INFERTILITAS DAN PERAN PERAWAT

Oleh : Atun Raudotul Ma’rifah, S.Kep.,Ns *

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Keperawatan maternitas merupakan pelayanan keperawatan profesional yang meliputi pemberian asuhan keperawatan pada klien dengan masalah reproduksi, diantaranyamengenai infertilitas. Masalah ini sangat menakutkan bagi pasangan yang menginginkan keturunan, dan masalah ini menjadi lebih kompleks karena melibatkan semua aspek biopsikososial spiritual, sehingga perlu managemen yang baik, yang mampu mengurangi tingkat stress pada pasangan yang mengalaminya. Hal ini merupakan tugas dan peran perawat dalam pelayanannya.

Insiden
Memperoleh anak sering menjadi pilihan yang perlu pertimbangan, banyak pasangan yang menghentikan penggunaan kontrasepsi dan ingin hamil setelah 5-6 bulan intercourse tanpa kontrasepsi. 70-80 % wanita bisa hamil tetapi 15 % wanita tidak bisa hamil.
Angka pasangan infertil meningkat dalam beberapa tahun ini sekitar 10-15 %. Normalnya pasangan dapat hamil dalam 6 bulan 60 %, dalam 2 bulan pertama 25 %, 75 % dalam 9 bulan, 80 % dalam satu tahun, 90 % dalam 18 bulan.

Definisi
Infertilitas : tidak terjadi konsepsi dalam satu tahun intercourse tanpa kontrasepsi
Infertilitas primer : tidak pernah terjadi kehamilan
Infertilitas sekunder : telah mengalami sekali kehamilan tetapi dalam waktu berikutnya tidak pernah terjadi lagi
Infertilitas relatif ; suatu kondisi yang menghalangi atau menunda kehamilan, tapi masih bisa dikoreksi
Steril ; tidak pernah terjadi konsepsi dan disebabkan oleh faktor yang tidak bisa diperbaiki

Efek Psikologis
Spesialis infertilitas harus waspada dan peka terhadap stress psikologis yang berhubungan dengan infertilitas. Harapan dari keluarga dan teman, hilangnya harga diri yang berhubungan dengan ketidakmampuan untuk memenuhi fungsi dasar ini. Stress yang berkaitan dengan hubungan perkawinan dan seksual, dan ketidakmampuan pasangan itu untuk merencanakan kehidupan pribadi dan kariernya semua ikut memberi dampak emosional pada keadaan itu. Pada saat yang sama, pasangan dapat ditentramkan bahwa selain efek pada libido dan kadang-kadang anovulasi yang berlangsung singkat, tidak terbukti adanya efek tekanan psikologis yang bermakna pada fertilitas. Hubungan suportif dengan dokter, pembahasan yang gamblang mengenai sifat berbagai terapi yang kadang-kadan lama, harapan yang realistik terhadap prognosisnya, dan keikutsertaan dalam kelompok pendukung misalnya pemecahan masalah, semua membantu pasangan ini untuk menyesuaikan diri terhadap keadaannya.

Penilaian Dasar
Evaluasi dan terapi dapat dimulai lebih awal bila cacat yang nyata dikenali, atau evaluasi dan terapi itu dapat ditunda, contohnya bila dikenali adanya faktor coitus (senggama) yang dapat dikoreksi, misalnya jarang berhubungan seksual. Biasanya 6 sampai 8 bulan pertama dari evaluasi radiologik untuk keadaan tuba yang patent (Histerosalpingogram/HSG).

Prognosis
Tanpa terapi, angka konsepsi spontan menurun pada pasangan yang tak subur. Karena itu, terapi ditujukan untuk meningkatkan angka itu disamping kemungkinan konsepsi, sayangnya, sebagian besar regimen terapeutik didasarkan pada pengalaman klinik kolektif dan bukan percobaan klinik terkontrol. Dengan evaluasi yang menyeluruh dan penerapan jenis terapi saat ini dengan pembuahan in vitro (INF) atau transfer ovum, 50 sampai 60 % pasangan yang tak subur akan mengalami konsepsi. Dengan penggunaan teknik yang belakangan ini secara penuh diharapkan bahwa sebagian besar pasangan yang mencoba semua metode terapi yang tersedia akhirnya akan berhasil.

