Health Info - Bingung Puting

Bingung puting (nipple confusion) sering terjadi karena bayi terlena dengan dot dan enggan/bingung saat dihadapkan pada puting ASI (nipple).

Mekanisme gerakan mulut, lidah, dan rahang bayi serta aliran air susu antara botol dot dan ASI memang berbeda. Pada botol dot, bayi cukup memasukkan mulutnya sampai ujung dot, susu akan mengalir dengan sendirinya tanpa perlu menghisap terlalu kuat. Sedangkan pada ASI, mulut bayi harus mencapai areola, bukan hanya ujung puting. Sering tanpa kerjasama mulut, lidah, dan rahangnya, ASI tidak sendirinya mengucur.

Pemakaian dot (pacifier) pada bulan-bulan awal kelahiran memang menimbulkan kontroversi. Di satu sisi mampu memberi kenyamanan pada bayi yang belum/tidak memperoleh ASI. Tetapi di sisi lain dapat menimbulkan istilah bingung puting ini (mungkin tidak semua dokter menyetujui istilah tersebut).

Sebaiknya memang si kecil hanya diberikan ASI saja selama 4-6 bulan pertama. Kondisi tertentu mungkin akan memaksa pemberian ASI yang diperas, susu formula, ASI/susu formula dengan botol (+ sendok atau dot). Misalnya:

• belum keluarnya ASI saat bayi baru lahir, apalagi bayi kuning
• ASI kurang lancar
• ibu sakit/sedang dalam pengobatan
• ibu bekerja

Bayi yang lebih dulu merasakan nikmatnya menggunakan dot (silikon atau [apalagi] karet) sebelum mencoba puting, biasanya akan mengalami bingung puting.

Berikut pengalaman pribadi, tips dan trik menghadapi bingung puting:

• jangan menyerah (bayi biasanya akan menangis meraung-raung karena kegemarannya tidak segera diberikan)
• sabar, si kecil mungkin merasakan kegusaran (stres) ibu/pemberi ASI
• selang-seling/perjarang pemakaian dot
• karena beberapa bayi sering tidak sabar menanti kucuran ASI, basahi sedikit permukaan puting dan areola dengan ASI dan lumuri pula pada bibir si kecil
• berikan ASI saat bayi belum terlalu lapar
• jika bayi sudah tidak sabar, peras ASI, coba berikan dengan sendok (jangan dot) secara perlahan (agar tidak mudah tersedak); dekatkan ke bibirnya, biarkan si kecil menyelesaikannya; ingat pula menyendawakannya
• perbanyak kontak kulit payudara dengan wajah dan bibir si kecil sehingga ia dapat merasakan kehangatan yang tidak didapatnya dari dot botol
• coba berikan ASI saat ia tertidur, saat itu si kecil mungkin lupa dengan dotnya; sering pula saya perhatikan si kecil tidur sambil sesekali menggerakkan bibir mungilnya seperti sedang menyusu

Semoga berhasil...

Untuk informasi dan bantuan lebih lanjut, silakan hubungi dokter spesialis anak anda...


Bacaan lainnya:

Pacifiers, breastfeeding and soothing

Physiologic Stability of Newborns During Cup- and Bottle-feeding

The Effects of Early Pacifier Use on Breastfeeding Duration

Pacifier Use and Short Breastfeeding Duration: Cause, Consequence, or Coincidence?

Nipple Confusion

"bingung puting" oleh Google

Vacation: what a concept (Part Deux)

Now it begins . . . .

AHLA's Health Lawyers Weekly

With AHLA's permission, here's the Table of Contents of today's issue of Health Lawyers Weekly:I. Top Stories: House Clears HIT Legislation FDA To Improve Transparency Of Advisory Panel Conflicts, Official Says II. Articles & Analyses:A Discussion About Alternative Dispute Resolution In The Healthcare Field 2005-2006 In-House Counsel Year In Review 2005-2006 Labor And Employment Year In ReviewIII

Vacation: what a concept!

HealthLawBlog will be on vacation for the next two weeks. With random exceptions, don't expect anything new here before August 10th. Stay cool. Be happy.

Yates: Not guilty by reason of insanity

Finally . . . .

NOLA murder arrests: further reflections

Today's CDC Public Health Law Newsletter has a link to a Chicago Tribune article that explores the ethics of triage and its applicability vel non to the NOLA cases previously discussed (here, here, and here):“Disaster plan: Time to think unthinkable?”Chicago Tribune (07/19/06) Ronald KotulakLast week, two nurses and a doctor were arrested in New Orleans on charges that they gave lethal doses of

Further thoughts on the Senate abortion bill

As previously noted, the Senate has passed a bill that would impose criminal penalties on anyone who helps a minor travel across state lines from a state that has a parental-notification or -consent law in order to obtain an abortion in a state that has no such restrictions. As the map on my post illustrates, 6 states have no restrictions on minors: Washington, Oregon, Vermont, New York,

Senate passes prohibition on interstate travel for abortion

The Washington Post has the story. The Senate has passed a a bill (S.403) "to prohibit taking minors across State lines in circumvention of laws requiring the involvement of parents in abortion decisions [preamble]," thus (according to The Post) handing a long-sought victory to the Bush administration and abortion opponents":The bill would help about three dozen states enforce laws that require

Juvenile court orders teen to accept chemo, reversed by circuit court

Starchild Abraham Cherrix has Hodgkin's disease, and when the disease returned after his initial round of chemo, he refused a second round, opting instead for "a sugar-free, organic diet and take herbal supplements under the supervision of a clinic in Mexico" [Washington Post]:A social worker asked a juvenile court judge to require the teen to continue conventional treatment, and the judge on

The American Way of Death IV

While we're talking about patient and family perceptions of end-of-life care in the hospital -- we were talking about that, weren't we? just yesterday? -- Pamela Winnick's essay in the Wall Street Journal on July 21 is well worth considering. She talks about a resident nicknamed "Dr. Death" who pursues family members down the hall to harangue them about her father's alleged desire to be allowed

