Area Health Service Research Articles

Enabling culturally safe sexual health services in western Sydney: a protocol to improve STI treatment outcomes for Aboriginal young people

BackgroundAboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services.MethodsThis qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed.DiscussionThis study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations.Trial registrationThe study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16).

Barriers to responding to reproductive coercion and abuse among women presenting to Australian primary care

BackgroundReproductive coercion and abuse is defined as any behaviour that seeks to control a woman’s reproductive autonomy. In Australia, women often access reproductive health care through a primary care clinician, however, little is known about clinicians’ experiences responding to reproductive coercion and abuse. This study aims to address this gap by exploring the barriers to responding to reproductive coercion and abuse in Australian primary care.MethodsIn this qualitative study, twenty-four primary care clinicians from diverse clinical settings in primary care across Australia were recruited to participate in a semi-structured interview. Data were analysed thematically.ResultsThrough analysis, three themes were developed: It’s not even in the frame; which centred around clinicians lack of awareness around the issue. There’s not much we can do, where clinicians described a lack of confidence in responding correctly as well as a lack of services to refer on to. Lastly There’s no one to help us, explaining the disconnect between referral services and primary care as well as the impacts of lack of abortion on women experiencing reproductive coercion and abuse.ConclusionsClinicians expressed similar experiences of barriers to respond to reproductive coercion and abuse. Many clinicians felt ill-equipped to identify and respond to reproductive coercion and abuse. Some clinicians hadn’t received any formal training, others were trained but had nowhere to refer women. Further complicating responses was a lack of support from referral services. This study highlights the need for more training and a streamlined referral pathways for women who experience reproductive coercion and abuse, as well as better access to reproductive health services in rural areas.

Polish Nurses' Opinions on the Expansion of Their Competences-Cross-Sectional Study.

The development of medical science creates new challenges for nurses to acquire new skills. Thanks to legal changes in Poland, nurses have gained the opportunity to independently provide health services in many areas, including consultations for patients. The aim of the survey is to analyze nurses’ opinions on the expansion of competences in their profession. This is a cross-sectional, descriptive study conducted among 798 nurses using the survey technique. The majority (65.48%) of the respondents believed that they were adequately prepared to take up new competences. Most of the respondents believed that the new competence would improve the efficiency of the healthcare system in Poland (71.06%) and facilitate patients’ access to health services (65.29%). According to the nurses, the scope of nursing advice will mainly concern the promotion of health education, wound treatment and prescribing medications. Age, seniority and education level significantly influenced the nurses’ opinions on the scope of nursing advice. The Mann–Whitney test and the Kruskal–Wallis test were used. A correlation between two quantitative variables was assessed with the Spearman’s rho coefficient. The significance level of p < 0.05 was assumed. The extension of the professional competences of nurses will increase the prestige of the profession and is another step toward introducing the role of Advanced Practice Nurse in Poland.

Uptake of Sexual And Reproductive Health Services and Associated Factors Among Rural Adolescents in Southern Ethiopia, 2020