PERAN PERAWAT DALAM MANAGEMENT INFERTILITAS

Pengkajian Keperawatan
Ketidakmampan terjadinya kehamilan biasanya berhubungan dengan abnormalitas anatomi dan fisioloi sistem reproduksi. Dalam investigasi perlu pemeriksaan dari kedua pasangan. Ketika pasangan infertil butuh perawatan maka perawatan ini harus diberikan pada keduanya agar tidak timbul perasaan bersalah terhadap pasangannya. Keduanya perlu devaluasi secara sistematis terpadu dan dengan sikap empati.


Penyelidikan awal
Kriteria umum infertil adalah terjadinya konsepsi dalam satu tahun intercourse tanpa kontrasepsi. Pasangan muda yang beresiko tinggi infertil diantaranya ada riwayat STDs endometriosis.
Infertilitas komprehensif meliputi pemeriksaan pada semua faktor termasuk konsepsi dan pengkajian anatomi fisiologi reproduksi kedua pasangan meliputi hal-hal berikut :
- koordinasi hipotalamus-pituitary-ovarium
- fungsi tuba fallopi
- keadaan cervik dan endometrium
- koordinasi hypotalamus-pituitary-testis
- produksi dan mortilitas sperma
Frekuensi dan tehnik coitus serta tingkat emosi tiap pasangan harus dipertimbangkan dalam mengevaluasi fertilitas

Interview
Pasangan yang pada tahap awal evaluasi infertil sering merasa sangat ketakutan, anxietas dan merasa malu bahwa ia tidak bisa hamil, atau malu karena untuk mengatasi masalahnya mereka akan membicarakan hubungan intim mereka dengan perawat dan pasti akan dilakukan pemeriksaan organ reproduksi. Sehingg dalam wawancara, perawat harus mampu memotivasi klien sehingga tercipta suasana kooperatif dengan tidak menghakimi dan tetap empati.

Pengkajian fertilitas pria
Masalah yang berhubungan dengan jumlah produksi sperma dan mortalitas, 35-40 % menjadi faktor yang mempengaruhi timbulnya infertilitas dalam semua kasus. Dari literatur lain dikatakan bahwa infertil yang terjadi dari faktor pria seitar 40-50 %

Pemeriksaan fisik
Abnormalitas alat genital pria menunjukkan adanya kemungkinan yang menyebabkan menurunnya jumlah sperma dan motilitas yang menjadikannya sebagai penyebab infertil.
Abnormalitas fisik yang mungkin adalah sebagai berikut :
- Cryptorchidsm (testis tidak turun)
- Hypoplasti testis
- Atropi testis
- Varicocele (varices vena scrotum)
- Riwayat hernia
- Kelainan struktur lain (genitourinary, endokrin immunologi)
Analisa semen
Pemeriksaan lab semen penting untuk mengetahui adanya infertilitas. Penjelasan yang akurat pada klien dapat mencegah kesalahan hasil test. Spesimen diambil dari “fresh ejaculate” melalui masturbasi setelah periode pantang 2-3 hari. Spesimen yang baru diambil, langsung dimasukkan ke wadah kaca kering dan bersih lalu segera bawa ke lab. Dan langsung diperiksa. Petugas lab harus mengetahui waktu pengambilan spesimen karena cairan semen akan menggumpal segera setelah ejakulasi antara 20-30 menit.
Spesimen yang dianalisa meliputi volume, densitas, motilitas, morfologi abnormal, leukosit dan bakteri seharusnya tidak terdapat spesimen. Keadaan normal harus didasarkan pada sekurang-kurangnya dua spesimen dan penaksiran yang tepat pada spesimen yang abnormal membutuhkan sekurang-kurangya tiga analisa, sehingga perlu penilaian ulang secara berkala. Sesuai interval spermatogenesis 60-90 hari.
Berkurangnya volume sperma merupakan indikasi dari kurangnya konsentrasi sperma volume <>60 % sperma hidup harus bergerak aktif pada 2 jam setelah ejakulasi, sperma hidup yang tidak bergerak, tidak mampu melakukan penetrasi ke telur yang siap dibuahi
Bentuk normal (kepala ganda, bentuk immature), jika 40 % dari jumlah total sperma tidak normal, berarti ada kesalahan saat spermatogenesis
Azoospermia, tidak ada sperma saat ejakulasi


