Background: Indonesia faces the challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health status. By examining the distribution patterns and identifying the areas of critical need, the study seeks to inform policy interventions that can more effectively address the health worker (HW) distribution. Methods: We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of HWs: General practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the HW-to-population ratio to quantify the availability of healthcare workers. We employed the Gini Index as a measure of distribution equality. In addition, we conducted a comparative metric approach to assess the quantity and the equity of healthcare worker distribution across the districts. Results: In Indonesia, the current HW ratio stands at 3.84 per 1000 people, falling short of the World Health Organization’s threshold of 4.45 for achieving 80% universal health coverage. This shortfall translates to a need for an additional 166,000 HWs. While midwives show a relatively equitable distribution, specialists and dentists exhibited significantly unequal distribution, especially at the district level. There were greater disparities at the district than at the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals. Conclusion: This study shows that human resources for health in Indonesia are both inadequate in terms of quantity, and unevenly distributed. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle each region’s unique problems.

Objective: To determine the risk factors associated the incidence of NPC, particularly in Indonesia. Methods: This systematic review and meta-analysis was conducted according to PRISMA statement. Database including PubMed, Scopus, Science Direct, Web of Science, and GARUDA were retrieved. Newcastle-Ottawa scale was used to assess the quality of published study and analyse the risk of bias of included study. Random-effect model and reported pooled Odds Ratio (OR) with 95%CI was carried out in our meta-analysis. Results: A pooled of 7 studies were included in our study which included 764 participants. We found that female gender was not associated with the incidences of NPC (OR 1.45, 95% CI: 0.61-3.45, p=0.40), and smoking was highly increased the incidence of NPC (OR 4.39 95% CI (0.79-24.40), but not statistically significant (p=0.09). Furthermore, salted fish consumption and some HLA alleles were associated with increased risk. Conclusion: The incidence of NPC is not associated with female gender nor smoking habits. However, the risk of NPC is higher for those who consume salted fish and have some susceptible HLA alleles. Further investigations in larger studies are needed to confirm these findings.

Purpose: Hybrid learning has been chosen as an alternative method in the conduction of clinical skill lectures during coronavirus disease 2019 (COVID-19) pandemic since students need to learn skills applied in emergency situations. This study aims to analyze students’ attitudes between hybrid and online learning methods.Methods: A non-randomized study was conducted between hybrid group (HG) and online group (OG) on three courses (intravenous [IV]-line insertion, nasogastric tube [NGT] insertion, and neonatal resuscitation). We developed a preformed validated questionnaire to assess students’ attitudes in five domains (willingness, understanding, capacity, self-efficacy, and intended behavior). The questionnaire was applied at the pre- and post-intervention.Results: A total of 100 participants were included (n=49 in HG, n=51 in OG). Post-course attitudes were significantly higher in online (IV-line, p=0.000; NGT, p=0.000; resuscitation, p=0.000) and hybrid (IV-line, p=0.000; NGT, p=0.000; resuscitation, p=0.000) groups compared to their pre-course. There were no significant differences in post-course attitude between groups (IV-line, p=0.072; NGT, p=0.163; resuscitation, p=0.146). Normalized-gain scores of all subjects were higher in HG (IV-line, p=0.012; NGT, p=0.085; resuscitation, p=0.033).Conclusion: In conclusion, hybrid learning could be considered as a better alternative in clinical skill lectures to maximize students’ attitudes, especially during COVID-19 pandemic.

Objective: One of the biggest therapy challenges for nasopharyngeal cancer (NPC) is still radioresistance. The radioresistance in NPC is thought to be caused by cyclin D1 overexpression. The purpose of this study was to determine how cyclin D1 contributes to radiation resistance in NPC. Methods: Adhering to the PRISMA guidelines, we systematically reviewed studies on cyclin D1-associated radioresistance in NPC from 2012 until 2023. From our search, 15 studies were included. Results: Cyclin D1’s role in radiotherapy resistance is elucidated through several mechanisms, notably SHP-1 and B-catenin. Overexpression of SHP-1 led to an increase in cyclin D1, a higher proportion of cells in the S-phase, and radioresistance. Conversely, inhibiting β-catenin and cyclin D1 expression enhances radiation sensitivity. Conclusion: In conclusion, Cyclin D1 has a strong correlation with radiation resistance; downregulation of the protein increases radiosensitivity, while overexpression of the protein promotes radioresistance.

