for complications.
G. Risk factors for type 2 DM
Some risk factors that could cause a person has type 2 diabetes are as follows:
1. Age
Age humans are classified into childhood, youth and adults. In adulthood classified into young adults (18-30 years), middle adult (30-60 years) and more mature (> 60 years). Aging process which occurs naturally caused a decrease in body function and the incidence of various diseases. In general is a chronic disease, frequent relapses and multi pathological (Riskiyana, 2004).
In NIDDM patients, carbohydrate tolerance gradually declines with age a person passes. Carbohydrate intolerance associated with this age has been associated with various things such as reduced release of insulin from beta cells, the slow release of insulin and / or decrease the sensitivity of blood vessels and nerves of the edge to insulin. The second physiological changes associated with age are important in managing diabetes is a decline in renal threshold for glucose in the average blood glucose level of 160-180 mg / dl (C. Long, 1996).
2. Knowledge
Knowledge is the result of knowing, and this happens after people doing sensing of a particular object. Sensing occurs through the human senses, the senses of sight, hearing, smell, taste and touch. Most human knowledge acquired through the eyes and ears (Notoatmodjo, 2003).
Knowledge of someone closely related to behavior that will take, because with this knowledge he has a reason and basis for determining an option. Lack of knowledge about the illness will lead to uncontrolled development of the disease process, including early detection of disease complications. Kosa and Robertson said that health behavior is motivated by psychological needs of individuals to reduce the anxiety caused by the threat of an illness. One of these psychological needs of the application of their own knowledge about health. One of the ten types of variables that determine health behavior is the available information, knowledge, culture and views of the judge. One of the many factors that influence behavior related to health are matters related to the knowledge of the disease (Muzahan, F, 1995).
Some studies have noted that 50-80% diabetisi (patient DM) has the knowledge and skills in managing the disease less and control blood sugar levels are ideal (Norris et al, 2001).
According to Badruddin et al, (2002) who obtained diabetisi education and guidance in self-care will improve the pattern of his life in order to manage blood sugar properly. As well as a reminder that health education be more effective if health workers to know the level of knowledge, attitudes and daily habits that client. According to him also, that the increased cognitive aspects of healthy behaviors diabetisi consists of monitoring blood sugar levels independently, planning to eat (diit), physical exercise, adequate rest and avoid smoking.
3. Obesity
The high number of people with diabetes mellitus (DM) in the diet resulted Indonesia Indonesian people who have a lot of carbohydrates consumed. With rice as a staple food, is not it strange that Indonesia ranked fourth in the number of diabetics in the world. Rice contains a lot of glucose in the quantity and excess glucose is one of the causes of diabetes (Gsianturi, 2005).
Diabetes mellitus is a disorder of carbohydrate metabolism is one element of macro nutrients. These metabolic disorders also cause metabolic disorders other nutrients are protein, fat, vitamins and minerals which the body's metabolic processes interact with each other among all the elements of nutrients. Therefore, DM is one of the "Nutrition Related Disease" in which one gangguaan metabolism of nutrients can cause diseases (MOH, 2003).
According to Drs. Alwi Sihab, chairman of the Central Information Diabetes and Lipid Sriwijaya University School of Medicine (FK Unsri), the factors causing the current increase in DM among other people's lifestyles, especially in urban areas tend to consume more foods that contain carbohydrates and fats with high levels and not balanced with adequate physical exercise. This will lead to obesity, especially due to fat deposits in the abdominal area that interfere with the work of insulin in regulating blood sugar levels.
To see a DM are obese, normal or malnourished, so nutritional status assessment conducted by calculating the Body Mass Index (BMI) which is the following formula, BMI = BB (kilograms) / TB ² (meters). Normal BMI in adults is between 18,5-25 (MOH, 2003).
4. Smoking
Smoking is bad habits that lead to various diseases. The irony of this smoking habit, especially in Indonesia seemed entrenched. Nearly 50% of the adult population smokes Indonesia (Notoatmodjo, 2003).