Nilai normal analisa semen
Volume
Jumlah
Motilitas

Leukosit
Bakteri
PH
Morfologi
2-5 ml
> 20 juta/ml
> 60 % setelah 1 jam
> 50 % setelah 2 jam
Tidak ada
Tidak ada
7,2-7,8
< 40 % dari total Pemeriksaan Fertilitas wanita Faktor pada wanita yang menyebabkan infertil sebesar 40-50% dan sebetulnya pengaruh wanita terhadap fertilitas jauh lebih kompleks dibanding pria. Pemeriksaan fisik Faktor yang mempengaruhi fertilitas sebagai berikut : 1. Proses penyakit (gangguan tyroid, diabetes, hipertensi, infeksi, heart disease 2. Status nutrisi dan rasio lemak tubuh, < 10 % indikasi malnutrisi yang dapat menyebabkan anovulasi (green et al, 1998) Pemeriksaan pelvis menunjukkan adanya masalah reproduksi · Massa pada ovarium kista · Tenderness pelvis sebagai tanda infeksi kronis subakut, lakukan screening terhadap chlamydia dan gonorrhea · Adanya nodul sepanjang ligament uterosacral, retrofleks uterus sering dihubungkan dengan endometriosis · Kelainan cerviks sebagai akibat terpaparnya uterus leh diethystil bestrol estrogen non steroid buatan yang telah digunakan secara luas untuk mencegah kegugran · Cervicitis atau dysplasia cervi dapat menurunkan jumlah dan kualitas mukus cervik Pengkajian ovulasi Kegagalan ovulasi merupakan salah satu penyebab infertil 20 % dari semua masalah reproduksi, wanita usia diatas 35 tahun, pola dan kualitas ovulasi menurun dan menjadi pendukung terhambanya dan mengurangi fertilitas. Untuk mengetahui efektivitas ovulasi yang harus dikaji adalah sebagai berikut : 1. Riwayat menstruasi, siklus tidak teratur, amenorrhea menunjukkan ovulasi jarang terjadi, disfungsi koordinasi hipotalamus-pituitary-ovarium 2. Pemeriksaan mukus serviks Test diagnostik ovulasi 1. Kadar progesteron pada fase lutheal biasanya 10 mg/ml dalam siklus memungkinkan terjadi konsepsi kadar 5 mg/ml menunjukkan aktivitas ovulasi 2. Biopsy endometrium, perubahan hormonal dan struktur secara progresif setelah ovulasi Pengkajian uterus Keadaan uterus berhubungan erat dengan fungsi ovulasi. Endometrium harus sesuai dengan pola hormonal dan struktur uterus harus bisa menjadi tempat implantasi dan pertumbuhan embrio. Masalah yang berhubungan dengan uterus sebagai berikut : 1. Asherman’s syndrome, infksi kronis pada uterus akibat kehamilan, sering melakukan aborsi, riwayat curret therapeutik maupun evaluasi 2. Tumor benigna fibroid, perubahan cavum uteri dan menghambat implantasi dan perkembangan kehamilan 3. Kelainan bentuk kongenital, meliputi kelainan ukuran dan bentuk uterus, tuba dan vagina dapat dikoreksi dengan pembedahan. Pengkajian tuba · Jaringan parut akibat infeksi, gonorrhoe salpingitis akut, chlamydia, infeksi pelvis non spesifik, infeksi yang berhubungan dengan penggunaan alat intrauterin, kista ovarium, peritonitis dari ruptur appendix · Endometriosis, kondisi dimana jaringan endometrium terdapat di cavum peritonium Test Diagnostik untuk kelainan tuba 1. Hysterosalpingogram, prosedur dengan x-ray untuk mengetahui penyebab yang menghalangi tuba 2. Laparoscopy