The HCA deal is done

The closing probably won't be till the 4th quarter, assuming the federal regulators bless it and the board doesn't get a better offer, but HCA's board has approved the sale of the company to an aglomeration of investment bankers and the founding Frist family. Of course, no one can quite agree whether the deal is worth $21 billion, $31 billion, or $33 billion, but what's a few billion here or

HCA close to $21 billion buyout

After coming oh so close to closing a deal last weekend, it looks like the board is on the verge of approving a $21 billion deal tonight. As reported by the NY Times, "HCA, the nation’s largest for-profit hospital operator, was close to a deal last night to sell itself to a consortium of private equity investors for about $21 billion, people involved in the talks said. The investors would also

Criminal Law III: More on the NOLA murder prosecutions

AP/Yahoo has an article today entitled, "Many see accused New Orleans MD as hero." State AG made much of the fact that both morphine and Versed were found in the the bodies of the four patients whose deaths were the basis for his order to arrest Dr. Pou and the two nurses. Contrary to his assertion that the two drugs together can mean only one thing -- that the health care workers' intent was to

The American Way of Death III

NPR's Studio 360 program has a wonderful item this week on Emily Dickinson and her iconic poem, "Because I Could Not Stop For Death." The program is available as an MP3 file here.We read this poem every year in Law, Literature & Medicine, where third-year law students from SMU and fourth-year medical students from UT-Southwestern wrestle with Dickinson's verses, among many others.Because I could

Giving up smoking

I used to smoke 40-50 cigarettes a day and I'm passionate now about the health ebenfits of not smoking. There's already several articles in the health section of http://www.healthandgoodness.com on smoking and health, and I've just added a new one tonight. Jonty is an ex-smoker and in this article he looks at the reasons to give up:

If you’re a smoker, you’re probably sick to death of the anti-cigarette lobby spinning out the same old lines about how you’re damaging your body and health. You’re not an idiot, you know all these facts.
to continue: http://healthandgoodness.com/health/why_stop_smoking.html

The American Way of Death II

Thanks to Joe Paduda's "Managed Care Matters" for pointing me to this story in the Minneapolis-St. Paul Business Journal about a recent article in Mayo Clinic Proceedings: "Adult Intensive Care Unit Use at the End of Life: A Population-Based Study," by Seferian and Afessa [abstract; full text available in 6 months]. As reported in the business journal:Intensive care costs comprise 30 to 40

The American Way of Death I

Back in the day, the phrase "The American Way of Death" invoked Jessica Mitford's classic expose of the funeral industry. In bioethics and law, however, it has a more immediate connotation. With 80% of all Americans dying in an insitutional setting, what is the meaning of "a good death"? And is it possible to achieve in a hospital? Palliative care services notwithstanding, the standard of care

What To Do If Your Child Is Overweight

Sadly a lot of children are now overweight. Here's some sound advice from Jim O'neill on what to do about it:

http://healthandgoodness.com/babieschildren/child_overweight.html

Criminal Law II: follow-up on the Memorial Hospital case

Now that the Louisiana Attorney General has had his day (see my earlier post), the extent of AG Foti's grandstanding is starting to come to light. You'd never know it from his office's press release on this case, but consider the following:the state attorney general has no power to indict or prosecute for these alleged crimes;the physician and nurses involved have not been charged with any

Criminal Law I: promoting off-label uses of approved drugs

Today's New York Times has an article about the recent arrest and prosecution of Dr. Peter Gleason for promoting use of the drug Xyrem, which is approved by the FDA for the treatment of narcolepsy, for the off-label treatment of depression and pain.Now, it's horn-book law that physicians can use approved drugs for off-label uses. And it's equally well-settled, though perhaps a little less

Is a Chiropractic a benefit to the "Well Individual"?

First question: What is chiropractic?

The word “chiropractic” is taken from Greek, and means “done by hand”.

This is exactly how chiropractic care works. The chiropractor uses his or her hands to manipulate your body, and help it to heal itself. It is the branch of the health sciences which focuses on the neuromusculoskeletal system.

That’s a very big word to simply say how your spine and nervous system work together. The spine is the highway for your central nervous system; if the highway is blocked or traffic is jammed, they are usually able healers. Many cultures, the Egyptians, the Greeks, the Chinese, and even the Africans have used some form of chiropractic care for several hundreds of years.

Is chiropractic a benefit to the well person?

Should you visit a chiropractor when really nothing is wrong?

It is a benefit and here is why:

The nature of a chiropractic treatment is the belief in the body’s own healing abilities.

Quite often, we can have small problems in one area of our body, and not even realize it until the effect is felt in a much larger way - sometimes somewhere else.

The practice of a chiropractic care focuses on the connection between your spine and your nervous system:

the spine is the structure, and the nervous system is the function.

Chiropractic believes these two systems work in unison to keep and then restore your body’s health.

Why has it taken so long for chiropractic care to receive its proper recognition in western medicine?

Because by its very nature, it creates a divide between traditional, western philosophies and practices and what the chiropractor practices. In modern, western medicine, prescription drugs play a huge role in our healing process.

To circumvent all those years of development, and investment on the part of the drug companies, is like climbing a rock cliff. It has taken many years, much evidence, and the demand of the general public to finally make progress towards the implementation chiropractic medicine as a realistic form of healing.

Chiropractic care in the western civilizations however has experienced many hurdles on its way to becoming one of best forms of back care and preventive medicine available today. To date, much research has been done and much material published on the benefits and cost-effective nature of chiropractic treatment.

The number of Americans who seek chiropractic care has more than tripled in the last ten years, and continues to grow each year.

It is a known fact, if you’ve ever visited the chiropractor, the philosophy works, your body feels better, it heals better, and you aren’t cut, drugged, and off from work for 6 weeks to recuperate.

It is interesting to note here, that chiropractors are still classified as holistic healers.

In other words, they believe in the whole body approach to healing. So do the acupuncturists, and the herbal healers.