Link of Video https://youtu.be/vwaMtqzZyI0 Background: Nasopharyngeal carcinoma (NPC) is a malignant tumor in the nasopharynx with a high incidence of metastasis. NPC is one of the most common cancers in Indonesia, and from the age distribution, it often affects the productive age population. This study aims to describe the characteristics of NPC patients in Dr.Soetomo General Academic Hospital from January 2017 – December 2018. Methods: This study is a retrospective descriptive by taking medical records of patients with NPC at Dr. Soetomo Hospital, Surabaya, from January 2017-December 2018, that meet the inclusion and exclusion criteria. The basic data taken are gender, age, education, and occupation. Complaints assessed are the main complaints of patients who make patients come for treatment listed in the medical record data. Results: Data from 262 patients showed that the five-year life expectancy for NPC sufferers in women is 84%, while in men, it is 78%. The main complaints of patients in this study were lumps in the neck in 130 patients (49.61%), with the highest distribution of patients based on stage IV a with 78 patients (29.77%), and the majority were non-keratinizing carcinoma undifferentiated type, with a total of 245 patients (93.51%). Conclusion: Male sufferers are more than females; the largest age group is 41-50. Most jobs are private employees, and most sufferers' last education is high school. The main complaint of most patients was a lump in the neck, and the patient came with an advanced stage where the most found was stage IV. The histopathological type of most patients is non-keratinizing carcinoma undifferentiated type.

Background: Indonesia, the world’s largest archipelago, faces unique challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health worker number and distribution. By dissecting the distribution patterns and identifying areas of critical need, the research seeks to inform policy interventions that can more effectively bridge the gap on health worker quantity and inequity. Methods: We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of health workers: General Practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the health worker ratio to determine the availability of healthcare workers relative to the population. To evaluate the distribution of these workers, we employed the Gini Index as a measure of distribution equality. Additionally, we conducted a comparative metric approach to assess both the quantity and the equity of healthcare worker distribution across the districts. Results: In Indonesia, the current health worker ratio stands at 3.84 per 1000 population, falling short of the WHO’s threshold of 4.45 for achieving 80% Universal Health Coverage. This shortfall translates to a need for an additional 166,000 health workers. Our analysis reveals a varied distribution of health worker categories: while midwives show a relatively equitable distribution, specialists and dentists exhibit significant inequality, especially at the district level. The Gini Index, used to measure this inequality, indicates greater disparities at the district level compared to the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals. Conclusion: This study shows that human resources for health in Indonesia suffer not only in quantity but also in distribution. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle unique problems each region faces. Evidence Before Study: Prior research has established that the quantity and distribution of health workers are critical factors in improving life expectancy and are fundamental components of the health system. Following Indonesia’s constitutional changes in 2001, which included the autonomy and decentralization of healthcare services, assessing the number of health workers at the district level has gained significant importance for determining national healthcare needs. There has been a notable gap in studies analyzing the quantity and distribution of health workers in Indonesia’s district level. Previous research often missed the nuances of district-level challenges, focusing instead on broader, national-level assessments. What This Study Adds: First National Study on Health Workforce: This is the first study of health workforce quantity and distribution at Indonesia’s National level. so this paper serves as a basic reference for future research Quantitative Analysis of Distribution Equity: Utilizing the Gini Index, the study quantifies the level of inequality in the distribution of healthcare workers, offering a clear metric to guide policymakers in assessing and addressing regional disparities. Identification of Regional Variations: The study highlights significant regional variations, with some provinces showing an inequitable distribution of health workers, demonstrating a critical need for increased healthcare personnel and better distribution strategies. Dual-dimensional assessment: The study introduces a quadrant comparative approach that simultaneously evaluates the quantity of healthcare workers and the equity of their distribution across Indonesian provinces. This dual-dimensional analysis is a significant methodological advancement, providing a more holistic understanding of healthcare workforce allocation. How This Study Might Affect Research, Practice, and/or Policy: This study has the potential to become the basis of policy-making related to the distribution of health workers and provide constructive feedback and strategical insights that could be utilized to decrease the gap between health workers and their maldistribution.