Introduction: Although 25% of Ethiopia’s population is an adolescent cohort of age 15-19 yrs, the Adolescent Sexual and Reproductive Health Service (ASRH) service utilization has not been adequately researched and addressed, and, therefore, they have had to deal with multiple reproductive health problems. Therefore, assessing the determinants of sexual and reproductive health service uptake in this age group is critical to boosting service use and, in doing so, reducing the burden of illness and disability among adolescents. And so, the motivation at the rear of this research was to look into the level of sexual and reproductive health services utilization and to find out determinants among adolescents who reside in rural districts of Guraghe zone, southern Ethiopia. Methods: A community-based cross-sectional study was undertaken from May 1-30, 2020. A multi-stage method of sampling was employed. A total of 1028 adolescents have been randomly chosen and participated in the study. Pre-tested structured questionnaires were used for data collection. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. A bivariable logistic regression analysis was conducted, and variables with a p-value less than 0.25 were considered candidates for a multivariable logistic regression model. In multivariate logistic regression, variables with p-values &lt;0.05 were declared as statistically significant. Results: of the sampled 1028 participants, 1009 took part in the study and yielded a response rate of 98.1%. The study found that 281 (27.8%) of adolescents received sexual and reproductive health services. Accordingly, among these SRH service users (n = 281), provision of SRH information and education was the most common item received by 171(60.8%) of adolescents whereas relatively few respondents 32(11.4%) got safe and /or postabortion care. Variables that became important determinants of SRH service utilization were; taking part in peer education (AOR:2.07; 95%CI:1.46-2.94), parental discussion (AOR:3.94; 95%CI:2.77-5.60), availability of youth clubs (AOR:3.15; 95%CI:2.22-4.49), and being knowledgeable on SRH issues (AOR:3.48; 95%CI: 2.44-4.96). Conclusion: In the study area, sexual and reproductive health service utilization was low. Since most adolescents are enrolled in school, schools can be an excellent way to increase adolescents’ awareness of SRH services through behavioral change communication (BCC). Furthermore, special attention should be given to promoting discussion between parents and adolescents and the creation and strengthening of youth clubs as important steps to improving the use of Sexual and reproductive services for adolescents by the relevant stakeholders.

Childhood Respiratory Outpatient Visits Correlate With Socioeconomic Status and Drive Geographic Patterns in Antibiotic Prescribing.

Reducing geographic disparities in antibiotic prescribing is a central public health priority to combat antibiotic resistance, but drivers of this variation have been unclear. We measured how variation in outpatient visit rates (observed disease) and antibiotic prescribing rates per visit (prescribing practices) contributed to geographic variation in per capita antibiotic prescribing in Massachusetts residents younger than 65 years between 2011 and 2015. Of the difference in per capita antibiotic prescribing between high- and low-prescribing census tracts in Massachusetts, 45.2% was attributable to variation in outpatient visit rates, while 25.8% was explained by prescribing practices. Outpatient visits for sinusitis, pharyngitis, and suppurative otitis media accounted for 30.3% of the gap in prescribing, with most of the variation in visit rates concentrated in children younger than 10 years. Outpatient visits for these conditions were less frequent in census tracts with high social deprivation index. Interventions aimed at reducing geographic disparities in antibiotic prescribing should target the drivers of outpatient visits for respiratory illness and should account for possible underutilization of health services in areas with the lowest antibiotic consumption. Our findings challenge the conventional wisdom that prescribing practices are the main driver of geographic disparities in antibiotic use.

Multilevel modeling of spatially nested functional data: Spatiotemporal patterns of hospitalization rates in the US dialysis population.

End-stage renal disease patients on dialysis experience frequent hospitalizations. In addition to known temporal patterns of hospitalizations over the life span on dialysis, where poor outcomes are typically exacerbated during the first year on dialysis, variations in hospitalizations among dialysis facilities across the US contribute to spatial variation. Utilizing national data from the United States Renal Data System (USRDS), we propose a novel multilevel spatiotemporal functional model to study spatiotemporal patterns of hospitalization rates among dialysis facilities. Hospitalization rates of dialysis facilities are considered as spatially nested functional data (FD) with longitudinal hospitalizations nested in dialysis facilities and dialysis facilities nested in geographic regions. A multilevel Karhunen-Loéve expansion is utilized to model the two-level (facility and region) FD, where spatial correlations are induced among region-specific principal component scores accounting for regional variation. A new efficient algorithm based on functional principal component analysis and Markov Chain Monte Carlo is proposed for estimation and inference. We report a novel application using USRDS data to characterize spatiotemporal patterns of hospitalization rates for over 400 health service areas across the US and over the posttransition time on dialysis. Finite sample performance of the proposed method is studied through simulations.

