Service Center Research Articles

Evaluation of Pharmacist-led Telehealth Medicare Annual Wellness Visits to Satisfy Quality Metrics and USPSTF Recommendations After Implementation of a Post-Visit Follow-Up Protocol.

Background: A Medicare Annual Wellness Visit (MAWV) serves Medicare patients by identifying and addressing gaps in preventive services and health screenings, often aligning with outpatient practice quality metrics. Objective: Evaluate an existing pharmacist-led MAWV telehealth service, determine the baseline quality metric satisfaction rate of telehealth MAWVs, and assess for improvement after implementing a post-MAWV follow-up protocol at a suburban, lower-income primary care clinic. Methods: This IRB-exempt, single-center retrospective chart review utilized the electronic health record at Christ Health Center, Birmingham, AL. From August 2020 through May 2022, 288 charts were assessed between 2 retrospective chart reviews that included patients 18 years or older with Medicare insurance and the ability to conduct a telehealth MAWV. The first chart review assessed metric and recommendation satisfaction within 12months of the visit. The second chart review was performed after follow-up protocol implementation to assess for additional improvement within 3 months of the visit. Results: The percentage of MAWV recommendations completed groups after implementing a follow-up protocol. For the first chart review, 57.1% of the assessed Health Resources and Services Administration (HRSA), Uniform Data System (UDS) quality metrics, and Centers for Medicare and Medicaid Services (CMS)-required MAWV components were satisfied from the first chart review compared to 53.3% of satisfied quality metrics post-protocol implementation in spite of a substantially shorter follow-up timeframe. Conclusion: Telehealth MAWVs improve preventive care and quality metric satisfaction for Medicare patients. Post-visit follow-up protocols enhance satisfaction rates. Pharmacist-led MAWVs foster interprofessional collaboration and comprehensive patient care.

Analysis of Transparency and Accountability of the Health Operational Assistance (BOK) Budget at Sirombu Inpatient Health Center

Health Operational Assistance (HOA) is a fund that is used to ease the public burden on financing the health sector, especially service in community health centers, reduction in maternal mortality, infant mortality and malnutrition. Puskesmas Sirombu as a health service unit is used as a medical center for the welfare of the community, but in reality the Puskesmas Sirombu has not been optimal in realizing the budgeted funds. This study aims to determine the transparency and accountability of budget execution Bantuan Operasional Kesehatan (BOK) at Puskesmas Rawat Inap Sirombu in 2021. The research sample was taken using the method purposive sampling (specific goals or criteria). The data analysis technique used is triangulation method which combines in-depth interviews and document searches and triangulation of sources using different information to do cross check information from several sources, to improve the results of the data obtained when getting different data. Based on the research results, it can be concluded that the Puskesmas Sirombu has implemented its transparency and accountability well but has not been optimal in managing the budget for transportation assistance for Health Operational Officers (BOK), this can be seen from the fact that some of the budget was not realized.

A retrospective study of Quality Control of Fresh Frozen Plasma (FFP) using Factor VIII levels in Central Blood Transfusion Services Indonesian Red Cross