It seems to me, that the traditional medicine has a lot of "catching up" to do - and they thought they were in the lead...

Well - maybe you have your own opinion about this...

Is a Chiropractic a benefit to the "Well Individual"?

First question: What is chiropractic?

The word “chiropractic” is taken from Greek, and means “done by hand”.

This is exactly how chiropractic care works. The chiropractor uses his or her hands to manipulate your body, and help it to heal itself. It is the branch of the health sciences which focuses on the neuromusculoskeletal system.

That’s a very big word to simply say how your spine and nervous system work together. The spine is the highway for your central nervous system; if the highway is blocked or traffic is jammed, they are usually able healers. Many cultures, the Egyptians, the Greeks, the Chinese, and even the Africans have used some form of chiropractic care for several hundreds of years.

Is chiropractic a benefit to the well person?

Should you visit a chiropractor when really nothing is wrong?

It is a benefit and here is why:

The nature of a chiropractic treatment is the belief in the body’s own healing abilities.

Quite often, we can have small problems in one area of our body, and not even realize it until the effect is felt in a much larger way - sometimes somewhere else.

The practice of a chiropractic care focuses on the connection between your spine and your nervous system:

the spine is the structure, and the nervous system is the function.

Chiropractic believes these two systems work in unison to keep and then restore your body’s health.

Why has it taken so long for chiropractic care to receive its proper recognition in western medicine?

Because by its very nature, it creates a divide between traditional, western philosophies and practices and what the chiropractor practices. In modern, western medicine, prescription drugs play a huge role in our healing process.

To circumvent all those years of development, and investment on the part of the drug companies, is like climbing a rock cliff. It has taken many years, much evidence, and the demand of the general public to finally make progress towards the implementation chiropractic medicine as a realistic form of healing.

Chiropractic care in the western civilizations however has experienced many hurdles on its way to becoming one of best forms of back care and preventive medicine available today. To date, much research has been done and much material published on the benefits and cost-effective nature of chiropractic treatment.

The number of Americans who seek chiropractic care has more than tripled in the last ten years, and continues to grow each year.

It is a known fact, if you’ve ever visited the chiropractor, the philosophy works, your body feels better, it heals better, and you aren’t cut, drugged, and off from work for 6 weeks to recuperate.

It is interesting to note here, that chiropractors are still classified as holistic healers.

In other words, they believe in the whole body approach to healing. So do the acupuncturists, and the herbal healers.

It seems to me, that the traditional medicine has a lot of "catching up" to do - and they thought they were in the lead...

Well - maybe you have your own opinion about this...

Is a Chiropractic a benefit to the "Well Individual"?

First question: What is chiropractic?

The word “chiropractic” is taken from Greek, and means “done by hand”.

This is exactly how chiropractic care works. The chiropractor uses his or her hands to manipulate your body, and help it to heal itself. It is the branch of the health sciences which focuses on the neuromusculoskeletal system.

That’s a very big word to simply say how your spine and nervous system work together. The spine is the highway for your central nervous system; if the highway is blocked or traffic is jammed, they are usually able healers. Many cultures, the Egyptians, the Greeks, the Chinese, and even the Africans have used some form of chiropractic care for several hundreds of years.

Is chiropractic a benefit to the well person?

Should you visit a chiropractor when really nothing is wrong?

It is a benefit and here is why:

The nature of a chiropractic treatment is the belief in the body’s own healing abilities.

Quite often, we can have small problems in one area of our body, and not even realize it until the effect is felt in a much larger way - sometimes somewhere else.

The practice of a chiropractic care focuses on the connection between your spine and your nervous system:

the spine is the structure, and the nervous system is the function.

Chiropractic believes these two systems work in unison to keep and then restore your body’s health.

Why has it taken so long for chiropractic care to receive its proper recognition in western medicine?

Because by its very nature, it creates a divide between traditional, western philosophies and practices and what the chiropractor practices. In modern, western medicine, prescription drugs play a huge role in our healing process.

To circumvent all those years of development, and investment on the part of the drug companies, is like climbing a rock cliff. It has taken many years, much evidence, and the demand of the general public to finally make progress towards the implementation chiropractic medicine as a realistic form of healing.

Chiropractic care in the western civilizations however has experienced many hurdles on its way to becoming one of best forms of back care and preventive medicine available today. To date, much research has been done and much material published on the benefits and cost-effective nature of chiropractic treatment.

The number of Americans who seek chiropractic care has more than tripled in the last ten years, and continues to grow each year.

It is a known fact, if you’ve ever visited the chiropractor, the philosophy works, your body feels better, it heals better, and you aren’t cut, drugged, and off from work for 6 weeks to recuperate.

It is interesting to note here, that chiropractors are still classified as holistic healers.

In other words, they believe in the whole body approach to healing. So do the acupuncturists, and the herbal healers.

It seems to me, that the traditional medicine has a lot of "catching up" to do - and they thought they were in the lead...

Well - maybe you have your own opinion about this...

Texas hospitals and immigration

There was a terrific article in The New York Times this past week on the different approaches taken by the public hospitals in Dallas County (Parkland) and Tarrant County (JPS), separated by about 40 miles and a river and a very different view of their missions. This country isn't close to figuring out a humane and sensible approach to immigrant health care, and the conflicts and contradictions

House fails to override presidential veto

The House failed to override Pres. Bush's veto of H.R.810 by a vote of 235-193, almost the identical vote when it was originally passed by the House in May. Not exactly earth-shattering news, but I offer it for the sake of closure if nothing else.

An excellent primer on the stem cell issue

Everything a reporter might need to know to cover this story intelligently -- and the rest of us will find helpful as well -- has been collected, organized, linkified, synthesized, and analyzed by Al Tompkins at the Poynter Center in last Friday's edition of Al's Morning Meeting. Thanks to AJOB's blog for the tip.

