Stimulasi Yang Tepat Untuk Bayi 6 – 9 Bulan

Setiap orang tua tentulah ingin buah hatinya berkembang sesuai tahap - tahap  perkembangan yang harus dicapai. Untuk itu orang tua harus sering menstimulasi bayinya. Namun dalam memberikan stimulasi pada bayinya, ada 4 hal cara stimulasi bayi yang benar benar harus diperhatikan, yaitu :

Pertama adalah bicaralah selalu padanya, apa pun yang Anda lakukan ajaklah bayi Anda berbicara. Tataplah matanya dan bicaralah perlahan-lahan. Bayi  sedang mendengarkan suara maupun kata - kata yang Anda ungkapkan dan bayi pun belajar untuk meresponnya.

Kedua adalah biarkan bayi bermain di lantai, tentunya lantai harus bersih dan aman, seringlah menaruh bayi dilantai untuk merangsangnya lebih leluasa bergerak dan bisa mengontrol gerakannya. Jangan sering menggendong atau menaruh bayi dikereta dorongnya. Meski aman baginya namun tidak membantunya mengembangkan otot - otot geraknya.

Ketiga adalah berikan aktivitas fisik, berrmainan permainan yang menggunakan fisik akan membantu perkembangan dan kerja otot - otot tubuhnya. Orang tua bisa membantu, misalnya, meletakan bayi dalam posisi terlentang kemudian menggerakan kedua kakinya seolah membuat gerakan mengayuh sepeda. Bisa juga dengan menegakkan bayi sambil kita pegang tubuhnya, lalu biarkan ia melakukan loncatan - loncatan dengan kedua kakinya atau bermain di lantai dengan merangkak dan mengejarnya.

Keempat adalah dengan memberikan pujian, setiap kali bayi menunjukan kemajuan pesat berilah pujian, ia pasti sering dan bersemangat untuk selalu mencoba serta mengulang kembali kemampuannya.

Sistem Sosial Budaya Indonesia

Pengertian Sistem Sosial Budaya

Sistem

Sistem adalah istilah yang artinya menggabungkan, untuk mendirikan, untuk menempatkan bersama. Sistem adalah kumpulan elemen berhubungan yang menjadi kesatuan atau kebulatan yang kompleks. Sistem merupakan jarintan kerja dari prosedur-prosedur yang saling berhubungan, untuk menjalankan fungsi masing-masing untuk menghasilkan atau menyelesaikan sesuatu yang menjadi sasaran bersama.

Sosial Budaya

Sosial menurut Lena Dominelli adalah bagian yang tidak utuh dari sebuah hubungan manusia sehingga membutuhkan pemakluman atas hal-hal yang bersifat rapuh didalamnya.
Edward B. Tylor berpendapat bahwa kebudayaan adalah keseluruhan yang kompleks, yang di dalamnya termuat  kepercayaan, pengetahuan, kesenian, moral, adat istiadat, hukum, dan kemampuan-kemampuan lain yang diperoleh seseorang sebagai bagian dari masyarakat. Perubahan sosial budaya bisa terjadi apabila satu kebudayaan melakukan kontak atau terjadi hubungan dengan kebudayaan asing. Perubahan sosial budaya merupakan sebuah gejala berubahnya struktur sosial dan juga pola budaya di dalam sebuah masyarakat.

Sistem Budaya merupakan bentuk abstrak dari kebudayaan.. Sistem budaya merupakan ide dan gagasan manusia yang hidup bermasyarakat.  Ide manusia tersebut tidak terlepas melainkan berkaitan satu dengan lainnya dalam sebuah sistem. Oleh karena itu sistem budaya adalah salah satu bagian dari kebudayaan, yaitu adat istiadat yang didalamnya termasuk sistem norma, nilai budaya, dan semua norma yang hidup dan berkembang di masyarakat.