Background: According to a report from the Ministry of Health of the Republic of Indonesia, there are 470 blood transfusion units in Indonesia (235 units managed by PMI, 220 units managed by the government, four units of health services provinces, nine units of vertical hospital BTUs, two unit’s Indonesian police and army hospital) distributed in 38 provinces. With so many BTUs spread throughout Indonesia, each BTU must have the same quality standards to maintain and improve blood services. Therefore, it is necessary to carry out Quality Control of the blood component products produced. Quality control is critical in safely and effectively processing blood and other components. A quality concept comprises quality control, assurance, and management. The laboratory service should have a quality control system. Quality testing and monitoring of blood components for transfusion have led to manufacturing or development. Factor VIII levels are internal quality control parameters required for quality analysis of Fresh Frozen plasma (FFP). As per international standard guidelines and government national regulations (PMK 91/2015) for quality assurance of FFP, 1% of all the units prepared, or four units per month, are tested for stable coagulation factors, including Factor VIII levels. Objective: This study aims to evaluate factor VIII levels in each units FFP to ensure the availability of high-quality products with maximum therapeutic and minimal risk to recipients. Methods: The retrospective data were collected from Research and Development CBTS Indonesian Red Cross archives from 1 January 2019 to 30 April 2023. Out of total 284 units FFP collected from Blood Transfusion Unit Indonesian Red Cross from Sumatera Island (Lampung Province, Palembang City, Pekanbaru City), DKI Jakarta Province (CBTS IRC), Jawa Barat Province (Depok City, District of Bekasi City, District of Bogor City), Banten Province (Tangerang City, District South of Tangerang City), Government Hospital (Fatmawati Hospital BTU), Army Hospital (RSPAD Gatot Soebroto BTU) were tested Quality Control with semi-automated Sysmex CA50 and automated Sysmex CA620 to determine of factor VIII levels in each unit FFP. Results: A total of 284 units of FFP were tested, and mean factor VIII levels were 1,2 IU/mL with a range of 0,3 IU/mL-5,3 IU/mL, the normal range measure being > 0,7 IU/mL. Only 4,9 % (14/284) FFP units were inappropriate from the standard, while 95,1 % (270/284) FFP units could be accepted criteria standard. Conclusion: We conclude that there are still those below-standard Quality FFP products from blood transfusion units; it is necessary to increase the processing of blood components so that the coagulation factors are maintained. From taking blood collecting, transporting, and shipping, it is required to carry out quality control to produce products that meet national and international standards.

Validation and reliability of teleaudiology approach among deaf or hard of hearing school age children in Malaysia: a preliminary study

ABSTRACT Objective This study investigated the implementation of teleaudiology in Malaysia's Special Education Service Centre (SESC), aiming to optimize audiological services. Design Using a cross-sectional design, the research compared the outcomes of audiological tests conducted via teleaudiology and traditional methods on deaf or hard of hearing (DHH) school-age children. Study Sample The study included 25 students for validation, 5 for reliability, and 5 educational audiologists and facilitators. Results The results demonstrated high validation and reliability values for video otoscopy, tympanometry, acoustic reflexes, and pure tone audiometry. Intra-rater reliability was consistently high. In terms of testing duration, the conventional approach took an average of 3.32 minutes longer than teleaudiology. Conclusion The successful implementation of teleaudiology in the SESC catered to the audiological needs of the DHH population and fostered professional collaboration, potentially benefiting educational audiologists.

Multiple Stakeholder Perspectives of Implementing Work-Related Cognitive Behavioral Therapy (WCBT) in Vocational Service Settings: A Qualitative Exploration of Intervention Acceptability and Sustainability.

Growing mental health treatment access disparities elevate the urgency for identifying and implementing innovative approaches for delivering evidence-supported interventions. Work-related cognitive behavioral therapy (WCBT), a technology-assisted CBT (t-CBT) designed to address social anxiety and employment outcomes among job seekers at vocational service centers and for delivery by vocational service professionals, offers a promising way to increase access to needed mental health care. This qualitative study, guided by the Organizational Transformation Model (OTM), explored factors related to WCBT's implementation at two Jewish Vocational Services (JVS) Human Service sites in Detroit, MI and Los Angeles County, CA. Twenty-seven staff-stakeholders across the two JVS sites completed in-depth, semi-structured interviews focused on their experiences with WCBT over the four-year study period. Thematic analysis identified five core codes that most broadly captured participants' perceptions of WCBT implementation and the factors influencing implementation, including: (1) Need, (2) Buy-in and engagement, (3) Communication, (4) Sustainability concerns, and (5) Implementation facilitators. Core codes aligned with OTM factors related to impetus to transform, improvement initiatives, integration across boundaries, alignment from top to bottom, and leadership. Findings identify implementation strategies likely to optimize uptake and sustainability of WCBT within JVS sites that can be tested in a larger, multi-site implementation trial.