melihat bagian uterus dengan hysteroscope atau laparoscope, selain itu dengan test ini kita dapat melihat area pelvis. Tumor fibroid, serta kelainan uterus yang lain Pengkajian serviks Jumlah dan kejernihan lendir dengan spinbarkeit, PH normal 6,5 Uji sims Huhner, pasca coitus 2-4 jam untuk menilai jumlah dan pergerakan spermatozoa Faktor penghambat fertilitas nonmedis 1. lubricant, mungkin menghambat motilitas sperma atau bahkan bersifat spermisid (hatcher et al.,1994) 2. Pembilasan vagina postcoital. Oleh karena itu wanita dianjurkan untuk berbaring telentang selama 5 menit setelah coitus untuk mencegah hilangnya semen secara cepat dari vagina 3. Ejakulasi prematur dapat mencegah semen mencapai serviks. Ejakulasi prematur ini merupakan hal yang memalukan dan dapt menyebabkan frustasi bagi pria, hal ni dapat diatasi dengan latihan khusus dan posisi alternatif untuk coitus 4. faktor psikogi, pekerjaan, keuangan, stress, depresi, fatique, mungkin dapat menurunkan fertilitas. Stress dan frustasi serta anxietas menghambat terjadinya ovulasi 5. Masalah fisik yang dapat mencegah intercourse (vaginismus), al ini masih bisa diperbaiki 6. Kurang pengetahuan tentang seksualitas dan anatomi fisiologi juga dapat mengganggu fertilitas. Penting bagi perawat untuk memberikan pendidikan keehatan bagaimana meningkatkan kemungkinan konsepsi alami. Asuhan keperawatan pada pasangan infertil Tujuan Asuhan Keperawatan :
1. Mendapatkan pengkajian lengkap melalui observasi perilaku, catatan dan wawancara
2. Memberikan penjelasan yang sangat dibutuhkan, pada keadaan infertil dan kebebasan memilih pertolongan/bantuan
3. Mengatasi kecemasan klien dengan memberikan informasi dan support emosioanal
Catatan : Ketika usaha sudah maksimal, tetapi Alloh belum memberikan amanah kepada qta, yakinlah bahwa ada hikmah dibalik semua itu. Luangkan sejenak waktu untuk membaca kisah ibunda kita St Aisyah, siapapun tak akan meragukan kesholehannya. Bukankah dia pun tidak mempunyai keturunan…….??, dan itu tidak mengurangi kemuliannya, tidak mengurangi kesempurnaannya sebagai seorang perempuan, ummul mukminin qta. setiap kita ada kekurangannya, dan itu tidak masalah. Toh didunia ini kalaupun bahagia tidak 100%, dan sengsarapun tidak 100 %, bahagia yang seutuhnya nanti di surga dan seburuk-buruk sengsara nanti di neraka. Dan yakinlah bahwa Alloh itu maha Adil, Mungkin kita dipermudah dalam rijki yang lain, misalnya punya pekerjaan yang baik, pasangan yang nyaah (bhs: sunda artinya sayang yang begitu mendalam), keluarga yang baik, bersykurlah atas semua itu niscaya kita tetap bahagia. Wallohu a’lam
* Penulis adalah dosen Maternitas di Stikes Harapan Bangsa, dan saat ini tercatat sebagai mahasiswa pasca sarjana Universitas Indonesia (PS 08), beliau bisa dihubungi di r4ud0h@ yahoo.co.id Daftar Pustaka Hamilton, Mary. Dasar-dasar keperawatan maternitas, Edisi 6 1995. EGC Jakarta Reedr, J Sharoon, Martin, L. Leonide Griffin. Maternity nursing 18 th edition lippincott Berbagai sumber lainnya.

