Background: Studies have shown a shortage of medical practitioners in rural areas, and that graduate doctors are reluctant to practice in the rural areas. To address this shortage and reluctance, the Government of Indonesia implemented a rural medical internship program with the aims of preparing medical graduates for primary medical practice, and attracting them to rural areas. The purpose of this study was to understand the experience of medical interns in the rural medical internship program, and to identify the barriers and enablers to achieving the program aims. Method: A purposive sample of 38 medical interns (70.4%) from five districts of West Sumatera Province, participated in focus group interviews. The interviews were recorded and transcribed verbatim. Data was coded and categorized before thematic analysis for experiences in rural setting specifically to identify factors important for retention of the doctors. Results: The medical interns indicated that their exposure to rural practice did not influence their decision to practice in rural area in the future, with most interns reporting that they did not intend to undertake clinical practice as rural doctors. The main reasons expressed were due to interpersonal issues with senior clinicians, nurses and hospital staff, which resulted in their autonomy and decision making processes being undermined; and a perceived lack of professional and financial reward for practicing as rural doctors. Overall, the study found that the program improved access to medical services in the five districts, but may not improve the shortage of medical practitioners in rural areas on a long term basis Conclusion: A rural medical internship program improves rural medical services. However, the program alone will not address the long term goal of improving rural workforce shortage. Providing incentives for rural doctors and structural change are needed in order to make rural practice more attractive.

This study aims to investigate e-health use in some hospitals in Indonesia through the readiness model. The readiness factor identified as the core, societal, technological and engagement readiness also expected efforts. The research model measured the influence of the readiness factors on e-health adoption and their impact on performance. A-104 respondent of e-health user among hospitals across Indonesia were obtained accidentally in the e-survey technique. The data was analysed to test six hypotheses using SEM/PLS. The result of this study identified four out of six hypotheses tested significantly influenced including core, societal, and technological readiness and impacted on performance achievement.

BACKGROUND: An existing study reported variation of the outcome of adjuvant hormone therapy on breast cancer. AIM: This study aimed to examine predictors of the hormone therapy to the outcome of recurrence-free survival (RFS) of estrogen receptor-positive (ER+) breast cancer. METHODS: In this cohort study, we followed up 219 eligible breast cancer patients with ER+ who had hormone therapy in 2017–2018. Age of patients, cancer stage, and various histopathology parameters were collected from the medical records, then we followed up with the patients within 2 years (2019–2020) to assess the RFS outcome. Bivariate analysis was conducted to assess the association between the clinicopathology parameters with RFS outcome. Multivariate analysis with logistic regression was also performed to see the dominant predictor. Mediation path analysis was also performed to determine the estimated effect of a predictor on the level of RFS and to see the visualization of the association of predictors with RFS. RESULTS: Breast cancer RFS was 91.3% within 2 years of hormone therapy. The recurrent rate was only 8.7%, which most of them (68.4%) were local. There was no association of age, lymphovascular invasion (LVI), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status with RFS. Based on the molecular subtype, the RFS was better in luminal A (p = 0.045), and also better gradually in the lower stage (p = 0.001). Multivariate analysis shows that the cancer stage was the dominant predictor of the RFS outcome (p = 0.001) with OR = 4.271 (Exp[B] = 1.937–9.417). Mediation analysis also found that there was a positively associated molecular subtype with RFS through cancer stage mediation (r = 16.7%, p = 0.006) but no statistically significant association of age, LVI, PR, and HER2 status (p > 0.005). CONCLUSION: Cancer stage is the main predictor of RFS of hormone therapy outcome. Luminal A is most also likely to have a better outcome of RFS, especially mediated by the lower stage.

BACKGROUND: The number of breast cancer cases has increased every year both in the world and in Indonesia, so that breast cancer has become a major health problem both in the world and in Indonesia. The specific cause of breast cancer is still not known with certainty, but many factors are thought to influence the development of breast cancer which are called risk factors. In women, reproductive factors are thought to influence the incidence of breast cancer. AIM: This study aims to determine the determinants of breast cancer in women in terms of reproductive factors. METHOD: This research is a quantitative research with a case control study design through a retrospective approach using a questionnaire instrument. The sample size obtained was 100 women with breast cancer (case sample) and 100 women without breast cancer (control sample) (1:1), so the total sample was 200 people. Data were analyzed bivariately using chi-square test, and multivariate using logistic regression test. RESULTS: From this study it is known that the reproductive factor associated with the incidence of breast cancer in women is the age of menarche with a value of p = 0.034 OR = 1.83 CI = 1.045-3.207, the age of giving birth to the first child with a value of p = 0.000 OR = 6.39 CI = 2,521-16,243, parity with p-value = 0.022 OR = 2.14 CI = 1.107-4.152, and history of breastfeeding with p-value = 0.000 OR = 4.16 CI = 1.967-8.830. Meanwhile, the age of menopause had no relationship with the incidence of breast cancer where the p-value was 0.384. Based on the results of multivariate analysis, it was found that the most dominant factor was the age at birth of the first child with a value of p = 0.002, Exp (B) = 5, 11 and CI = 1, 85-14, 10. CONCLUSION: The results of this study indicate that reproductive factors in women (age of menarche, age at first birth, parity, and history of breastfeeding) are risk factors for breast cancer. Based on the results of this study, women must get married immediately if they have entered the ideal age for marriage and do not delay having children so that they can immediately carry out the breastfeeding process to minimize risk factors to avoid breast cancer.

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