Coral skeletal proxy records database for the Great Barrier Reef, Australia

Abstract. The Great Barrier Reef (GBR), Australia, has a long history of palaeoenvironmental coral research. However, it can be logistically difficult to find the relevant research and records, which are often unpublished or exist as “grey literature”. This hinders researchers' abilities to efficiently assess the current state of coral core studies on the GBR and thus identify any key knowledge gaps. This study presents the Great Barrier Reef Coral Skeletal Records Database (GBRCD), which compiles 208 records from coral skeletal research conducted since the early 1990s. The database includes records from the Holocene, from ∼8000 years ago, to the present day; records are from the northern, central, and southern GBR from inshore and offshore locations. Massive Porites spp. coral records comprise the majority (92.5 %) of the database, and the remaining records are from Acropora, Isopora, or Cyphastrea spp. The database includes 78 variables, with Sr/Ca, U/Ca, and Ba/Ca being the most frequently measured. Most records measure data over 10 or more years and are at monthly or lower resolution. The GBRCD is machine readable and easily searchable so that users can find records relevant to their research, e.g. by filtering for site name, time period, or coral type. It is publicly available as comma-separated values (CSV) data and metadata files with entries linked by the unique record ID and as Linked Paleo Data (LiPD) files. The GBRCD is publicly available from the NOAA National Center for Environmental Information World Data Service for Paleoclimatology at https://doi.org/10.25921/hqxk-8h74 (Arzey et al., 2024). The intention is to update the GBRCD annually, depending on the availability of relevant new GBR records or submission of legacy records to the GBRCD for archiving. The collection and curation of existing GBR coral research data provide researchers with the ability to analyse common proxies such as Sr/Ca across multiple locations and/or examine regional to reef-scale trends. The database is also suitable for multi-proxy comparisons and combination or composite analyses to determine overarching changes recorded by the proxies. This database represents the first comprehensive compilation of coral records from the GBR. It enables the investigation of multiple environmental factors via various proxy systems for the GBR, northeastern Australia, and potentially the broader Indo-Pacific region.

A study to explore the role of a low threshold, fitness focussed physical rehabilitation intervention with protein supplementation to target physical function and frailty in people with problematic substance use and homelessness: protocol for a single-arm pre-post intervention study.

Background People who are homeless are more likely to experience poor mental health and addiction as well as suffering from non-communicable diseases. There is evidence of frailty and accelerated physical ageing among people experiencing homelessness. Appropriate physical rehabilitation and nutritional supplementation strategies can stabilise or reverse frailty and general physical decline, but it is not known how this type of intervention would work in practice in this population. Aim To evaluate the feasibility and pre-post intervention impact of a low threshold physical rehabilitation intervention with protein supplementation to target physical functioning and frailty in people with problematic substance use who are experiencing homelessness. Methods The intervention will consist of a 12-week low threshold rehabilitation programme with protein supplementation. Participants will be service users of the Ballyfermot Advance Project, a day services centre for people with addiction issues and experiencing homelessness. Primary outcomes will be feasibility including numbers recruited, retention of participants and adherence to the exercise intervention and protein supplement. Any adverse events will be recorded. Secondary outcomes will be strength and muscular mass, physical performance and lower extremity physical function, pain, frailty and nutritional status. Discussion An immediate impact may be simply a distraction from difficult circumstances and potentially an improvement of physical health of participants, which can be a conduit for the emergence of other positive behaviours and recovery. Longer term, this study will generate preliminary data on which to inform the design of a definitive randomised controlled trial of physical rehabilitation and protein supplementation, if indicated. Ethics and dissemination Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee in TCD. Study findings will be disseminated through publication into an international peer-reviewed journal and presented at national and international conferences.

A Million Person Study Innovation: Evaluating Cognitive Impairment and other Morbidity Outcomes from Chronic Radiation Exposure Through Linkages with the Centers for Medicaid and Medicare Services Assessment and Claims Data.