Unsur-unsur Sistem Sosial Budaya
Sepuluh unsur sistem sosial menurut Alvin L. Bertrand
1. Perasaan (sentiment)
2. Keyakinan (pengetahuan)
3. Norma Tujuan
4. Tujuan
5. Tingkatan atau pangkat (rank) Status dan peranan
6. Status dan peranan
7. Sanksi
8. Kekuasaan atau pengaruh (power) Sanksi
9. Tekanan ketegangaan (stress strain)
10. Sarana atau fasilitas

Unsur Budaya menurut Bronislaw Malinowski

1. sistem norma sosial - yang memberikan kemungkinan kepada masyarakat untuk bekerjasama dan menyesuaikan diri
2. organisasi ekonomi
3. alat atau Lembaga Pendidikan (Keluarga)
4. organisasi politik

Ciri Sistem Sosial adalah terbuka atau menerima unsur-unsur yang datang dari luar. Hal ini menjadikan terjadinya jalinan antar unsur-unsur dan pertukaran sistem sosial yang berasal dari luar(eksternal).

Proses-proses sistem sosial:

• Komunikasi
• Memelihara tapal batas
• Penjalinan sistem
• Sosialisasi
• Pengawasan sosial
• Pelembagaan
• Perubahan social

Wujud Kebudayaan
J.J.Hoenigman membagi kebudayaan menjadi tiga wujud:
1. Gagasan
Gagasan,ide, nilai, atau norma merupakan bentuk ideal dari kebudayaan
2. Aktivitas
Bentuk kebudayaan aktivitas adalah sistem sosial berupa tindakan berpola manusia dalam masyarakat.
3. Artefak
Artefak merupakan wujud kebudayaan fisik yang bisa di lihat, diraba, ataupun didokumentasikan hasil karya atau perbuatan manusia.

Fungsi Sistem Sosial Budaya
Fungsi sistem budaya adalah untuk menata dan juga menetapkan tidakan serta tingkah laku masyarakat(manusia). Proses pembelajaran sistem ini dilakukan dengan pembudayaan atau pelembagaan yang bertujuan untuk dapat menyesuaikan diri(pikiran dan sikap) denngan norma adat, dan peraturan yang hidup di lingkungan kebudayaannya. Proses pembelajaran dilakukan mulai dari kecil dari lingkungan keluarga, lingkungan diluar rumah, dan lingkungan selanjutnya. Dimulai dari meniru apapun(sesuatu yang baik) yang ada di lingkungan tersebut kemudian tindakan tersebut akan menimbulkan dorongan untuk dimasukkan kedalam kepribadian sehingga menjadi pola dan norma yang mengatur tindakan yang dibudayakan. Tidak semua orang mampu untuk beradaptasi dengan sistem budaya di lingkungan sosial atau disebut juga deviants.

Negara juga sangat memerhatikan kebudayaan terbukti dalam konstitusi Indonesia UUD 1945 pasal 32 yang berbunyi
(1) Negara memajukan kebudayaan nasional Indonesia di tengah peradaban dunia dengan menjamin kebebasan masyarakat dalam memelihara dan mengembangkan nilai-nilai budayanya.
(2) Negara menghormati dan memelihara bahasa daerah sebagai kekayaan budaya nasional.

Sistem Indonesia

Sistem Indonesia berisi semua tentang Sistem yang berlaku atau diterapkan di Indonesia. Sistem adalah suatu kebulatan atau keseluruhan yang kompleks dan terorganisasi, suatu himpunan atau perpaduan ha-hal atau bagian yang membentuk suatu kebulatan atau keseluruhan yang kompleks. Di dalam sistem ada komponen yang terhubung dan mempunyai fungsi masing-masing terhubung menjadi sistem menurut pola. Sistem merupakan susunan pandangan, teori, asas yang teratur.
Di Indonesia terdapat banyak sekali sistem-sistem yang ada atau berjalan. Berikut adalah sistem-sistem di Indonesia:

Sistem Pemerintahan Indonesia
Sistem Pemerintahan adalah susunan yang teratur dari pandangan, teori, atau asas tentang pemerintahan negara. Sistem pemerintahan yang pernah diterapkan di Indonesia adalah sistem parlementer dan presidensial. Keduanya memiliki ciri-ciri serta kelebihan dan kekurangan masing-masing.