Clinical smoking is one important factor for DM disease. According to Emil Bogen (1978) states that the blood circulation reacts to nicotine with a narrowing of blood vessels followed by increased blood pressure. Smoking can also cause the secretion of adrenal glands which in turn will raise blood sugar.
Smokers types divided into 4 types, namely:
1. Heavy smokers
If you consume more than 31 cigarettes per day to stem smoking interval is 5 minutes after waking in the morning.
2. Heavy smokers
If the consume about 21-30 cigarettes a day by the time interval since smoking is up in the morning ranged between 6-30 minutes
3. Smokers were
When you spend 11-21 cigarettes a rod with an interval of 31-60 minutes after waking in the morning
4. Light smokers
When finished cigarettes about 10 cigarettes a day with an interval of 60 minutes from up in the morning
According to Silvan Tomkins (in AL Bakhri, 1991), there are 4 types of smoking behavior, namely:
1. Type of smokers are affected by the positive feelings
With smoking, one feels the addition of a positive sense (in the psychological factors in smoking, 1978) there are 3 sub-types:
a. Pleasure relaxation: the smoking behavior in order to add or enhance the enjoyment which is obtained, such as smoking after drinking coffee or after dinner.
b. Stimulation to pick them up: the smoking behavior only done for fun feelings Sekedarnya
c. Pleasure of handling the cigarette: the pleasure gained by holding a cigarette, very specific to the pipe smoker. Pipe smoker will spend the time to fill the pipe with tobacco, and to suck it only takes a few minutes, or smokers prefer to linger to play a cigarette with her fingers long before he lit the fire.
2. Smoking behavior is influenced by negative feelings
Many people use cigarettes to reduce the negative feelings, such as when he was angry, anxious, nervous, cigarettes are considered as a savior. They use a cigarette when feeling bad happened, so avoid feeling even more uncomfortable.
3. Smoking behavior is addictive
Green called the Psycological addiction. Those who have addiction, smoking will increase the dose used any time after the effects of reduced cigarette dihisapnya. They generally will go out to buy cigarettes even though the middle of the night, because he was worried that cigarettes are not available every he wants.
4. Smoking behavior that has become a habit
Are those who use cigarettes was not due to control their feelings, but because it really has become a regular habit. Can be said to people this type, smoking is a behavior that is automatic, often without thought and without realizing it, he switched his cigarette when the cigarette fire earlier had been completely discharged (Mu'tadin, Z, 2002).
Cigarettes contain about 4000 more chemicals. Important element and dangerous include tar, nicotine, benzopyrin, methyl chloride, acetone, ammonia and carbon monoxide. Of the many, there are three of the most dangerous of tar, nicotine and carbon monoxide. Immediately after contact with the nicotine will arise stimulant or stimulation of the adrenal glands that causes the release of epinephrin (adrenaline) is one of the substances in the body. Loss of adrenaline stimulates the body to release glucose so sudden blood sugar levels, blood pressure, respiration and heart rate increases. Nicotine also suppress insulin from the pancreas of expenditure, so that blood sugar will rise. Nicotine metabolism may be lost from the body within a few hours. However, if continued smoking, the nicotine levels in the body will accumulate and grow stronger, and this dependence will be followed by a reaction that will add to the difficulty of quitting smoking. Risk of death among smokers are twice as compared with non-smokers and this risk will increase to four-fold in heavy smokers (Prop. health office. Jateng, 2004).
Morbidity and mortality associated with cigarette smoking is almost linearly correlated with the number of cigarettes smoked per day and years of use. Risks of smoking two packs of cigarettes a day are three times higher than in the smoking half a pack a day. Statisticians measure that someone who smoked for 8-9 years, each cigarette cigarette reduces life expectancy 5.5 minutes. There is some evidence that current methods of filters and low-nicotine cigarettes have reduced significantly the risk of death (Robins and Kumar, 1995).