KAMPUS KU INSPIRASI KU

" Senyum kebahagaian Kami "

"Donor darah adalah wujud kepedulian kami kepada masyarakat"

"Bermusik adalah salah satu bagian dari kami"

"Pramuka adalah wujud rasa kerjasama dan saling membantu antar sesama"

brosur

Materi 1
Coffee may protect against oral cancers
Reuters HealthTuesday, January 6, 2009
By Megan Rauscher
NEW YORK (Reuters Health) - New research indicates that drinking coffee lowers the risk of developing cancer of the oral cavity or throat, at least in the general population of Japan.
The consumption of coffee in Japan is relatively high, as is the rate of cancer of the esophagus in men. To look into any protective effect of coffee drinking, Dr. Toru Naganuma of Tohoku University, Sendai, and colleagues, analyzed data from the population-based Miyagi Cohort Study in Japan.
The study included information about diet, including coffee consumption. Among more than 38,000 study participants aged 40 to 64 years with no prior history of cancer, 157 cases of cancer of the mouth, pharynx and esophagus occurred during 13 years of follow up.
Compared with people who did not drink coffee, those who drank one or more cups per day had half the risk of developing these cancers, Naganuma's group reports in the American Journal of Epidemiology.
They note that the reduction in risk included people who are at high risk for these cancers, namely, those who were current drinkers and/or smokers at the start of the study.
"We had not expected that we could observe such a substantial inverse association with coffee consumption and the risk of these cancers," Naganuma commented to Reuters Health, "and the inverse association in high-risk groups for these cancers as well."
The researchers conclude in their article, "Although cessation of alcohol consumption and cigarette smoking is currently the best known way to help reduce the risk of developing these cancers, coffee could be a preventive factor in both low-risk and high-risk populations."
SOURCE: American Journal of Epidemiology, December 15, 2008.

Materi 2
Insomnia Costs Billions in Lost Productivity
Canadian study hints at huge costs here in the United States
HealthDayThursday, January 1, 2009
TUESDAY, Dec. 30 (HealthDay News) -- Sleepless nights are costing the small Canadian province of Quebec, population 7 million-plus, more than $6.5 billion annually, new research shows.
No doubt, sleepless nights from Seattle to Tampa are costing the United States, population 300 million-plus, much more.
Susan Zafarlotfi, clinical director of the Institute for Sleep and Wake Disorders at the Hackensack University Medical Center, said that the costs detailed in the Canadian study likely underestimate the costs of insomnia in the United States by a wide margin.
"One of the issues that exists in our society, unlike European and Canadian societies, is that we do not have the habit of talking about anything that happens in the privacy of the bedroom including insomnia," she said.
Insomnia becomes a secondary diagnosis, discovered only while physicians treat other, related disorders such as anxiety and depression. And that means many costs aren't being factored into current estimates.
Also, the "insomnia syndrome" that the Canadian researchers mention does not actually exist in the U.S. medical lexicon, which is related to the fact that insomnia in the United States is not a primary diagnosis and is not recognized by many insurance companies, Zafarlotfi explained.
The lion's share of the costs in the Canadian study -- $5 billion, or 76 percent of the total -- come from insomnia-related work absences and reduced productivity. The report was published in the Jan. 1 issue of Sleep.
The information is not necessarily new or surprising but quantifying the problem does highlight its magnitude, said Dr. Donald Greenblatt, director of the Strong Sleep Disorders Center at the University of Rochester Medical Center, in New York.
According to background information in the study, some 6 percent to 10 percent of the population have "insomnia syndrome," while about one-third experience symptoms of insomnia at some point.
And the study authors, from Universite Laval in Quebec City, noted that insomnia remains largely an untreated problem.
These investigators analyzed information from questionnaires filled out by 948 adults in Quebec, as well as health data from the Quebec government.
The total annual direct and indirect costs of insomnia in the province came to an estimated $6.6 billion in Canadian dollars.
Direct costs included $191.2 million for doctors' visits, $36.6 million for transportation to and from these visits, $16.5 million for prescription drugs, $1.8 million for over-the-counter remedies, and a whopping $339.8 million for alcohol used as a sleep aid.
Eight percent of individuals in the study, average age almost 44 and 60 percent female, reported having used alcohol to fall asleep, including 28 percent of those with insomnia symptoms or syndrome.
Loss of productivity amounted to $5 billion, or 27.6 days per year, for people with insomnia syndrome and 6.2 days a year for those with symptoms.
Job absenteeism racked up $970.6 million in indirect costs, or 4.36 days missed per year, for people with insomnia syndrome.
Absenteeism and lost productivity totaled almost $6 billion and represented 91 percent of all costs.
The average per-person cost including both direct and indirect losses were $5,010 for people with insomnia syndrome and $1,431 for those with symptoms of insomnia and $421 for "good sleepers."
"Sleep should be considered part of the big triangle of life, with diet and exercise," Greenblatt.
How much is enough sleep? While most people end up in the seven-to-nine-hour range, said Greenblatt, rumor has it that Thomas Edison got by with three or four hours a night, while Albert Einstein "got by" with 10 or 11.
"There seems to be an optimum sleep requirement for each person. To say we all need eight hours of sleep is the same as saying we all need size-11 shoes," Greenblatt said. "We need to figure out what our own sleep requirements are."
HealthDayCopyright (c) 2009 ScoutNews, LLC. All rights reserved.