The study of One Million U.S. Radiation Workers and Veterans, the Million Person Study (MPS), examines the health consequences, both cancer and non-cancer, of exposure to ionizing radiation received gradually over time. Recently the MPS has focused on mortality patterns from neurological and behavioral conditions, e.g., Parkinson's disease, Alzheimer's disease, dementia, and motor neuron disease such as amyotrophic lateral sclerosis. A fuller picture of radiation-related late effects comes from studying both mortality and the occurrence (incidence) of conditions not leading to death. Accordingly, the MPS is identifying neurocognitive diagnoses from fee-for-service insurance claims from the Centers for Medicare and Medicaid Services (CMS), among Medicare beneficiaries beginning in 1999 (the earliest date claims data are available). Linkages to date have identified ∼540,000 workers with available health information. Such linkages provide individual information on important co-factor and confounding variables such as smoking, alcohol consumption, blood pressure, obesity, diabetes and many other health and demographic characteristics. The total person-level set of time-dependent variables, outcomes, organ-specific dose measures, co-factors, and demographics will be massive and much too large to be evaluated with standard software. Thus, development of specialized open-source software designed for large datasets (Colossus) is nearly complete. The wealth of information available from CMS claims data, coupled with individual dose reconstructions, will thus greatly enhance the quality and precision of health evaluations for this new field of low-dose radiation and neurocognitive effects.

Increasing step count of employees through the Semmelweis Workplace Health Promotion Program

Abstract Background Lifestyle greatly contributes to the development of age-related diseases. The goal of the Semmelweis University’s ‘Semmelweis Workplace Health Promotion Program’ is to develop interventions that facilitate healthy ageing. The aim of its first intervention was to increase the step count of participants by incorporating motivational elements offered through the university’s Center of Preventive Services. Methods A randomized controlled trial was conducted in spring 2024 with three study groups: those undergoing motivational interviews (MI, n = 49), those receiving motivational emails (ME, n = 51), and a control group (n = 53). Intervention groups (MI+ME) received weekly emails for 8 weeks emphasizing the benefits of increased step count and providing feedback on achievements. The MI group also took part in 4 biweekly consultations. Mean step counts of last week and energy expended while walking (MET) calculated from the International Physical Activity Questionnaire were recorded five and three times, respectively. Mixed model regressions were conducted for two pre-planned comparisons: MI+ME vs. controls, and MI vs. ME. Results Intervention groups exhibited a significant increase in average step count (1001 steps; 95% Confidence Interval [95% CI]: 349-1651) as a result of the program, while the control group experienced a non-significant decrease. This was accompanied by a significant increase in energy expenditure for walking (45 MET; 95% CI: 4-87) in intervention groups and a non-significant decrease for the control group. The study found no significant differences in step count and energy expenditure between the two intervention groups (MI vs. ME). Conclusions Our results suggest that workplace health promotion programs may effectively increase physical activity, and thus may be key in tackling the challenges posed by aging demographics. Preliminary findings did not indicate a superiority between email-based and motivational interview-based motivation. Key messages • Workplace health promotion is an essential tool in promoting healthy aging among the working-age population. • Step-count programs based on motivational interviewing serve as an effective and simple tool in increasing physical activity.