Sistem Politik Indonesia
Sistem Politik Indonesia adalah keseluruhan kegiatan(termasuk pendapat, prinsip, penentuan tujuan, upaya mewujudkan tujuan, pengambilan keputusan, skala prioritas, dll) yang terorganisir dalan negara Indonesia untuk mengatur pemerintahan dan mempertahankan kekuasaan demi kepentingan umum dan kemaslahatan rakyat.

Sistem Demokrasi di Indonesia
Tentang demokrasi di Indonesia hal-hal yang perlu dibahas antara lain Pengertian Demokrasi, Budaya Demokrasi, Sejarah dan Perkembangan Demokrasi di Indonesia, serta Pelaksanaan Demokrasi di Indonesia.

Sistem Hukum Indonesia
Sistem Hukum di Indonesia merupakan campuran dari sistem hukum adat, hukum agama, dan hukum negara eropa khususnya Belanda. Sistem hukum di Indonesia memiliki unsur-unsur hukum dan ciri-ciri khas. Hukum di Indonesia juga memiliki sejarah yang panjang mulai zaman kolonialisme hingga sekarang.

Sistem Sosial Indonesia

Sistem Irigasi Subak, Bali, Indonesia
Penjelasan sistem pengairan atau irigasi Subak, Bali, Indonesia.

Sistem Pendidikan di Indonesia
Kondisi Pendidikan Indonesia sekarang, kurikulum, jenjang, jenis, dll

Peta Indonesia Terbaru

Peta Indonesia Terbaru

Peta Indonesia

Peta Provinsi di Indonesia

Peta Zona Waktu Indonesia

Peta Lempeng Indonesia

Prosas ewel deri sabueh progrem diklet dimulei deri parminteen celon pasarte diklet. Bardeserken SOP Parminteen Celon Pasarte Diklet, Kapele Pusdiklet sataleh mamalejeri kelandar diklet den hermonisesi progrem diklet, manugeske Kebid Panyalanggereen untuk mambuet Suret Parminteen Celon Pasarte Diklet. Kamudien Kebid Panyalanggereen maminte Kesibud Panyalanggereen I untuk mambuet konsap suret tarsabut. Kesubid Panyalanggereen I salenjutnye manugesken paleksene untuk mangumpulken dete-dete den manyusun konsap suret parminteen celon pasarte diklet. Sataleh konsap suret siep, prosas salenjutnye edeleh panalitien konsap suret mulei deri kesubid panyalanggereen I, kamudien kebid panyalanggereen, sempei kapele pusdiklet. epebile konsap tarsabut disatujui meke suret parminteen celon pasarte diklet tarsabut dikirim kapede unit panggune malelui Begien Tete Usehe. Wektu panyalaseien prosas ini manurut SOP edeleh 3 jem 45 manit.

                                                Suret Parminteen Celon Parminten Diklet dikirim kapede unit panggune setu bulen sabalum diklet disalanggereken. Delem suret ini tardepet samue katantuen entere lein taneng jumleh kuote diklet, wektu palekseneen diklet, lokesi palekseneen diklet, syeret celon pasarte diklet(usie meksimel, pengket, den golongen), parlangkepen yeng herus disiepken olah celon pasarte diklet, pambaritehuen pandefteren sacere onlina, sarte Tarm of Rafaranca(TOR). Dangen edenye parsyereten delem suret ini meke diherepken unit panggune eken mamenggil celon pasarte diklet yeng mamanuhi samue kritarie/parsyereten untuk disempeiken delem suret panyempeien defter neme celon pasarte diklet kapede pusdiklet tarkeit sasuei wektu yeng ditatepken.

                                                Parmeselehen tarjedi katike suret yeng dikirim kapede unit panggune dibeles katike wektu palekseneen sudeh senget daket eteu behken tidek dibeles dangen suret jeweben delem jengke wektu setu bulen sajek suret parminteen celon pasarte diklet dikirimken. Idaelnye, suret panyempeien celon pasarte diklet ditarime meksimel e minggu sabalum repet parsiepen dilekseneken. Nemun bardeserken konfirmesi deri bideng panyalanggereen manganei dete jumleh suret  rasmi panyempeien defter neme celon pasarte diklet deri unit panggune yeng dibeles tapet wektu den tidek dibeles hingge seet-seet ekhir betes wektu, tarnyete jumleh entere suret yeng dibeles labih sadikit dibending suret yeng tidek dibeles olah unit panggune. Hel ini tantu eken barpangeruh pede prosas salenjutnye deri diklet tarkeit.