Materi 3
Teens are influenced by health risks of smoking
Reuters HealthWednesday, December 31, 2008
By Amy Norton
NEW YORK (Reuters Health) - Teenagers who underestimate the risks of smoking -- or overestimate the social value -- are substantially more likely than their peers to take up the habit, a new study suggests.
Researchers found that among 395 high school students they followed for two years, those who thought the health risks of smoking were fairly low, or the social benefits fairly high, were about three times more likely than their peers to start smoking.
The fact that these perceptions influence teenagers' likelihood of smoking makes sense, but until now it hadn't been clear whether this was the case.
"This is the first paper that really shows that perceptions truly predict behavior," senior researcher Dr. Bonnie L. Halpern-Felsher told Reuters Health.
The findings also show that teens' ideas about the long-term and short- term consequences of smoking are equally important, said Halpern-Felsher, an associate professor of pediatrics at the University of California, San Francisco.
Heart disease, lung cancer and chronic respiratory conditions are among the major long-term risks of smoking, while shorter-term problems include chronic cough, a higher risk of colds and social hassles like smelling like smoke.
In this study, teens who thought they had little chance of developing any of these types of problems were three to four times more likely to start smoking.
The findings suggest that anti-smoking messages aimed at teenagers should address the short-term risks, as well as the long-range ones, Halpern-Felsher and her colleagues report in the American Journal of Public Health. []
They note that the more immediate consequences of smoking -- even something as minor as "bad breath" -- may carry greater weight with teenagers than the health risks down the road.
The study also points to the importance of kids' ideas about the social benefits of smoking -- such as the notion that smoking will make them "look cool," Halpern-Felsher said, or feel more relaxed.
Adults shouldn't deny that smoking has social value among teenagers, she noted, but should instead help kids find other ways to get the social benefits they want.
SOURCE: American Journal of Public Health, online December 23, 2008.

Materi 4
Many Teens Don't Keep Virginity Pledges
Pledgers are also less likely to use birth control, study finds
HealthDayMonday, December 29, 2008
MONDAY, Dec. 29 (HealthDay News) -- Teens who take virginity pledges are just as likely to have sex as teens who don't make such promises -- and they're less likely to practice safe sex to prevent disease or pregnancy, a new study finds.
"Previous studies found that pledgers were more likely to delay having sex than non-pledgers," said study author Janet E. Rosenbaum, a post doctoral fellow at the Johns Hopkins Bloomberg School of Public Health. "I used the same data as previous studies but a different statistical method."
This method allowed Rosenbaum to compare those who had taken a virginity pledge with similar teens who hadn't taken a pledge but were likely to delay having sex, she said. She added that she didn't include teens who were unlikely to take a pledge.
"Virginity pledgers and similar non-pledgers don't differ in the rates of vaginal, oral or anal sex or any other sexual behavior," Rosenbaum said. "Strikingly, pledgers are less likely than similar non-pledgers to use condoms and also less likely to use any form of birth control."
The findings were published in the January issue of the journal Pediatrics.
For the study, Rosenbaum collected data on 934 high school students who had never had sex or had taken a virginity pledge. The data came from the National Longitudinal Study of Adolescent Health.
Rosenbaum matched students who had taken a virginity pledge with those who hadn't. After five years of follow-up, those who had taken a pledge did not differ from teens who hadn't taken a pledge in rates of premarital sex, oral or anal sex, or sexually transmitted diseases.
Teens who had taken a pledge had 0.1 fewer sex partners during the past year, but the same number of partners overall as those who had not pledged. And pledgers started having sex at the same age as non-pledgers, Rosenbaum found.
The study also found that teens who took a virginity pledge were 10 percent less likely to use a condom and less likely to use any other form of birth control than their non-pledging counterparts.
"Sex education programs for teens who take pledges tend to be very negative and inaccurate about condom and birth control information," Rosenbaum said.
The study also found that, five years after taking a virginity pledge, more than 80 percent of pledgers denied ever making such a promise. "This high rate of disaffiliation may imply that nearly all virginity pledgers view pledges as nonbinding," Rosenbaum said.
She said teens who are religious tend to delay having sex, but that has nothing to do with virginity pledges or abstinence-only sex education programs.
Bill Albert, chief program officer for The National Campaign to Prevent Teen and Unplanned Pregnancy, said teens need to be encouraged to delay having sex, but they also need to be given the facts about safe sex.
"When pledgers fell off the wagon, they fell off hard," he said. "What have we gained if we encourage young people only to delay sex until they are older, but when they do become sexually active, they don't protect themselves or their partners?"
"The notion that it has to be either a virginity pledge or encouraging teens to have sex is a false dichotomy," Albert added. "There is a public consensus in this country to encourage teens to delay sex, but also provide them with information about contraception."
HealthDayCopyright (c) 2008 ScoutNews, LLC. All rights reserved.