Promoting Equity: Child & Adolescent Health Service

Abstract The health and well-being of children and adolescents face significant challenges, particularly in times of social instability. In response to these challenges, the Norwegian government allocated funding in 2021 to establish a national center for Child and Adolescent Health Promotion Services. Situated within the Norwegian Institute of Public Health, this center focuses on enhancing expertise, professional development, and research within municipal maternity and child health clinics, school health services, and youth health clinics. This presentation delves into the crucial role of Universal Health Promoting Services (UHPS) in mitigating the adverse effects of social inequality on child and adolescent health. By leveraging evidence-based practices and identifying knowledge gaps in health promotion and disease prevention in primary care settings, UHPS serve as catalysts for reducing health disparities and enhancing outcomes among expecting parents, children, and adolescents. Moreover, UHPS plays a vital role in addressing the underlying determinants of health inequality, including social network, lifestyle factors, promotion of health literacy and ensuring accessible health care services for all. UHPS empowers individuals and communities to actively participate in health promotion efforts, fostering a culture of health equity and resilience. Through targeted health education programs, early intervention strategies, and community empowerment initiatives the UHPS work both at a systems and individual level to address social inequality in health. This presentation contextualizes UHPS within a broader picture aimed at promoting child and adolescent health while addressing social inequality in health. By highlighting effective approaches and areas requiring further research, it aims to contribute to the ongoing discourse on optimizing health outcomes for young populations.

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

ICARUS registry: findings from the first 1595 cases of acute decompensated heart failure in a single center in a latin american country

Abstract Introduction Institutional aCute decompensAted HeaRt FailUre RegiStry (ICARUS) will provide information on clinical characteristics, medical practice, patterns of treatment, and outcomes of patients hospitalized with Acute Decompensated Heart Failure (ADHF) in a hospital in a middle-income country. Objective Describe the methodological aspects, sociodemographic, and clinical characteristics of patients hospitalized with ADHF and their short-term outcomes. Method Prospective cohort of patients with ADHF from the emergency service of a cardiovascular center. Descriptive statistics were used to synthesize sociodemographic characteristics, clinical characteristics during hospitalization, and outcomes. Results 1595 patients with ADHF. The median age was 68 years (Q1=58; Q3=76), and 69.28% were men. The median hospital stay was six days (Q1=4; Q3=11), with an accumulative incidence (AI) for rehospitalization at 30 days of 8.70 % (95% CI 7.18 to 10.40%), in-hospital mortality AI of 4.33% (95% CI 3.38 to 5.44%), and a median change in the quality-of-life score like Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 30 days of -20 points (Q1=-37; Q3=-5). At discharge, all patients had a percentage greater than 70% of the use of quadruple neurohormonal blockade therapy. Conclusions ICARUS is one of the first registries in Latin America since the indication of the use of SGLT2 inhibitors, evaluating the clinical and sociodemographic characteristics, treatment patterns, and outcomes of a preliminary cohort of 1595 patients hospitalized for ADHF. The results indicate that, at discharge, up to 82.79% of patients were receiving quadruple neurohormonal blockade therapy, which is considerably challenging to achieve in Latin America. Considering the results of the Safety, tolerability and efficacy of up-titration of Guideline-Directed Medical therapies for acute heart failure (STRONG-HF study), our study reinforces the benefit of discharge with Guideline-Directed Medical Therapy (GDMT) for heart failure from hospitalization. The use of GDMT for heart failure may have influenced our positive outcomes in terms of in-hospital mortality, improvement in quality of life, and the percentage of short-term rehospitalizations compared to similar cohorts.Proportion of HF drug group

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Missed opportunities of method information index plus (MII+) counseling among current modern contraceptive users. multi-level analysis from the Ethiopian PMA 2021 data set

IntroductionIn Ethiopia, there is a decrease in percentage of women who receive method information index counseling service from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally, and less than 40% of these services provided are high quality. Therefore, the aim of this study was to identify modern contraceptive users-related factors at individual level and community level associated with missed opportunities of method information index plus counseling.MethodsThis study used the datasets from the 2019 Performance Monitoring for Action Ethiopia Survey, which comprised a total of 8,365 households (98.9%) and 7,988 women (98.8%). The data analysis was done with Stata version 14. Using multilevel mixed effect logistics regression, both individual and community-level factors were found to be associated with missed opportunities of method information index plus counseling. a P-value of less than 0.05 was used to declare statistical significance. The association was presented using an adjusted odds ratio with a 95% confidence interval.ResultsThe study shows that the prevalence of missed opportunity MII + family planning counseling among current modern contraceptive users was 81% (79.15, 82.66) and factors significantly associated with missed opportunities of method information index plus counselling are educational status, low level of media exposure, religion, receiving the service in health centers and health posts, never heard of any other methods, number of children at first contraceptive use and region.ConclusionsIn Ethiopia 81% of women had a missed opportunities of MII + counseling service. In order to address this, we recommend policy makers to focus on training of health care workers and pharmacists about MII + counseling, and establishing ways to improve access to media exposure.