5. Physical activity
Physical activity is useful for cardiovascular tone, endurance, muscle strength, flexibility and weight control. Physical exercise also has a positive effect on members of the movement, persyarafan, the circulation of the blood vessels, respiration, digestion and urinal system.
Physical activity was divided according to the aerobic and anaerobic. Aerobic activities are supported by aerobic metabolism (carbohydrate and fat solution to carbon dioxide and water to produce oxygen). Aerobic exercise is marked activity involving large muscle groups and implemented according to the natural rhythm continuously for 15 minutes. Examples of aerobic exercise consisted of walking fast, running, jogging, swimming, aerobic dancing and others. While anaerobic exercise consists of anaerobic metabolism (breakdown of glucose into lactic acid on the condition there is no oxygen). implementation is through a high intensity, so the available oxygen is used until exhausted for purposes of additional energy. Training examples consisting of weight lifting, competitive sports, basketball, voley ball, soccer and others. Big advantage for physical fitness can be achieved through aerobic exercise (C. Long, in 1996).
DM patients are encouraged to exercise regularly 3-4 times a week, at least 20-30 minutes (for example, fast walking, gymnastics) to improve insulin activity, other than sports that help weight loss in overweight and obese patients (MOH, 2003 ).
H. Theory Framework
Theoretical framework according to the Directorate General of Disease Control & Environmental Health MOH (2006) and Almatsier (2006), namely:
SOCIAL STRUCTURE
- Age
- Gender
- Social Status
- Knowledge
ENVIRONMENT
- Geographic
- Working environment
- House
- Schools
TYPE 2 DM
LIFESTYLE
- Smoking
- Physical activity
- Diet
- Stress
BIOLOGY
- Blood pressure
- Cholesterol
- Blood Sugar
- Obesity
Figure 2.1 Scheme framework theory Some Factors Associated with Incident type 2 DM
CHAPTER III
RESEARCH METHOD
A. Framework Concept
Conceptual framework of research are as follows:
Independent Variables Variable Bound
a. Age
b. Obesity
c. Smoking
d. Knowledge
e. Physical activity
Incident type 2 diabetes
Figure 3.1 Framework Concept
B. Research Hypothesis
The hypothesis of this study are:
1. There is a relationship between age with the incidence of type 2 DM outpatients in hospitals Brebes
2. There is a relationship between knowledge of the incident type 2 diabetes outpatients in hospitals Brebes
3. There is a relationship between obesity with incident type 2 diabetes outpatients in hospitals Brebes
4. There is a relationship between smoking with incident type 2 diabetes outpatients in hospitals Brebes
5. There is a relationship between physical activity with incident type 2 diabetes outpatients in hospitals Brebes
C. Research Variables
1. Independent Variables
a. Age
b. Knowledge
c. Obesity
d. Smoking
e. Physical exercise
2. Tied Variables
Incident type 2 diabetes
D. Operational Definition
Operational definition of this research is described in the following table:
Table 3.1 Definition of Operations
No. How to measure the variable definition categories measuring scale
1. Incident type 2 diabetes
All patients diagnosed with type 2 diabetes by a doctor at the hospital observation of medical records in hospital 1. DM type 2
0. Not DM type 2
Nominal
2. Age to Age people as suffering from type 2 diabetes Observation medical records in hospital 1. > 30 yrs
0. 30 yrs
Source:
Palestin, B, 2007 Nominal
No Variable Definition Category Scale How To Measure Measure
3. Knowledge Knowledge of the disease patients with type 2 DM
Which include: understanding of DM, the risk factors of DM, the prevention of DM 1 interview using a questionnaire. Not good (0-3)
0. Good (4-6) Nominal
4. Obesity Obesity in people with type 2 diabetes expressed in Body Observation Period Index medical records in hospital 1. Obesity (BMI> 25)
0. Not obese (BMI <25) Nominal
5. Smoking history of smoking in people with type 2 diabetes using a questionnaire interview 1. Smoking (1)
0. No smoking (2) Nominal
6. Physical activity or activity sports activities routinely conducted interviews using a questionnaire 1. No activity (1-3)
0. Activities (4-6) Nominal
E. Types and Methods of Research
Used this kind of research is explanatory research study, which describes the factors that cause the disease incidence by case control approach, the study of epidemiology which studies the relationship between exposure (study factor) and disease by comparing the case group and control group based on the status of his presentation, with In other words the effect (disease) identified at this time, then the risk factors identified the existence or occurrence in the past and analyze it by comparing the proportion between the variables object of research with the control variables (Notoatmodjo, 2002). Case control study design can be described as follows:
Retrospective study design drawings
Risk Factors in Retrospective Studies Browsable begins
Figure 3.2 Research Design Retrospective
F. Study Site
Research conducted at the outpatient units of hospitals located in Brebes Brebes.