Summer Fruit Smoothies

It's really hot here at the moment and there's lots of wonderful fruit around, so it's definitely time to make some smoothies. Here's some great advice from Kit Heathcock on how to do just that:

http://healthandgoodness.com/nutritiondiet/recipe_fruit_smoothies.html

President signs fraudulent Fetus Farming Prohibition Act

The news stories on the president's veto haven't mentioned the other bill that was sent to him for his signature, but now that a transcript of the veto/signing ceremony is available from the White House, I can report that he has signed S.3504, the purpose of which is "to prohibit any person or entity involved in interstate commerce from: (1) soliciting or knowingly acquiring, receiving, or

President carries out veto threat on stem-cell measure

The AP's Mary Dalrymple reports that President Bush has vetoed H.R.810. Here are his reported remarks:"This bill would support the taking of innocent human life of the hope of finding medical benefits for others. It crosses a moral boundary that our society needs to respect, so I vetoed it," Bush said at a White House event where he was surrounded by 18 families who "adopted" frozen embryos that

Caplan on Bush's veto of stem-cell bill

Art Caplan is at his best today in his column about Bush's promised veto of H.R.810. Here are the opening and closing paragraphs:President Bush’s embryonic stem cell policy began with lies and has now ended with one. Bush reserved his first veto as president for one of the only valuable things this do-almost-nothing Congress has managed to actually get done. With a flourish of a veto pen that has

HCA nearly bought out in recent days

The Wall Street Journal reports (link good for 7 days) that a group of private investors, including members of the founding Frist family, nearly consummated a buyout of HCA over the weekend. With a market capitalization of $17.6 billion, HCA's sale would have been one of the largest in recent memory. It apparently cratered because of the size of HCA's debt ($11 billion), which left the parties

Stem cell minuet proceeding almost as planned; Bush set to veto the most meaningful of three bills

Congress' action on three stem cell bills yesterday and today's expected veto of one of them by President Bush are front-page stories in this morning's Washington Post and New York Times, as was the case in the Dallas Morning News and I suspect most of the dailies around the country. As previously discussed here, this has been a carefully choreographed performance by the Congressional leadership

Walking A Marathon

In 2001 I did the London marathon. I'd never done much running before, and looking back it was a silly thing to have done. Inevitably I pushed myself in training and so injured myself 3 weeks before the big day. I still "ran" the marathon but was in pain from about 2 miles in. I spent part of the time halucinating I was up a mountain because I was in so much pain!!

I've often wished I'd done it as a walking marathon rather than a running marathon. I don't think I would have been much slower and I would have enjoyed the training and the event a whole lot more.

If that idea appeals to you, I've just published an article on how to prepare to walk a marathon:

http://www.sportandme.com/docs/sports/walking/guide/walking_marathon.html

happy walking!

Tenet physician and 2 nurses arrested for murder in Louisiana

According to the state's attorney in Louisiana, a physician and two nurses euthanized four patients in LifeCare Hospitals' long-term-care unit at Tenet's 603-bed Memorial Medical Center in New Orleans in the days after Hurricane Katrina devastated that city. (Modern Healthcare). The three were arrested, charged with four counts of second-degree murder, and released on personal recognizance

Biochemic Tissue Salts

When my children were little and not well, they often said: “I want some magic tablets.” The ‘magic tablets’ got their nickname because of how quickly they dissolved on the tongue, and how soon they made my children feel better.

I really rate these gentle remedies for harrassed mums and dads, so I've just put a pice about them on www.healthandgoodness.com:

http://healthandgoodness.com/babieschildren/biochemic_tissue_salts.htm

Ethical Health

I'm really excited to be associated with www.ethical-junction.org. The site is undergoing a major revamp and I am sponsoring the health section. As well as this, I will be contributing to their newsletter - my first article is entitled "What is ethical health", being a moderator on the health forum and lots more.

I am delighted that the guys behind Ethical Junction recognise how well our beliefs and business practices coincide. This is how they describe what they do:

"Our Network provides information on positively screened ethical companies, organisations, products and services, linking you through to the ethical, environmental and sustainability markets."

Union boss to Fortune 500 CEO's: let's reform health care together

Andy Stern is president of the Service Employees International Union and in today's Wall Street Journal (link good for at least 7 days), he makes the case for moving health care away from the employer-provided model and toward "a universal system that provides affordable coverage, choice of doctors and insurance plans, core benefits, and shared financing among employers, employees and government.

Am I Drinking Enough Water?

It's very hot in England at the moment. Over the weekend John and I cycled on our tandem from our home in Penzance to Fowey, camped for the night and then cycled back. The round trip was over 100 miles. Because it was so hot I was really aware of how much I needed to drink a lot of water, but even when it's not hot and we're not exercising water is still very important. I was talking about it this morning to someone who didn't know how to tell if she was drinking enough water, so I have written an article for her and for people like her:

http://healthandgoodness.com/nutritiondiet/drinking_enough_water.html

Confidence

I've added a new confidence section to Health & Goodness. In general I have lots of confidence, but I know many people don't, so if you are one of these people take a look at thios new section:

http://healthandgoodness.com/symptoms/symptom_confidence.html

SSRN roundup: health law

The 5 top-downloaded health law articles on SSRN:Safe Storage Gun Laws: Accidental Deaths, Suicides, and CrimeYale Law School, Law & Economics Working Paper No. 237John R. Lott Jr. and John E. WhitleyAmerican Enterprise Institute (AEI) and University of Adelaide - School of EconomicsDate Posted:May 22, 2000Last Revised:June 10, 2002Working Paper Series 8966 downloads Abortion and Crime: Unwanted

Capital punishment and organized medicine: still a no-go in Mo.

As reported in this morning's New York Times, U.S. District Judge Fernando J. Gaitan, Jr., previously "had demanded an overhaul of the system after the doctor who now mixes the drugs for the state described an improvised process that Judge Gaitan found so chilling that he temporarily barred executions in Missouri."In a sworn deposition, the Missouri doctor, whose name is being withheld by the

Kids & Exercise

I wish I'd done more to encourage my kids to take exercise when they were young, so I'm delighted to include this article on http://www.sportandme.com on taking your kids hiking:

http://www.sportandme.com/docs/common/children/hiking_with_kids.html

we need to get kids doing more to avoid the obesity epidemic that is developing!