Factors Associated with Getting Timely Coronary Catheterization of Patients with Acute Ischemic Heart Disease of Hospitals in Thailand

The objective of this study was to investigate the current effectiveness of timely coronary catheterization among patients with acute ischemic heart disease and to study the rates of timely coronary catheterization separated according to various hospital factors, including the study of various hospital factors affecting the timely delivery of coronary catheterization of patients with acute ischemic heart disease in Thailand. The secondary data during 2018-2019 was collected from 1,180 hospitals serving cardiac patients in Thailand and analyzed by using descriptive statistics and inferential statistics. The difference between variables were conducted by one-way ANOVA and the relationship between variables were analyzed by multiple regression analysis. The study found that Thailand still has problems with both a shortage of cardiac catheterization centers and improper concentration of the cardiac catheterization center. Most of the hospitals that serve cardiac patients in Thailand (89%) do not have a cardiac catheterization facility, especially in the Northeast area of Thailand. Instead, a high concentration of cardiac catheterization center was found in hospitals in Bangkok (10.42%). It’s also found that cardiac catheterization rooms are often located in larger hospitals with size of more than 120 beds (80.77%). As such problems contribute to the rate of timely cardiac catheterization. In general, Thailand has not yet passed the threshold (more than 50%) because it can only achieve 49.15%, especially the 7th health service area (Khon Kaen, Kalasin, Mahasarakham, Roi Et) has a low rate of timely treatment (15. 22%). The results found that the mean rate of timely catheterization statistically better among the hospitals larger than 120 beds, hospitals with cardiac catheterization center and private hospitals, and by analyzing the relationship between various factors of hospitals including the number of beds, the established period, proportion of the number of cardiac catheterization centers to the number of service area hospitals in where the hospital is located, type of hospital and the existence of cardiac catheterization center to the rate of timely catheterization by analyzing multiple regression analysis, it was found that various hospital factors can jointly predict trends of the rate of timely treatment at a moderate level, 24 percent (adjusted R2 = 0. 246). The results suggest that the rate of timely coronary catheterization is currently lagging and the Thai Ministry of Public Health budget should be allocated to provide more cardiac catheterization centers and should be more inclusive throughout the country especially in the northeastern provinces where there is still a shortage.

Family Medicine Physicians' Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services.

Primary care settings often function as the front lines for behavioral health services in rural areas. The lack of formal behavioral health care in rural areas is also well documented. Rural family practice physicians were interviewed regarding the state of behavioral health care in their communities and their ideas for increasing access to quality care. Thirteen family practice physicians in rural locations participated in in-depth semi-structured interviews. Interviews were transcribed, coded, and analyzed following a phenomenological design. Physicians described a lack of quality behavioral health services and challenges for integrating and collaborating with those that do exist. Participants also described the changing role of stigma, service delivery strategies that are currently working, and the unique role primary care plays in rural behavioral health care. Several ideas for increasing access to and efficacy of services are discussed; these ideas are informative for future research and interventions.

Rural Development Through Non-State Actors in Highlands of Pakistan

We explored the contribution and effectiveness of state and non-state institutions in rural development efforts in highlands (Khyber Pakhtunkhwa [KPK] province) of Pakistan. This study employed mixed-methods research design and data were collected from 300 household heads, randomly selected from six villages from two purposively selected districts Mansehra and Nowshehra. Findings showed people in KPK were deprived of due to conflicts, conspiracies and terrorism, poor governance, small landholdings and subsistence farming followed by sluggish marketing system, insufficient education and training for people, and inadequate employment opportunities. Regarding contribution, non-state institutions had more contribution as compared to state institutions. T-test analysis showed that the non-state institutions had an effective provision of agricultural extension and forestry advisory services, education, health services in remote areas, skill development, and provision of microcredit schemes. The results of F-test statistics showed highly significant difference among the perceived effectiveness of rural development activities of different types of non-state actors (localite, cosmopolite, and religious/faith-based) working in the research area. This study recommends state-owned rural development departments revisit their working mechanism and develop synergistic working relationship with the non-state institutions in discharging rural development efforts.