G. Population and Sample
1. Population
a. Population cases
Population of cases in this study is that all type 2 diabetes patients who seek treatment in hospitals Brebes road
b. Population control
Population controls were all patients who were diagnosed by the hospital medical team did not suffer from type 2 diabetes and was treated at hospitals Brebes road
2. Sample
a. Sample cases
Sample cases in this study were all type 2 diabetes patients who seek treatment in hospitals Brebes road starting from july 2007 moon back to get the number of cases has been determined that 63 cases, whereas the sampling method used was purposive technique of eligible cases ( Notoatmodjo, 2002).
Criteria for inclusion are:
• Patients in hospitals outpatient Brebes
• Down with type 2 diabetes
• Respondents to cooperate with investigators
Exclusion criteria are:
• Suffering from ear, nose and throat (ENT)
b. Control sample
Control samples determined based on the requests of all patients who do not suffer from type 2 diabetes, but have the characteristics of disease and risk factors with type 2 diabetes. Control samples taken by using random sampling techniques
Criteria for inclusion are:
• Patients in hospitals outpatient Brebes
• Suffering from ear, nose and throat (ENT)
• Respondents to cooperate with investigators
Exclusion criteria are:
• Respondents did not want to be interviewed
The way to determine the large sample in this study are as follows:
According Lemeshow (1990) to calculate the required sample of the used formula that aims case-control odds ratio test on the case and control groups, namely:
n Subject = (Z1/2α √ 2P2 (1-P2) + P1 √ Zβ (1-P1) + P2 (1-P2)) ²
(P1 - P2) ²
(R) P2
P1 =
(R) P2 + (1 - P2)
Description:
n = number of samples
R = estimated odds ratio = 2
Z1/2α = value of the standard normal distribution corresponding to α = 1.96
Zβ = value of the standard normal distribution corresponding to β = 0.84
P2 = proportion of controls exposed to the exposure being studied = 100% - the percentage of patients discovery
Proportion not suffer from type 2 diabetes (controls) were exposed to the exposure under investigation is 50% because researchers are skeptical about the control exposed to the studied exposure.
unknown
R = 2
Z1/2α = 1.96
Zβ = 0.84
P0 = 50%
P1 = 2 x 0.5
2 x 0.5 + (1 - 0.5) ²
= 0.66
n = 1.96 x √ (2x0, 5 (1-0,5) + 0.84 √ 0.66 (1-0,66) +0.5 (1-0,5)) ²
(0.66 to 0.5) ²
= (0.5 + 0.98 √ 0.84 √ 0.1744) ²
(0.16) ²
= (1.273) ²
0.0256
n = 63
Thus the required 63 cases and 63 controls, the ratio of cases and controls 1: 1
H. Source Data
Source data obtained from this study is divided into:
1. Primary Data
2. Secondary Data
I. How to Collecting Data
J. Research Instruments
1. Validity
R =
2.
K. Analysis Method
1. Data Processing
a. Editing
b. Coding
c.
d.
e.
2. Data Analysis
a.
b.