Materi 5
Playing Video Games May Boost Older Brains
Study suggests video gaming could be part of mental exercise routine for older people
HealthDayThursday, December 11, 2008
THURSDAY, Dec. 11 (HealthDay News) -- Older people who want to stay sharp should reconsider the notion that video games are only for lazy children and pick up a joystick themselves, a new study suggests.
While past studies have shown that playing video games has many positive benefits, ranging from improved problem-solving abilities in young people to improved operating skills in surgeons, the study in the December issue of Psychology and Aging went one step further. The research, which was not funded by the gaming industry, is the first to indicate that playing complex video games after receiving training may improve the cognitive functions that typically decline with age.
The researchers tested the cognitive abilities of 40 people in their 60s and 70s before and after playing the video game "Rise of Nations," which rewards the complex task of creating a society, including building cities, employing people and expanding territory.
Half of the group received training before playing the game while the other half served as a comparison group and received no training.
Testing showed that people in the trained group performed better not only on the game but also on tests of memory, reasoning and the ability to identify rotated objects compared to those who were not trained. The results may eventually help older people who are struggling with managing tasks they once found to be simple.
"Juggling multiple tasks such as cooking, answering the door, and talking on the phone might be simple for a young person, while an older person might feel overwhelmed and burn their food," said study author Chandramallika Basak, a postdoctoral researcher at the University of Illinois. "These are the kind of things that older people do in their everyday lives, so if you're not very good at juggling different tasks it does impact your lifestyle."
The study offers welcome news for America's aging baby boomer population. The whole concept that the older brain in aging individuals can improve is really important right now, said Paul Sanberg, director of the University of South Florida's Center for Aging and Brain Repair. "The interesting thing is that less than 24 hours of training not only improved mental and cognitive functions, but also enhanced their ability to function in some other tasks," he said.
Researchers cautioned that questions remain about whether people with better cognitive abilities are naturally attracted to video games and other complex tasks, or whether the act of playing the video games boosted cognitive ability.
"Perhaps the brains of people who enjoy video games are very different than somebody who doesn't want that challenge," suggested Basak. "At this point, it's pure speculation."
"This would be a good type of experiment to combine with brain-imaging studies to see the effect of the training on these people, and whether there's increased activity in the brain and new connections," said Sanberg. "It's also nice to see if there's some correlation with actual brain function."
While a growing number of studies have found that playing video games can be beneficial, experts warn against too much of a good thing, noting that playing video games can be an isolating experience that mitigates other health benefits.
"Clearly mental exercises, whether through a game or another media outlet, aren't that bad, but you want to establish societal connections as well," cautioned Sanberg. "Doing too much of one thing might not be the best idea."
Basak suggests that playing strategy-based games such as chess or video games with other people might offer a way to achieve the same benefits without sacrificing social interaction.
"When we look at improvements in cognition, it's not just one thing that's affecting, it's all integrative," said Basak. "There are many factors that go into it."
HealthDayCopyright (c) 2008 ScoutNews, LLC. All rights reserved.