Health Informatics - Konsultasi Email Pasien-Dokter

Sejalan dengan perkembangan teknologi komunikasi informasi dewasa ini, semakin memudahkan komunikasi pasien dengan dokter tanpa harus tatap muka langsung. Telepon, televisi, radio, media cetak, pesan singkat (SMS), situs web/weblog, dan surat elektronik (email) dapat dimanfaatkan untuk memperoleh informasi kesehatan dari sumber-sumber yang dapat dipercaya. Beberapa media juga memberikan fasilitas konsultasi interaktif.

Media komunikasi pasien-dokter yang 'relatif' baru (masih kurangnya penetrasi Internet) di Indonesia adalah surat elektronik. Konsultasi pasien-dokter melalui surat elektronik semakin banyak dilakukan di negara-negara yang memiliki kemudahan akses Internet. Hal ini mungkin terjadi karena kesadaran masyarakat akan pentingnya informasi kesehatan. Dapat juga karena adanya keterbatasan komunikasi pasien-dokter (di ruang praktik) selama ini.

Komunikasi pasien-dokter melalui media ini merupakan suatu upaya diseminasi informasi yang tidak terbatas waktu, tempat dan ruang. Menurut saya, konsultasi pasien-dokter melalui surat elektronik ini pun memiliki beberapa kelebihan dan kelemahan.

Bagi pasien, beberapa kelebihannya yaitu:

• anonimitas; identitas penanya dapat ter-rahasia-kan, terutama diuntungkan jika pertanyaan kesehatan pribadi diungkap melalui milis yang sifatnya terbuka (arsip milis dapat dibaca oleh sesama anggota milis maupun pengunjung Internet lainnya)
• sesuai dengan masalah kesehatan yang ingin diketahui; dibandingkan dengan sekedar mengunjungi situs kesehatan umum yang belum menyertakan fasilitas interaktif
• hemat tempat, waktu, dan biaya; tidak perlu memenuhi tempat antre dokter atau rumah sakit (RS), menunggu antrian dipanggil, dan relatif hemat biaya perjalanan, parkir (kecuali ke warnet), dan biaya konsultasi/pemeriksaan.
• tersedia arsip (disimpan dalam kotak masuk [inbox] atau bahkan dicetak) untuk dapat berbagi informasi bagi yang lainnya

Bagi dokter atau praktisi kesehatan lainnya, kelebihannya yaitu:

• rangsangan tetap belajar (update)
• mampu memberi informasi/konsultasi kesehatan untuk pencegahan dan edukasi ke beberapa orang sekaligus
• dapat berkonsultasi dahulu dengan sesama kolega atau mempertimbangkan kepustakaan lain, sehingga informasi lebih akurat

Beberapa kelemahan bagi pasien:

• kasus hanya yang bersifat non emergensi
• identitas penjawab yang kurang jelas (terutama milis)
• tidak dapat untuk memperoleh diagnosis (karena tidak adanya pemeriksaan fisik/kontak langsung/tatap muka)
• jawaban belum tentu diperoleh segera; sehingga lebih tepat untuk kasus non emergensi
• jawaban belum tentu memuaskan karena tim dokter/moderator/penjawab harus menjawab beberapa masalah sekaligus
• keterbatasan jatah lampiran (attachment)
• privasi dan legalitas yang kadang terabaikan

Beberapa kelemahan bagi dokter atau praktisi kesehatan:

• data/informasi keluhan penyakit atau identitas pasien yang kurang lengkap
• belum adanya panduan standar komunikasi surat elektronik pasien-dokter
• belum adanya legalitas kedokteran/kesehatan yang mengatur komunikasi virtual ini

Apa lagi ya..

Komunikasi cara lain ini tentu dapat memudahkan, tetapi tetap tidak dapat menggantikan sentuhan/kontak langsung pasien-dokter. Pasien pun tidak selamanya dapat menggunakan hasil konsultasi untuk mendukung pengambilan keputusan akan kesehatannya (belum berupa diagnosis), walaupun tetap dapat dimanfaatkan sebagai sebuah opini yang membantu.

Dengan meningkatkan penetrasi Internet di negara kita, antusias masyarakat pencari informasi kesehatan (health seekers) untuk berselancar di dunia maya mudah-mudahan semakin baik. Sehingga orientasi dan kebutuhan akan informasi sehat pun akan mampu meningkatkan derajat kesehatan masyarakat.

Has the Texas legislature made performing abortions a capital offense?

That's the question raised by a recent request for an Attorney General's Opinion (RQ-0501-GA). The literal question posed by David Swinford (R) (chair of the House Committee on State Affairs) is a bit more technical than that, of course:Does a physician’s failure to comply with the requirements of either § 164.052(a)(18) (restricting third-trimester abortions performed on viable unborn children)

Professional Web Sites For Therapists

I wrote an article on http://www.mytherapypractice.com/ about a great web site design and hosting package for therapists:

http://www.mytherapypractice.com/Successful_practice/web_site_package.htm

Maura Barry of Ireland is one of the first to take advantage of this. Her web site is http://www.green-healing.com/, and here's what she told me in an email:

"I found it extremely easy to set up and the help from Michael was fantastic,
he always answered my questions and was extremely nice to deal with. He
helped me through the whole process.

"I would also like to thank you for bringing the package to my attention as I
is extremely expensive to set up a website and difficult when you are not
computer friendly but this was amazingly easy and inexpensive."

I'm really pleased that she's so pleased!

Pain control and end-of-life care are not simply their own reward

Excellence in end-of-life care and pain management are also sometimes rewarded by others, in this case by the AHA, which recently gave nurse practitioner Peg Nelson and St. Joseph Mercy Hospital in Pontiac, MI, its Circle of Life Award (which includes $10,000). This article from the Detroit Free Press has the details of their approach to end-of-life care.