Is the Patient Centered Outcomes Research Institute Really More Industry-Centered?

One of the biggest reasons our health care system seems so dysfunctional is that clinicians and patients have great difficulty determining what might be the appropriate management of particular clinical problems.  Due to endless and sometimes deceptive marketing, conflicts of interest affecting health care professionals and academics, and manipulation and suppression of clinical research, making truly evidence based decisions that put individual patients interests first has become very difficult.  Instead, we may end up using excessively expensive, relatively ineffective, and more dangerous than anticipated drugs, devices, and diagnostic and therapeutic strategies, thus leading to poor patient outcomes and high costs.

Background - the Patient-Centered Outcomes Research Institute (PCORI)

One lingering hope has been that better clinical research, particularly focusing on the outcomes that are most important to patients (patient-centered outcomes), and comparing clinical strategies that may be widely used but poorly evaluated (comparative effectiveness research) would help dissipate the fog.  An attempt to promote such research in the US appeared in our recent health reform legislation, the Affordable Care Act.  It authorized the creation of the Patient Centered Outcomes Research Institute (PCORI).

However, as we observed, how good a solution this would be would depend on the details.  Our concerns were that PCORI, which is an independent although government sponsored institute, not a government agency, might be too beholden to "stake-holders" including the large organizations, device and pharmaceutical companies, insurance companies, hospital systems, etc, that already dominate health care and may promote their and particularly their executives' interests ahead of patients.

Recently, Merrill Goozner, the editor of Modern Healthcare, raised similar concerns,

there is the law's requirement for stakeholder boards to set PCORI research priorities. They must include representatives of researchers, clinicians, patients, providers, insurers, employers and industry. The interests of those groups are not the same. Priority-setting by stakeholder boards could turn into a prescription for steering clear of the most controversial, and therefore most significant, questions.

So,

There is no shortage of drug and device firms, specialty hospitals and medical specialty societies with a vested interest in leaving certain questions unasked or muddying the waters with methodological quibbles. They shouldn't be allowed to hijack or soften the agenda.

PCORI is now in operation, but has seemingly not gotten a lot of scrutiny. What scrutiny it has received as not allayed these concerns.

The PCORI Advisory Panels

Recently, the publication of the membership of four key advisory panels for PCORI got the attention of  Michael Millenson, blogging on the Health Care Blog.  He noted that initially the members of the panels were identified only by name and city of residence, without any information on their other affiliations or characteristics.  He suggested,

PCORI isn’t a church, where all are created equal in the eyes of God, but a politically created, politically governed, controversial dispenser of a very large amount of money that a host of interest groups would like to control. PCORI staff chose the panel members in part by looking at their affiliations, and those connections (or lack of them) should be an immediate part of the public record when the appointments are announced. By being vague, PCORI obfuscates political and power relationships and makes it more difficult for the public and industry stakeholders to either approve of or criticize those choices.

Eventually, PCORI did release somewhat more information on membership of these panels, on Addressing Disparities, Assessment of Prevention, Diagnosis, and Treatment Options, Improving Healthcare Systems, and Patient Engagement.  Mr Millenson was able to review the membership of one panel, and noted some strange anomalies in a comment to his original blog post. 

One panel member who supposedly represents "patients, caregivers, and patient advocates" had a full time position with a pharmaceutical company.  Another worked for a big consumer organization which is heavily funded by the pharmaceutical industry.

This raised concerns that PCORI may get guidance from people whose interests are actually different from those they are supposed to represent.

Therefore, I attempted to review the stated affiliations of all PCORI advisory panels.

Review of the what was made public about the membership of the advisory panels revealed several additional important anomalies.  Members said to be representing "patients, caregivers, and patient advocates" appeared to have positions working for organizations who might have their own, and different interests from the group they were supposed to be representing. 