Factors Affecting the Early Diagnosis of Smear-positive Pulmonary Tuberculosis in Patients in Qom Province, Iran

Background and Objectives: According to the report of the World Health Organization (WHO), almost one-third of the world’s population is infected with tuberculosis (TB). The delay in TB diagnosis, in addition to increasing mortality, can increase the duration of disease transmission. This study aims to identify the factors affecting the early detection of smear-positive pulmonary TB in Patients in Qom Province, Iran. Methods: In this case-control study, 120 patients with smear-positive pulmonary TB (60 with a diagnosis delayed for more than three months and 60 with a timely diagnosis) diagnosed from 2018 to 2021 in Qom Province participated. To determine the factors effective in early diagnosis of pulmonary TB, the odds ratio of each factor was calculated, and logistic regression analysis was used for data analysis. Results: The prescription of the sputum test at the first visit had the most significant effect on the early diagnosis of pulmonary TB (odds ratio=161, P<0.001). The TB in patients who visited the clinics and those visited by general practitioners was diagnosed with a higher delay. The lack of knowledge of existing TB diagnosis and treatment services in health centers had increased the diagnosis delay by 2.3. Occupation, gender, and place of residence were not found to be effective factors. Conclusion: It seems that most doctors in Iran neglect to prescribe a sputum test for patients suspected of pulmonary TB and only prescribe chest x-rays. Training and informing doctors, private medical centers, and pharmacies in referring patients suspected of pulmonary TB to the health centers where the patients live can cause timely diagnosis of pulmonary TB.

INCREASING PUBLIC AWARENESS IN DRUG USE THROUGH SMART COMMUNITY MOVEMENT USING DRUGS (SCMUD)

The community tends to try to overcome health problems through easier and more cost-efficient methods. This triggers the tendency of the community to self-medicate. Self-medication is the use of drugs by individuals, not based on a doctor's prescription, but based on the individual's initiative. This community service aims to increase awareness of using drugs through Smart Community Movement Using Drugs (SCMUD) in the Bulakdawung community, Parang village, Banyakan district, Kediri regency. The activity was carried out on May 17, 2024, by providing Health Counseling to mothers who accompany their children to study groups, with lecture and question and answer methods, the media used was the leaflet of awareness of using drugs. The results of the activity were 21 mothers with most elementary school education backgrounds (80.95%), work as housewives (95.23%), less knowledge about awareness of using drugs (71.42%), good attitudes awareness of using drugs (66.67%) and drug use behavior in the family (80.9%) and those lacking 19.1%. After being given health education regarding the safe use of drugs through the Smart Community Movement Using Drugs, the community increasingly understands and carries out awareness to avoid the negative impacts of self-medication and provide appropriate treatment for family members who are sick and utilize health service centers appropriately. It was concluded that the activity can increase public awareness in the use of drugs through health counseling.

Issues and Challenges of the Digitisation of the Capital Market in India

Governance involves the use of political, economic, and administrative power to manage a nation's affairs and ensure citizens' rights. E-governance utilizes electronic means for efficient, transparent public service delivery. India's National e-Governance Plan (NeGP) aims to enhance governance through a Public-Private Partnership (PPP) model, establishing over 100,000 Common Service Centres (CSCs). These CSCs act as delivery hubs for public and private services, addressing regional development while fostering private sector and community participation for sustainable livelihoods. Mitigating the challenges of digitization requires raising user awareness and advancing the regulatory system through the use of cybersecurity practices

Typology Model Based Building and Land Infrastructure Structure Organization and Duties Bali Area Police