Senate votes to allow drug reimportation by individuals

On Tuesday, the Senate approved (68-32) S. Amdmt. 4548 to H.R. 5441 (Department of Homeland Security Appropriations Act, 2007): "To prohibit the United States Customs and Border Protection from preventing an individual not in the business of importing a prescription drug from importing an FDA-approved prescription drug." As reported by The New York Times on Wednesday, the House is unlikely to

Health Informatics - Diagnosis Related Groups (DRG)

Mahalnya biaya kesehatan dan tidak seragamnya/tidak menentunya prosedur dan biaya pelayanan kesehatan untuk kasus penyakit akut yang sejenis di pusat pelayanan kesehatan terutama rumah sakit (RS) sering dihubungkan dengan perilaku dokter yang membebani pembayaran pasien atas obat/farmasi dan tindakan (bedah, diagnostik/terapi alat-alat canggih) yang sebenarnya tidak perlu.

Di beberapa RS luar negeri kita dapat mengetahui lebih pasti berapa biaya yang akan kita bayar jika kita didiagnosis penyakit tertentu sesuai standar yang ada, bahkan beberapa biaya operasi ditengarai lebih murah.

Dengan menggunakan standar (saat ini) klasifikasi ICD 10 untuk penyakit, dan ICD 9-CM untuk prosedur tindakan, serta data-data demografis dari rekam medis, kemudian dapat ditentukan biaya clinical costing (untuk mengetahui rata-rata tarif pelayanan rawat inap RS; kini banyak tersedia perangkat lunak untuk menghitungnya), perbandingan model DRG negara lain, maka dapatlah sekiranya disusun suatu kode standar tertentu yang menjadi sistem pembayaran RS, sering disebut Diagnosis Related Groups (DRG).

Jadi pasien dengan penyakit akut tertentu, berobat di seluruh RS di Indonesia, jika memerlukan pembedahan atau tindakan tertentu, akan dikenakan prosedur dan beban biaya yang sama karena kelompok-kelompok pasien tersebut memiliki kondisi klinis yang sama dan menggunakan sumber-sumber (pengobatan) yang sama (case-mix).

Hal ini tentu akan mendorong meningkatkan pemahaman masyarakat/konsumen atas pelayanan RS dan paket-paketnya. Standardisasi prosedur dan pengobatan akan meningkatkan pelayanan pasien. Dari segi biaya, tentunya akan lebih efisien serta memudahkan pihak asuransi dan RS dalam pembiayaan dan administrasinya. Informasi komparatif pun tersedia antar RS.

Untuk mengembangkan DRG Indonesia (ID-DRG?), dibutuhkan Sistem Informasi RS (SIRS)/kelengkapan data rekam medis yang memadai, pemantauan kualitas pelayanan melalui clinical pathway, pemantauan biaya melalui clinical costing, penetapan standar kodifikasi dan perangkat lunak yang digunakan. Jika mengadopsi sistem negara lain sebaiknya disesuaikan dengan kondisi di Indonesia.

Tantangan mungkin datang dari rekan-rekan dokter yang terkesan kreativitas atau seninya terbatasi atau bahkan pihak RS yang berisiko menderita kerugian.

Life - Formasi 4-4-2 Tim Impian

Sisa demam piala dunia kemarin menyisakan angan-angan menjadi manajer sepak bola (menurut Kamus Besar Bahasa Indonesia [KBBI], penulisan suku katanya dipisah demikian).

Saya lebih menyukai formasi klasik 4-4-2 (plus kiper [goalkeeper] tentunya) yang fleksibel. Mudah diadaptasi dan disesuaikan saat menyerang, bertahan, maupun saat kehilangan pemain karena kartu merah atau cedera. Formasi ini menggunakan 4 pemain belakang/bertahan (defenders), 4 pemain tengah (midfielders) dan 2 penyerang depan (forwards). Pemain bertugas menjaga zona masing-masing. Menurut saya, formasi ini juga terasa pas/terbagi rata di lapangan yang berbentuk kotak/persegi.. :D. Lebih baik memiliki stok pemain yang mampu bermain lebih dari 1 posisi untuk memudahkan rotasi.

Pemain belakang/bertahan terdiri dari 2 bek tengah (centre back/central defenders) dan 2 bek sayap (wing back/right-left defenders). Paling tidak memiliki karakteristik agresif, akselerasi, mampu bertarung di udara (heading yang baik, badannya tinggi besar, misalnya Marco Materazzi, Sol Campbell, Lilian Thuram) dan satunya lincah memblok serangan, menjaga pergerakan lawan (marking) dengan ketat (misalnya Rio Ferdinand, Fabio Cannavaro, Alessandro Nesta). Pemain belakang sayap kanan dan kiri selain bertahan juga mampu memberikan suplai umpan (passing dan crossing) melalui pergerakan sepanjang tepi lebar lapangan. Hal ini membantu kerja pemain sayap tengah dan memudahkan determinasi pemain untuk saling mengisi kekosongan zona yang ditinggalkan saat menyerang. Bek sayap tentunya harus memiliki stamina dan kecepatan yang baik untuk mendukung serangan sekaligus juga bertahan (pilihan saya jatuh pada Roberto Carlos, Phillip Lahm [bek kiri], Cafu, Gianluca Zambrotta [bek kanan]).

Lapangan tengah terdiri dari 2 pemain tengah (central midfielders) dan 2 sayap (right-left winger/midfielders). Saya lebih menyukai tipe pemain tengah yang memang berperan sentral (central midfielder) dengan karakter kemampuan mengolah/menggiring bola (dribling) yang tinggi, didukung umpan (passing) yang baik, kepemimpinan, dan kreativitas yang mumpuni seperti Zinedine Zidane. Bisa juga diisi pemain tengah bertahan (defensive midfielder centre) seperti Steven Gerrard, Patrick Vieira atau pemain tengah menyerang (attacking midfielder centre) seperti Pavel Nedved, Frank Lampard, Kaka dan yang dapat menjadi penyerang depan seperti Ronaldinho dan Andrea Pirlo. Pemain tengah seperti ini biasanya memiliki posisi sebagai kapten tim. Pemain sayap tengah memiliki karakter serupa wing back, mampu mendukung zona depan sekaligus turun bertahan. Saya memilih pemain seperti Cristiano Ronaldo, David Beckham (sayap kanan), Franc Ribery, Arjen Robben (sayap kiri).