Family support on utilization of adolescent reproduction health service at the area of public health service (Puskesmas) of Martapura

Adolescent reproductive health should obtain special attention from various parties, but adolescent have not yet utilized reproduction health service optimally. This study aims to identify the relationship of family support and adolescent's utilization of reproduction health service. This research used a correlational descriptive design and 370 adolescents in the working area of Public Health Service Martapura were chosen randomly as design. Questionnaires were used as a research instrument. The data were analyzed by using spearman correlation. Research result shows that there is a significant relationship between family support and utilization of reproduction health service (p value 0.000). This study indicates that the family support is vital for adolescents for adolescent to use reproductive health services appropriately. To increase the utilization of reproduction health service, it is recommended to increase family support and health officer should increase socialization to parents and adolescent.

Perfil nutricional e socioeconômico de idosos admitidos no pronto atendimento médico de um hospital universitário

A população mundial passa por processo de envelhecimento, sendo o idoso mais susceptível a alterações do estado nutricional, devendo ser sempre avaliado para que haja intervenção precoce. Objetivou-se traçar o perfil nutricional e socioeconômico de idosos admitidos no pronto atendimento médico de um hospital universitário. Trata-se de estudo transversal, prospectivo, amostra por conveniência, realizado nas primeiras 48 horas de internação nas áreas verde, amarela e vermelha do Sistema Único de Saúde. Foram avaliados 100 idosos de ambos os sexos, por meio de formulário socioeconômico, triagem MNA®-SF e avaliação nutricional. Observou-se uma maioria desnutrida ou sob risco nutricional, com prevalência masculina e forte relação com perda de peso, diminuição da ingesta, estresse ou doença aguda. Assim, constatou-se maior sensibilidade da MNA®-SF na identificação precoce do risco nutricional mesmo nos pacientes eutróficos ou em sobrepeso pelo IMC. Sugerem-se mais estudos associando transtornos neuropsicológicos em idosos e sua influência no estado nutricional na hospitalização.

Community-based Mental Health Services in Norway.

Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding. Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community. The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.

Engaging future healthcare professionals for rural health services in South Africa: students, graduates and managers perceptions

BackgroundThe shortage of healthcare professionals (HCP) negatively affects health services in rural areas in many parts of the world, as is the case in South Africa. Innovative programs designed to improve the recruitment strategies for health system in a rural area are essential. They need support with a scholarship and mentorship programme for young people from rural areas to study for health science degrees, with the aim that they would take up a post at the hospital in their community, once qualified.This paper reports the perceptions and experiences of the students and graduates sponsored by the foundation, and those of managers from the facilities where the students were ultimately placed, in order to gauge whether such a programme can make a sustainable contribution to address the shortage of health personnel in rural areas and to what extent this is happening.MethodsThe authors used qualitative methods, combining semi-structured in-depth interviews and focus groups and the data were analyzed thematically.ResultsThe results provide information on students interviewed who appreciated the financial and socio-emotional support that they received. On the other hand, graduates value the availability of jobs in their home community on completion of their studies. The managers reported the success of the programme in increasing the number of healthcare personnel at the hospitals, and the increased range of available medical services. Since the graduates are familiar with the language and culture of their patients the managers considered that they are better able to assist them.ConclusionsThe system was well thought-out and achieved its goal of improving health services in an underdeveloped rural area of South Africa. More could be achieved if other government services in the area were simultaneously improved and if the system were replicated elsewhere. The students and graduates from rural areas are involved on sustaining health services in rural areas while rural managers support the programme and make suggestions for improvement and to promote the program in other regions.