Let me summarize the apparent anomalies by advisory panel.  In each case, in alphabetical order by panel,  I will list the panelists name, supposed representation, and affiliation, with my comments. 

Addressing Disparities

Monique Carter MS - Dallas, TX
representing: patients, caregivers, and patient advocates
affiliation: Senior Research Scientist, AROG Pharmaceuticals Inc

So this person would appear to be more of an industry (pharmaceuticals) representative.

Venus Gines, MA, P/CHWI - Manvel, TX
representing: patients, caregiver, and patient advocates
affiliation: Instructor, Chronic Disease Prevention and Control Research Center, Department of Medicine, Baylor College of Medicine

So this person appears to be more of a clinician, or health system representative

Doriane C Miller MD - Chicago, IL
representing: patients, caregivers, and patient advocates
affiliation: Director, Center for Community Health and Vitality, University of Chicago Medical Center

So this person also appears to be more of a clinician, or health system representative.

Carmen E Reyes, MA - Whittier, CA
representing: patients, caregivers, and patient advocates
affiliation: Center and Community Relations Manager, Los Angeles Community Academic Partnership in Research in Again, UCLA

So this person appears to be more of a health system representative.

Mary Ann Sander, MHA, MBA, NHA - Pittsuburgh, PA
representing: patients, caregivers, and patient advocates
affiliation: Vice President, Aging  and Disability Services, UPMC Community Provider Services

So this person appears to be more of a health system representative

Deborah Steward, MD, MBA - Jacksonville, FL
representing: clinicians
affiliation: Florida Blue

So in summary, this panel included five people who ostensibly represent patients, caregivers, and patient advocates but who actually work for large academic medical centers or health systems, and one who was there to ostensibly represent patients, caregivers, and patient advocates who works for a pharmaceutical firm.  (In addition, one person supposedly representing clinicians apparently works full time for a health insurance company.)

Assessment of Prevention, Diagnosis, and Treatment Options

Karen Chesbrough, MPH - Annandale, VA
representing: patients, caregivers, and patient advocates
affiliation: Scientific Program Administrator, Foundation for Physical Therapy.

Note that the stated mission of the Foundation for Physical Therapy is that it "supports the physical therapy profession’s research needs," and the foundation is funded in part by companies that make physical therapy devices and supplies  (look here).  Therefore, this person appears to be more of a representative of clinicians, or perhaps industry (devices).

Bettye Green RN - South Bend, IN
representing: patients, caregivers, and patient advocates
affiliation: Community Outreach Nurse and Associate Director of Advocacy, Alliance for Clinical Trials in Oncology, Saint Joseph Regional Medical Center

So this person appears to be more of a health system representative.

Debra Madden - Newtown, CT
representing: patients, caregivers, and patient advocates
affiliation: Clinical Applications Systems Analyst, Associated Neurologists

So this person appears to be more of a clinician representative.

Daniel Wall - Spencer, WI
representing: patients, caregivers, and patient advocates
affiliation: Analyst, Biomedical Informatics Research Center, Marshfield Clinic Foundation

So this person appears to be more of a clinician or health system representative

So in summary, this panel included four people who ostensibly represent patients, caregivers, and patient advocates but who actually work for health systems or clinician organizations, and one of the latter organizations appears to be heavily funded by the medical device and supplies industry.

Improving Healthcare Systems

Susan Diaz MPAS, PA-C - Jacksonville, FL
representing patients, caregivers, and patient advocates
affiliation: Physician Assistant in Liver Transplant, Mayo Clinic in Florida

So this person appears to be more of a clinician, or health system representative.

Anne Sales PhD-  Ann Arbor, MI
representing: patients, caregivers, and patient advocates
affiliation: Professor, School of Nursing, University of Michigan

So this person appears to be more of a clinician, or health system representative.

Jamie Sullivan MPH - Silver Spring, MD
representing: patients, caregivers, and patient advocates
affiliation: Director of Public Policy, COPD Foundation.

Note that the COPD Foundation receives support at least from "Boehringer-Ingelheim/Pfizer Inc. and Grifols" (look here).  .

So this person appears to be at least somewhat an industry (pharmaceutical) representative.