Materi 6
Painkillers Linked to Increase in Overdose Deaths
More popularity, availability of these medications may be reason, study suggests
HealthDayTuesday, December 9, 2008
TUESDAY, Dec. 9 (HealthDay News) -- Deaths from overdoses of prescription drugs, primarily pain relievers, appear to be on the rise throughout the United States, new research suggests.
West Virginia, in particular, has seen a large increase in such unintentional deaths, say government researchers, who have uncovered patterns of "doctor shopping" for drugs and overdosing on medications not used as prescribed.
"We found that two-thirds of these deaths involved prescription drugs that had not been prescribed to the individuals who died," said the lead researcher, Dr. Aron J. Hall, an epidemic intelligence service officer for the U.S. Centers for Disease Control and Prevention.
In addition, one in five had "doctor shopped," looking for physicians to prescribe pain medications, particularly opioids like methadone, hydrocodone and oxycodone, Hall said.
"This epidemic of prescription drug overdose involves a substantial amount of substance abuse, and it affects not just West Virginia, but particularly rural areas of the country," Hall said. "It's been a problem throughout the country. Our study focused on West Virginia as the tip of the iceberg."
Hall's group thinks that doctors and pharmacists have a critical role in preventing the misuse of these drugs. "It is essential that they counsel patients not only about the risk of overdose to themselves, but about the risks to those with whom they might share their drugs," he said.
In addition, Hall advises doctors to use prescription monitoring programs, which can tell them if patients are getting drugs from other doctors.
The report is published in the Dec. 10 issue of the Journal of the American Medical Association.
For the study, Hall's team looked at deaths from unintentional overdoses in West Virginia in 2006. From 1999 to 2004, deaths from unintentional poisoning in the state increased 550 percent, the greatest increase for any state in the country.
To determine the size of the problem in West Virginia, the researchers collected data from medical examiners, prescription drug-monitoring programs, and opiate treatment program records.
In 2006, 295 West Virginians died from unintentional overdoses of pain killers, Hall's group found. Of these, 67.1 percent were men and 91.9 percent were between the ages of 18 and 54.
Most on those who died (63.1 percent) used painkillers, but did not have a prescription for them. And 21.5 percent had prescriptions for these drugs from at least five doctors in the year before their death, the researchers found.
Women were more likely to doctor shop than men (30.9 percent vs. 16.7 percent), and younger people used painkillers for non-medical purposes more than their older counterparts did, according to the report.
In 79.3 percent of the deaths, people had used several medications. Opioids were the most common drugs used, accounting for 93.2 percent of the deaths. Of these deaths, only 44.4 percent of the victims had any evidence of having a prescription for these drugs, Hall's group noted.
Methadone was the most common drug linked to fatal overdoses, accounting for 40 percent of the deaths. People who died from a methadone overdose were less likely to have a prescription for the drug than people who overdosed on hydrocodone or oxycodone, the researchers found.
In 1997, two reports called for better management of chronic pain and encouraged the use of opioid pain medications. Since that time, the sales of these painkillers has gone up dramatically as have overdoses, deaths and recreational use linked to these drugs, Hall said.
Dr. Adam Bisaga, an associate professor of clinical psychiatry in the division on substance abuse at Columbia University College of Physicians and Surgeons in New York City, thinks that improved guidelines for appropriate prescribing, along with training to detect substance use disorders in patients, might reduce the unintended consequences seen in this study.
"This finding is not surprising. Opiates are generally very safe if used appropriately, but opiate abuse/dependence is an illness with high mortality rates," Bisaga said. "So the issue is not with the medication, but rather the detection and treatment of those who abuse and become addicted to opiates."
In addition, there is a need to expand access to addiction treatment, particularly in high-risk populations, Bisaga said.
"I strongly believe that present results could be directly used to justify implementing changes in practice and treatment to promptly reverse this worrisome trend that is likely to be occurring throughout the country, not just in one state," Bisaga said.
HealthDayCopyright (c) 2008 ScoutNews, LLC. All rights reserved.

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