Polsek was a police station in the district that provides police services to the community. There are four types of Polsek, namely A, B, C, and D. Polsek in the Bali Area are 58 with types B and C. Polsek is expected to have adequate supporting infrastructure such as Integrated Police Service Center rooms, facilities for the disabled, children's playgrounds, breastfeeding rooms, detention cells, and parking, open spaces. However, the land area is only sometimes adequate. The analysis used interview methods, observation, literature studies, and SWOT analysis. The results show that Polsek's need for land Type B is 631.54 m2, and Type C is 377.14 m2. The SWOT analysis was in the strength and threat quadrant, so a policy is needed to evenly distribute the development of each Polsek type B and C, starting from land acquisition by the main tasks and functions of the police in serving the community.

Evaluating the Availability and Accessibility of Agricultural Extension Services Under the Single Spine System in Uganda. A Case of Smallholder Crop Farmers in Buhweju District

Purpose: This study evaluated the availability and accessibility of agricultural extension services under the Single Spine System, with a specific focus on smallholder crop farmers in Buhweju District. Methodology: The study adopted a mixed-methods approach, employing both quantitative and qualitative data collection techniques. Structured questionnaires were administered to a sample of 393 smallholder crop farmers and key informant interviews with district agricultural officers and extension workers provided in-depth insights into the delivery of services. Findings: The results indicate that education was positively and significantly (P<0.01) associated with knowledge about the availability of extension services. Farmers with more years of schooling had a greater likelihood of being aware of extension providers. Similarly, larger households with more labor resources (median size = 4) had better access to extension services. Moreover, household land size (median = 3 acres) and income (median = UGX 250,000) were significantly correlated with both availability and access to extension services, with wealthier farmers seeking more information to improve agricultural productivity. The study also revealed that proximity to extension service centers was a critical factor; households closer to sub-county offices (median distance = 1.5 km) had higher knowledge of available services. Access to credit and group membership were also major determinants of both awareness and access to extension services. Challenges were also identified, including limited outreach by extension officers, inadequate allowances, and insufficient logistical support for field officers. Unique Contribution to Theory, Policy and Practice: The study recommends increased sensitization efforts using local leaders, social media, and community networks, alongside greater support for sub-county agricultural officers to ensure effective service delivery.

THE ROLE OF PUBLIC ORGANIZATIONS IN PROVIDING SOCIAL ASSISTANCE TO INTERNALLY DISPLACED PERSONS (ON THE EXAMPLE OF ODESSA REGION)

The article presents the results of a study on determining the role of public organizations in providing social assistance to internally displaced persons on the example of Odesa region. The concepts of «social assistance» and «social assistance to internally displaced persons» are defined. A diagnostic cross-section was carried out on the basis of administrative service centers during monitoring visits to communities, which covered IDPs of Zatyshansk, Bolgradsk, Znamyansk and Sergiivsk communities of Odessa region. Also, the survey was conducted directly among social workers of the public organization «Tenth of April». The purpose of the article is to conduct research on determining the role of public organizations in providing social assistance to internally displaced persons on the example of Odesa region. The research used questionnaire and semi-structured interview methods. The results of the survey showed that: a large part of respondents (78%) experience financial difficulties; 65% are satisfied with their level of adaptation to life in the host community, although they do not rule out that the situation could have been better; the most acute security problem in the respondents' previous places of residence was the destruction of property due to military actions (78%); respondents' most important needs are access to housing and employment, as well as basic needs such as food and clothing; the main types of assistance that public organizations can provide are assistance in finding a job, filing documents, receiving social benefits, care for the elderly and people with disabilities, support for families with children, psychological support, etc. Also, the majority of respondents (52%) experience difficulties in obtaining assistance due to a lack of information about available services, the procedure for obtaining them, contacts of public organizations, etc. Based on the results of the research, the authors developed a number of conclusions and recommendations addressed to state authorities, local self-government and civil society organizations.