So in summary, this panel includes three people who ostensibly represent patients, caregivers, and patient advocates, two of whom actually work for large health system, and one who works for a foundation with significant pharmaceutical industry support.  

Patient Engagement

Stephen Arcona MA PhD - East Hanover, NJ
representing patients, caregivers, and patient advocates
affiliation: Executive Director, Outcomes Research Methods & Analytics, Department of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation

So this person appears to be more of a researcher, and industry (pharmaceutical) representative.

Marc Boutin JD - Washington, DC
representing patients, caregivers, and patient advocates
affiliation: Executive Vice President and Chief Operating Officer, National Health Council 

Note that while the National Health Council claims to be an advocate for people with chronic disease and disability, its core membership includes "major pharmaceutical, medical device, health insurance, and biotechnology companies." and it receives considerable industry support.  For example, it disclosed contributions in the $100,000 - $300,000 range from Amgen, Astra-Zeneca, Eli Lilly, Novartis, Pfizer, and the Pharmaceutical Research and Manufacturers of America (PhRMA), and smaller but still significant contributions from other pharmaceutical companies and other industry associations.  So this person appears to be at least somewhat of an industry (pharmaceutical) representative.

Charlotte W Collins JD - Elkridge, MD
representing patients, caregivers, and patient adovcates
affiliation: Vice President of Policy and Programs, Asthma and Allergy Foundation of America

Note that while the Asthma and Allergy Foundation of America claims to be a patient advocacy organization, it disclosed financial support from many pharmaceutical, device, and health insurance companies, and from major health care systems

So this person appears to be at least somewhat an industry, health insurance, and/or health system representative.

Amy Gibson, RN MS - Washington, DC
representing patients, caregivers, and patient advocates
affiliation: Chief Operating Officer, Patient-Centered Primary Care Collaborative (PCPCC)

Note that the PCPCC has an executive committee that includes multiple pharmaceutical, device, and health insurance companies, and health systems.  So this person appears to be at least somewhat an industry, health insurance, and/or health system representative.

Julie Ginn Moretz - Augusta, GA
representing patients, caregivers, and patient advocates
affiliation: Associate Vice Chancellor, Patient- and Family-Centered Care, University of Arkansas for Medical Sciences

So this person appears to be more of health system representative.

Sara Triagle van Geertruyden - Washington, DC
representing patients, caregivers, and patient advocates
affiliation: Executive Director, Partnership to Improve Patient Care (PIPC)
(Note: this affiliation appears incomplete.  Sara van Geertruyden is listed as a current partner of Thorn Run Partners, a lobbying firm, with a major practice area in health care, boasting, "Thorn Run Partners offers one of Washington, DC’s most comprehensive, competent and effective health policy practices."


Note also that PIPC has membership that includes many specialty physician societies, and a steering committee that includes the Biotechnology Industry Organization, and PhRMA. 

So this person appears to be more of an industry (pharmaceutical and biotechnology) representative.

So in summary this panel includes six members who ostensibly represent patients, caregivers, and patient advocates, but who work for either patient advocacy organizations that get considerable industry support, or a health system, or a pharmaceutical company.  One person whose affiliation was listed as a patient advocacy organization also somehow appears to be a full-time lobbyist.  

Summary

While PCORI has set up advisory panels that seem to strongly emphasize representation of patients, caregivers, and patient advocates, a substantial fraction of the people who are supposed to provide this representation seem to work for patient advocacy groups with considerable industry support, or directly for industry or health care systems.  Some of them may work as clinicians or researchers, but many appear to have high level executive positions with these organizations.  One appears to be a full-time lobbyist at a firm that has a strong health care practice. 

Thus it appears that PCORI advisory panels actually may be as much about the interests of big health care organizations, including pharmaceutical and device companies, health insurance companies, and large hospital systems, as they are about patients, caregivers, or patient advocates.  

I am afraid my and Merrill Goozner's original fears that PCORI may end up being more about industry-centered interests than patient-centered outcomes may not be paranoid.  I do hope that PCORI leadership manages to put improving patients' and the public's health ahead of making industry executives happy. 

by Roy M. Poses MD, for Health Care Renewal