Epidemiological aspects of visceral leishmaniasis in the municipality of Montes Claros-MG

Visceral leishmaniasis (VL), also known as ‘calazar’, is a serious chronic disease caused by Leishmania species from Leishmania (Leishmania) donovani complex, which the disease is characterized by abdominal swelling (hepatosplenomegaly) and may evolve to death in extreme cases. In this sense, the aim of our study was to assess the epidemiological profile of the cases found in Montes Claros (Minas Gerais state). A retrospective or cross-sectional study was carried out using secondary data provided by Health Information System (SINAN/HM) of Brazil from January 2010 to February 2020. Our data has shown that VL is an endemic disease in Montes Claros region, with 413 VL cases reported, 62.00% (252) male, average age ± standard deviation (years), and 93.46% (386) lived in Montes Claros city. The presence of comorbidities was observed in 13.70% (54) of the patients and in 7.26% (30). As for the evolution of the disease, 246 (59.56%) were cured, 30 (7.26%) died due to VL. Between 2010 and 2015, Glucantime® stands out, in which 46 (11.13%) patients used the drug, followed by common Amphotericin B 24 (13.48%) and liposomal Amphotericin B 38 (21.34%). In the period between 2016 and 2020, the most prevalent drug was liposomal Amphotericin B, with 71 (29.83%) patients using it, followed by Glucantime® 45 (18.9%). The condition evolved to death. We conclude that Montes Claros is still an endemic area for VL with an increased number of cases over time and a noticeable shift in patient profile towards children and young people. Joint efforts from different areas of scientific knowledge and public health services are needed to improve the effectiveness of visceral leishmaniasis surveillance and control actions. The population can contribute to this process of disease prevention and control, through educational actions in health and the environment.

Reducing Maternal Mortality: A Qualitative Study of Health Workers’ Expectation in Urban Area, Indonesia

BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality.&#x0D; AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas.&#x0D; METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising.&#x0D; RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity.&#x0D; CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.

Expert system for heart disease based on electrocardiogram data using certainty factor with multiple rule

&lt;span id="docs-internal-guid-b7163134-7fff-29de-9179-24e242f1239b"&gt;&lt;span&gt;Limited public health services in remote areas, where the lack of transportation infrastructure, facilities, communication facilities and minimal medical personnel, especially for areas with underdeveloped, foremost, and regular (3T) status. The limitation of medical personnel is one of the factors for the high mortality rate of heart disease. On the other hand, the development of information technology, especially in the field of computing, is very fast in the era of the industrial revolution 4.0, but not yet used optimally, especially in the health sector. This study aims to develop a system or software that can replace a doctor for the process of identifying heart defects based on an expert system. Expert system developed with the certainty factor with multiple rule approach. System testing is carried out from the results of the system validity with experts, so that the system test results produce a certainty factor value for a normal heart of 0.95 and an accuracy level of 95%, while the certainty factor (CF) value for an abnormal heart is 0.99 and produces an accuracy rate of 99%.&lt;/span&gt;&lt;/span&gt;&lt;br /&gt;&lt;div style="mso-element: comment-list;"&gt;&lt;div style="mso-element: comment;"&gt;&lt;div id="_com_1" class="msocomtxt"&gt;&lt;!--[if !supportAnnotations]--&gt;&lt;/div&gt;&lt;!--[endif]--&gt;&lt;/div&gt;&lt;/div&gt;

Work Engagement in Nurses during the Covid-19 Pandemic: A Cross-Sectional Study.

In some areas of Spain, health services and professionals working in the front line against the Sars-Cov-2 virus have been widely overwhelmed at all levels. Therefore, the objective of this study was to assess the level of work engagement of Spanish nurses during the COVID-19 pandemic. A cross-sectional study was carried out. The sample consisted of 510 active nurses from all over Spain, without age exclusion, who voluntarily accepted to participate in the study. Work engagement was assessed with the 9-item Utrecht Work Engagement Scale (UWES) questionnaire, through an online questionnaire and non-probabilistic snowball sampling. The results showed a mean age of 45.9 years (SD = 10.7 years), most of them women (78.1%), and 58.5% were in primary care. The mean score for the UWES-9 questionnaire was 4.6 points (SD = 1.35). The categorical regression analysis performed revealed an R2 value of 0.75 and a significance of p < 0.01 in the sex, type of unit, and training variables. The Spanish nurses in the sample present high levels of work engagement in all dimensions in general, although the lowest mean scores are found in the vigor dimension, among men, and nurses working in hospital and critical units.