Dua penyerang depan (forwards) haruslah saling melengkapi. Yang satu sebagai second striker berposisi agak di belakang penyerang utama, dapat berpostur kecil, lincah, cepat, pengumpan yang akurat dalam melihat peluang (seperti Lukas Podolski, Del Piero, Robinho, Wayne Rooney) tapi juga dapat menyelesaikan peluang menjadi gol saat penyerang utama dijaga ketat. Tipe penyerang lainnya adalah saya tempatkan sebagai striker murni, berbadan tinggi besar (untuk pertarungan udara), dan tidak kalah gesit (seperti Adriano, Miroslav Klose, Thierry Henry, Luca Toni, Andriy Shevchenko).

Untuk kiper, Gianluigi Buffon dan Dida mantap di bawah mistar gawang.

Saat menyerang, formasi dapat beradaptasi, misalnya menjadi 4-3-3, 4-4-1-1, 4-2-4, 4-3-1-2. Saat bertahan, formasi menjadi 4-1-3-2, 5-3-2, 4-2-2-2, 4-5-1, 5-4-1. Walaupun cenderung bertahan, formasi bertahan ini dapat pula digunakan menyerang tergantung komposisi pemain yang kita miliki.

Health Info - Bulan Pertama

Berikut pengalaman pribadi bersama si kecil yang kini berusia 2 bulan:

Menangis
Biasanya karena lapar, buang air kecil/besar (popok basah), kaget (bising, lampu), kedinginan, gerah kepanasan, belum sendawa (setelah minum biasakan sendawakan bayi anda, jika tidak, kadang ia akan gelisah karena lambungnya terasa belum nyaman).
Jika tetap menangis, selimuti bayi (bedong) lalu peluk dan dekap erat (mummy wrap). Pertimbangkan kolik (dibahas berikutnya) jika tangisnya tidak mereda.

Minum susu
ASI tetap yang terbaik. Biasanya bayi yang menyusu akan minum setiap 2 jam, karena ASI lebih cepat terserap. Bayi minum susu formula setiap 3 jam. Jika diberi susu tambahan, perhatikan petunjuk pembuatan susu tambahan/formula pada masing-masing kemasan yang disesuaikan dengan berat bayi. Tinggikan posisi kepala sekitar 30 cm dan rajin menyendawakannya. Setelah minum, biarkan posisi kepalanya agak tinggi sebentar hingga ia merasa nyaman untuk tidur terlentang (Tidur telungkup? Dibahas berikutnya). Jika gumoh (reflux/regurgitasi)/seperti muntah, jangan panik, miringkan ke kanan.

Kolik
Sekitar 20% bayi, terutama sekitar usia 3 minggu, dikatakan sering menderita kolik (kejang/kram perut) tanpa diketahui pasti sebabnya. Dekapan dan usapan minyak telon dapat membantu.

Buang air
Saat baru lahir, kotoran bayi akan berwarna hitam kehijauan dan agak lengket (disebut mekonium) hingga seminggu sesudahnya. Berikutnya akan berwarna kekuningan dan agak cair (bukan diare). Kotoran bayi menyusu akan berwarna lebih muda dan lebih cair serta frekuensinya lebih jarang (ASI lebih mudah dicerna) dibanding bayi yang minum susu formula, dimana kotorannya lebih padat, kecoklatan. Buang air kecilnya minimal 6-8 kali ganti popok sehari.

Tali pusar
Tali pusarnya tidak dibungkus seperti dulu, tapi dibiarkan terbuka (kontak udara) dan dijaga dalam keadaan kering. Jika perlu cukup dibersihkan dengan sedikit alkohol saja (waspadai alkohol jangan sampai menyentuh kulit perut, kadang mengakibatkan kemerahan untuk kulit sebagian bayi yang sangat sensitif). Pusarnya lepas tepat seminggu (dengan alkohol, mungkin lebih lama).

Kuning
Kondisi ini dapat terjadi pada minggu pertama si bayi (sering terjadi setelah pulang dari tempat bersalin, sehingga belum terdeteksi). Kulit dan bagian putih matanya nampak kuning di bawah penerangan sinar matahari yang cukup. Karena hati (hepar/liver) bayi belum berfungsi sempurna (ini keadaan normal pada bayi cukup bulan), zat kuning (bilirubin) hasil olahan darah belum berhasil dikeluarkan dengan baik oleh bayi. Manfaatkan kunjungan dalam minggu pertama bayi ke dokter untuk mengenali penyebab naiknya kadar bilirubin. Usahakan bayi minum ASI secara cukup. Waspadai penyakit kuning (ikterus) yang lebih serius karena dapat mengganggu fungsi otak.

Jerawat
Secara normal, ini dapat disebabkan oleh hormon ibunya. Sering kali tidak memerlukan pengobatan dan dapat hilang sendiri dalam hitungan 1-2 bulan.

Keputihan
Bayi perempuan dapat mengeluarkan cairan putih dari vaginanya. Ini juga normal karena pengaruh hormon ibunya dan dapat hilang sendiri.

Berat badan
Pada 4-5 hari pertama, biasanya berat badan bayi akan turun, tetapi dapat naik kembali pada minggu berikutnya. Terutama jika ASI mulai lancar.

Payudara
Karena pengaruh hormon ibunya, payudara bayi baru lahir dapat tampak agak besar.

Bedong
Untuk membungkus bayi agar hangat, tetapi jangan terlalu ketat sehingga menghambat gerakannya. Secara ilmiah tidak berhubungan dengan kaki bengkok.