The Importance and Impact of Recognizing MAFLD in Patients With Chronic Hepatitis C

Background: Metabolic (dysfunction) associated fatty liver disease (MAFLD) can develop in any patient, including those with chronic hepatitis C (CHC). In this context, dual aetiology liver disease may have different characteristics and outcomes compared to those whose disease is due to a single factor. The recently proposed diagnostic criteria for MAFLD provide a unique opportunity to investigate the impact of concomitant fatty liver in patients with another cause for their liver disease. Methods: We evaluated 1,181 patients including 744 with CHC and 437 with MAFLD who had a liver biopsy with scoring for fibrosis stage and disease activity. Results: Nearly half (43.1%) of patients with CHC had concomitant MAFLD. Comparing CHC alone to patients having dual aetiology disease, the latter had worse hepatic liver injury, hepatic inflammation and fibrosis (all P <0.001). Although the MAFLD only group had worse metabolic markers, patients with significant fibrosis (F3-F4) were more common in those with dual disease (CHC/MAFLD; 33%) compared to MAFLD alone (29%). Interestingly, lean patients with CHC and MAFLD had similar fibrosis stage compared to the two other subgroups of MAFLD (obesity and/or Diabetes Mellitus). Conclusion: Patients with chronic hepatitis C and concomitant MAFLD have more severe liver disease than those with viral hepatitis alone. Recognizing coexisting MAFLD in patients with CHC is important for the delivery of holistic care. Funding Statement: No additional funding. Declaration of Interests: No conflicts of interest for all authors mentioned. Ethics Approval Statement: Ethics approvals were obtained from the Human Research Ethics Committee of the Sydney West Area Health Service and Nepean Blue Mountains Local Health District, Human Research Ethics Committees. Written informed consent was obtained from all patients.

Webinar Technology-Based Science Article Writing Training

The purpose of this Community Service is to equip doctors in the field of writing scientific articles for promotion. The results of medical research in the form of research in the health environment can be used as a scientific article to be published in national and international journals. The method used in assisting the writing of scientific articles based on health research is by the direct practice of writing articles and their implementation submitted in journals. The method used in this research-based article writing assistance is by the direct practice of writing and its implementation in submitting articles to journals through Webinars. The results of this article writing assistance are felt to be very beneficial for doctors in the Bantul Health Service area, Yogyakarta. Through two days of training, doctors can write health research-based articles. Doctors can also easily be promoted when the articles are published in proceedings or scientific journals. Through this article training, it can increase the motivation of doctors in improving their functional positions and support better doctor interactions, so that the future hope is to improve the performance of doctors.Scientific Articles, Webinars, National Journals, International Journals

IMPLEMENTASI RETRIBUSI DAERAH PELAYANAN KESEHATAN DI UPTD KESEHATAN PUSKESMAS PUSPO

This study discusses the implementation of the Retribution areas of health service in the UPTD Health Center Puspo. The objectives of this study are: 1). To find out the implementation process of Retribution Area of health service in UPTD Health Puspo. 2). To know the factors that influence in its implementation. The method used in this research is qualitative method. With qualitative methods we can describe the regional levy for health services and the factors that influence the implementation of the levy. The results of the study showed that the implementation of regional levy has not been effective. Efforts that need to be made by local governments in order to effectively implement. The effectiveness of service levy in Puskesmas Puspo must be done according to the applicable rules.