Popok
Gantilah popok setiap si kecil buang air. Biarkan kontak udara sebentar sebelum dikenakan popok ganti. Asam tinja dapat membuat kulit si kecil iritasi (ruam popok). Salep yang mengandung zinc oxide dapat meredakannya. Gunakan popok sekali pakai (diapers) untuk saat tertentu saja (misalnya saat bepergian).

Memotong kuku
Potonglah kukunya dengan gunting khusus bayi. Basahi sedkit dengan kapas hangat untuk melunakkannya/lakukan setelah mandi dan saat si kecil tertidur atau dalam kondisi tidak banyak bergerak.

Tidur
Tidur terlentang ataupun telungkup sama saja. Memang kadang tidur telungkup lebih nyaman buat si kecil. Untuk melatih otot-otot leher dan perut, baik tidur telungkup, tetapi tetap diawasi agar pernapasannya tidak terganggu (SIDS/Sudden Infant Death Syndrome).

NYC unveils pandemic preparedness plan

From today's CDC Public Health Law News:"City unveils a plan to identify, and contain, a flu pandemic" -- The New York Times (07/11/06) Diane Cardwell [link]New York City Mayor Michael R. Bloomberg and city health commissioner Thomas R. Frieden this week announced a new plan to address avian influenza preparedness. The plan details the steps for identifying and containing an outbreak and

Senate stem-cell vote set for next Tuesday

Laurie Kellman of The Washington Post has the story on the upcoming Senate vote on three stem-cell research bills, which were first discussed here two weeks ago:The Senate will vote next week on three bills related to stem-cell research, including a measure that would expand federal funding for a procedure that uses and destroys human embryos in the drive to cure diseases that afflict millions of

Triathlons

as many of you know I'm a keen cyclist - I rode across America on my bike two years ago! Once I did a novice triathlon - swim, bike and run. I enjoyed it but have never repeated it.

It's interetsing to read in the paper that triathlons are the "in" sport now, so I've been putting more articles on this demanding sport on http://www.sportandme.com.

The latest one is "Ironman Triathlon-Run Equipment Choices" by Ray Fauteux. He offers lots of excellent, down-to-earth advice for the novice traithlete.

http://www.sportandme.com/docs/sports/triathlon/guide/ironman_equipment.html

The current issue of Health Affairs is dedicated to public health. There are some terrific articles, but I particularly commend these:Can Public Health And Medicine Partner In The Public Interest? [link]J. Michael McGinnisAbstract: The dominant issues for health and health care today can be effectively engaged only if public health and medicine work together as better partners. Yet historical,

Golf and weight training

I've never understood the delights of playing golf - I prefer to go out on my bike - but I know there are lost of epople who do, so I've posted another golf article on http://www.sportandme.com:

http://www.sportandme.com/docs/sports/golf/guide/golf_weight_training.html

NH court: Doc has 1st Amendment right to be a jerk

As reported by the Associated Press, New Hampshire judge Edward Fitzgerald "has ordered the state Board of Medicine to stop disciplinary proceedings against a doctor accused of telling a patient she was so obese she might only be attractive to black men and advising another to shoot herself following brain surgery." The article reports that Terry Bennett, M.D., says "he planned to sue everyone

Water Rowers

Some ears ago I bought a water rower, and it really is great. Close your eyes and think you'r eon a river.

Antony Wilton agrees with me, so I've included his article "Water Rower, Like A Cruise Down The River Without Getting Wet" on http://www.sportandme.com:

http://www.sportandme.com/docs/sports/rowing/guide/water_rower.html

Many hospice patients live longer than expected

Terrific story (via Kaiser Family Foundation's Daily Health Policy Report) about hospice:McClatchy Newspapers/St. Paul Pioneer Press on Wednesday examined how some patients who check into hospices believing they are near death later go on to recover and leave hospice care. For Medicaid and Medicare beneficiaries to cover hospice care, the patient's doctor and the hospice's doctor must agree that

HPV debate moves to the states

On June 30 Stateline.org published a useful summary of the issues surrounding the recently recommendation from the CDC's Advisory Committee on Immunization Practices that all 11- and 12-year-old girls receive the vaccine for the most dangerous strains of human papillomavirus (HPV), which causes cervical cancer. As a public health matter, the advisory committee's recommendation is pretty

NEJM Perspective on Roe

There's an excellent (and free) article on Roe and partial-birth abortion in this week's New England Journal of Medicine. The authors leave no room for doubt as to their position on legal abortions, including late-term procedures, but their article is no more polemic: it's reasoned and supported by data and careful argument, ending with these four paragraphs:Watson Bowes, emeritus professor of

emotions and biology

I've just posted two interesting articles by Tom Harrison on http://www.mytherapypractice.com:

Depression & Obesity Go Hand in Hand
by Tom Harrison
People who are "fat but happy" are likely the exception rather than the rule. Read more on this at:
http://www.mytherapypractice.com/psychology_emotions/depression_obesity.html

and

Early Childhood Neglect Leaves Biological Mark
Children who are deprived of a loving caregiver in their early years may experience abnormal activity of vasopressin and oxytocin, two hormones essential to forming social bonds and achieving emotional intimacy. Here's the full article:

http://www.mytherapypractice.com/psychology_emotions/early_childhood_neglect.htm

Health care costs going up by 9.6%

An article in today's Wall Street Journal (click here - link should be good for about a week) reports that "Americans should expect to pay more for medical costs whether they are employed or retired, according to two new studies. The reports, by Milliman Inc. and Watson Wyatt Worldwide, show that health-care costs are still rising at a fast pace -- despite slowing from double-digit rates in

Happy 4th of July

There's something really stirring about listening to the news-readers and commentators on NPR read the Declaration of Independence every 4th of July. If you missed it this morning, click here.For some Independence Day fun, check out the National Archives' Charter of Freedom exhibit, where you'll find some interesting information about the signers (for example, 24 of the 56 signers were lawyers) [

Garry Trudeau on creationism

[click for larger view]